The DIAMOND Initiative: Implementing Collaborative Care for Depression in 75 Primary Care Clinics

Background: The many randomized trials of the collaborative care model for improving depression in primary care have not described the implementation and maintenance of this model. This paper reports how and the degree to which collaborative care process changes were implemented and maintained for the 75 primary care clinics participating in the DIAMOND Initiative (Depression Improvement Across Minnesota–Offering a New Direction). Methods: Each clinic was trained to implement seven components of the model and participated in ongoing evaluation and facilitation activities. For this study, assessment of clinical process implementation was accomplished via completion of surveys by the physician leader and clinic manager of each clinic site at three points in time. The physician leader of each clinic completed a survey measure of the presence of various practice systems prior to and one and two years after implementation. Clinic managers also completed a survey of organizational readiness and the strategies used for implementation. Results: Survey response rates were 96% to 100%. The systems survey confirmed a very high degree of implementation (with large variation) of DIAMOND depression practice systems (mean of 24.4 ± 14.6%) present at baseline, 57.0 ± 21.0% at one year (P = \u3c0.0001), and 55.9 ± 21.3% at two years. There was a similarly large increase (and variation) in the use of various quality improvement strategies for depression (mean of 29.6 ± 28.1% at baseline, 75.1 ± 22.3% at one year (P = \u3c0.0001), and 74.6 ± 23.0% at two years. Conclusions: This study demonstrates that under the right circumstances, primary care clinics that are prepared to implement evidence-based care can do so if financial barriers are reduced, effective training and facilitation are provided, and the new design introduces the specific mental models, new care processes, and workers and expertise that are needed. Implementation was associated with a marked increase in the number of improvement strategies used, but actual care and outcomes data are needed to associate these changes with patient outcomes and patient-reported care

The handbook for standardized field and laboratory measurements in terrestrial climate change experiments and observational studies (ClimEx)

1. Climate change is a world‐wide threat to biodiversity and ecosystem structure, functioning and services. To understand the underlying drivers and mechanisms, and to predict the consequences for nature and people, we urgently need better understanding of the direction and magnitude of climate change impacts across the soil–plant–atmosphere continuum. An increasing number of climate change studies are creating new opportunities for meaningful and high‐quality generalizations and improved process understanding. However, significant challenges exist related to data availability and/or compatibility across studies, compromising opportunities for data re‐use, synthesis and upscaling. Many of these challenges relate to a lack of an established ‘best practice’ for measuring key impacts and responses. This restrains our current understanding of complex processes and mechanisms in terrestrial ecosystems related to climate change. 2. To overcome these challenges, we collected best‐practice methods emerging from major ecological research networks and experiments, as synthesized by 115 experts from across a wide range of scientific disciplines. Our handbook contains guidance on the selection of response variables for different purposes, protocols for standardized measurements of 66 such response variables and advice on data management. Specifically, we recommend a minimum subset of variables that should be collected in all climate change studies to allow data re‐use and synthesis, and give guidance on additional variables critical for different types of synthesis and upscaling. The goal of this community effort is to facilitate awareness of the importance and broader application of standardized methods to promote data re‐use, availability, compatibility and transparency. We envision improved research practices that will increase returns on investments in individual research projects, facilitate second‐order research outputs and create opportunities for collaboration across scientific communities. Ultimately, this should significantly improve the quality and impact of the science, which is required to fulfil society's needs in a changing world

Mesh bags underestimated arbuscular mycorrhizal abundance but captured fertilization effects in a mesocosm experiment

Aims: Ingrowth bags are widely used to estimate mycorrhizal growth and dynamics. However, it remains unclear to what extent they reflect the surrounding soil, and how this varies with environmental conditions. Methods: We used a fertilization experiment to investigate if carbon-free mesh bags were representative of their surrounding soil. We determined AMF hyphal length density (HLD), phospholipid fatty acids (PLFA 16:1ω5) and neutral lipid fatty acids (NLFA 16:1ω5). Results: When AMF abundance in surrounding soil was high, HLD and both fatty acids were underestimated by the mesh bags. The PLFA 16:1ω5 in surrounding soil included bacterial PLFA, complicating the comparison of PLFA 16:1ω5 between mesh bags and surrounding soil. Both NLFA 16:1ω5 and HLD showed a significantly positive correlation, and fertilization effects were mostly similar for mesh bags and surrounding soil. Conclusions: Although carbon-free mesh bags can underestimate AMF abundance in soils, they represent a useful method to compare patterns in AMF abundance across environmental gradients and can be particularly useful in combination with the use of stable isotope tracers for unraveling patterns in AMF growth. NLFA 16:1ω5 appeared a more accurate measure for AMF than PLFA 16:1ω5 because the latter included bacterial PLFA

Favorable effect of mycorrhizae on biomass production efficiency exceeds their carbon cost in a fertilization experiment

Biomass production efficiency (BPE), the ratio of biomass production to photosynthesis, varies greatly among ecosystems and typically increases with increasing nutrient availability. Reduced carbon partitioning to mycorrhizal fungi (i.e., per unit photosynthesis) is the hypothesized underlying mechanism, as mycorrhizal abundance and plant dependence on these symbionts typically decrease with increasing nutrient availability. In a mesocosm experiment with Zea mays, we investigated the effect of nitrogen (N) and phosphorus (P) addition and of mycorrhizal inoculation on BPE. Photosynthesis and respiration were measured at mesocosm scale and at leaf scale. The growth of arbuscular mycorrhizal fungi (AMF) was assessed with ingrowth bags while also making use of the difference in δ13 C between C4 plants and C3 soil. Mesocosms without AMF, that is, with pasteurized soil, were used to further explore the role of AMF. Plant growth, photosynthesis, and BPE were positively affected by P, but not by N addition. AMF biomass also was slightly higher under P addition, but carbon partitioning to AMF was significantly lower than without P addition. Interestingly, in the absence of AMF, plants that did not receive P died prematurely. Our study confirmed the hypothesis that BPE increases with increasing nutrient availability, and that carbon partitioning to AMF plays a key role in this nutrient effect. The comparison of inoculated vs. pasteurized mesocosms further suggested a lower carbon cost of nutrient uptake via AMF than via other mechanisms under nutrient rich conditions

Mesh bags underestimated arbuscular mycorrhizal abundance but captured fertilization effects in a mesocosm experiment

Aims: Ingrowth bags are widely used to estimate mycorrhizal growth and dynamics. However, it remains unclear to what extent they reflect the surrounding soil, and how this varies with environmental conditions. Methods: We used a fertilization experiment to investigate if carbon-free mesh bags were representative of their surrounding soil. We determined AMF hyphal length density (HLD), phospholipid fatty acids (PLFA 16:1ω5) and neutral lipid fatty acids (NLFA 16:1ω5). Results: When AMF abundance in surrounding soil was high, HLD and both fatty acids were underestimated by the mesh bags. The PLFA 16:1ω5 in surrounding soil included bacterial PLFA, complicating the comparison of PLFA 16:1ω5 between mesh bags and surrounding soil. Both NLFA 16:1ω5 and HLD showed a significantly positive correlation, and fertilization effects were mostly similar for mesh bags and surrounding soil. Conclusions: Although carbon-free mesh bags can underestimate AMF abundance in soils, they represent a useful method to compare patterns in AMF abundance across environmental gradients and can be particularly useful in combination with the use of stable isotope tracers for unraveling patterns in AMF growth. NLFA 16:1ω5 appeared a more accurate measure for AMF than PLFA 16:1ω5 because the latter included bacterial PLFA

Favorable effect of mycorrhizae on biomass production efficiency exceeds their carbon cost in a fertilization experiment

Biomass production efficiency (BPE), the ratio of biomass production to photosynthesis, varies greatly among ecosystems and typically increases with increasing nutrient availability. Reduced carbon partitioning to mycorrhizal fungi (i.e., per unit photosynthesis) is the hypothesized underlying mechanism, as mycorrhizal abundance and plant dependence on these symbionts typically decrease with increasing nutrient availability. In a mesocosm experiment with Zea mays, we investigated the effect of nitrogen (N) and phosphorus (P) addition and of mycorrhizal inoculation on BPE. Photosynthesis and respiration were measured at mesocosm scale and at leaf scale. The growth of arbuscular mycorrhizal fungi (AMF) was assessed with ingrowth bags while also making use of the difference in δ13C between C4 plants and C3 soil. Mesocosms without AMF, that is, with pasteurized soil, were used to further explore the role of AMF. Plant growth, photosynthesis, and BPE were positively affected by P, but not by N addition. AMF biomass also was slightly higher under P addition, but carbon partitioning to AMF was significantly lower than without P addition. Interestingly, in the absence of AMF, plants that did not receive P died prematurely. Our study confirmed the hypothesis that BPE increases with increasing nutrient availability, and that carbon partitioning to AMF plays a key role in this nutrient effect. The comparison of inoculated vs. pasteurized mesocosms further suggested a lower carbon cost of nutrient uptake via AMF than via other mechanisms under nutrient rich conditions

Phosphorus addition increased carbon partitioning to autotrophic respiration but not to biomass production in an experiment with Zea mays

Plant carbon (C) partitioning—the relative use of photosynthates for biomass production, respiration, and other plant functions—is a key but poorly understood ecosystem process. In an experiment with Zea mays, with or without arbuscular mycorrhizal fungi (AMF), we investigated the effect of phosphorus (P) fertilization and AMF on plant C partitioning. Based on earlier studies, we expected C partitioning to biomass production (i.e., biomass production efficiency; BPE) to increase with increasing P addition due to reduced C partitioning to AMF. However, although plant growth was clearly stimulated by P addition, BPE did not increase. Instead, C partitioning to autotrophic respiration increased. These results contrasted with our expectations and with a previous experiment in the same set-up where P addition increased BPE while no effect on autotropic respiration was found. The comparison of both experiments suggests a key role for AMF in explaining these contrasts. Whereas in the previous experiment substantial C partitioning to AMF reduced BPE under low P, in the current experiment, C partitioning to AMF was too low to directly influence BPE. Our results illustrate the complex influence of nutrient availability and mycorrhizal symbiosis on plant C partitioning