Accountable Care Organizations in Medicare and the Private Sector: A Status Update

Provides an overview of accountable care organizations - provider networks with financial incentives to slow spending growth while maintaining or improving quality of care - and their state of adoption, as well as key considerations

Will the Patient-Centered Medical Home Transform the Delivery of Health Care?

Explores various definitions of the medical home model, its components, rationale, effect on primary care, issues for implementation such as costs and payment methods, evidence of effectiveness, and healthcare reform provisions promoting it

Current challenges in cell wall biology in the cereals and grasses

Plant cell walls consist predominantly of polysaccharides and lignin. There has been a surge of research activity in plant cell wall biology in recent years, in two key areas. Firstly, in the area of human health it is now recognized that cell wall polysaccharides are key components of dietary fiber, which carries significant health benefits. Secondly, plant cell walls are major constituents of lignocellulosic residues that are being developed as renewable sources of liquid transport biofuels. In both areas, the cell walls of the Poaceae, which include the cereals and grasses, are particularly important. The non-cellulosic wall polysaccharides of the Poaceae differ in comparison with those of other vascular plants, insofar as they contain relatively high levels of heteroxylans as “core” polysaccharide constituents and relatively smaller amounts of heteromannans, pectic polysaccharides, and xyloglucans. Certain grasses and cereals walls also contain (1,3;1,4)-β-glucans, which are not widely distributed outside the Poaceae. Although some genes involved in cellulose, heteroxylan, and (1,3;1,4)-β-glucan synthesis have been identified, mechanisms that control expression of the genes are not well defined. Here we review current knowledge of cell wall biology in plants and highlight emerging technologies that are providing new and exciting insights into the most challenging questions related to the synthesis, re-modeling and degradation of wall polysaccharides

Combining transcriptional datasets using the generalized singular value decomposition

Background Both microarrays and quantitative real-time PCR are convenient tools for studying the transcriptional levels of genes. The former is preferable for large scale studies while the latter is a more targeted technique. Because of platform-dependent systematic effects, simple comparisons or merging of datasets obtained by these technologies are difficult, even though they may often be desirable. These difficulties are exacerbated if there is only partial overlap between the experimental conditions and genes probed in the two datasets. Results We show here that the generalized singular value decomposition provides a practical tool for merging a small, targeted dataset obtained by quantitative real-time PCR of specific genes with a much larger microarray dataset. The technique permits, for the first time, the identification of genes present in only one dataset co-expressed with a target gene present exclusively in the other dataset, even when experimental conditions for the two datasets are not identical. With the rapidly increasing number of publically available large scale microarray datasets the latter is frequently the case. The method enables us to discover putative candidate genes involved in the biosynthesis of the (1,3;1,4)-β-D-glucan polysaccharide found in plant cell walls. Conclusion We show that the generalized singular value decomposition provides a viable tool for a combined analysis of two gene expression datasets with only partial overlap of both gene sets and experimental conditions. We illustrate how the decomposition can be optimized self-consistently by using a judicious choice of genes to define it. The ability of the technique to seamlessly define a concept of "co-expression" across both datasets provides an avenue for meaningful data integration. We believe that it will prove to be particularly useful for exploiting large, publicly available, microarray datasets for species with unsequenced genomes by complementing them with more limited in-house expression measurements.Andreas W Schreiber, Neil J Shirley, Rachel A Burton and Geoffrey B Finche

Genetic diversity and genome wide association study of β-glucan content in tetraploid wheat grains

Non-starch polysaccharides (NSPs) have many health benefits, including immunomodulatory activity, lowering serum cholesterol, a faecal bulking effect, enhanced absorption of certain minerals, prebiotic effects and the amelioration of type II diabetes. The principal components of the NSP in cereal grains are (1,3;1,4)-β-glucans and arabinoxylans. Although (1,3;1,4)-β-glucan (hereafter called β-glucan) is not the most representative component of wheat cell walls, it is one of the most important types of soluble fibre in terms of its proven beneficial effects on human health. In the present work we explored the genetic variability of β-glucan content in grains from a tetraploid wheat collection that had been genotyped with a 90k-iSelect array, and combined this data to carry out an association analysis. The β-glucan content, expressed as a percentage w/w of grain dry weight, ranged from 0.18% to 0.89% across the collection. Our analysis identified seven genomic regions associated with β-glucan, located on chromosomes 1A, 2A (two), 2B, 5B and 7A (two), confirming the quantitative nature of this trait. Analysis of marker trait associations (MTAs) in syntenic regions of several grass species revealed putative candidate genes that might influence β-glucan levels in the endosperm, possibly via their participation in carbon partitioning. These include the glycosyl hydrolases endo-β-(1,4)-glucanase (cellulase), β-amylase, (1,4)-β-xylan endohydrolase, xylanase inhibitor protein I, isoamylase and the glycosyl transferase starch synthase II

The role of temperate treed swamps as a carbon sink in southwestern Nova Scotia

Accepted VersionForested wetlands may represent important ecosystems for mitigating climate change effects through carbon (C) sequestration because of their slow decomposition and C storage by trees. Despite this potential importance, few studies have acknowledged the role of temperate treed swamps in the C cycle. In southwestern Nova Scotia, Canada, we examined the role of treed swamps in the soil C cycle by determining C inputs through litterfall, assessing decomposition rates and soil C pools, and quantifying C outputs through soil greenhouse gas (GHG) emissions. The treed swamps were found to represent large supplies of C inputs through litterfall to the forest floor. The swamp soils had substantially greater C stores than the swamp–upland edge or upland soils. We found growing season C inputs via litterfall to exceed C outputs via GHG emissions in the swamps by a factor of about 2.5. Our findings indicate that temperate treed swamps can remain a C sink even if soil GHG emissions were to double, supporting conservation efforts to preserve temperate treed swamps as a measure to mitigate climate change

Striking A Balance: An Exploration of Staff-Camper Relationship Formation

Previous research highlights a range of positive developmental outcomes associated with attending summer camp. Close staff-camper relationships likely contribute to positive development, but little is known about how these bonds are formed. The current study utilized constructivist thematic analysis of interviews with campers (n = 8) and staff members (n = 7) at an overnight summer camp to examine the factors and processes that promote or inhibit close staff-camper relationship formation. The main themes identified were striking a balance, level of experience, and relationship-promoting behaviors. Staff members experience apparent paradoxes in their roles (e.g., relating to campers while also exerting authority), but navigate these tensions by using relationship-promoting behaviors and through increased experience. These findings suggest that staff training and supervision should emphasize relationship-promoting behaviors, continue throughout the summer, and be informed by campers’ perspectives. Additionally, camp administrators should capitalize on accrued experience by prioritizing staff retention

Identification of candidate MYB transcription factors that influence CslF6 expression in barley grain

(1,3;1,4)-β-Glucan is a non-cellulosic polysaccharide required for correct barley grain fill and plant development, with industrial relevance in the brewing and the functional food sector. Barley grains contain higher levels of (1,3;1,4)-β-glucan compared to other small grain cereals and this influences their end use, having undesirable effects on brewing and distilling and beneficial effects linked to human health. HvCslF6 is the main gene contributing to (1,3;1,4)-β-glucan biosynthesis in the grain. Here, the transcriptional regulation of HvCslF6 was investigated using an in-silico analysis of transcription factor binding sites (TFBS) in its putative promoter, and functional characterization in a barley protoplast transient expression system. Based on TFBS predictions, TF classes AP2/ERF, MYB, and basic helix-loop-helix (bHLH) were over-represented within a 1,000 bp proximal HvCslF6 promoter region. Dual luciferase assays based on multiple HvCslF6 deletion constructs revealed the promoter fragment driving HvCslF6 expression. Highest HvCslF6 promoter activity was narrowed down to a 51 bp region located −331 bp to −382 bp upstream of the start codon. We combined this with TFBS predictions to identify two MYB TFs: HvMYB61 and HvMYB46/83 as putative activators of HvCslF6 expression. Gene network analyses assigned HvMYB61 to the same co-expression module as HvCslF6 and other primary cellulose synthases (HvCesA1, HvCesA2, and HvCesA6), whereas HvMYB46/83 was assigned to a different module. Based on RNA-seq expression during grain development, HvMYB61 was cloned and tested in the protoplast system. The transient over-expression of HvMYB61 in barley protoplasts suggested a positive regulatory effect on HvCslF6 expression