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Background Public insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care. Methods This community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders. Discussion The information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities. Trial registration This protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404 . Registered June 6, 2018.

Inequities in access to health care create barriers to physical and mental health treatment for the rapidly aging American Indian population in the United States. This study uses concept mapping-a participatory, mixed-methods approach to understanding complex phenomena-to examine the perceived impacts of multilevel factors influencing Elders' ability to access and use health care and how these perceptions vary according to gender and age, with the aim of identifying tailored strategies to address inequities. Using data from a purposive sample of American Indian Elders (n = 65) in two states, we compared ratings of thematic clusters and individual factors perceived to impact Elder health care across four participant subgroups: women aged 55-64, women aged 65+, men aged 55-64, and men aged 65+. Provider Issues and Relationships and Tribal/National Policy were themes perceived to have a particularly high impact on Elder health. Key variations between subgroups regarding individual health care access factors reflected unique interpersonal and accessibility challenges among older women, problems stemming from lack of familiarity with health care among younger Elders and men, and challenges navigating complex bureaucracies and tribal decision-making processes among older Elders. Findings underscore the need to address multilevel gender- and age-specific factors contributing to health disparities for Elders.

  First, New Mexico doesn't have to pay the Federal Medical Assistance Percentage, known as the FMAP, for Native Americans, who make up approximately 10 percent of New Mexico's population. The FMAP is a big deal because it tells us who pays for what portion of a state's Medicaid program. Currently, the federal government shoulders 100 percent of the cost of Medicaid expansion. However, as of 2020, the FMAP is approximately a 90 percent federal and 10 percent state mix, meaning that for every dollar spent by the Medicaid program, the federal government covers 90 cents and the state covers 10 cents. Now, as a result of the Affordable Care Act, IHS is experiencing an influx of funding due to third-party reimbursements from Medicaid expansion. Native Americans are signing up and taking advantage of the benefits of Medicaid. IHS' Albuquerque Area Service Unit has reported that they are now paying for priority three and four cases as a result of increased enrollment in Medicaid by Native Americans.

The European Randomised study of Screening for Prostate Cancer (ERSPC) has shown significant reductions in prostate cancer mortality after 9 years and 11 years of follow-up, but screening is controversial because of adverse events such as overdiagnosis. We provide updated results of mortality from prostate cancer with follow-up to 2010, with analyses truncated at 9, 11, and 13 years. ERSPC is a multicentre, randomised trial with a predefined centralised database, analysis plan, and core age group (55–69 years), which assesses prostate-specific antigen (PSA) testing in eight European countries. Eligible men aged 50–74 years were identified from population registries and randomly assigned by computer generated random numbers to screening or no intervention (control). Investigators were masked to group allocation. The primary outcome was prostate cancer mortality in the core age group. Analysis was by intention to treat. We did a secondary analysis that corrected for selection bias due to non-participation. Only incidence and no mortality data at 9 years’ follow-up are reported for the French centres. This study is registered with Current Controlled Trials, number ISRCTN49127736. With data truncated at 13 years of follow-up, 7408 prostate cancer cases were diagnosed in the intervention group and 6107 cases in the control group. The rate ratio of prostate cancer incidence between the intervention and control groups was 1·91 (95% CI 1·83–1·99) after 9 years (1·64 [1·58–1·69] including France), 1·66 (1·60–1·73) after 11 years, and 1·57 (1·51–1·62) after 13 years. The rate ratio of prostate cancer mortality was 0·85 (0·70–1·03) after 9 years, 0·78 (0·66–0·91) after 11 years, and 0·79 (0·69–0·91) at 13 years. The absolute risk reduction of death from prostate cancer at 13 years was 0·11 per 1000 person-years or 1·28 per 1000 men randomised, which is equivalent to one prostate cancer death averted per 781 (95% CI 490–1929) men invited for screening or one per 27 (17–66) additional prostate cancer detected. After adjustment for non-participation, the rate ratio of prostate cancer mortality in men screened was 0·73 (95% CI 0·61–0·88). In this update the ERSPC confirms a substantial reduction in prostate cancer mortality attributable to testing of PSA, with a substantially increased absolute effect at 13 years compared with findings after 9 and 11 years. Despite our findings, further quantification of harms and their reduction are still considered a prerequisite for the introduction of populated-based screening. Each centre had its own funding responsibility.

Enteroaggregative Escherichia coli (EAEC) causes diarrhea and intestinal inflammation worldwide. EAEC strains are characterized by the presence of aggregative adherence fimbriae (AAF), which play a key role in pathogenesis by mediating attachment to the intestinal mucosa and by triggering host inflammatory responses. Here, we identify the epithelial transmembrane mucin MUC1 as an intestinal host cell receptor for EAEC, demonstrating that AAF-mediated interactions between EAEC and MUC1 facilitate enhanced bacterial adhesion. We further demonstrate that EAEC infection also causes elevated expression of MUC1 in inflamed human intestinal tissues. Moreover, we find that MUC1 facilitates AAF-dependent migration of neutrophils across the epithelium in response to EAEC infection. Thus, we show for the first time a proinflammatory role for MUC1 in the host response to an intestinal pathogen. IMPORTANCE EAEC is a clinically important intestinal pathogen that triggers intestinal inflammation and diarrheal illness via mechanisms that are not yet fully understood. Our findings provide new insight into how EAEC triggers host inflammation and underscores the pivotal role of AAFs—the principal adhesins of EAEC—in driving EAEC-associated disease. Most importantly, our findings add a new dimension to the signaling properties of the transmembrane mucin MUC1. Mostly studied for its role in various forms of cancer, MUC1 is widely regarded as playing an anti-inflammatory role in response to infection with bacterial pathogens in various tissues. However, the role of MUC1 during intestinal infections has not been previously explored, and our results describe the first report of MUC1 as a proinflammatory factor following intestinal infection. EAEC is a clinically important intestinal pathogen that triggers intestinal inflammation and diarrheal illness via mechanisms that are not yet fully understood. Our findings provide new insight into how EAEC triggers host inflammation and underscores the pivotal role of AAFs—the principal adhesins of EAEC—in driving EAEC-associated disease. Most importantly, our findings add a new dimension to the signaling properties of the transmembrane mucin MUC1. Mostly studied for its role in various forms of cancer, MUC1 is widely regarded as playing an anti-inflammatory role in response to infection with bacterial pathogens in various tissues. However, the role of MUC1 during intestinal infections has not been previously explored, and our results describe the first report of MUC1 as a proinflammatory factor following intestinal infection.

ABSTRACT Enteroaggregative Escherichia coli (EAEC) causes diarrhea and intestinal inflammation worldwide. EAEC strains are characterized by the presence of aggregative adherence fimbriae (AAF), which play a key role in pathogenesis by mediating attachment to the intestinal mucosa and by triggering host inflammatory responses. Here, we identify the epithelial transmembrane mucin MUC1 as an intestinal host cell receptor for EAEC, demonstrating that AAF-mediated interactions between EAEC and MUC1 facilitate enhanced bacterial adhesion. We further demonstrate that EAEC infection also causes elevated expression of MUC1 in inflamed human intestinal tissues. Moreover, we find that MUC1 facilitates AAF-dependent migration of neutrophils across the epithelium in response to EAEC infection. Thus, we show for the first time a proinflammatory role for MUC1 in the host response to an intestinal pathogen. IMPORTANCE EAEC is a clinically important intestinal pathogen that triggers intestinal inflammation and diarrheal illness via mechanisms that are not yet fully understood. Our findings provide new insight into how EAEC triggers host inflammation and underscores the pivotal role of AAFs—the principal adhesins of EAEC—in driving EAEC-associated disease. Most importantly, our findings add a new dimension to the signaling properties of the transmembrane mucin MUC1. Mostly studied for its role in various forms of cancer, MUC1 is widely regarded as playing an anti-inflammatory role in response to infection with bacterial pathogens in various tissues. However, the role of MUC1 during intestinal infections has not been previously explored, and our results describe the first report of MUC1 as a proinflammatory factor following intestinal infection.

Periodization is a methodological system that distributes training contents. With the evolution of sports, several periodization models were developed based on Matveev’s classic periodization, Verkhoshansky’s Blocks periodization model, Vorobiev’s Modular, Arosiev and Kalinin`s Pendular, Tschiene`s High Load, Valdivielso’s ATR, Platonov’s Multicyclical, and Bompa’s Priority, among others. The vast majority of models - and even their variations - have made it difficult to classify and select which periodization to use. To that end, the aim of the present study was to create criteria to identify sports training periodization models and, with the use of analysis and discussion of their characteristics, propose a classification and indicate the applicability of the most widely cited models in the literature. In the methodology of this study, a group technique known as direct discussion was used. The group consisted of 20 Master’s students, all researchers of the models proposed and sports training students at the Science of Human Motricity Course of Castelo Branco University, in addition to four discussion mediators. Despite a number of conceptual differences, the results show that most of the contemporary periodization training models derive from Matveev’s model, in an attempt to meet the demands currently imposed by sports. We analyzed the models investigated and concluded that despite their diversity, some characteristics are common and help distinguish each of them in terms of structure, load variation, number of peaks, sports level and applicability. La periodización es un sistema metodológico que distribuye los contenidos formativos. Con la evolución de los deportes, se desarrollaron varios modelos de periodización basados en la periodización clásica de Matveev, el modelo de periodización de Bloques de Verkhoshansky, Modular de Vorobiev, Pendular de Arosiev y Kalinin, Carga de alto de Tschiene, ATR de Valdivielso, Multicíclico de Platonov y Prioridad de Bompa, entre otros. La gran mayoría de modelos, e incluso sus variaciones, han dificultado la clasificación y selección de qué periodización utilizar. Para ello, el objetivo del presente estudio fue generar criterios para identificar modelos de periodización del entrenamiento deportivo y, con el uso del análisis y discusión de sus características, proponer una clasificación e indicar la aplicabilidad de los modelos más citados en la literatura. En la metodología de este estudio se utilizó una técnica grupal conocida como discusión directa. El grupo estuvo integrado por 20 estudiantes de maestría, todos investigadores de los modelos propuestos y estudiantes de formación deportiva del Curso de Ciencia de la Motricidad Humana de la Universidad Castelo Branco, además de cuatro mediadores de discusión. Los resultados muestran que la mayoría de los modelos de entrenamiento de periodización contemporáneos derivan del modelo de Matveev, en un intento de satisfacer las demandas impuestas actualmente por los deportes. Analizamos los modelos investigados y concluimos que a pesar de su diversidad, algunas características son comunes y ayudan a distinguir cada uno de ellos en cuanto a estructura, variación de carga, número de picos, nivel deportivo y aplicabilidad.

This paper uses the E-simulate model of electricity generation to estimate how much the stacking order of different technologies changes when a carbon price is introduced. Different coal and gas price scenarios are explored, and some sensitivity analysis is made of the relative market share of coal and gas under various carbon price levels. The objective of the paper is to estimate how much CO2 reduction could happen in the UK through fuel switching (coal to natural gas) for different carbon price levels during Phase II (2008-2012) of the EU ETS. This country is indeed reported to have the greatest potential within the EU thanks to its suitable fuel mix (39% of coal and 36% of gas in 2007). Our results feature that 27 Mton of CO2/year can be abated at carbon prices around e25/ton (essentially through fuel-switching during the summer), 36 Mton of CO2/year can be abated at carbon prices around e40/ton (in that case, the carbon price triggers fuel-switching during the whole year), and that a maximum of 40 Mton of CO2/year can be achieved at high carbon prices (e125/ton). We also provide various scenarios depending on the relative levels of fuel prices.

The creation of the EU ETS led to changes in the merit order of the different plants competing on the electricity grid, and in the fuel-switching opportunities in the UK. This country has the greatest potential for CO2 emissions reduction through fuel-switching within the EU, thanks to its suitable energy mix (39% of coal and 36% of natural gas in 2007). Through the modelling of the UK power system with the E-Simulate model, our central contribution documents that fuel-switching did occur in the UK as a consequence of the EU ETS: 20.1 Mton in 2005, 7.8 Mton in 2006, 0.52 Mton in 2007, and 14.3 Mton in 2008. We assess the relative contribution of different factors (carbon price, fuel prices and load in the power sector) to CO2 emissions abatement by disentangling the impacts coming from the EU ETS, relative fuel prices variation, and with a 'switching band' analysis.