Population level effectiveness of implementing collaborative care management for depression

AbstractObjectiveCare management is feasible to deploy in routine care, and the depression outcomes of patients reached by this evidence-based practice are similar to those observed in randomized controlled trials. However, no studies have estimated the population level effectiveness of care management when deployed in routine care. Population level effectiveness depends on both reach into the target population and the clinical effectiveness for those reached.MethodThis multisite hybrid Type 3 effectiveness–implementation study employed a pre-post, quasi-experimental design. The study was conducted at 22 Veterans Affairs community-based outpatient clinics. Evidence-based quality improvement was used as the facilitation strategy to promote adoption. Medication possession ratios (MPRs) were calculated for 1558 patients with an active antidepressant prescription. Differences in treatment response rates at implementation and control sites were estimated from observed differences in MPR.ResultsReach into the target population at implementation sites was 10.3%. Patients at implementation sites had a significantly higher probability of having MPR≥0.9 than patients at control sites [odds ratio=1.38, confidence interval95=(1.07, 1.78), P=.01]. This increase in MPR was estimated to yield a 1% point increase in response rates.ConclusionsWhile depression care management improves outcomes for patients receiving services, low levels of reach can reduce overall population level effectiveness

Near-infrared Thermal Emission Detections of a number of hot Jupiters and the Systematics of Ground-based Near-infrared Photometry

We present detections of the near-infrared thermal emission of three hot Jupiters and one brown-dwarf using the Wide-field Infrared Camera (WIRCam) on the Canada-France-Hawaii Telescope (CFHT). These include Ks-band secondary eclipse detections of the hot Jupiters WASP-3b and Qatar-1b and the brown dwarf KELT-1b. We also report Y-band, $K_{CONT}$-band, and two new and one reanalyzed Ks-band detections of the thermal emission of the hot Jupiter WASP-12b. We present a new reduction pipeline for CFHT/WIRCam data, which is optimized for high precision photometry. We also describe novel techniques for constraining systematic errors in ground-based near-infrared photometry, so as to return reliable secondary eclipse depths and uncertainties. We discuss the noise properties of our ground-based photometry for wavelengths spanning the near-infrared (the YJHK-bands), for faint and bright-stars, and for the same object on several occasions. For the hot Jupiters WASP-3b and WASP-12b we demonstrate the repeatability of our eclipse depth measurements in the Ks-band; we therefore place stringent limits on the systematics of ground-based, near-infrared photometry, and also rule out violent weather changes in the deep, high pressure atmospheres of these two hot Jupiters at the epochs of our observations.Comment: 27 pages, 23 figures, ApJ submitted June 16th, 2014. Version revised to address referee comment

High-precision photometry by telescope defocussing. III. The transiting planetary system WASP-2

We present high-precision photometry of three transits of the extrasolar planetary system WASP-2, obtained by defocussing the telescope, and achieving point-to-point scatters of between 0.42 and 0.73 mmag. These data are modelled using the JKTEBOP code, and taking into account the light from the recently-discovered faint star close to the system. The physical properties of the WASP-2 system are derived using tabulated predictions from five different sets of stellar evolutionary models, allowing both statistical and systematic errorbars to be specified. We find the mass and radius of the planet to be M_b = 0.847 +/- 0.038 +/- 0.024 Mjup and R_b = 1.044 +/- 0.029 +/- 0.015 Rjup. It has a low equilibrium temperature of 1280 +/- 21 K, in agreement with a recent finding that it does not have an atmospheric temperature inversion. The first of our transit datasets has a scatter of only 0.42 mmag with respect to the best-fitting light curve model, which to our knowledge is a record for ground-based observations of a transiting extrasolar planet.Comment: Accepted for publication in MNRAS. 9 pages, 3 figures, 10 table

A Re-conceptualization of Access for 21st Century Healthcare

Many e-health technologies are available to promote virtual patient–provider communication outside the context of face-to-face clinical encounters. Current digital communication modalities include cell phones, smartphones, interactive voice response, text messages, e-mails, clinic-based interactive video, home-based web-cams, mobile smartphone two-way cameras, personal monitoring devices, kiosks, dashboards, personal health records, web-based portals, social networking sites, secure chat rooms, and on-line forums. Improvements in digital access could drastically diminish the geographical, temporal, and cultural access problems faced by many patients. Conversely, a growing digital divide could create greater access disparities for some populations. As the paradigm of healthcare delivery evolves towards greater reliance on non-encounter-based digital communications between patients and their care teams, it is critical that our theoretical conceptualization of access undergoes a concurrent paradigm shift to make it more relevant for the digital age. The traditional conceptualizations and indicators of access are not well adapted to measure access to health services that are delivered digitally outside the context of face-to-face encounters with providers. This paper provides an overview of digital “encounterless” utilization, discusses the weaknesses of traditional conceptual frameworks of access, presents a new access framework, provides recommendations for how to measure access in the new framework, and discusses future directions for research on access

Neptunes Dynamic Atmosphere from Kepler K2 Observations: Implications for Brown Dwarf Light Curve Analyses

Observations of Neptune with the Kepler Space Telescope yield a 49-day light curve with 98% coverage at a 1-minute cadence. A significant signature in the light curve comes from discrete cloud features. We compare results extracted from the light curve data with contemporaneous disk-resolved imaging of Neptune from the Keck 10-meter and Hubble Space Telescope. The direct comparison validates the zonal wind profile and cloud feature variability information extracted from the light curve. Neptunes clouds vary in location and intensity on short and long time scales, with large discrete storms dominating the light curves; smaller or fainter clouds contribute to its variability. This has implications for the interpretation of information extracted from light curves of directly imaged exoplanets and cloudy brown dwarfs

A rocky composition for an Earth-sized exoplanet

Planets with sizes between that of Earth (with radius R[subscript circle in cross]) and Neptune (about 4 R[subscript circle in cross]) are now known to be common around Sun-like stars. Most such planets have been discovered through the transit technique, by which the planet’s size can be determined from the fraction of starlight blocked by the planet as it passes in front of its star. Measuring the planet’s mass—and hence its density, which is a clue to its composition—is more difficult. Planets of size 2–4 R[subscript circle in cross] have proved to have a wide range of densities, implying a diversity of compositions, but these measurements did not extend to planets as small as Earth. Here we report Doppler spectroscopic measurements of the mass of the Earth-sized planet Kepler-78b, which orbits its host star every 8.5 hours (ref. 6). Given a radius of 1.20 ± 0.09 R[subscript circle in cross] and a mass of 1.69 ± 0.41 M[subscript circle in cross], the planet’s mean density of 5.3 ± 1.8 g cm[superscript −3] is similar to Earth’s, suggesting a composition of rock and iron.Kepler Participating Scientist Progra

Methane Throughout the Atmosphere of the Warm Exoplanet WASP-80b

The abundances of major carbon and oxygen bearing gases in the atmospheres of giant exoplanets provide insights into atmospheric chemistry and planet formation processes. Thermochemistry suggests that methane should be the dominant carbon-bearing species below $\sim$1000 K over a range of plausible atmospheric compositions; this is the case for the Solar System planets and has been confirmed in the atmospheres of brown dwarfs and self-luminous directly imaged exoplanets. However, methane has not yet been definitively detected with space-based spectroscopy in the atmosphere of a transiting exoplanet, but a few detections have been made with ground-based, high-resolution transit spectroscopy including a tentative detection for WASP-80b. Here we report transmission and emission spectra spanning 2.4-4.0 micrometers of the 825 K warm Jupiter WASP-80b taken with JWST's NIRCam instrument, both of which show strong evidence for methane at greater than 6-sigma significance. The derived methane abundances from both viewing geometries are consistent with each other and with solar to sub-solar C/O and ~5$\times$ solar metallicity, which is consistent with theoretical predictions.Comment: 23 pages, 10 figures, 3 tables. This preprint has been submitted to and accepted in principle for publication in Nature without significant change

Characterizing the Cool KOIs II. The M Dwarf KOI-254 and its Hot Jupiter

We report the confirmation and characterization of a transiting gas giant planet orbiting the M dwarf KOI-254 every 2.455239 days, which was originally discovered by the Kepler mission. We use radial velocity measurements, adaptive optics imaging and near infrared spectroscopy to confirm the planetary nature of the transit events. KOI-254b is the first hot Jupiter discovered around an M-type dwarf star. We also present a new model-independent method of using broadband photometry to estimate the mass and metallicity of an M dwarf without relying on a direct distance measurement. Included in this methodology is a new photometric metallicity calibration based on J-K colors. We use this technique to measure the physical properties of KOI-254 and its planet. We measure a planet mass of Mp = 0.505 Mjup, radius Rp = 0.96 Rjup and semimajor axis a = 0.03 AU, based on our measured stellar mass Mstar = 0.59 Msun and radius Rstar = 0.55 Rsun. We also find that the host star is metal-rich, which is consistent with the sample of M-type stars known to harbor giant planets.Comment: AJ accepted (in press