Favorable Ratings of Providers\u27 Communication Behaviors Among U.S. Women with Depression: A Population-based Study Applying the Behavioral Model of Health Services Use

Background Little is known about the relationships between sociodemographic characteristics and ratings of provider communication behavior among women with depression in the United States. This study uses the Andersen Behavioral Model to examine the relationships among predisposing, enabling, and need factors and ratings of perceived patient–provider communication in women with depression. Methods The sample consisted of women with depression who visited any provider in the previous 12 months in the 2002–2008 Medical Expenditure Panel Survey (n = 3,179; weighted n = 4,707,255). Multivariate logistic regression was used to examine the independent contribution of predisposing, enabling, and need factors on providers\u27 communication behavior measures. Findings Black (non-Hispanic) women were more likely to report that providers always listened carefully (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.01–1.94), explained so they understood (OR, 1.53; 95% CI, 1.10–2.11), and showed respect for what they had to say (OR, 1.39; 95% CI, 1.01–1.92). Women participating in the paid workforce and those without a usual source of care were at increased risk for less favorable experiences. Conclusions Participation in the paid workforce and lack of a usual source of care were associated with an increased likelihood of less optimal communication experiences. Implications for Practice and/or Policy Ensuring that women with depression have reliable access to a continuous source of care and expanding the availability of nonemergent, after-hours care may be instrumental for improving patient–provider communication in this population

The Impact of Patient–Provider Communication and Language Spoken on Adequacy of Depression Treatment for U.S. Women

Many women with depression are untreated or undertreated for their condition. The quality of patient–provider communication may impact the receipt of depression treatment. We examine the relationship between patient–provider communication and receipt of adequate treatment for depression among women. The study sample consisted of women with depression who visited a provider in the previous 12 months in the 2002–2008 Medical Expenditure Panel Survey (N = 3,179). Multivariate regression was used to examine the independent contribution of sociodemographic characteristics, health care factors, patient–provider communication, and respondent language on depression treatment status (none, some, adequate). We found that more than one-third of women with depression in the United States did not receive adequate treatment. Women reporting that providers usually or always listened carefully were more likely to receive adequate treatment (OR = 1.59; 95% CI = 1.10−2.30 and OR = 1.55; 95% CI = 1.07−2.23, respectively). Non-English-speaking women were 50% less likely to receive adequate treatment (OR = 0.49; 95% CI = 0.30−0.80). Having a usual source of care was associated with an increased likelihood of receiving some and adequate treatment (OR = 1.84; 95% CI = 1.24−2.73 and OR = 2.22; 95% CI = 1.61−3.05, respectively). Effective provider listening behaviors may help increase the number of U.S. women with depression who receive adequate treatment. Efforts to improve language access for limited English-proficient women are likely critical for improving treatment outcomes in this population. Additionally, ensuring that women with depression have consistent access to health care services is important for obtaining adequate depression care

Keeping the World’s Environment under Review

How do we take stock of the state and direction of the world’s environment, and what can we learn from the experience? Among the myriad detailed narratives about the condition of the planet, the Global Environment Outlook (GEO) reports—issued by the United Nations Environment Programme—stand out as the most ambitious. For nearly three decades the GEO project has not only delivered iconic global assessment reports, but through its multitude of contributors has inspired hundreds of similar processes worldwide from the regional to the local level. This book provides an inside account of the evolution of the GEO project from its earliest days. Building on meticulous research, including interviews with former heads of the United Nations Environment Programme, diplomats, leading contributing scientists, and senior leaders of collaborating organizations, the story is told from the perspective of five GEO veterans who all played a pivotal role in shaping the periodic assessments. The GEO’s history provides striking insights and will save valuable time to those who commission, design and conduct, as well as critique and improve, assessments of environmental development in the next decade

Spatial concordance of DNA methylation classification in diffuse glioma.

BACKGROUND: Intratumoral heterogeneity is a hallmark of diffuse gliomas. DNA methylation profiling is an emerging approach in the clinical classification of brain tumors. The goal of this study is to investigate the effects of intratumoral heterogeneity on classification confidence. METHODS: We used neuronavigation to acquire 133 image-guided and spatially separated stereotactic biopsy samples from 16 adult patients with a diffuse glioma (7 IDH-wildtype and 2 IDH-mutant glioblastoma, 6 diffuse astrocytoma, IDH-mutant and 1 oligodendroglioma, IDH-mutant and 1p19q codeleted), which we characterized using DNA methylation arrays. Samples were obtained from regions with and without abnormalities on contrast-enhanced T1-weighted and fluid-attenuated inversion recovery MRI. Methylation profiles were analyzed to devise a 3-dimensional reconstruction of (epi)genetic heterogeneity. Tumor purity was assessed from clonal methylation sites. RESULTS: Molecular aberrations indicated that tumor was found outside imaging abnormalities, underlining the infiltrative nature of this tumor and the limitations of current routine imaging modalities. We demonstrate that tumor purity is highly variable between samples and explains a substantial part of apparent epigenetic spatial heterogeneity. We observed that DNA methylation subtypes are often, but not always, conserved in space taking tumor purity and prediction accuracy into account. CONCLUSION: Our results underscore the infiltrative nature of diffuse gliomas and suggest that DNA methylation subtypes are relatively concordant in this tumor type, although some heterogeneity exists

<i>MYCN</i> amplification drives an aggressive form of spinal ependymoma

Spinal ependymal tumors form a histologically and molecularly heterogeneous group of tumors with generally good prognosis. However, their treatment can be challenging if infiltration of the spinal cord or dissemination throughout the central nervous system (CNS) occurs and, in these cases, clinical outcome remains poor. Here, we describe a new and relatively rare subgroup of spinal ependymal tumors identified using DNA methylation profiling that is distinct from other molecular subgroups of ependymoma. Copy number variation plots derived from DNA methylation arrays showed MYCN amplification as a characteristic genetic alteration in all cases of our cohort (n = 13), which was subsequently validated using fluorescence in situ hybridization. The histological diagnosis was anaplastic ependymoma (WHO Grade III) in ten cases and classic ependymoma (WHO Grade II) in three cases. Histological re-evaluation in five primary tumors and seven relapses showed characteristic histological features of ependymoma, namely pseudorosettes, GFAP- and EMA positivity. Electron microscopy revealed cilia, complex intercellular junctions and intermediate filaments in a representative sample. Taking these findings into account, we suggest to designate this molecular subgroup spinal ependymoma with MYCN amplification, SP-EPN-MYCN. SP-EPN-MYCN tumors showed distinct growth patterns with intradural, extramedullary localization mostly within the thoracic and cervical spine, diffuse leptomeningeal spread throughout the whole CNS and infiltrative invasion of the spinal cord. Dissemination was observed in 100% of cases. Despite high-intensity treatment, SP-EPN-MYCN showed significantly worse median progression free survival (PFS) (17 months) and median overall survival (OS) (87 months) than all other previously described molecular spinal ependymoma subgroups. OS and PFS were similar to supratentorial ependymoma with RELA-fusion (ST-EPN-RELA) and posterior fossa ependymoma A (PF-EPN-A), further highlighting the aggressiveness of this distinct new subgroup. We, therefore, propose to establish SP-EPN-MYCN as a new molecular subgroup in ependymoma and advocate for testing newly diagnosed spinal ependymal tumors for MYCN amplification

The mosaic of KIR haplotypes in rhesus macaques

To further refine and improve biomedical research in rhesus macaques, it is necessary to increase our knowledge concerning both the degree of allelic variation (polymorphism) and diversity (gene copy number variation) in the killer cell immunoglobulin-like receptor (KIR) gene cluster. Pedigreed animals in particular should be studied, as segregation data will provide clues to the linkage of particular KIR genes/alleles segregating on a haplotype and to its gene content as well. A dual strategy allowed us to screen the presence and absence of genes and the corresponding transcripts, as well as to track differences in transcription levels. On the basis of this approach, 14 diverse KIR haplotypes have been described. These haplotypes consist of multiple inhibitory and activating Mamu-KIR genes, and any gene present on one haplotype may be absent on another. This suggests that the cost of accelerated evolution by recombination may be the loss of certain framework genes on a haplotype

The theory of the firm and its critics: a stocktaking and assessment

Includes bibliographical references."Prepared for Jean-Michel Glachant and Eric Brousseau, eds. New Institutional Economics: A Textbook, Cambridge, Cambridge University Press.""This version: August 22, 2005."Since its emergence in the 1970s the modern economic or Coasian theory of the firm has been discussed and challenged by sociologists, heterodox economists, management scholars, and other critics. This chapter reviews and assesses these critiques, focusing on behavioral issues (bounded rationality and motivation), process (including path dependence and the selection argument), entrepreneurship, and the challenge from knowledge-based theories of the firm