Project HOPE Research Articles

Evaluating the Project HOPE’s Enhancing Reading Skills Activity: Basis for Community Literacy Program to Persons Deprived of Liberty

Evaluating the Project HOPE’s Enhancing Reading Skills Activity: Basis for Community Literacy Program to Persons Deprived of Liberty

The Election; The ACA At The Supreme Court.

The new president will put his stamp on the Affordable Care Act as the Supreme Court seems unlikely to invalidate the entire law.

Health Spending, Medicaid, And More

From the Editor-In-Chief Health AffairsVol. 39, No. 11: Health Spending, Medicaid & More Health Spending, Medicaid, And MoreAlan R. WeilPUBLISHED:November 2020Free Accesshttps://doi.org/10.1377/hlthaff.2020.01945AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSCosts and spendingMedicaidGlobal healthCOVID-19PandemicsCoronavirusLow incomeHigh-deductible health plansFee-for-serviceAffordable Care ActPhysician paymentMedicareMedicaid physician feesHealth disparitiesRacismEthnic disparitiesDisparities in accessHealth equityImmigrantsIn addition to the final versions of five papers originally published online, four of which relate to coronavirus disease 2019 (COVID-19), this month’s issue of Health Affairs covers a range of topics, including health spending, Medicaid policy, equity, and global health.Health SpendingFee-for-service payment is routinely blamed for excess US health spending. Michael Gusmano and coauthors analyze how physician fees are set in France, Germany, and Japan—countries that pay physicians fee-for-service. Although their approaches differ, all three countries set fees through centralized negotiation within the context of spending constraints. In the US, the authors conclude, “The absence of arrangements similar to those in the three countries we have studied leaves payers fragmented and gives providers too much control over their own prices.”Geographic variation in Medicare spending has long been viewed as evidence of health system inefficiency. With administered pricing, Medicare spending variation reflects different patterns of care that cannot be explained by population health characteristics. Analyzing fee-for-service data between 2007 and 2017, Yongkang Zhang and Jing Li report that the risk- and price-adjusted gap in spending between the highest- and lowest-decile hospital referral regions declined by 14 percent.MedicaidRebecca Myerson and coauthors explore the effects of Medicaid expansion on preconception health. Centers for Disease Control and Prevention surveillance data show important improvements in preconception health among low-income women with a recent live birth, including a 4-percentage-point increase in the share of women reporting a preconception health conversation with a provider. They also find increases in the share of women reporting daily folic acid intake in the month before pregnancy and in the use of effective contraception during the postpartum period.Providing Medicaid coverage as adults transition from incarceration to living in the community can yield significant health and social benefits. Justin Blackburn and coauthors examine how Indiana combined Medicaid expansion through a Section 1115 waiver with additional policies designed to maximize Medicaid coverage for low-income justice-involved adults. Implementation of these policies was associated with an increase in enrollment within 120 days of release from 8.8 percent to 44.9 percent. Key to the state’s success were interagency cooperation and data sharing.Oral health is an area of significant unmet need, particularly among people with low incomes. Hawazin Elani and colleagues, analyzing how the Affordable Care Act affected dental coverage for adults with incomes below 125 percent of poverty, find that it increased rates of dental coverage by almost 20 percentage points among this population in states that expanded Medicaid and that include dental care as a benefit. In states that do not offer dental coverage through Medicaid, dental coverage for this population remained below 20 percent.EquityHigh-deductible health plans (HDHPs), which are increasingly prevalent among people with private health insurance, are often paired with health savings accounts (HSAs) to improve access to care before the enrollee meets their deductible. Using survey data, Jacqueline Ellison and coauthors identify racial and ethnic, as well as socioeconomic, disparities in enrollment in HDHPs and HSAs. “The fact that HDHP enrollment is increasing over time for low-income, Hispanic, and Black adults, without similar rates of increase in HSA participation, may further contribute to…disparities,” the authors warn.Leonard Egede and colleagues examine racial and ethnic disparities in COVID-19 outcomes in Milwaukee, Wisconsin, a highly segregated “minority-majority” city. Blacks and Hispanics are 3.7 times and 3.1 times, respectively, more likely to test positive for COVID-19 than non-Hispanic Whites. Among those who test positive, members of either group are twice as likely to be hospitalized as Whites, with Hispanics twice as likely to die as Whites.Global Health PolicyAs many countries aim to implement universal health coverage, James Macinko and coauthors examine whether adults ages fifty and older are being left out. Using survey data from twenty-three high- and middle-income countries, the authors find that catastrophic health care expenditures (out-of-pocket expenses that are 25 percent or more of the household’s income) were more prevalent among rural inhabitants, those with incomes in the lowest quintile, people with a greater number of health problems, and current and former smokers.Alexander Peters and coauthors estimate the macroeconomic consequences of firearm-related fatalities in the thirty-six Organization for Economic Cooperation and Development (OECD) countries. They estimate cumulative losses of $239.0 billion in economic output from 2018 to 2030, with $152.5 billion attributable to the US alone, meaning that losses in the US exceed the combined losses of all other OECD countries. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 November 2020 Information© 2020 Project HOPE—The People-to-People Health Foundation, Inc.PDF download

An American Disgrace

An American Disgrace

Pathogenic Effects of F8 Gene Mutations Identified in the Algerian Population Using In Silico Methods

Since the publication of the F8 gene sequence, a large number of F8 gene mutations has been identified. These mutations are responsible for causing hemophilia A, an inherited bleeding disorder resulting from a reduced or absence of the coagulant FVIII protein activity. In the present study, we aimed to analyze the structural and functional impact of novel F8 gene mutations, previously identified in the Algerian population, through several in silico methods : HSF, ESE Finder, I-Mutant 2, SIFT, Polyphen 2, Align GVGD, ConSurf and Project Hope. Our analysis showed that the splice site mutation c.5219+1G>T is responsible of exon 14 skipping which cause the deletion of the protein B domain. Concerning the missense mutation c.200A> C (p.Lys48Thr), physicochemical changes between Lysine and Threonine were predicted to have deleterious effects on both structure and function of the protein. The c.200A> C introduces a neutral residue to the protein structure which could be responsible of hydrogen bonds loss causing improper folding of the FVIII protein. The novel missense mutation c.2189G> A (p.Cys711Tyr) is responsible of the rupture of the disulfide bridge (Cys630-Cys711) causing a FVIII protein destabilization. This study demonstrates the effectiveness of the combined use of several in silico methods to assess the deleterious effects of novel mutations. In silico methods, despite being useful in providing informations about effects of mutations, can also serve as a first-pass filter for experimental studies.

Contraceptive Mandate, ACA Final Rules, And COVID-19.

The Supreme Court upheld broad exemptions to the Affordable Care Act contraceptive mandate; new ACA rules were finalized.

Care Is A Basic Human Right

Care Is A Basic Human Right

Consumerism Made Real

Consumerism Made Real

In silico analysis of CDC73 gene revealing 11 novel SNPs with possible association to Hyperparathyroidism-Jaw Tumor syndrome

Abstract Hyperparathyroidism-Jaw Tumor (HPT-JT) is an autosomal dominant disorder with variable expression, with an estimated prevalence of 6.7 per 1,000 population. Genetic testing for predisposing CDC73 (HRPT2) mutations has been an important clinical advance, aimed at early detection and/or treatment to prevent advanced disease. The aim of this study is to assess the most deleterious SNPs mutations on CDC73 gene and to predict their influence on the functional and structural levels using different bioinformatics tools. Method: Computational analysis using twelve different in-silico tools including SIFT, PROVEAN, PolyPhen-2, SNAP2, PhD-SNP, SNPs&GO, P-Mut, I-Mutant ,Project Hope, Chimera, COSMIC and dbSNP Short Genetic Variations were used to identify the impact of mutations in CDC73 gene that might be causing jaw tumor. Results: From (733) SNPs identified in the CDC73 gene we found that only Eleven SNPs (G49C, L63P, L64P, D90H, R222G, W231R, P360S, R441C, R441H, R504S and R504H) has deleterious effect on the function and structure of protein and expected to cause the syndrome. Conclusion: Eleven substantial genetic/molecular aberrations in CDC73 gene identified that could serve as diagnostic markers for hyperparathyroidism-jaw tumor (HPT-JT).

The Headache.

Narrative MattersPatient-Centered Care Health AffairsVol. 39, No. 4: Integrating Social Services & Health NARRATIVE MATTERSThe HeadacheAnjali Jain Affiliations Anjali Jain ([email protected]) is a physician scientist and writer who lives and works in Washington, D.C. This poem was a winner of the 2019 Narrative Matters poetry contest.PUBLISHED:April 2020Free Accesshttps://doi.org/10.1377/hlthaff.2020.00056AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSPatient experiencePhysiciansPersonal storiesMy friend, also a doctor, described his headache to me.He said it was like someone or somethingScraping the inside of his skull,Metal against bone,Pain unimaginable and yetI try to go there.Wincing,My heart breaks forTender stalks of capillaries,Uprooted like tiny mushrooms,Feathery and pink. Mine is not so bad,A weight pulling on the left side of my neckWarm in my hand when I cradle my head,Stroke my hair.A dull thud reaches for my left templeAnd brow, insistent,A gray shade,Partially unfurled. A sullen teenager,The headache has moved in,Comes and goes as it pleases,Mine and not mine,Punishing me for that glass of wineOr lost hour of sleep,As if payment was overdue. We don’t understand much about painOnly that it is necessary—The strict teacher no one wantsEven knowing you’ll learn the most. I wonder if my pain helps me know yoursOr, instead, consumes me—Keeps me within myself.Am I ableOr unableTo grasp the sufferingOf another?Hurt comes from hurt,Pain often from pain,This I know to be true.Both cause and solution,Misery loving company,Two schoolchildren camping in the rain,Waiting for the storm to pass. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 6 April 2020 Information© 2020 Project HOPE—The People-to-People Health Foundation, Inc.PDF downloadRelated articlesPoems - The Headache, Epidemic, Admission07 Apr 2020Default Digital Object Series

Predictors for Poor Linkage to Care Among Hospitalized Persons Living with HIV and Co-Occurring Substance Use Disorder.

Persons living with HIV (PLWH) with substance use disorders (SUD) remain a population difficult to engage in HIV care. Project HOPE (Hospital Visits as an Opportunity for Prevention and Engagement), a randomized controlled trial testing patient navigation with/without contingency management for PLWH with SUD, aimed to address this disparity. PLWH with SUD who were out of care were recruited from 11 hospitals across the United States from 2012 to 2014. Baseline socioeconomic factors, medical mistrust scores, and perceived discrimination surveys were collected at enrollment and evaluated for effects on linkage to care at the 6-month follow-up assessment. Linkage to care (attending an outpatient visit for HIV care), early linkage to care (attending first visit within 30 days of enrollment), and engagement in care (two HIV visits within the 6-month period) were determined by medical record abstraction, supplemented by self-report. Among 801 participants enrolled in the study (mean age 45 years, 33% women, and 73% African American), those who did not complete high school and with severe food insecurity had lower odds of being linked to care at 6 months. Those with high levels of medical mistrust, recent drug use, and who did not complete high school had lower odds of early linkage to care. Early linkage was associated with higher odds of engagement at 6 months and was mitigated by both patient navigator interventions (all p < .05). Addressing social determinants of health is critical to correct the disparity seen in HIV outcomes among PLWH with SUD. Identifying factors that alter the effect of interventions could help identify patients who would benefit most.

The Affordable Care Act Turns 10.

The ACA has increased access to health care for vulnerable populations; decreased the percentage of Americans who say they went without care due to cost; and spurred America's insurers, hospitals, and clinicians to change how they deliver and pay for health care. At the same time, the ACA has been challenged in the courts of justice and public opinion.

Do Americans have the political will to tackle healthcare costs? a Q&A with Gail Wilensky, PhD.

To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a healthcare thought leader. For the February issue, we turned to Gail Wilensky, PhD, an economist and senior fellow at Project HOPE.

Japanese version of The Cancer Genome Atlas, JCGA, established using fresh frozen tumors obtained from 5143 cancer patients.

This study aimed to establish the Japanese Cancer Genome Atlas (JCGA) using data from fresh frozen tumor tissues obtained from 5143 Japanese cancer patients, including those with colorectal cancer (31.6%), lung cancer (16.5%), gastric cancer (10.8%) and other cancers (41.1%). The results are part of a single‐center study called “High‐tech Omics‐based Patient Evaluation” or “Project HOPE” conducted at the Shizuoka Cancer Center, Japan. All DNA samples and most RNA samples were analyzed using whole‐exome sequencing, cancer gene panel sequencing, fusion gene panel sequencing and microarray gene expression profiling, and the results were annotated using an analysis pipeline termed “Shizuoka Multi‐omics Analysis Protocol” developed in‐house. Somatic driver alterations were identified in 72.2% of samples in 362 genes (average, 2.3 driver events per sample). Actionable information on drugs that is applicable in the current clinical setting was associated with 11.3% of samples. When including those drugs that are used for investigative purposes, actionable information was assigned to 55.0% of samples. Germline analysis revealed pathogenic mutations in hereditary cancer genes in 9.2% of samples, among which 12.2% were confirmed as pathogenic mutations by confirmatory test. Pathogenic mutations associated with non–cancerous hereditary diseases were detected in 0.4% of samples. Tumor mutation burden (TMB) analysis revealed 5.4% of samples as having the hypermutator phenotype (TMB ≥ 20). Clonal hematopoiesis was observed in 8.4% of samples. Thus, the JCGA dataset and the analytical procedures constitute a fundamental resource for genomic medicine for Japanese cancer patients.

Texas Ruling Brings More ACA Uncertainty.

Texas ruling and other legal challenges raise questions about the ACA's future even as enrollment holds steady.

Data Mining Analysis of &amp;lt;i&amp;gt;ESCO2&amp;lt;/i&amp;gt; Gene Single Nucleotide Polymorphisms Associated with Roberts’s Syndrome

Roberts’s syndrome is a genetic disorder characterized by limb and facial abnormalities. Affected individuals also grow slowly before and after birth. This syndrome is associated with <i>ESCO2</i> (Establishment of Sister Chromatid cohesion N- acetyltransferase 2) gene mutations. SNPs in the coding region (exonal SNPs) that are non-synonymous (nsSNPs), the SNPs and related ensembles protein (ESNP) were obtained from the SNPs database (dbSNP) for computational analysis. Bioinformatics analysis of <i>ESCO2</i> exonal non-synonymous SNPs initiated by GeneMANIA, SIFT, Polyphen-2, PHD, SNP&GO, Provean and ProjctHope. There were 85 nsSNPs, they had been submitted to SIFT software to predict the tolerant and intolerant SNPs, they had been sorted to 65 Tolerated SNPs and 20 Deleterious SNPs. SIFT deleterious SNPs had been tested by polyphen-2 software and the result was 3 benign SNPs, 3 possibly damaging and 14 probably damaging SNPs. The same 20 SNPs were tested using SNP&GO software and gave the same result for PHD and SNP&GO (4 diseased and 16 neutral) and the result obtained when using Provean software was 12 SNPs were neutral while only 8 SNPs were deleterious. The total nsSNPs affecting the structure, function and causing disease in the tested software were 4 nsSNPs (rs80359868, rs146312522, rs200548692, rs373708669) Protein structural analysis was done using all of CPH server, Raptor X, Project HOPE and chimera for the 4 pathological SNPs (W539, C392Y, R427C and D403V) resulted in all function prediction software. and, these results are at use for further researches and studies on this gene and it`s mutations.

In silico analysis of likely pathogenic variants in human GGCX gene

Genetic polymorphisms in the GGCX gene have been associated with many vitamin K-dependent protein disorders including vitamin K-dependent clotting factors deficiency, osteoporosis, vascular calcification disorders, and pseudoxanthoma elasticum syndrome (PXE). Identifying functional SNPs in disease-associated genes is difficult experimentally; thus it is better to first explore putative functional SNPs. In this study, computational tools have been utilized to identify nsSNPs which are deleterious to the function, stability, and structure of GGCX enzyme, and might be causative agents of these diseases. In silico analysis was performed using different bioinformatics tools, including: SIFT, PolyPhen-2, SNPs&Go, PhD-SNP, and PROVEAN, to predict the SNPs functional effect on the protein, while I-Mutant and MUpro were used to check the stability of the protein upon SNP, and Project Hope was used to predict the SNPs structural effect. The study revealed six previously reported disease-causing SNPs including: rs121909682 (R476H), rs121909681(R476G, R476C), rs121909675 (L394R), rs1486505438 (493C), rs1341151059 (K218Q), and 37 non-reported SNPs including: R694C, R693C, N605K, F543S, L538R, G537E, P536S, P484L, P484S, R480G, F467C, I465T, Q446P, D442G, M401T, G396S, G393V, T391K, N388D, Y379C, L319P, H287R, R276S, L264P, Y227C, A214V, Y211C, R204H, L163P, N159H, W157R, W157G, G132D, A126P, R68L, R68H, and R68C. Most of these non-reported SNPs are located in or close to a conserved domain region, which make them strong candidates for causing diseases related to vitamin K-dependent proteins. Future studies should consider these nsSNPs as main targets in various diseases involving GGCX dysfunction. This is the first study in which GGCX gene variants were analyzed using in silico tools; hence they can be assistive when considering experimental studies for disease related to these polymorphisms. Furthermore, mutational studies might be helpful in exploring the precise effects of these SNPs.

A Comprehensive In-Silico Analysis of Deleterious Missense SNPs in Human Trehalase Gene: Gaining an Interactome Insights into Type 2 Diabetes Mellitus

Introduction: Trehalase (TREH), a glycoside hydrolase enzyme that catalyses the conversion of trehalose to glucose in sugar metabolism. In spite of severe health threats caused by diabetes worldwide, no systematic and programmed study on human TREH Single Nucleotide Polymorphism (SNPs) and its functional role in Type 2 Diabetes Mellitus (T2DM) has been performed. Aim: This study aimed to identify pathogenic missense SNPs in the human TREH gene. Materials and Methods: A series of different bioinformatic tools including Sorting Intolerant from Tolerant (SIFT), Polyphen, I-mutant, Variant Effect Predictor, Project Hope and GeneMANNIA were used for this study. At all stages, a p-value of 0.05 was considered as statistically significant. Results: This study demonstrated 10 potential mutations out of 241 missense human TREH SNPs from the SNP Database (dbSNP) database of National Center for Biotechnology Information (NCBI), three of which confirmed to have damaging effects on protein function. Out of these three, rs535722007 had the most deleterious effect that altered secondary properties and tertiary structure of the experimental TREH protein and decreased the stability. Further analysis showed a strong connection among TREH, Insulin (INS) and other genes of carbohydrate metabolism associated with T2DM. Gene expression studies found the down-regulation of TREH in all of the experimental studies linked toT2DM. Conclusion: As the probability of the disease predisposition increases with SNPs in primary or co-expressed gene(s), therefore, characterisation of TREH SNPs from human and its gene networking analysis can aid in better understanding of genetic variations and signalling pathways as well as to elucidate the effective diagnostic and treatment strategies.

Computational determination of human PPARG gene: SNPs and prediction of their effect on protein functions of diabetic patients

BackgroundThe Peroxisome proliferator-activated receptor gamma gene (PPARG), encodes a member of the peroxisome-activated receptor subfamily of nuclear receptors. PPARs form heterodimers with retinoid X receptors (RXRs) which regulate transcription of various genes. Three subtypes of PPARs are known: PPAR-alpha, PPAR-delta and PPAR-gamma. The protein encoded by this gene is PPAR-gamma which is a regulator of adipocyte differentiation. PPARG-gamma has been implicated in the pathology of numerous diseases including obesity, diabetes, atherosclerosis and cancer.AimThis study aimed to perform insilico analysis to predict the effects that can be imposed by SNPs reported in PPARG gene.MethodologyThis gene was investigated in NCBI database (http://www.ncbi.nlm.nih.gov/) during the year 2016 and the SNPs in coding region (exonal SNPs) that are non-synonymous (ns SNPs) were analyzed by computational softwares. SIFT, Polyphen, I-Mutant and PHD-SNP softwares). SIFT was used to filter the deleterious SNPs, Polyphen was used to determine the degree of pathogenicity, I-Mutant was used to determine the effect of mutation on protein stability while PHD-SNP software was used to investigate the effect of mutation on protein function. Furthermore, Structural and functional analysis of ns SNPs was also studied using Project HOPE software and modeling was conducted by Chimera.ResultsA total of 34,035 SNPs from NCBI, were found, 21,235 of them were found in Homo sapiens, 134 in coding non synonymous (missense) and 89 were synonymous. Only SNPs present in coding regions were selected for analysis. Out of 12 deleterious SNPs sorted by SIFT, 10 were predicted by Polyphen to be probably damaging with PISC score = 1 and only two were benign. All these 10 double positive SNPs were disease related as predicted by PHD-SNPs and revealed decreased stability indicated by I-Mutant.ConclusionBased on the findings of this study, it can be concluded that the deleterious ns SNPs (rs72551364 and rs121909244SNPs) of PPARG are important candidates for the cause of different types of human diseases including diabetes mellitus.

Patient Costs, Bundled Payment, And More

Patient Costs, Bundled Payment, And More