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HEALTH CARE NEWS

US Congress extends CHIP, funds opioid crisis response following temporary shutdown

Publish date: February 9, 2018

By 

Gregory Twachtman 

Oncology Practice

 

 

 

 

 

 

 

 

 

Congress, despite a second shutdown in less than a month, was able to pass a number of financial extenders to fund key health care programs.

The bipartisan spending bill (H.R. 1892), passed in the early morning hours on Feb. 9 by a 71-28 vote in the Senate (16 Republicans and 12 Democrats voted against it, and Sen. John McCain [R-Ariz.] was not present) and a 240-186 vote in the House (67 Republicans and 119 Democrats voted against and 5 representatives did not vote). President Trump signed the bill later that morning.

 

The spending bill and continuing resolution to fund the government through March 23 includes $6 billion to fund treatment for opioid addiction and other mental health issues, $2 billion in additional funding for the National Institutes of Health, and 4 additional years of funding for the Children’s Health Insurance Program. The additional CHIP funding extends the program for a total of 10 years.

The funding bill also made a technical correction to the Merit-based Incentive Payment System (MIPS) track of the Medicare Quality Payment Program. It removes Part B drug reimbursement from the MIPS payment adjustment, so any positive or negative change to physician payments based on the MIPS score will only be applied to physician fee schedule payments.

The bill also repeals the Independent Payment Advisory Board, a panel created by the Affordable Care Act that would have the power to slash Medicare spending under certain budget circumstances. That board was never convened.

The funding legislation also accelerates closure of the Medicare Part D “donut hole,” the coverage gap in which beneficiaries must pay 100% of medication costs prior to entering catastrophic coverage.

Just over $7 billion was provided for community health centers and Medicare’s therapy caps were repealed.

While the funding bill was written in the Senate with bipartisan input and received bipartisan support, Sen. Rand Paul (R-Ky.) held up votes over objections to the more than $1 trillion it will add to the nation’s debt, as well as for the fact that there was no opportunity to introduce and vote on amendments, leading to an hours-long government shutdown.

There also were concerns about two issues that could have derailed the vote in the House. Democrats wanted to add language to address immigrants brought to this nation illegally as children, while some Republicans did not want to increase the federal debt. However, there were enough votes to pass the funding legislation.

gtwachtman@frontlinemedcom.com

Napping Can Help Tired Teens' Performance in School Researchers found that regular mid-day naps can help adolescents overcome lack of sleep

Drotumdi O

Napping.jpg

Newswise — Researchers from Case Western Reserve University School of Medicine and colleagues have discovered how two brain regions work together to maintain attention, and how discordance between the regions could lead to attention deficit disorders, including schizophrenia, bipolar disorder, and major depression.

People with attention deficits have difficulty focusing and often display compulsive behavior. The new study suggests these symptoms could be due to dysfunction in a gene—ErbB4that helps different brain regions communicate. The gene is a known risk factor for psychiatric disorders, and is required to maintain healthy neurotransmitter levels in the brain.

In a study published in the current issue of Neuron, researchers showed mice lacking ErbB4 activity in specific brain regions performed poorly on timed attention tasks. The mice struggled to pay attention and remember visual cues associated with food. Neuroscientists describe the kind of thought-driven attention required for the tasks as “top-down attention.” Top-down attention is goal-oriented, and related to focus. People who lack efficient top-down attention are at a higher risk for attention deficit hyperactivity disorder (ADHD). The study is the first to connect ErbB4 to top-down attention.

“The results reveal a mechanism for top-down attention, which could go wrong in attention disorders,” says corresponding author Lin Mei, PhD, professor and chair of the department of neurosciences at Case Western Reserve University School of Medicine. “And since ErbB4 is a risk factor for schizophrenia, bipolar disorder, and major depression, the results provide insights into mechanisms of these disorders.”

When the researchers attached probes to the mice to measure brain activity, they found mice without ErbB4 had brain regions that were acting independently, rather than together in synchrony. In particular, the researchers studied the prefrontal cortex—normally associated with decision-making—and the hippocampus—a region that supports memory. These two regions coordinate for a variety of brain tasks, including memory and attention.

“We found top-down attention, previously thought to be controlled by the prefrontal cortex, also involves the hippocampus in a manner where the two regions are highly synchronized when attention is high,” says Mei. “Our findings give importance to synchrony between the prefrontal cortex and hippocampus in top-down attention and open up the possibility that attention deficit disorders, like ADHD, might involve impairments in the synchrony between these two regions.”

According to the new study, ErbB4 coordinates a cascade of brain signals that “bridge” the two regions. ErbB4 itself encodes a receptor found on the surface of brain cells. The study found that when a protein (neuregulin-1) attaches to the ErbB4 receptor, it triggers a chain reaction that ultimately determines neurotransmitter levels in the prefrontal cortex and hippocampus. Without ErbB4, neurotransmitter levels go awry. The researchers discovered mice lacking ErbB4 have low levels of a particular neurotransmitter—GABA, or gamma-aminobutyric acid—in their brain. Low GABA levels can lead to impaired top-down attention in the prefrontal cortex, and impairs how the prefrontal cortex can efficiently coordinate with the hippocampus. The researchers concluded that ErbB4 helps link the two brain regions to maintain attention.

The study used a novel mouse model to study brain functions. By using genetic and chemical techniques, Mei’s team can specifically inhibit ErbB4 in a specific brain region. “We generated a mutant mouse that enables us to inhibit ErbB4 activity whenever and wherever we want, thus allowing temporal and spatial control of ErbB4 activity,” says Mei. “This positions us to understand how different brain regions and their neurotransmitter activity regulate various brain functions.” The researchers are planning to use the novel mouse model to study how ErbB4 may coordinate brain activities, in an effort to learn more about mechanisms behind attention deficit disorders.

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This study was supported by a grant from the NIH (MH083317 to Lin Mei). Zhibing Tan is supported in part by a 2017 NARSAD Young Investigator Grant from the Brain & Behavior Research Foundation (26842).

Tan, Z., Robinson, H., et al. “Dynamic ErbB4 activity in hippocampal-prefrontal synchrony and top-down attention in rodents.” Neuron. doi.org/10.1016/j.neuron.2018.03.018

For more information about Case Western Reserve University School of Medicine, please visit: case.edu/medicine.

 

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