Outpatient Management of Mood Disorders by the Family Physician

It is well-known that the demand for psychiatric care in the US is higher than the supply of psychiatric clinical providers. Vermont, in particular, has a paucity of psychiatric providers and there are minimal providers in Chittenden County and the greater Burlington area. Many patients with psychiatric conditions are inconsistently managed given the lack of available outpatient providers, particularly for patients on Medicaid. Often times, patients suffer from psychiatric episodes that require an emergency department visit or inpatient stay, and they may leave the hospital with an outpatient medication regimen that can then be carried out by a primary care provider. Patients should not have to endure a psychotic episode bringing them into the hospital in order to receive appropriate psychiatric care. A possible solution to this gap in care would be for primary care providers to be armed with the knowledge and skills to appropriately and sustainably manage psychiatric conditions on an outpatient level. Tools to summarize the evidence and current guidelines around prescribing, testing, surveillance, and other drug-related parameters may enable providers to quickly assess the recommendations during a busy clinical day, especially if such tools were consistently updated and embedded into the electronic medical record. This project focuses on management of mood disorders in the outpatient family medicine clinic; a one-pager table summarizing guidelines around commonly prescribed mood stabilizers in the setting of bipolar disorder was created and displayed in the Hinesburg Family Medicine clinic.https://scholarworks.uvm.edu/fmclerk/1485/thumbnail.jp

Patient‐Defined Goals for the Treatment of Severe Aortic Stenosis: A Qualitative Analysis

Patients with severe aortic stenosis (AS) at high risk for aortic valve replacement are a unique population with multiple treatment options, including medical therapy, surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR). Traditionally, in elderly populations, goals of treatment may favour quality of life over survival. Professional guidelines recommend that clinicians engage patients in shared decision making, a process that may lead to decisions more aligned with patient-defined goals of care. Goals of care for high-risk patients with AS are not well defined in the literature, and patient-reported barriers to shared decision making highlight the need for explicit encouragement from clinicians for patient involvement

Aberrant Neuronal Dynamics during Working Memory Operations in the Aging HIV-Infected Brain.

Impairments in working memory are among the most prevalent features of HIV-associated neurocognitive disorders (HAND), yet their origins are unknown, with some studies arguing that encoding operations are disturbed and others supporting deficits in memory maintenance. The current investigation directly addresses this issue by using a dynamic mapping approach to identify when and where processing in working memory circuits degrades. HIV-infected older adults and a demographically-matched group of uninfected controls performed a verbal working memory task during magnetoencephalography (MEG). Significant oscillatory neural responses were imaged using a beamforming approach to illuminate the spatiotemporal dynamics of neuronal activity. HIV-infected patients were significantly less accurate on the working memory task and their neuronal dynamics indicated that encoding operations were preserved, while memory maintenance processes were abnormal. Specifically, no group differences were detected during the encoding period, yet dysfunction in occipital, fronto-temporal, hippocampal, and cerebellar cortices emerged during memory maintenance. In addition, task performance in the controls covaried with occipital alpha synchronization and activity in right prefrontal cortices. In conclusion, working memory impairments are common and significantly impact the daily functioning and independence of HIV-infected patients. These impairments likely reflect deficits in the maintenance of memory representations, not failures to adequately encode stimuli

Differences in the Determinants of Retirement Preparation between Farm and Nonfarm Households

As principal farm operators age, retirement and succession planning has become increasingly important to the U.S. agriculture industry. This study examined differences in the determinants of retirement preparation between farm and nonfarm households using the Survey of Consumer Finances. Factors such as risk preferences, financial capability, human capital, and other demographic characteristics of farmers that may play a role in their decision to plan for retirement were examined. Retirement planning was investigated by running three separate sets of logistic regressions on the overall sample, farm households, and nonfarm households. Likelihood of consulting a financial planner, expecting to leave a bequest, and household net worth were used as dependent variables. Results indicate some significant differences between farm and nonfarm households and highlight limitations in currently available data sets for studies such as this one. Implications for practitioners, researchers, and policymakers regarding farm family retirement and succession planning are discussed

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

CO \u3c inf\u3e 2 enrichment and warming of the atmosphere enhance both productivity and mortality of maple tree fine roots

• Fine roots are the key link for plant water and nutrient uptake, soil carbon (C) input and soil microbial activity in forest ecosystems, and play a critical role in regulating ecosystem C balance and its response to global change. • Red maple (Acer rubrum) and sugar maple (Acer saccharum) seedlings were grown for four growing seasons in open-top chambers and exposed to ambient or elevated carbon dioxide concentration [CO2] in combination with ambient or elevated temperature. Fine-root production and mortality were monitored using minirhizotrons, and root biomass was determined from soil cores. • Both elevated [CO2] and temperature significantly enhanced production and mortality of fine roots during spring and summer of 1996. At the end of the experiment in September 1997, fine root biomass was significantly lower in elevated temperature chambers, but there were no effects of elevated [CO2] or the interactions between elevated [CO2] and temperature. • Deciduous trees have dynamic root systems, and their activity can be enhanced by CO2 enrichment and climatic warming. Static measures of root response, such as soil core data, obscure the dynamic nature, which is critical for understanding the response of forest C cycling to global change. © New Phytologist (2004)

Radiomic Features of Multiparametric MRI Present Stable Associations with Analogous Histological Features in Patients with Brain Cancer

Magnetic resonance (MR)-derived radiomic features have shown substantial predictive utility in modeling different prognostic factors of glioblastoma and other brain cancers. However, the biological relationship underpinning these predictive models has been largely unstudied, and the generalizability of these models had been called into question. Here, we examine the localized relationship between MR-derived radiomic features and histology-derived “histomic” features using a data set of 16 patients with brain cancer. Tile-based radiomic features were collected on T1, post-contrast T1, FLAIR, and diffusion-weighted imaging (DWI)-derived apparent diffusion coefficient (ADC) images acquired before patient death, with analogous histomic features collected for autopsy samples coregistered to the magnetic resonance imaging. Features were collected for each original image, as well as a 3D wavelet decomposition of each image, resulting in 837 features per MR and histology image. Correlative analyses were used to assess the degree of association between radiomic–histomic pairs for each magnetic resonance imaging. The influence of several confounds was also assessed using linear mixed-effect models for the normalized radiomic–histomic distance, testing for main effects of different acquisition field strengths. Results as a whole were largely heterogeneous, but several features showed substantial associations with their histomic analogs, particularly those derived from the FLAIR and postcontrast T1W images. These features with the strongest association typically presented as stable across field strengths as well. These data suggest that a subset of radiomic features can consistently capture texture information on underlying tissue histology