Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical Homes

Describes in detail eight change concepts as a guide to transforming a practice into a patient-centered medical home, including engaged leadership, quality improvement strategy, continuous and team-based healing relationships, and enhanced access

Behavioral sleep problems and their potential impact on developing executive function in children

Bedtime resistance and night waking are common sleep problems throughout childhood, especially in the early years. These sleep problems may lead to difficulties in neurobehavioral functioning, but most research into childhood sleep problems has not emphasized the importance of the developmental context in which disruptions in neurobehavioral and daytime functioning occur. We review the development of sleep as well as executive functioning (EF) in childhood and suggest that EF may be particularly vulnerable to the effects of these common childhood sleep problems because of its prolonged course of maturation. Behavioral problems associated with common sleep problems suggest poor self-regulation in the context of sleep loss, and developing EF skills play important roles in self-regulation. A research agenda that considers a developmental approach to sleep and sleep problems in the context of childhood EF performance is outlined to promote future research in this area

The American Dream eludes many urban youth of color. And they think it's their own fault.

Segregation is not a thing of the past for young people of color in the US; many attend under-resourced and segregated school districts. Despite these disadvantages, America's leaders tell young people of color that they can achieve the "American Dream" via hard work and determination. In new research, David T. Lardier Jr., Kathryn G. Herr, Veronica R. Barrios, Pauline Garcia-Reid ..

Exploring secondary bonding in p-block chemistry – an experimental study of [GeX 2 {o-C 6 H 4 (PMe 2 ) 2 }] using variable pressure single crystal X-ray diffraction

Secondary bonding interactions play a major role in governing the overall structures adopted. The low energy contributions from these weak interactions make structure prediction very difficult, hence there is a need for experimental techniques that contribute to understanding the interplay between different types of secondary bonding. Variable pressure single crystal X-ray diffraction studies on the homologous series, [GeX2{o-C6H4(PMe2)2}], X = Cl 1, Br 2, I 3, show that probing the different interfaces between layers of structural building blocks, rather than conventional molecular units, provides very valuable insights. 1 and 3 undergo a smooth compression as the pressure is increased, whereas a phase transition occurs for 2 at a pressure between 29 and 41 kbar. This is associated with an abrupt change in the β angle (from 111.33(2)° to 92.24(8)°). The structural consequences are most evident in the aromatic⋯aromatic layer interface. Below the phase transition there is an edge-to-face C–H⋯π arrangement (like 1), with the angle between the planes of adjacent rings of ~75°, whereas above the transition this interface has transformed to an offset-parallel face-to-face π–π stacking interaction (like 3). The GeX2⋯X2Ge interface undergoes a concomitant, but smoother compression with increasing pressure. 2 also has the highest void volume at ambient pressure (11.9%), and as expected the phase transition results in a structure with much more efficient packing. This, the first such study involving p-block coordination complexes, reveals the subtlety and complexity of the interplay between the different forms of weak, secondary (supramolecular) interactions present. The results indicate that this type of experimental study can provide valuable additional information to help guide crystal structure prediction by computational methods, an important and very challenging target

The heterocyst regulatory protein HetP and its homologs modulate heterocyst commitment in Anabaena sp. strain PCC 7120

The commitment of differentiating cells to a specialized fate is fundamental to the correct assembly of tissues within a multicellular organism. Because commitment is often irreversible, entry into and progression through this phase of development must be tightly regulated. Under nitrogen-limiting conditions, the multicellular cyanobacterium Anabaena sp. strain PCC 7120 terminally commits ∼10% of its cells to become specialized nitrogen-fixing heterocysts. Although commitment is known to occur 9–14 h after the induction of differentiation, the factors that regulate the initiation and duration of this phase have yet to be elucidated. Here, we report the identification of four genes that share a functional domain and modulate heterocyst commitment: hetP (alr2818), asl1930, alr2902, and alr3234. Epistatic relationships between all four genes relating to commitment were revealed by deleting them individually and in combination; asl1930 and alr3234 acted most upstream to delay commitment, alr2902 acted next in the pathway to inhibit development, and hetP acted most downstream to drive commitment forward. Possible protein–protein interactions between HetP, its homologs, and the heterocyst master regulator, HetR, were assessed, and interaction partners were defined. Finally, patterns of gene expression for each homolog, as determined by promoter fusions to gfp and reverse transcription–quantitative PCR, were distinct from that of hetP in both spatiotemporal organization and regulation. We posit that a dynamic succession of protein–protein interactions modulates the timing and efficiency of the commitment phase of development and note that this work highlights the utility of a multicellular cyanobacterium as a model for the study of developmental processes

Effectiveness and cost-effectiveness of the PLAN-A intervention, a peer led physical activity program for adolescent girls:Results of a cluster randomised controlled trial

Background Physical activity is associated with improved health. Girls are less active than boys. Pilot work showed that a peer-led physical activity intervention called PLAN-A was a promising method of increasing physical activity in secondary school age girls. This study examined the effectiveness and cost-effectiveness of the PLAN-A intervention. Methods We conducted a cluster randomised controlled trial with Year 9 (13–14 year old) girls recruited from 20 secondary schools. Schools were randomly assigned to the PLAN-A intervention or a non-intervention control group after baseline data collection. Girls nominated students to be peer leaders. The top 18 % of girls nominated by their peers in intervention schools received three days of training designed to prepare them to support physical activity. Data were collected at two time points, baseline (T0) and 5–6 months post-intervention (T1). Participants wore an accelerometer for seven days to assess the primary outcome of mean weekday minutes of moderate-to-vigorous physical activity (MVPA). Multivariable mixed effects linear regression was used to estimate differences in the primary outcome between the two arms on an Intention-to-Treat (ITT) basis. Resource use and quality of life were measured and a within trial economic evaluation from a public sector perspective was conducted. Results A total of 1558 girls were recruited to the study. At T0, girls in both arms engaged in an average of 51 min of MVPA per weekday. The adjusted mean difference in weekday MVPA at T1 was − 2.84 min per day (95 % CI = -5.94 to 0.25) indicating a slightly larger decline in weekday MVPA in the intervention group. Results were broadly consistent when repeated using a multiple imputation approach and for pre-specified secondary outcomes and sub-groups. The mean cost of the PLAN-A intervention was £2817 per school, equivalent to £31 per girl. Economic analyses indicated that PLAN-A did not lead to demonstrable cost-effectiveness in terms of cost per unit change in QALY. Conclusions This study has shown that the PLAN-A intervention did not result in higher levels of weekday MVPA or associated secondary outcomes among Year 9 girls. The PLAN-A intervention should not be disseminated as a public health strategy

Association of self-reported physical activity with obstructive sleep apnea: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

We examined associations of mild and moderate to severe obstructive sleep apnea (OSA; apnea-hypopnea index ≥5 and ≥15, respectively) with recommended amounts of moderate-vigorous physical activity (MVPA) or vigorous physical activity (VPA) and by type of activity (i.e., recreational, transportation, and work activity). The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter population-based study, enrolled individuals from 2008 to 2011 from four U.S. metropolitan areas (Bronx, New York; Chicago, Illinois; Miami, Florida; San Diego, California). Participants in this study included 14,206 self-identified Hispanic/Latino ages 18 to 74 years from theHCHS/SOL. Survey logistic regression analysis was used to compute odds ratios [OR] and 95% confidence intervals [CI], adjusting for sociodemographics, smoking status, and body mass index (BMI). Relative to being inactive, performing some MVPA (>0 to <150 minutes/week) or meeting the recommended MVPA (≥150 minutes/week) were associated with lower odds of mild OSA (ORs and 95% CIs 0.70 [0.61-0.82] and 0.76 [0.63-0.91], respectively), as well as moderate to severe OSA (ORs and 95% CIs 0.76 [0.62-0.93] and 0.76 [0.59-0.98], respectively). Associations of VPA with OSA were not significant. Engaging in medium or high levels of transportation activity was associated with lower odds of mild OSA (OR: 0.84, 95% CI: 0.74-0.96; OR: 0.64, 95% CI: 0.43-0.95, respectively). Performing some recreational MVPA was associated with lower likelihood of mild and moderate to severe OSA (OR: 0.82, 95% CI: 0.71-0.93; OR: 0.79, 95% CI: 0.64-0.97, respectively). Health promotion and OSA prevention efforts should encourage individuals to engage in at least some MVPA

Sleep During Pregnancy: The nuMoM2b Pregnancy and Sleep Duration and Continuity Study

Study Objectives: To characterize sleep duration, timing and continuity measures in pregnancy and their association with key demographic variables. Methods: Multisite prospective cohort study. Women enrolled in the nuMoM2b study (nulliparous women with a singleton gestation) were recruited at the second study visit (16-21 weeks of gestation) to participate in the Sleep Duration and Continuity substudy. Women <18 years of age or with pregestational diabetes or chronic hypertension were excluded from participation. Women wore a wrist activity monitor and completed a sleep log for 7 consecutive days. Time in bed, sleep duration, fragmentation index, sleep efficiency, wake after sleep onset, and sleep midpoint were averaged across valid primary sleep periods for each participant. Results: Valid data were available from 782 women with mean age of 27.3 (5.5) years. Median sleep duration was 7.4 hours. Approximately 27.9% of women had a sleep duration of 9 hours. In multivariable models including age, race/ethnicity, body mass index, insurance status, and recent smoking history, sleep duration was significantly associated with race/ethnicity and insurance status, while time in bed was only associated with insurance status. Sleep continuity measures and sleep midpoint were significantly associated with all covariates in the model, with the exception of age for fragmentation index and smoking for wake after sleep onset. Conclusions: Our results demonstrate the relationship between sleep and important demographic characteristics during pregnancy

Heterotrophy of oceanic particulate organic matter elevates net ecosystem calcification

Author Posting. © American Geophysical Union, 2019. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geophysical Research Letters 46(16), (2019): 9851-9860, doi:10.1029/2019GL083726.Coral reef calcification is expected to decline due to climate change stressors such as ocean acidification and warming. Projections of future coral reef health are based on our understanding of the environmental drivers that affect calcification and dissolution. One such driver that may impact coral reef health is heterotrophy of oceanic‐sourced particulate organic matter, but its link to calcification has not been directly investigated in the field. In this study, we estimated net ecosystem calcification and oceanic particulate organic carbon (POCoc) uptake across the Kāne'ohe Bay barrier reef in Hawai'i. We show that higher rates of POCoc uptake correspond to greater net ecosystem calcification rates, even under low aragonite saturation states (Ωar). Hence, reductions in offshore productivity may negatively impact coral reefs by decreasing the food supply required to sustain calcification. Alternatively, coral reefs that receive ample inputs of POCoc may maintain higher calcification rates, despite a global decline in Ωar.Data needed for calculations are available in the supporting information. Additional data can be provided upon request directly from the corresponding author or accessed by links provided in the supporting information. The authors declare no competing financial interests. We thank Texas Sea Grant for providing partial funding for this project to A. Kealoha through the Grants‐In‐Aid of Graduate Research Program. We also thank the NOAA Nancy Foster Scholarship for PhD program funding to A. Kealoha and Texas A&M University for funds awarded to Shamberger that supported this work. This research was also supported by funding from National Science Foundation Grant OCE‐1538628 to Rappé. The Hawaii Institute of Marine Biology (particularly the Rappé Lab and Jason Jones), NOAA's Coral Reef Ecosystem Program, Connie Previti, Serena Smith, and Chris Maupin were instrumental in sample collection and data analysis.2020-02-2