Analytical Interpretation of the Patient Centered Medical Home: A Meta-Review of the Literature

Medical care in the United States is plagued by extremely high costs, inconsistent quality and fragmented delivery at best. In response to these issues new concepts of integrated health care delivery systems have been developed. The Patient-Centered Medical Home (PCMH) is an increasingly popular health care delivery model that emphasizes continuous coordinated patient care. In theory, the PCMH takes a preventative approach to medicine that addresses the individual not the disease, and takes a holistic approach to health care. The PCMH model has been shown to lower health care costs while improving health care outcomes. Despite PCMH being a new movement in the business, little agreement is reached concerning the definition and practice of PCMH, nor specifics on implementation or anticipated barriers. As Americans seek for ways to fix the health care crisis,\u27 the PCMH offers an alluring model for improved health care delivery while containing the ever escalating costs associated. Appropriate analysis of the feasibility of this model, including limitations and barriers to implementation are necessary at the birth of proposed health care reforms emerge. This article will report relevant research related to cost effectiveness, health care outcomes, and barriers to implementation and utilization of the patient-centered medical home model being applied at the primary level of care

Transcriptional Investigations into Neonatal Gut Development Related to Early Feeding

Introduction: While numerous correlational studies suggest that human milk (HM) optimizes infant gut development, little is known about the physiological process. To investigate HM\u27s protective mechanisms for intestinal development, we used the neonatal piglet model. The recommended time to exclusively breastfeed an infant is six months, which is equivalent to one month in piglets. We hypothesized that HM-fed piglets would show increased paracellular junctions and reduced inflammatory markers in the intestines compared to infant formula (IF)-fed piglets. Methods: We reared littermate Yorkshire-duroc piglets for 28 days, assigning them to HM-fed (n=6) and IF-fed (n=6) groups, alongside controls reared on sow’s milk (n=2) at the farm. Following euthanasia and tissue collection, we extracted RNA from intestinal tissues, purified them of DNA contaminants, synthesized complementary DNA (cDNA), and performed quantitative-PCR (qPCR). We examined paracellular junction proteins (Claudin 1, Tight Junction Protein 1, Tight Junction Protein 2, Occludin, and Cadherin 1), immunomodulatory cytokines (Interleukin (IL)-2, IL-4, IL-8, IL-10, IL-1B, and TNFa), and lymphocyte markers (CD3e, CD8a, CD20, CD79b). Results were normalized to the reference gene beta actin within individuals and averaged across feeding groups. Results: We used ANOVA, analysis of variance, with multiple comparisons to determine differences between feeding groups. Discussion:Contrary to our expectations, there were no significant differences in the expression of inflammatory markers or paracellular junctions. However, as part of a larger project, it is still clear HM plays a role in optimizing gut development. Future research will involve a global transcriptomic analysis of the ileum using next-generation sequencing data

Human milk immune factors, maternal nutritional status, and infant sex: The INSPIRE study

Breastfeeding is an energetically costly and intense form of human parental investment, providing sole-source nutrition in early infancy and bioactive components, including immune factors. Given the energetic cost of lactation, milk factors may be subject to tradeoffs, and variation in concentrations have been explored utilizing the Trivers-Willard hypothesis. As human milk immune factors are critical to developing immune system and protect infants against pathogens, we tested whether concentrations of milk immune factors (IgA, IgM, IgG, EGF, TGFβ2, and IL-10) vary in response to infant sex and maternal condition (proxied by maternal diet diversity [DD] and body mass index [BMI]) as posited in the Trivers-Willard hypothesis and consider the application of the hypothesis to milk composition.This study is supported with funds from the National Science Foundation's INSPIRE Track 1 Grant: What is Normal Milk? Sociocultural, Evolutionary, Environmental, and Microbial Aspects of Human Milk Composition (Award #1344288), National Institutes of Health NICHD R01 HD092297 and the US Department of Agriculture National Institute of Food and Agriculture, Hatch project IDA01643 and in-kind donations from Medela. We sincerely thank the Washington State University Health Equity Center for their support. Additionally, we thank Andrew Doel (Medical Research Council Unit, The Gambia) for field supervision and logistics planning and Alansan Sey for questionnaire administration and taking anthropometric measurements in The Gambia; Jane Odei (University of Ghana) for supervising field data collection in Ghana; Haile Belachew (Hawassa University), and Birhanu Sintayehu for planning and logistics and the administration and staff at Adare Hospital in Hawassa for assistance with logistics in Ethiopia; Catherine O. Sarange (Egerton University) for field supervision and logistics planning and Milka W. Churuge and Minne M. Gachau for recruiting, questionnaire administration, and taking anthropometric measurements in Kenya; Gisella Barbagelatta (Instituto de Investigación Nutricional) for field supervision and logistics planning, Patricia Calderon (Instituto de Investigación Nutricional) for recruiting, questionnaire administration, and taking anthropometric measurements, and Roxana Barrutia (Instituto de Investigación Nutricional) for the management and shipping of samples in Peru; Leónides Fernández, Cristina García-Carral and Irene Espinosa (Complutense University of Madrid) for technical assistance and expertise, and M. Ángeles Checa (Zaragoza, Spain), Katalina Legarra (Guernica, Spain), and Julia Mínguez (Huesca, Spain) for participation in the collection of samples in Spain; Kirsti Kaski and Maije Sjöstrand (both Helsingborg Hospital) for participation in the collection of samples, questionnaire administration, and anthropometric measurements in Sweden; Renee Bridge and Kara Sunderland (both University of California, San Diego); Janae Carrothers and Shelby Hix (Washington State University) for logistics planning, recruiting, questionnaire administration, sample collection, and taking anthropometric measurements in California and Washington; Glenn Miller (Washington State University) for his expertise and critical logistic help that were needed for shipping samples and supplies worldwide.Peer reviewe

Investigations on the Role of the Immune System In Mammary Development And Maternal Immunity In the Marsupial, Monodelphis domestica

All newborn mammals are highly dependent upon milk for nourishment and immune protection. This is especially true for marsupials, a lineage of mammals with a short gestation, limited placental development, and an increased reliance on an extended lactation period. Most newborn marsupials do not receive passive maternal immunity in utero and therefore are entirely dependent upon factors within the milk for immune protection until capable of mounting their own response. In this project we seek to characterize the complex lactation program utilized by marsupials, and seek greater understanding of the maternal role in the establishment of the developing immune system of a model marsupial, the gray short-tailed opossum, Monodelphis domestica. The ontogeny of opossum immune development has been well established, however investigations into correlations with changes in the mammaries during lactation are lacking in this species. Towards these goals, a combination of histology, immunohistochemistry and quantitative PCR was used to investigate mammary development and immune system presence in the opossum mammaries throughout lactation. These investigations have the potential to impact the understanding of the role the immune system plays in mammary development and function from an evolutionary perspective

Creatine monohydrate supplementation changes total body water and DXA lean mass estimates in female collegiate dancers

Collegiate dance is unique because it requires athletic and academic performance; therefore, optimizing physical and mental function is crucial. Research among athletic populations demonstrate improvements in body composition, performance, and cognition following creatine monohydrate (CR) supplementation, yet dancers have not been investigated. The purpose of this study was to determine the effects of CR supplementation on body composition, performance, and cognitive function in female collegiate dancers. Participants were randomized to CR (CR; n = 7; 0.1 g·kg −1·day −1 CM +0.1 g·kg −1·day −1 corn-starch maltodextrin) or placebo (PL; n = 6; 0.2 g·kg −1·day −1 corn-starch maltodextrin) for 42 days. Pre- and post-testing included body composition, total body water (TBW), Depression, Anxiety and Stress Scale, Diet History Questionnaire, the National Institute of Health Toolbox fluid cognition battery and isokinetic strength, vertical jump, medicine ball throw, and Wingate anaerobic power test. CR demonstrated a significant increase in TBW (pre, 32.2 ± 3.5 kg; post, 32.7 ± 3.6 kg; p = 0.024) and lean mass (LM; pre, 39.8 ± 3.6 kg; post, 41.5 ± 4.5 kg; p = 0.020). CR supplementation may be an effective strategy to increase TBW and estimates of LM in female collegiate dancers. Although this may optimize aesthetics, larger samples sizes with resistance training are needed to determine if CR supplementation increases muscle mass and translates to improved performance

Sodium and Potassium Concentrations and Somatic Cell Count of Human Milk Produced in the First Six Weeks Postpartum and Their Suitability as Biomarkers of Clinical and Subclinical Mastitis

The sodium (Na) concentration and the ratio of Na to potassium (K; Na/K) in human milk are used commonly as biomarkers of subclinical mastitis, but limited data exist on their relationship to and ability to predict clinical mastitis. Here, we assessed concentrations of Na, K, Na/K, and somatic cell count (SCC), a mammary health biomarker used in the dairy industry, in milk prospectively collected from both breasts of 41 women over the first 6 weeks postpartum. Although values differed over time postpartum, there were no differences in mean values between breasts. Nearly one-quarter (24%) of participants experienced clinical mastitis. Somatic cell counts >4.76 × 105 cells/mL were most strongly related to development of clinical mastitis in the following week (odds ratio, 7.81; 95% CI, 2.15–28.30; p = 0.002), although relationships were also observed for SCC > 4.00 × 105 cells/mL and Na concentration >12 mmol/L. Estimates of the prevalence of subclinical mastitis in women who never progressed to clinical mastitis differed by biomarker but ranged from 20 to 75%. Despite these findings, positive predictive values (PPV) of the biomarkers for identifying clinical mastitis were low (≤0.34), indicating additional research is needed to identify single biomarkers or composite measures that are highly specific, sensitive, and predictive of clinical mastitis in women