Making Medical Homes Work: Moving From Concept to Practice

Explores practical considerations for implementing a medical home program of physician practices committed to coordinating and integrating care based on patient needs and priorities, such as how to qualify medical homes and how to match patients to them

General Hospitals, Specialty Hospitals and Financially Vulnerable Patients

Examines whether specialty hospitals draw well-insured patients away from general and safety-net hospitals, reducing their ability to cross-subsidize less profitable services and uncompensated care, in three cities. Notes challenges and implications

Program Annual Technology Report: Physics of the Cosmos Program Office

From ancient times, humans have looked up at the night sky and wondered: Are we alone? How did the universe come to be? How does the universe work? PCOS focuses on that last question. Scientists investigating this broad theme use the universe as their laboratory, investigating its fundamental laws and properties. They test Einsteins General Theory of Relativity to see if our current understanding of space-time is borne out by observations. They examine the behavior of the most extreme environments supermassive black holes, active galactic nuclei, and others and the farthest reaches of the universe, to expand our understanding. With instruments sensitive across the spectrum, from radio, through infrared (IR), visible light, ultraviolet (UV), to X rays and gamma rays, as well as gravitational waves (GWs), they peer across billions of light-years, observing echoes of events that occurred instants after the Big Bang. Last year, the LISA Pathfinder (LPF) mission exceeded expectations in proving the maturity of technologies needed for the Laser Interferometer Space Antenna (LISA) mission, and the Laser Interferometer Gravitational-Wave Observatory (LIGO) recorded the first direct measurements of long-theorized GWs. Another surprising recent discovery is that the universe is expanding at an ever-accelerating rate, the first hint of so-called dark energy, estimated to account for 75% of mass-energy in the universe. Dark matter, so called because we can only observe its effects on regular matter, is thought to account for another20%, leaving only 5% for regular matter and energy. Scientists now also search for special polarization in the cosmic microwave background to support the notion that in the split-second after the Big Bang, the universe inflated faster than the speed of light! The most exciting aspect of this grand enterprise today is the extraordinary rate at which we can harness technologies to enable these key discoveries

HPV-Reactive T-Cell Receptor Expand in Combination Therapy

https://openworks.mdanderson.org/sumexp22/1001/thumbnail.jp

Metabolic rates, feed intake, appetite control, and gut transit of clownfish Amphiprion ocellaris exposed to increased temperature and limited feed availability

Episodes of elevated temperature, combined with lower feed availability, are among the predicted scenarios of climate change representing a challenge for coral reef fish. We investigated the response of clownfish (Amphiprion ocellaris) to a scenario in which it received a single meal to satiety after 48 h fasting at 32 °C (climate change scenario) and 28 °C (control). We analysed the metabolic rate (MR), feed intake, gut transit, and expression of selected brain neuropeptides and one receptor believed to be involved in appetite control. Fish at 32 °C ingested 17.9% less feed and had a faster gut transit than did fish at 28 °C. MR in the unfed fish was 31% higher at 32 °C compared to 28 °C. In the fed fish, postprandial MR at 28 °C was 30% higher compared to that of unfed fish, while at 32 °C it was only 15% higher. The expression of agrp1 did not differ between unfed and refed fish. The levels of both pomca and mc4r increased immediately after the meal and subsequently declined, suggesting a possible anorexic role for these genes. Notably, this pattern was accelerated in fish kept at 32 °C compared with that in fish kept at 28 °C. The dynamics of these changes in expression correspond to a faster gut transition of ingested feed at elevated temperatures. For both agrp2 and pomcb there was an increase in expression following feeding in fish maintained at 32 °C, which was not observed in fish kept at 28 °C. These results suggest that low feed availability and elevated temperature stimulate anorexigenic pathways in clownfish, resulting in significantly lower feed intake despite the temperature-induced increase in metabolic rate. This may be a mechanism to ameliorate the decrease in aerobic scope that results from higher temperatures.publishedVersio

The Impact of Coexisting Coeliac Disease on Type 1 Diabetes

Coeliac disease (CD) coexists with type 1 diabetes (T1D) substantially more than in the general population. This body of work examines the broad and pervasive relationship between CD on T1D, including the epidemiology, screening practices, microvascular complications, quality of life (QoL), nutrition, glycaemic variability, and bone health. In particular, the contribution of gluten free diet (GFD) adherence is explored. Study 1: The 20-year incidence of CD in 4,379 people with T1D aged 5 years. Study 2: We systematically reviewed the epidemiology of CD in 11,157 youth with T1D alone and 587 with coexisting CD; 55% of CD cases were diagnosed within 2 years of T1D and 79% within 5 years. We concluded that CD screening should be performed at T1D diagnosis and repeated within 5 years of T1D. Study 3: Comparing 129 youth with T1D and CD vs 2,510 with T1D alone, retinopathy, albumin excretion rate (AER) and neuropathy did not differ. HbA1c was lower in those with CD (8.3% vs 8.6%, p=0.04), however elevated AER was more prevalent in those who did not adhere to the GFD (40% vs 23%, p=0.04). Study 4: In a case control study of 35 youth with T1D and 35 with coexisting CD, and their carers, generic and diabetes-specific QoL did not differ. Youth using insulin pumps had similar generic and diabetes specific QoL to those using multiple daily injections. However, those who did not adhere to the GFD had lower diabetes specific QoL and lower general wellbeing, as did their carers. Study 5: In a case control study using continuous glucose monitoring, youth with T1D and CD had greater glycaemic variability, with a shorter time to peak blood glucose levels (BGL), higher peak, and higher postprandial BGLs than T1D alone, despite similar pre-meal BGLs. Both groups had inadequate calcium, folate and fibre, with excessive saturated fat and sodium intake. Study 6: In a case control study utilising dual energy x-ray absorptiometry and peripheral quantitative computational tomography, youth with coexisting T1D and CD had lower bone mineral content, abnormal trabecular and cortical bone development, and a lower bone turnover state with reduced muscle pull vs T1D alone. These studies further our understanding of the impact of coexisting CD in T1D. The findings inform screening and management of CD, and provide evidence in support of GFD adherence to optimise clinical, dietary, and psychosocial management

Central Neuroplasticity and Decreased Heart Rate Variability after Particulate Matter Exposure in Mice

BackgroundEpidemiologic studies show that exposure to fine particulate matter [aerodynamic diameter < or = 2.5 microm (PM(2.5))] increases the total daily cardiovascular mortality. Impaired cardiac autonomic function, which manifests as reduced heart rate variability (HRV), may be one of the underlying causes. However, the cellular mechanism(s) by which PM(2.5) exposure induces decreased HRV is not known.ObjectivesWe tested the hypothesis that exposure to PM(2.5) impairs HRV by decreasing the excitability of the cardiac vagal neurons in the nucleus ambiguus. We also determined the effect of iron on PM-exposure-induced decrease in HRV.MethodsWe measured 24-hr HRV in time domains from electrocardiogram telemetry recordings obtained in conscious, freely moving mice after 3 days of exposure to PM(2.5) in the form of soot only or iron-soot. In parallel studies, we determined the intrinsic properties of identified cardiac vagal neurons, retrogradely labeled with a fluorescent dye applied to the sinoatrial node.ResultsSoot-only exposure decreased short-term HRV (root mean square of successive difference). With the addition of iron, all HRV parameters were significantly reduced. In nonexposed mice, vagal blockade significantly reduced all HRV parameters, suggesting that HRV is, in part, under vagal regulation in mice. Iron-soot exposure had no significant effect on resting membrane potential but decreased spiking responses of the identified cardiac vagal neurons to depolarizations (p < 0.05). The decreased spiking response was accompanied with a higher minimal depolarizing current required to evoke spikes and a lower peak discharge frequency.ConclusionsThe data suggest that PM-induced neuroplasticity of cardiac vagal neurons may be one mechanism contributing to the cardiovascular consequences associated with PM(2.5) exposure seen in humans

Elevated sea temperature combined with dietary methionine levels affect feed intake and appetite-related neuropeptide expression in the brains of juvenile cobia (Rachycentron canadum)

This study aimed to determine the impact of elevated temperature combined with different levels of dietary methionine concentrations on feed intake (FI) and brain expression of selected neuropeptides and one receptor involved in appetite control in juvenile cobia (approximately 3.7 g body weight). The genes studies were neuropeptide y, npy; agouti-related protein, agrp; cocaine- and amphetamine-regulated transcript, cart; cholecystokinin, cck and melanocortin 4 receptor; mc4r. The cobia were reared at typical sea water temperature in Vietnam (30 °C) and elevated temperature (34°C; selected as one of the predicted scenarios of climate change). The fish were fed diets with different levels of methionine: deficient (M9; 9.1 g/kg), sufficient (M12; 12.8 g/kg) and surplus (M16, 16.8 g/kg) for 6 weeks (triplicate tanks per treatment). Both dietary methionine concentration and temperature affected FI in cobia. Dietary methionine deficiency (i.e., M9) and elevated temperature reduced FI in cobia. Temperature significantly influenced the mRNA expression of agrp, cart, cck and mc4r. Expression of the orexigenic neuropeptide npy was consistently higher before the meal than after the meal for all diets and at both temperatures. At 30°C, prefeeding levels of npy correlated with both increased methionine levels and FI. The interaction between dietary methionine and temperature on the levels of brain npy expression was significant (P<0.05). There was higher brain expression of agrp, cart and cck in cobia at 34°C than in fish at 30°C, which was correlated with a lower FI. In conclusion, both feeding, temperature and/or dietary methionine levels affected the brain expression of npy and agrp, cart, cck and mc4r. This suggests that these neuropeptides as well as the mc4r receptor are actively involved in adjusting feed intake to compensate for changing energetic demands, as well as metabolic adjustments due to the variable availability of methionine at elevated temperature.publishedVersio

Evaluating the Response of Chemoradiation Combined with Immunotherapy in Treating Locally Advanced Cervical Cancer

https://openworks.mdanderson.org/sumexp23/1007/thumbnail.jp

Optimization of high-definition video coding and hybrid fiber-wireless transmission in the 60 GHz band

This paper was published in OPTICS EXPRESS and is made available as an electronic reprint with the permission of OSA. The paper can be found at the following URL on the OSA website: http://dx.doi.org/10.1364/OE.19.00B895. Systematic or multiple reproduction or distribution to multiple locations via electronic or other means is prohibited and is subject to penalties under law[EN] The paper addresses the problem of distribution of highdefinition video over fiber-wireless networks. The physical layer architecture with the low complexity envelope detection solution is investigated. We present both experimental studies and simulation of high quality high-definition compressed video transmission over 60 GHz fiberwireless link. Using advanced video coding we satisfy low complexity and low delay constraints, meanwhile preserving the superb video quality after significantly extended wireless distance. © 2011 Optical Society of America.This work has been partly funded by the European Commission under FP7 ICT-249142 FIVER project and by the by the Spanish Ministry of Science and Innovation under the TEC2009-14250 ULTRADEF project.Lebedev, A.; Pham, T.; Beltrán Ramírez, M.; Yu, X.; Ukhanova, A.; Llorente Sáez, R.; Monroy, I.... (2011). Optimization of high-definition video coding and hybrid fiber-wireless transmission in the 60 GHz band. Optics Express. 19(26):895-904. https://doi.org/10.1364/OE.19.00B895S8959041926Stockhammer, T., Hannuksela, M. M., & Wiegand, T. (2003). H.264/AVC in wireless environments. IEEE Transactions on Circuits and Systems for Video Technology, 13(7), 657-673. doi:10.1109/tcsvt.2003.815167Yong, S. K., & Chong, C.-C. (2006). An Overview of Multigigabit Wireless through Millimeter Wave Technology: Potentials and Technical Challenges. EURASIP Journal on Wireless Communications and Networking, 2007(1). doi:10.1155/2007/7890