Asunto(s)
Servicios de Salud Comunitaria/economía , Accesibilidad a los Servicios de Salud/economía , Cuidados a Largo Plazo/economía , Programas Controlados de Atención en Salud/economía , Capitación , Financiación Gubernamental , Humanos , Formulación de Políticas , Gobierno Estatal , Estados UnidosAsunto(s)
Financiación Gubernamental , Anciano Frágil , Viviendas para Ancianos/economía , Anciano , Personas con Discapacidad , Financiación Gubernamental/tendencias , Viviendas para Ancianos/estadística & datos numéricos , Humanos , Cuidados a Largo Plazo/economía , Cuidados a Largo Plazo/tendencias , Formulación de Políticas , Privacidad , Garantía de la Calidad de Atención de Salud , Gobierno Estatal , Estados UnidosAsunto(s)
Servicios de Salud Comunitaria/economía , Anciano Frágil , Gastos en Salud/estadística & datos numéricos , Servicios de Salud para Ancianos/economía , Medicaid/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Servicios de Salud Comunitaria/estadística & datos numéricos , Servicios de Salud Comunitaria/tendencias , Personas con Discapacidad , Predicción , Gastos en Salud/tendencias , Servicios de Salud para Ancianos/estadística & datos numéricos , Servicios de Salud para Ancianos/tendencias , Humanos , Cuidados a Largo Plazo/economía , Cuidados a Largo Plazo/tendencias , Medicaid/tendencias , Gobierno Estatal , Estados UnidosRESUMEN
Many states have responded to growing Medicaid long-term care expenditures by limiting the number of long-term care providers through certificate-of-need (CON) programs and moratoriums on new construction or certification for participation in the Medicaid program. This article focuses on the use of these policies in 13 states. Most of the 13 states control the supply of nursing home beds and hospital conversions with CONs or moratoriums, but they are struggling to adapt the role of supply policy to the growth of home health and residential care. As an increasing proportion of Medicaid long-term care spending goes to these nursing home alternatives, supply policy needs to keep pace with the changing provider market and the changing demographics of the consumer market if it hopes to ensure access to long-term care and control Medicaid expenditures.
Asunto(s)
Cuidados a Largo Plazo/estadística & datos numéricos , Medicaid/economía , Casas de Salud/estadística & datos numéricos , Anciano , Certificado de Necesidades , Humanos , Cuidados a Largo Plazo/tendencias , Estados UnidosRESUMEN
In the thirteen Assessing the New Federalism states, strategies to control the rate of increase in long-term care spending are extremely varied, especially in comparison with acute care's single-minded focus on managed care. States use three broad strategies: offsetting state spending with increased private and federal contributions, making the delivery system more efficient, and using traditional cost-control mechanisms, including controlling the nursing home bed supply and cutting Medicaid reimbursement rates.
Asunto(s)
Política de Salud/economía , Servicios de Salud para Ancianos/economía , Cuidados a Largo Plazo/economía , Planes Estatales de Salud/economía , Anciano , Control de Costos , Asignación de Recursos para la Atención de Salud , Gastos en Salud , Humanos , Medicaid/economía , Política , Gobierno Estatal , Estados UnidosRESUMEN
Hairy roots of Brassica napus (rape cv. Giant) were produced by cocultivating leaf and cotyledon explants with Agrobacterium rhizogenes strain A4T. The hairy roots grew prolifically on solid and in liquid media. Incorporation of ammonium sulphate or phosphinothricin (PPT) into the media reduced growth. PPT treatment reduced glutamine synthetase (GS) activity and increased the ammonia content of the hairy roots. We have found that PPT treatment also induces a loss of glutamine from the roots and this may influence root growth. To test this we grew hairy roots in a liquid medium containing 10 mM glutamine. This glutamine treatment overcame the PPT induced suppression of growth but also significantly increased GS activity, reduced ammonia accumulation and increased the levels of glutamate and asparagine.
RESUMEN
Hairy roots of Brassica napus (rape cv. Giant) have been produced that contain the cytosolic glutamine synthetase (GS) gene from Glycine max (soybean). Leaf explants were cocultivated with Agrobacterium rhizogenes strain A4T harbouring the binary vector pLN16. This vector was constructed by inserting a soybean cytosolic GS cDNA into the multiple cloning site of pGA643, placing it under the control of the CaMV promoter. In addition, the T-DNA region of pLN16 contained a NPTII gene for selection of transformed cells. Transgenic hairy roots grew prolifically on hormone-free media containing a selective level of kanamycin. Southern and northern analyses confirmed the presence of soybean GS DNA and transcripts, respectively. These transformed hairy roots also have a greater abundance of the GS polypeptide, approximately 3-6 fold greater GS activity and lower levels of endogenous ammonia. Hairy roots provide a useful system for studying responses to phosphinothricin (PPT). Hairy roots grown in media containing PPT had lower GS activity, greater ammonia accumulation and slower growth than controls. The presence of the soybean GS gene in the hairy roots reduced these PPT-induced effects and resulted in higher GS activity, lower ammonia levels and faster growth than in PPT-treated controls. Greater tolerance of PPT was also seen in shoots regenerated from the hairy roots displaying elevated levels of GS activity.