Lack of myeloid Fatp1 increases atherosclerotic lesion size in Ldlr-/- mice.

BACKGROUND AND AIMS: Altered metabolism is an important regulator of macrophage (MΦ) phenotype, which contributes to inflammatory diseases such as atherosclerosis. Broadly, pro-inflammatory, classically-activated MΦs (CAM) are glycolytic while alternatively-activated MΦs (AAM) oxidize fatty acids, although overlap exists. We previously demonstrated that MΦ fatty acid transport protein 1 (FATP1, Slc27a1) was necessary to maintain the oxidative and anti-inflammatory AAM phenotype in vivo in a model of diet-induced obesity. The aim of this study was to examine how MΦ metabolic reprogramming through FATP1 ablation affects the process of atherogenesis. We hypothesized that FATP1 limits MΦ-mediated inflammation during atherogenesis. Thus, mice lacking MΦ Fatp1 would display elevated formation of atherosclerotic lesions in a mouse model lacking the low-density lipoprotein (LDL) receptor (Ldlr-/-). METHODS: We transplanted bone marrow collected from Fatp1+/+ or Fatp1-/- mice into Ldlr-/- mice and fed chimeric mice a Western diet for 12 weeks. Body weight, blood glucose, and plasma lipids were measured. Aortic sinus and aorta lesions were quantified. Atherosclerotic plaque composition, oxidative stress, and inflammation were analyzed histologically. RESULTS: Compared to Fatp1+/+Ldlr-/- mice, Fatp1-/-Ldlr-/- mice exhibited significantly larger lesion area and elevated oxidative stress and inflammation in the atherosclerotic plaque. Macrophage and smooth muscle cell content did not differ by Fatp1 genotype. There were no significant systemic alterations in LDL, high-density lipoprotein (HDL), total cholesterol, or triacylglyceride, suggesting that the effect was local to the cells of the vessel microenvironment in a Fatp1-dependent manner. CONCLUSIONS: MΦ Fatp1 limits atherogenesis and may be a viable target to metabolically reprogram MΦs.

A framework for guiding efforts to reward value instead of volume.

The U.S. healthcare system is in the midst of a major shift from fee-for-service to value-based reimbursement models. To date, these new reimbursement models have been focused on quality-contingent bonuses and cost-of-care risk sharing for providers, both of which have yielded only modest success.An analysis of health policy and business strategy literature was performed to identify the mechanisms of how value is rewarded in other industries and to understand the barriers to those mechanisms operating in the healthcare industry. A framework was developed to organize these findings. Rewarding healthcare providers for delivering value can only be achieved by enabling profitability to increase as value increases relative to competitors. Four variables determine a provider's profitability, each of which is considered as a potential lever to reward value with profit. The lever that offers the greatest potential is quantity (i.e., market share). Ironically, this means rewarding value with volume. The major barriers to value improvements being rewarded with market share are identified, and the profound impact of minimizing or removing those barriers is illustrated using a variety of examples from our healthcare system. Trending reforms that rely on quality-contingent bonuses and cost-of-care risk sharing are limited in the degree of value improvement they will stimulate because they rely on ineffective levers to reward value; instead, reform efforts must focus on removing barriers to rewarding value with market share. The framework presented can be used to predict the impact of any proposed reform.

Parent Perceptions of Sexual Education Needs for Their Children With Autism.

Primary responsibility for sexual education for adolescents with autism spectrum disorder falls on parents who have reported a lack of professional and material support. The purpose of this study was to 1) describe parent perceptions of sexual education needs of their children aged 14-20 with an autism spectrum disorder diagnosis and 2) determine parent-preferred mechanisms of delivery for tailored educational intervention strategies. DESIGN AND METHODS: The study aims were accomplished by a qualitative research design using focus groups and telephone interviews assisted by a structured interview guide. Study methods and analysis were guided by social marketing principles. RESULTS: A total of 15 parents (5 participated in 1 focus group and 10 completed individual interviews) acknowledged their primary role in providing sexual education for their children and confirmed a need for resources to assist them in this role. All parents in this study found that some level of sexual education was necessary and important and that all children had been introduced to sexual information but in varying degrees. Topic preferences included those that would increase the recognition of healthy relationships, provide a measure of self-protection, and ameliorate undesirable consequences of sexual activity. Parents were knowledgeable about how their children best learned and suggested future interventions use technology interfaces with engaging displays and allow for individualized content. CONCLUSION AND IMPLICATIONS: These findings highlight a need for additional research and enhanced clinical services to ensure that adolescents with autism spectrum disorder have their informational needs met, are able to avoid risks, and have the greatest capacity for a healthy sexuality as they transition to adulthood.

Cation separation and preconcentration using columns containing cyclen and cyclen-resorcinarene derivatives.

The selectivity and separation of transition metal ions on two columns packed with cyclen-based macrocycles adsorbed onto 55% cross-linked styrene-divinylbenzene resin are presented. The N-cyclen and cyclen-resorcinarene stationary phases were made by adsorbing hydrophobically substituted N-cyclen or a cyclen-resorcinarene derivative (cyclenbowl) on the resin, respectively. The stability constants of cyclen with transition metal ions demonstrate that cyclen has selectivity for Cu²âº over other transition metal ions. Mn²âº, Co²âº, Ni²âº, Cd²âº, and Zn²âº ions were separated from Cu²âº using HNO3 eluent with the cyclenbowl column. The preconcentration of Cu²âº in parts per billion level from a high concentration matrix of Mn²âº, Co²âº, Ni²âº, Cd²âº, and Zn²âº ions was achieved in the cyclenbowl column using a nitric acid eluent gradient. Recovery of Cu²âº at >98% was obtained based on direct interaction of metal ion and cyclen. Although Mn²âº, Co²âº, Ni²âº, Cd²âº, and Zn²âº were not separated by HNO3 eluent, addition of oxalic acid yielded a very good separation. A retention mechanism is proposed for the latter system in which the protonated cyclen units attract negatively charged HC2O4⁻ ions that cooperate with cyclen sites in retaining transition metal ions.

Finding the sweet spot: how to get the right staffing for variable workloads.

All too often, hospital department managers set their staff schedules too much in anticipation of high levels of demand for services, leading to higher-than-necessary staffing costs when demand is lower than expected. The opposite approach of scheduling too few staff to meet demand, then relying on on-call or callback staff to address the shortage, also results in higher-than-necessary costs due to the premium wages that such staff must be paid. A staffing and workload simulation tool allows hospital departments to find the right balance between these extremes.