Associations between the Patient-Centered Medical Home and Preventive Care and Healthcare Quality for Non-Elderly Adults with Mental Illness: A Surveillance Study Analysis

Background Patient-centered medical homes (PCMHs) may improve outcomes for non-elderly adults with mental illness, but the extent to which PCMHs are associated with preventive care and healthcare quality for this population is largely unknown. Our study addresses this gap by assessing the associations between receipt of care consistent with the PCMH and preventive care and healthcare quality for non-elderly adults with mental illness. Methods This surveillance study used self-reported data for 6,908 non-elderly adults with mental illness participating in the 2007–2012 Medical Expenditure Panel Survey. Preventive care and healthcare quality measures included: participant rating of all healthcare; cervical, breast, and colorectal cancer screening; current smoking; smoking cessation advice; flu shot; foot exam and eye exam for people with diabetes; and follow-up after emergency room visit for mental illness. Multiple logistic regression models were developed to compare the odds of meeting preventive care and healthcare quality measures for participants without a usual source of care, participants with a non-PCMH usual source of care, and participants who received care consistent with the PCMH. Results Compared to participants without a usual source of care, those with a non-PCMH usual source of care had better odds of meeting almost all measures examined, while those who received care consistent with the PCMH had better odds of meeting most measures. Participants who received care consistent with the PCMH had better odds of meeting only one measure compared to participants with a non-PCMH usual source of care. Conclusions Compared with having a non-PCMH usual source of care, receipt of care consistent with the PCMH does not appear to be associated with most preventive care or healthcare quality measures. These findings raise concerns about the potential value of the PCMH for non-elderly adults with mental illness and suggest that alternative models of primary care are needed to improve outcomes and address disparities for this population

Optical Characterization of Chromophoric Dissolved Organic Matter (CDOM) and Fe(II) Concentrations in Soil Porewaters Along a Channel-Bank Transect in a Salt Marsh

Chromophoric dissolved organic matter (CDOM) optical properties were measured in surface and porewaters as a function of depth and distance from the channel in a transect up the bank in a southern California salt marsh. Higher absorbance coefficients and fluorescence intensities in porewaters at depth vs. surface waters and shallower porewaters suggest soil porewater is a reservoir of CDOM in the marsh. Higher values were observed at the marsh sites compared to the channel site, suggesting increased production and storage in the marsh sites, and reduced leaching into overlying surface waters, is occurring. Spectral slope ratios decreased with depth, consistent with more aromatic, higher molecular weight material in the deeper porewaters, possibly due to different bacterial processing in the anaerobic vs. aerobic zones. Fe(II) concentrations, indicative of anaerobic bacterial processing, increased significantly at depth to values \u3e 1000 μM, consistent with active anaerobic microbial processing occurring at depth. The transitions to higher reduced iron concentrations correlated with increased absorbance and fluorescence, suggesting processing by anaerobic iron-reducing bacteria in these deeper zones may not mineralize as much carbon as in the shallower aerobic zones. Alternatively, this may be due to reduction of solid iron oxides coated with organic matter releasing both DOM and Fe(II). The ratio of humic-like fluorescence to the absorption coefficient decreased with increasing iron concentration, possibly due to optical interference by iron species. Taken together, the data indicate that marsh sites in the salt marsh act as a reservoir for higher molecular weight, more aromatic organic matter

Quantification of Sympathetic Transduction in Type 2 Diabetes Patients

Type 2 Diabetes patients (T2D) have been shown to have greater alpha­-adrenergic sensitivity. How this impacts the transduction of muscle sympathetic nerve activity (MSNA) to arterial blood pressure under resting conditions using spontaneous fluctuations in MSNA, as well as during stressors known to elicit sympatho­-excitation (e.g., cold pressor test (CPT)) is unclear. PURPOSE: We tested the hypothesis that T2D patients would exhibit greater sympathetic transduction compared to age­ and BMI­-matched, healthy controls. METHODS: MSNA (microneurography), heart rate (ECG), and beat­-to­-beat arterial blood pressure (finger photoplethysmography) were continuously recorded during a 10 minute baseline period, and in response to a 2­minute CPT in six T2D patients and six age­ and BMI­-matched, healthy controls (CON).To quantify sympathetic transduction at rest, normalized burst heights were divided into four quartiles (smallest to largest), related to the corresponding peak change in mean arterial pressure (MAP) within those quartiles and a slope was determined. To quantify sympathetic transduction in response to a stressor, the change in MAP was related to the change in MSNA from rest to the last minute of CPT. RESULTS: There were no differences in resting sympathetic transduction between groups (CON slope: 0.0103±0.0023 mmHg/AU, T2D slope: 0.0095±0.0016 mmHg/AU; p=0.78). Indeed, signal averaging of MSNA bursts indicated a similar peak increase in blood pressure in CON (+4.2±0.6 mmHg) and T2D (+4.0±0.9 mmHg) (p=0.66). Although the peak increase in blood pressure to CPT tended to be higher in T2D (T2D: +31.6±3.4 mmHg, CON: +21.4±3.7 mmHg; p=0.096), the Δ MAP/ Δ MSNA relationship during CPT was not different between groups (CON: 0.4158±0.21, T2D: 0.1862±0.05; p=0.36). CONCLUSIONS: Despite clear sympathetically-­mediated increases in blood pressure in T2D patients and healthy CON subjects both at rest and during the CPT, neither of the methodologies used to estimate sympathetic transduction, with respect to changes in arterial blood pressure, detected group differences

Analysis of Electrodeposited Nickel-Iron Alloy Film Composition Using Particle-Induced X-Ray Emission

The elemental composition of electrodeposited NiFe thin films was analyzed with particle-induced X-ray emission (PIXE). The thin films were electrodeposited on polycrystalline Au substrates from a 100mM NiSO4, 10 mM FeSO4, 0.5M H3BO3, and 1M Na2SO4 solution. PIXE spectra of these films were analyzed to obtain relative amounts of Ni and Fe as a function of deposition potential and deposition time. The results show that PIXE can measure the total deposited metal in a sample over at least four orders of magnitude with similar fractional uncertainties. The technique is also sensitive enough to observe the variations in alloy composition due to sample nonuniformity or variations in deposition parameters

Establishment and metabolic analysis of a model microbial community for understanding trophic and electron accepting interactions of subsurface anaerobic environments

<p>Abstract</p> <p>Background</p> <p>Communities of microorganisms control the rates of key biogeochemical cycles, and are important for biotechnology, bioremediation, and industrial microbiological processes. For this reason, we constructed a model microbial community comprised of three species dependent on trophic interactions. The three species microbial community was comprised of <it>Clostridium cellulolyticum</it>, <it>Desulfovibrio vulgaris </it>Hildenborough, and <it>Geobacter sulfurreducens </it>and was grown under continuous culture conditions. Cellobiose served as the carbon and energy source for <it>C. cellulolyticum</it>, whereas <it>D. vulgaris </it>and <it>G. sulfurreducens </it>derived carbon and energy from the metabolic products of cellobiose fermentation and were provided with sulfate and fumarate respectively as electron acceptors.</p> <p>Results</p> <p>qPCR monitoring of the culture revealed <it>C. cellulolyticum </it>to be dominant as expected and confirmed the presence of <it>D. vulgaris </it>and <it>G. sulfurreducens</it>. Proposed metabolic modeling of carbon and electron flow of the three-species community indicated that the growth of <it>C. cellulolyticum </it>and <it>D. vulgaris </it>were electron donor limited whereas <it>G. sulfurreducens </it>was electron acceptor limited.</p> <p>Conclusions</p> <p>The results demonstrate that <it>C. cellulolyticum</it>, <it>D. vulgaris</it>, and <it>G. sulfurreducens </it>can be grown in coculture in a continuous culture system in which <it>D. vulgaris </it>and <it>G. sulfurreducens </it>are dependent upon the metabolic byproducts of <it>C. cellulolyticum </it>for nutrients. This represents a step towards developing a tractable model ecosystem comprised of members representing the functional groups of a trophic network.</p

The jellification of north temperate lakes.

Calcium (Ca) concentrations are decreasing in softwater lakes across eastern North America and western Europe. Using long-term contemporary and palaeo-environmental field data, we show that this is precipitating a dramatic change in Canadian lakes: the replacement of previously dominant pelagic herbivores (Ca-rich Daphnia species) by Holopedium glacialis, a jelly-clad, Ca-poor competitor. In some lakes, this transformation is being facilitated by increases in macro-invertebrate predation, both from native (Chaoborus spp.) and introduced (Bythotrephes longimanus) zooplanktivores, to which Holopedium, with its jelly coat, is relatively invulnerable. Greater representation by Holopedium within cladoceran zooplankton communities will reduce nutrient transfer through food webs, given their lower phosphorus content relative to daphniids, and greater absolute abundances may pose long-term problems to water users. The dominance of jelly-clad zooplankton will likely persist while lakewater Ca levels remain low.This work was primarily supported by grants from the Natural Sciences and Engineering Research Council of Canada and funding from the Ontario Ministry of the Environment.This is the accepted manuscript. The final version is available at http://rspb.royalsocietypublishing.org/content/282/1798/20142449