Associations between physical activity and BMI, body fatness, and visceral adiposity in overweight or obese Latino and non-Latino adults.

Background/objectivesAlthough several studies have reported associations between moderate to vigorous physical activity (MVPA), body fatness and visceral adipose tissue (VAT), the extent to which associations differ among Latinos and non-Latinos remains unclear. This study evaluated the associations between body composition and MVPA in Latino and non-Latino adults.Subjects/methodsAn exploratory, cross-sectional analysis was conducted using baseline data collected from 298 overweight adults enrolled in a 12-month randomized controlled trial that tested the efficacy of text messaging to improve weight loss. MVPA, body fatness and VAT were assessed by waist-worn accelerometry, dual-energy x-ray absorptiometry (DXA), and DXA-derived software (GE CoreScan GE, Madison, WI, USA), respectively. Participants with <5 days of accelerometry data or missing DXA data were excluded; 236 participants had complete data. Multivariable linear regression assessed associations between body composition and MVPA per day, defined as time in MVPA, bouts of MVPA (time per bout ⩾10 min), non-bouts of MVPA (time per bout <10 min) and meeting the 150-min MVPA guideline. The modifying influence of ethnicity was modeled with a multiplicative interaction term.ResultsThe interaction between ethnicity and MVPA in predicting percent body fat was significant (P=0.01, 95% confidence interval (CI) (0.58, 4.43)) such that a given increase in MVPA was associated with a greater decline in total body fat in non-Latinos compared with Latinos (adjusted for age, sex and accelerometer wear time). There was no interaction between ethnicity and MVPA in predicting VAT (g) (P=0.78, 95% CI (-205.74, 273.17)) and body mass index (BMI) (P=0.18, 95% CI (-0.49, 2.26)).ConclusionsAn increase in MVPA was associated with a larger decrease in body fat, but neither BMI nor VAT, in non-Latinos compared with Latinos. This suggests that changes in VAT and BMI in response to MVPA may be less influenced by ethnicity than is total body fatness

Telehealth and Mobile Health Applied To IntegratedBehavioral Care: OpportunitiesFor Progress In New Hampshire

This paper is an accompanying document to a webinar delivered on May 16, 2017, for the New Hampshire Citizens Health Initiative (Initiative). As integrated behavioral health efforts in New Hampshire gain traction, clinicians, administrators, payers, and policy makers are looking for additional efficiencies in delivering high quality healthcare. Telehealth and mobile health (mHealth) have the opportunity to help achieve this while delivering a robust, empowered patient experience. The promise of video-based technology was first made in 1964 as Bell Telephone shared its Picturephone® with the world. This was the first device with audio and video delivered in an integrated technology platform. Fast-forward to today with Skype, FaceTime, and webinar tools being ubiquitous in our personal and business lives, but often slow to be adopted in the delivery of medicine. Combining technology-savvy consumers with New Hampshire’s high rate of electronic health record (EHR) technology adoption, a fairly robust telecommunications infrastructure, and a predominately rural setting, there is strong foundation for telehealth and mHealth expansion in New Hampshire’s integrated health continuum

Integrating Behavioral Health & Primary Care in New Hampshire: A Path Forward to Sustainable Practice & Payment Transformation

New Hampshire residents face challenges with behavioral and physical health conditions and the interplay between them. National studies show the costs and the burden of illness from behavioral health conditions and co-occurring chronic health conditions that are not adequately treated in either primary care or behavioral health settings. Bringing primary health and behavioral health care together in integrated care settings can improve outcomes for both behavioral and physical health conditions. Primary care integrated behavioral health works in conjunction with specialty behavioral health providers, expanding capacity, improving access, and jointly managing the care of patients with higher levels of acuity In its work to improve the health of NH residents and create effective and cost-effective systems of care, the NH Citizens Health Initiative (Initiative) created the NH Behavioral Health Integration Learning Collaborative (BHI Learning Collaborative) in November of 2015, as a project of its Accountable Care Learning Network (NHACLN). Bringing together more than 60 organizations, including providers of all types and sizes, all of the state’s community mental health centers, all of the major private and public insurers, and government and other stakeholders, the BHI Learning Collaborative built on earlier work of a NHACLN Workgroup focused on improving care for depression and co-occurring chronic illness. The BHI Learning Collaborative design is based on the core NHACLN philosophy of “shared data and shared learning” and the importance of transparency and open conversation across all stakeholder groups. The first year of the BHI Learning Collaborative programming included shared learning on evidence-based practice for integrated behavioral health in primary care, shared data from the NH Comprehensive Healthcare Information System (NHCHIS), and work to develop sustainable payment models to replace inadequate Fee-for-Service (FFS) revenues. Provider members joined either a Project Implementation Track working on quality improvement projects to improve their levels of integration or a Listen and Learn Track for those just learning about Behavioral Health Integration (BHI). Providers in the Project Implementation Track completed a self-assessment of levels of BHI in their practice settings and committed to submit EHR-based clinical process and outcomes data to track performance on specified measures. All providers received access to unblinded NHACLN Primary Care and Behavioral Health attributed claims data from the NHCHIS for provider organizations in the NH BHI Learning Collaborative. Following up on prior work focused on developing a sustainable model for integrating care for depression and co-occurring chronic illness in primary care settings, the BHI Learning Collaborative engaged consulting experts and participants in understanding challenges in Health Information Technology and Exchange (HIT/HIE), privacy and confidentiality, and workforce adequacy. The BHI Learning Collaborative identified a sustainable payment model for integrated care of depression in primary care. In the process of vetting the payment model, the BHI Learning Collaborative also identified and explored challenges in payment for Substance Use Disorder Screening, Brief Intervention and Referral to Treatment (SBIRT). New Hampshire’s residents will benefit from a health care system where primary care and behavioral health are integrated to support the care of the whole person. New Hampshire’s current opiate epidemic accentuates the need for better screening for behavioral health issues, prevention, and treatment referral integrated into primary care. New Hampshire providers and payers are poised to move towards greater integration of behavioral health and primary care and the Initiative looks forward to continuing to support progress in supporting a path to sustainable integrated behavioral and primary care

Injection of Radioactivities into the Forming Solar System

Meteorite studies have revealed the presence of short-lived radioactivities in the early solar system. The current data suggests that the origin of at least some of the radioactivities requires contribution from recent nucleosynthesis at a stellar site. This sets a strict time limit on the time available for the formation of the solar system and argues for the theory of the triggered origin of the solar system. According to this scenario, the formation of our planetary system was initiated by the impact of an interstellar shock wave on a molecular cloud core. The shock wave originated from a nearby explosive stellar event and carried with it radioactivities produced in the stellar source. In addition to triggering the collapse of the molecular cloud core, the shock wave also deposited some of the freshly synthesized radioactivities into the collapsing system. The radioactivities were then incorporated into the first solar system solids, in this manner leaving a record of the event in the meteoritic material. The viability of the scenario can be investigated through numerical simulations studying the processes involved in mixing shock wave material into the collapsing system. The high-resolution calculations presented here show that injection occurs through Rayleigh-Taylor instabilities, the injection efficiency is approximately 10%, and temporal and spatial heterogeneities in the abundances of the radioactivities existed at the time of their arrival in the forming solar system.Comment: 13 pages, including 3 figures. Better-quality figures available at http://www.public.asu.edu/~hvanhal/pubs

Extreme 54Cr-rich nano-oxides in the CI chondrite Orgueil -Implication for a late supernova injection into the Solar System

Systematic variations in 54Cr/52Cr ratios between meteorite classes (Qin et al., 2010a; Trinquier et al., 2007) point to large scale spatial and/or temporal isotopic heterogeneity in the solar protoplanetary disk. Two explanations for these variations have been proposed, with important implications for the formation of the Solar System: heterogeneous seeding of the disk with dust from a supernova, or energetic-particle irradiation of dust in the disk. The key to differentiating between them is identification of the carrier(s) of the 54Cr anomalies. Here we report the results of our recent NanoSIMS imaging search for the 54Cr-rich carrier in the acid-resistant residue of the CI chondrite Orgueil. A total of 10 regions with extreme 54Cr-excesses ({\delta}54Cr values up to 1500 %) were found. Comparison between SEM, Auger and NanoSIMS analyses showed that these 54Cr-rich regions are associated with one or more sub-micron (typically less than 200 nm) Cr oxide grains, most likely spinels. Because the size of the NanoSIMS primary O- ion beam is larger than the typical grain size on the sample mount, the measured anomalies are lower limits, and we estimate that the actual 54Cr enrichments in three grains are at least 11 times Solar and in one of these may be as high as 50 times Solar. Such compositions strongly favor a Type II supernova origin. The variability in bulk 54Cr/52Cr between meteorite classes argues for a heterogeneous distribution of the 54Cr carrier in the solar protoplanetary disk following a late supernova injection event. Such a scenario is also supported by the O-isotopic distribution and variable abundances in different planetary materials of other presolar oxide and silicate grains from supernovae

Cash by any other name? Evidence on labeling from the UK Winter Fuel Payment

Government transfers to individuals are often given labels indicating that they are designed to support the consumption of particular goods. Standard economic theory implies that the labeling of cash transfers or cash-equivalents should have no effect on spending patterns. We study the UK Winter Fuel Payment, a cash transfer to older households. Our empirical strategy nests a regression discontinuity design within an Engel curve framework. We find robust evidence of a behavioral effect of labeling. On average households spend 47% of the WFP on fuel. If the payment were treated as cash, we would expect households to spend 3% of the payment on fuel. © 2014 Elsevier B.V