The most well understood type is ChAT deficiency, formerly known as CMS with episodic apnea. This form is CMS is different from the rest in that symptoms are generally restricted to spontaneous episodes of severe shortness of breath and bulbar (speech, chewing, and swallowing) weakness. Symptoms can sometimes last in some form for weeks after an episode. Episodes can also be triggered by fevers, for example. This form appears to be severest at birth when the newborns may need the help of a ventilator. Cholinesterase inhibitors, like Mestinon, are effective for this type of CMS as a prophylactic to prevent or mitigate the episodes. Parents of CMS children are also instructed to take precautions to be able to handle incidents of apnea. This type of CMS is caused by a genetic mutation affecting the choline acetyltransferase (ChAT) gene, which catalyzes acetylcholine production and affects the formation and maturation of synapses. Fourteen separate mutations have been shown to affect ChAT.
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Adding to the difficulties facing low-income students, sharp reductions in state funding for higher education have led to significant tuition increases. Tuition at the average public college or university nationally is up $1,936 (28 percent) since the 2007-08 school year, after adjusting for inflation.  While more federal financial aid is now available to offset rising tuition for low-income students, increases in costs of room and board along with a higher “sticker price” at many colleges and universities likely cause some students to choose not to enroll.  Reforms Can Reduce Incarceration Rates and Produce Savings States can reduce their incarceration rates and realize significant long-term budget savings without harming public safety.  To do this, state policymakers need to enact reforms that target the main drivers of high incarceration rates: the number of people admitted (or re-admitted) into correctional facilities and the length of their prison stays. States should consider four basic kinds of reforms: