Dual Use of Veterans Health Administration and Indian Health Service: Healthcare Provider and Patient Perspectives

Many American Indian and Alaska Native veterans are eligible for healthcare from Veterans Health Administration (VHA) and from Indian Health Service (IHS). These organizations executed a Memorandum of Understanding in 2003 to share resources, but little was known about how they collaborated to deliver healthcare. To describe dual use from the stakeholders’ perspectives, including incentives that encourage cross-use, which organization’s primary care is “primary,” and the potential problems and opportunities for care coordination across VHA and IHS. VHA healthcare staff, IHS healthcare staff and American Indian and Alaska Native veterans. Focus groups were conducted using a semi-structured guide. A software-assisted text analysis was performed using grounded theory to develop analytic categories. Dual use was driven by variation in institutional resources, leading patients to actively manage health-seeking behaviors and IHS providers to make ad hoc recommendations for veterans to seek care at VHA. IHS was the “primary” primary care for dual users. There was little coordination between VHA and IHS resulting in delays and treatment conflicts, but all stakeholder groups welcomed future collaboration. Fostering closer alignment between VHA and IHS would reduce care fragmentation and improve accountability for patient care

Scoping review and evidence mapping of interventions aimed at improving reproducible and replicable science: Protocol

BACKGROUND: Many interventions, especially those linked to open science, have been proposed to improve reproducibility in science. To what extent these propositions are based on scientific evidence from empirical evaluations is not clear. AIMS: The primary objective is to identify Open Science interventions that have been formally investigated regarding their influence on reproducibility and replicability. A secondary objective is to list any facilitators or barriers reported and to identify gaps in the evidence. METHODS: We will search broadly by using electronic bibliographic databases, broad internet search, and contacting experts in the field of reproducibility, replicability, and open science. Any study investigating interventions for their influence on the reproducibility and replicability of research will be selected, including those studies additionally investigating drivers and barriers to the implementation and effectiveness of interventions. Studies will first be selected by title and abstract (if available) and then by reading the full text by at least two independent reviewers. We will analyze existing scientific evidence using scoping review and evidence gap mapping methodologies. RESULTS: The results will be presented in interactive evidence maps, summarized in a narrative synthesis, and serve as input for subsequent research. REVIEW REGISTRATION: This protocol has been pre-registered on OSF under doi https://doi.org/10.17605/OSF.IO/D65YS

Age-related change in brain metabolite abnormalities in autism: a meta-analysis of proton magnetic resonance spectroscopy studies

Abnormal trajectory of brain development has been suggested by previous structural magnetic resonance imaging and head circumference findings in autism spectrum disorders (ASDs); however, the neurochemical backgrounds remain unclear. To elucidate neurochemical processes underlying aberrant brain growth in ASD, we conducted a comprehensive literature search and a meta-analysis of 1H-magnetic resonance spectroscopy (1H-MRS) studies in ASD. From the 22 articles identified as satisfying the criteria, means and s.d. of measure of N-acetylaspartate (NAA), creatine, choline-containing compounds, myo-Inositol and glutamate+glutamine in frontal, temporal, parietal, amygdala-hippocampus complex, thalamus and cerebellum were extracted. Random effect model analyses showed significantly lower NAA levels in all the examined brain regions but cerebellum in ASD children compared with typically developed children (n=1295 at the maximum in frontal, P<0.05 Bonferroni-corrected), although there was no significant difference in metabolite levels in adulthood. Meta-regression analysis further revealed that the effect size of lower frontal NAA levels linearly declined with older mean age in ASD (n=844, P<0.05 Bonferroni-corrected). The significance of all frontal NAA findings was preserved after considering between-study heterogeneities (P<0.05 Bonferroni-corrected). This first meta-analysis of 1H-MRS studies in ASD demonstrated robust developmental changes in the degree of abnormality in NAA levels, especially in frontal lobes of ASD. Previously reported larger-than-normal brain size in ASD children and the coincident lower-than-normal NAA levels suggest that early transient brain expansion in ASD is mainly caused by an increase in non-neuron tissues, such as glial cell proliferation

Efectos del entrenamiento de la musculatura respiratoria sobre el rendimiento.

Actualmente, es aceptado por la comunidad científica que el sistema respiratorio puede limitar el ejercicio en personas con enfermedad pulmonar y/o cardiovascular. El objetivo del presente artículo es la revisión de algunos estudios realizados en relación al papel limitante del sistema respiratorio en el rendimiento físico de deportistas. Se realiza una breve descripción técnica de los dispositivos más utilizados para el entrenamiento de la musculatura respiratoria. Finalmente, se presentan los resultados más representativos, obtenidos por diversos investigadores y en distintas poblaciones, relacionados con el entrenamiento de la musculatura respiratoria y sus efectos en el rendimiento físico. Los resultados obtenidos en las distintas investigaciones consultadas sobre el entrenamiento de los músculos respiratorios son dispares, puesto que algunos han mostrado mejoras significativas, mientras otros no han mostrado grandes efectos en el rendimiento. En todos ellos se refleja cómo el sistema respiratorio es un factor limitante del rendimiento físico en deportistas y es preciso plantearse nuevas metodologías, protocolos y planificaciones en el entrenamiento deportivo. El entrenamiento de los músculos respiratorios, tanto mediante dispositivos umbral, de resistencia, o isocapnica, puede provocar mejoras en valores como la presión inspiratoria máxima y mejoras en el rendimiento de algunos deportes; sin embargo, son muy escasos los estudios que han encontrado mejoras en el consumo máximo de oxígeno (VO2max). Las discrepancias entre los estudios analizados pueden estar provocadas por diferencias en las intensidades y duración de los ejercicios utilizados, así como por diferencias en el diseño experimental y el nivel de condición física de los sujetos

Tissue time course and bioavailability of the pyrethroid insecticide bifenthrin in the Long-Evans rat

<p>1. Pyrethroids are neurotoxic and parent pyrethroid appears to be toxic entity. This study evaluated the oral disposition and bioavailability of bifenthrin in the adult male Long-Evans rat.</p> <p>2. In the disposition study, rats were administered bifenthrin (0.3 or 3 mg/kg) by oral gavage and serially sacrificed (0.25 h to 21 days). Blood, liver, brain and adipose tissue were removed. In the bioavailability study, blood was collected serially from jugular vein cannulated rats (0.25 to 24 h) following oral (0.3 or 3 mg/kg) or intravenous (0.3 mg/kg) administration of bifenthrin. Tissues were extracted and analyzed for bifenthrin by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS).</p> <p>3. Bifenthrin concentration in blood and liver peaked 1–2-h postoral administration and were approximately 90 ng/ml (or g) and 1000 ng/ml (or g) for both tissues at 0.3 and 3 mg/kg, respectively. Bifenthrin was rapidly cleared from both blood and liver. Brain concentrations peaked at 4–6 h and were lower than in blood at both doses (12 and 143 ng/g). Bifenthrin in adipose tissue peaked at the collected time points of 8 (157 ng/g) and 24 (1145 ng/g) h for the 0.3 and 3 mg/kg doses, respectively and was retained 21 days postoral administration. Following intravenous administration, the blood bifenthrin concentration decreased bi-exponentially, with a distribution half-life of 0.2 h and an elimination half-life of 8 h. Bifenthrin bioavailability was approximately 30%. These disposition and kinetic bifenthrin data may decrease uncertainties in the risk assessment for this pyrethroid insecticide.</p

Environmentally relevant pyrethroid mixtures: A study on the correlation of blood and brain concentrations of a mixture of pyrethroid insecticides to motor activity in the rat

Human exposure to multiple pyrethroid insecticides may occur because of their broad use on crops and for residential pest control. To address the potential health risk from co-exposure to pyrethroids, it is important to understand their disposition and toxicity in target organs such as the brain, and surrogates such as the blood when administered as a mixture. The objective of this study was to assess the correlation between blood and brain concentrations of pyrethroids and neurobehavioral effects in the rat following an acute oral administration of the pyrethroids as a mixture. Male Long-Evans rats were administered a mixture of β-cyfluthrin, cypermethrin, deltamethrin, esfenvalerate and cis- and trans-permethrin in corn oil at seven dose levels. The pyrethroid with the highest percentage in the dosing solution was trans-permethrin (31% of total mixture dose) while deltamethrin and esfenvalerate had the lowest percentage (3%). Motor activity of the rats was then monitored for 1 h. At 3.5 h post-dosing, the animals were euthanized and blood and brain were collected. These tissues were extracted and analyzed for parent pyrethroid using HPLC-tandem mass spectrometry. Cypermethrin and cis-permethrin were the predominate pyrethroids detected in blood and brain, respectively, at all dosage levels. The relationship of total pyrethroid concentration between blood and brain was linear (r = 0.93). The pyrethroids with the lowest fraction in blood were trans-permethrin and β-cyfluthrin and in brain were deltamethrin and esfenvalerate. The relationship between motor activity of the treated rats and summed pyrethroid blood and brain concentration was described using a sigmoidal Emax model with the Effective Concentration50 being more sensitive for brain than blood. The data suggests summed pyrethroid rat blood concentration could be used as a surrogate for brain concentration as an aid to study the neurotoxic effects of pyrethroids administered as a mixture under the conditions used in this study.Fil: Hughes, Michael F.. National Health and Environmental Effects Research Laboratory; Estados UnidosFil: Ross, David G.. National Health and Environmental Effects Research Laboratory; Estados UnidosFil: Starr, James M.. National Exposure Research Laboratory; Estados UnidosFil: Scollon, Edward J.. National Health and Environmental Effects Research Laboratory; Estados UnidosFil: Wolansky, Marcelo Javier. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. National Research Council; Estados UnidosFil: Crofton, Kevin M.. National Health and Environmental Effects Research Laboratory; Estados UnidosFil: DeVito, Michael J.. National Health and Environmental Effects Research Laboratory; Estados Unido