Field evaluation of a point-of-care triage test for active tuberculosis (TriageTB).

BACKGROUND: To improve tuberculosis (TB) diagnosis, the World Health Organisation (WHO) has called for a non-sputum based triage test to focus TB testing on people with a high likelihood of having active pulmonary tuberculosis (TB). Various host or pathogen biomarker-based testing devices are in design stage and require validity assessment. Host biomarkers have shown promise to accurately rule out active TB, but further research is required to determine generalisability. The TriageTB diagnostic test study aims to assess the accuracy of diagnostic test candidates, as well as field-test, finalise the design and biomarker signature, and validate a point-of-care multi-biomarker test (MBT). METHODS: This observational diagnostic study will evaluate sensitivity and specificity of biomarker-based diagnostic candidates including the MBT and Xpert® TB Fingerstick cartridge compared with a gold-standard composite TB outcome classification defined by symptoms, sputum GeneXpert® Ultra, smear and culture, radiological features, response to TB therapy and presence of an alternative diagnosis. The study will be conducted in research sites in South Africa, Uganda, The Gambia and Vietnam which all have high TB prevalence. The two-phase design allows for finalisation of the MBT in Phase 1 in which candidate host proteins will be evaluated on stored serum from Asia, South Africa and South America and on fingerstick blood from 50 newly recruited participants per site. The MBT test will then be locked down and validated in Phase 2 on 250 participants per site. DISCUSSION: By targeting confirmatory TB testing to those with a positive triage test, 75% of negative GXPU may be avoided, thereby reducing diagnostic costs and patient losses during the care cascade. This study builds on previous biomarker research and aims to identify a point-of-care test meeting or exceeding the minimum World Health Organisation target product profile of a 90% sensitivity and 70% specificity. Streamlining TB testing by identifying individuals with a high likelihood of TB should improve TB resources use and, in so doing, improve TB care. TRIAL REGISTRATION: NCT04232618 (clinicaltrials.gov) Date of registration: 16 January 2020.

Effect of Local Atomic Structure on Sodium Ion Storage in Hard Amorphous Carbon.

The fundamental understanding of sodium storage mechanisms in amorphous carbon is essential to develop high-performance anode materials for sodium-ion batteries. However, the intrinsic relation between the structure of amorphous carbon and Na+ storage remains to be debated due to the difficulty in controlling and characterizing the local atomic configurations of amorphous carbon. Here we report quantitative measurements of Na+ storage in a low-temperature dealloyed hard carbon with a tunable local structure from completely disordered micropores to gradually increased graphitic order domains. The structure-capacity-potential correlation not only verifies the disputing "adsorption-intercalation" mechanisms, i.e., Na+ intercalation into local graphitic domains for the low-voltage plateaus and adsorption in fully disordered carbon for the sloping voltage profiles, but also unveils a new mechanism of Na+ adsorption on defective sites of graphitic carbon in the medium-potential sloping region. The quantitative investigations provide essential insights into the reaction mechanisms of Na+ with amorphous carbon for designing advanced sodium-ion battery anodes.

Racial Implicit Associations in Psychiatric Diagnosis, Treatment, and Compliance Expectations.

OBJECTIVE: Racial and ethnic disparities are well documented in psychiatry, yet suboptimal understanding of underlying mechanisms of these disparities undermines diversity, inclusion, and education efforts. Prior research suggests that implicit associations can affect human behavior, which may ultimately influence healthcare disparities. This study investigated whether racial implicit associations exist among medical students and psychiatric physicians and whether race/ethnicity, training level, age, and gender predicted racial implicit associations. METHODS: Participants completed online demographic questions and 3 race Implicit Association Tests (IATs) related to psychiatric diagnosis (psychosis vs. mood disorders), patient compliance (compliance vs. non-compliance), and psychiatric medications (antipsychotics vs. antidepressants). Linear and logistic regression models were used to identify demographic predictors of racial implicit associations. RESULTS: The authors analyzed data from 294 medical students and psychiatric physicians. Participants were more likely to pair faces of Black individuals with words related to psychotic disorders (as opposed to mood disorders), non-compliance (as opposed to compliance), and antipsychotic medications (as opposed to antidepressant medications). Among participants, self-reported White race and higher level of training were the strongest predictors of associating faces of Black individuals with psychotic disorders, even after adjusting for participant's age. CONCLUSIONS: Racial implicit associations were measurable among medical students and psychiatric physicians. Future research should examine (1) the relationship between implicit associations and clinician behavior and (2) the ability of interventions to reduce racial implicit associations in mental healthcare.

Identification and Quantification of Technetium Species in Hanford Waste Tank AN-102.

Technetium-99 (Tc), a high yield fission product generated in nuclear reactors, is one of the most difficult contaminants to address at the U.S. Department of Energy Hanford, Savannah River, and other sites. In strongly alkaline solutions typifying Hanford tank waste, Tc exists as pertechnetate (TcO4-) (oxidation state VII) as well as in reduced forms (oxidation state < VII), collectively known as non-pertechnetate (non-TcO4-) species. Designing strategies for effective Tc management, including separation and immobilization, necessitates understanding the molecular structure of the non-TcO4- species and their identification in actual tank waste samples. Identification of non-TcO4- species would facilitate the development of new treatment technologies effective for dissimilar Tc species. Toward this objective, a spectroscopic library of the Tc(I) [fac-Tc(CO)3]+ and Tc(II, IV, V, VII) compounds was generated and applied to the characterization of the actual Hanford AN-102 tank waste supernatant, which was processed to adjust Na concentration to ∼5.6 M and remove 137Cs by spherical resorcinol-formaldehyde (sRF) ion-exchange resin. Post 137Cs removal, the cesium-loaded sRF column was eluted with 0.45 M HNO3. As-received AN-102, Cs-depleted effluent, and sRF eluate fractions were comprehensively characterized for chemical composition and speciation of Tc using 99Tc nuclear magnetic resonance spectroscopy and X-ray absorption spectroscopy. It was demonstrated for the first time that non-TcO4- Tc present in the AN-102 tank waste is composed of several low-valent Tc species, including the Tc(I) [fac-Tc(CO)3]+ and Tc(IV) compounds. This is the first demonstration of multiple non-TcO4- species co-existing in the Hanford tank waste, highlighting their importance for the waste processing.

Lessons From Low- and Middle-Income Countries: Alleviating the Behavioral Health Workforce Shortage in the United States.

The United States is facing a mental health workforce shortage, exacerbated by the COVID-19 pandemic. Low- and middle-income countries (LMICs) have historically grappled with even greater shortages. Therefore, LMICs have thought creatively about expanding the mental health workforce and the settings in which to deliver evidence-based and equitable mental health care. The authors introduce some mental health interventions in LMICs, describe evidence of the efficacy of these interventions gleaned from this context, and discuss the applicability of these interventions to the United States. The authors also reflect on the benefits and challenges of implementing these interventions in the U.S. mental health care system to alleviate its current workforce shortage.

3D Continuously Porous Graphene for Energy Applications.

Constructing bulk graphene materials with well-reserved 2D properties is essential for device and engineering applications of atomically thick graphene. In this article, the recent progress in the fabrications and applications of sterically continuous porous graphene with designable microstructures, chemistries, and properties for energy storage and conversion are reviewed. Both template-based and template-free methods have been developed to synthesize the 3D continuously porous graphene, which typically has the microstructure reminiscent of pseudo-periodic minimal surfaces. The 3D graphene can well preserve the properties of 2D graphene of being highly conductive, surface abundant, and mechanically robust, together with unique 2D electronic behaviors. Additionally, the bicontinuous porosity and large curvature offer new functionalities, such as rapid mass transport, ample open space, mechanical flexibility, and tunable electric/thermal conductivity. Particularly, the 3D curvature provides a new degree of freedom for tailoring the catalysis and transport properties of graphene. The 3D graphene with those extraordinary properties has shown great promises for a wide range of applications, especially for energy conversion and storage. This article overviews the recent advances made in addressing the challenges of developing 3D continuously porous graphene, the benefits and opportunities of the new materials for energy-related applications, and the remaining challenges that warrant future study.

Plotter Cut Stencil Masks for the Deposition of Organic and Inorganic Materials and a New Rapid, Cost Effective Technique for Antimicrobial Evaluations.

Plotter cutters in stencil mask prototyping are underutilized but have several advantages over traditional MEMS techniques. In this paper we investigate the use of a conventional plotter cutter as a highly effective benchtop tool for the rapid prototyping of stencil masks in the sub-250 µm range and characterize patterned layers of organic/inorganic materials. Furthermore, we show a new diagnostic monitoring application for use in healthcare, and a potential replacement of the Standard Kirby-Bauer Diffusion Antibiotic Resistance tests was developed and tested on both Escherichia coli and Xanthomonas alfalfae as pathogens with Oxytetracycline, Streptomycin and Kanamycin. We show that the reduction in area required for the minimum inhibitory concentration tests; allow for three times the number of tests to be performed within the same nutrient agar Petri dish, demonstrated both theoretically and experimentally resulting in correlations of R ≈ 0.96 and 0.985, respectively for both pathogens.

Graphene-coated nanoporous nickel towards a metal-catalyzed oxygen evolution reaction.

Developing highly active electrocatalysts with low costs and long durability for oxygen evolution reactions (OERs) is crucial towards the practical implementations of electrocatalytic water-splitting and rechargeable metal-air batteries. Anodized nanostructured 3d transition metals and alloys with the formation of OER-active oxides/hydroxides are known to have high catalytic activity towards OERs but suffer from poor electrical conductivity and electrochemical stability in harsh oxidation environments. Here we report that high OER activity can be achieved from the metallic state of Ni which is passivated by atomically thick graphene in a three-dimensional nanoporous architecture. As a free-standing catalytic anode, the non-oxide transition metal catalyst shows a low OER overpotential, high OER current density and long cycling lifetime in alkaline solutions, benefiting from the high electrical conductivity and low impedance resistance for charge transfer and transport. This study may pave a new way to develop high efficiency transition metal OER catalysts for a wide range of applications in renewable energy.

Green Preparation of Citric Acid Crosslinked Starch for Improvement of Physicochemical Properties of Cyperus Starch.

OBJECTIVES: This study was undertaken to assess the properties of Cyperus esculentus tuber starch crosslinked with citric acid from liquid substrates of orange peel derived via the natural solid-state fermentation process; a green approach. MATERIALS AND METHODS: The flow properties of the prepared starches were evaluated using standard methods. Water-holding capacity, swelling capacity, moisture sorption capacity, gelatinization temperature using differential scanning calorimetry, morphology, fourier infrared spectroscopy, and pH of the starches were evaluated. RESULTS: Results showed that the pH of the crosslinked starches were lower (3.39-4.07) than that of the native starch (5.25) and the flow profile was found to improve. The crosslinked starches' water-holding capacity (90.67%-96.69%) were higher, whereas its emulsion capacity (15.33) was similar to that of the native starch (15.33). No change was observed in the morphology of the crosslinked starches' granules. The infrared spectra of the native and crosslinked starches showed identical peaks; however, the enthalpy of gelatinization (ΔHgel) of the crosslinked products were found to differ from that of the native starch. Modified starches show propensity of being exploited as binding agents in food and pharmaceutical industries. CONCLUSION: The green modification process proved to be a valuable addition to the available starch modification processes.

Atomic Ni and Cu co-anchored 3D nanoporous graphene as an efficient oxygen reduction electrocatalyst for zinc-air batteries.

Highly active, cost-effective and durable electrocatalysts for the oxygen reduction reaction (ORR) are critically important for renewable energy conversion and storage. Here we report a 3D bicontinuous nitrogen doped nanoporous graphene electrocatalyst co-anchoring with atomically dispersed nickel and copper atoms ((Ni,Cu)-NG) as a highly active single-atom ORR catalyst, fabricated by the combination of chemical vapor deposition and high temperature gas transportation. The resultant (Ni,Cu)-NG exhibits an exceptional ORR activity in alkaline electrolytes, comparable to the Pt-based benchmarks, from the synergistic effect of the CuNx and NiNx complexes. Endowed with high catalytic activity and outstanding durability under harsh electrochemical environments, rechargeable zinc-air batteries using (Ni,Cu)-NG as the cathodes show excellent energy efficiency (voltage gap of 0.74 V), large power density (150.6 mW cm-2 at 250 mA cm-2) and high cycling stability (>500 discharge-charge cycles at 10 mA cm-2). This study may pave an efficient avenue for designing highly durable single-atom ORR catalysts for metal-air batteries.

Twisting of 2D Kagomé Sheets in Layered Intermetallics.

Chemical bonding in 2D layered materials and van der Waals solids is central to understanding and harnessing their unique electronic, magnetic, optical, thermal, and superconducting properties. Here, we report the discovery of spontaneous, bidirectional, bilayer twisting (twist angle ∼4.5°) in the metallic kagomé MgCo6Ge6 at T = 100(2) K via X-ray diffraction measurements, enabled by the preparation of single crystals by the Laser Bridgman method. Despite the appearance of static twisting on cooling from T ∼300 to 100 K, no evidence for a phase transition was found in physical property measurements. Combined with the presence of an Einstein phonon mode contribution in the specific heat, this implies that the twisting exists at all temperatures but is thermally fluctuating at room temperature. Crystal Orbital Hamilton Population analysis demonstrates that the cooperative twisting between layers stabilizes the Co-kagomé network when coupled to strongly bonded and rigid (Ge2) dimers that connect adjacent layers. Further modeling of the displacive disorder in the crystal structure shows the presence of a second, Mg-deficient, stacking sequence. This alternative stacking sequence also exhibits interlayer twisting, but with a different pattern, consistent with the change in electron count due to the removal of Mg. Magnetization, resistivity, and low-temperature specific heat measurements are all consistent with a Pauli paramagnetic, strongly correlated metal. Our results provide crucial insight into how chemical concepts lead to interesting electronic structures and behaviors in layered materials.

What Does Immunology Have to Do With Normal Brain Development and the Pathophysiology Underlying Tourette Syndrome and Related Neuropsychiatric Disorders?

Objective: The goal of this article is to review the past decade's literature and provide a critical commentary on the involvement of immunological mechanisms in normal brain development, as well as its role in the pathophysiology of Tourette syndrome, other Chronic tic disorders (CTD), and related neuropsychiatric disorders including Obsessive-compulsive disorder (OCD) and Attention deficit hyperactivity disorder (ADHD). Methods: We conducted a literature search using the Medline/PubMed and EMBASE electronic databases to locate relevant articles and abstracts published between 2009 and 2020, using a comprehensive list of search terms related to immune mechanisms and the diseases of interest, including both clinical and animal model studies. Results: The cellular and molecular processes that constitute our "immune system" are crucial to normal brain development and the formation and maintenance of neural circuits. It is also increasingly evident that innate and adaptive systemic immune pathways, as well as neuroinflammatory mechanisms, play an important role in the pathobiology of at least a subset of individuals with Tourette syndrome and related neuropsychiatric disorders In the conceptual framework of the holobiont theory, emerging evidence points also to the importance of the "microbiota-gut-brain axis" in the pathobiology of these neurodevelopmental disorders. Conclusions: Neural development is an enormously complex and dynamic process. Immunological pathways are implicated in several early neurodevelopmental processes including the formation and refinement of neural circuits. Hyper-reactivity of systemic immune pathways and neuroinflammation may contribute to the natural fluctuations of the core behavioral features of CTD, OCD, and ADHD. There is still limited knowledge of the efficacy of direct and indirect (i.e., through environmental modifications) immune-modulatory interventions in the treatment of these disorders. Future research also needs to focus on the key molecular pathways through which dysbiosis of different tissue microbiota influence neuroimmune interactions in these disorders, and how microbiota modification could modify their natural history. It is also possible that valid biomarkers will emerge that will guide a more personalized approach to the treatment of these disorders.

Inlaid ReS2 Quantum Dots in Monolayer MoS2.

Two-dimensional (2D) transition-metal dichalcogenides (TMDs) are prospective materials for quantum devices owing to their inherent 2D confinements. They also provide a platform to realize even lower-dimensional in-plane electron confinement, for example, 0D quantum dots, for exotic physical properties. However, fabrication of such laterally confined monolayer (1L) nanostructure in 1L crystals remains challenging. Here we report the realization of 1L ReS2 quantum dots epitaxially inlaid in 1L MoS2 by a two-step chemical vapor deposition method combining with plasma treatment. The lateral lattice mismatch between ReS2 and MoS2 leads to size-dependent crystal structure evolution and in-plane straining of the 1L ReS2 quantum dots. Optical spectroscopies reveal the abnormal charge transfer between the 1L ReS2 quantum dots and the MoS2 matrix, resulting from electron trapping in the 1L ReS2 quantum dots. This study may shed light on the development of in-plane quantum-confined devices in 2D materials for potential applications in quantum information.

Dirac Fermion Kinetics in 3D Curved Graphene.

3D integration of graphene has attracted attention for realizing carbon-based electronic devices. While the 3D integration can amplify various excellent properties of graphene, the influence of 3D curved surfaces on the fundamental physical properties of graphene has not been clarified. The electronic properties of 3D nanoporous graphene with a curvature radius down to 25-50 nm are systematically investigated and the ambipolar electronic states of Dirac fermions are essentially preserved in the 3D graphene nanoarchitectures, while the 3D curvature can effectively suppress the slope of the linear density of states of Dirac fermion near the Fermi level are demonstrated. Importantly, the 3D curvature can be utilized to tune the back-scattering-suppressed electrical transport of Dirac fermions and enhance both electron localization and electron-electron interaction. As a result, nanoscale curvature provides a new degree of freedom to manipulate 3D graphene electrical properties, which may pave a new way to design new 3D graphene devices with preserved 2D electronic properties and novel functionalities.

A nuclear lamina-chromatin-Ran GTPase axis modulates nuclear import and DNA damage signaling.

The Ran GTPase regulates nuclear import and export by controlling the assembly state of transport complexes. This involves the direct action of RanGTP, which is generated in the nucleus by the chromatin-associated nucleotide exchange factor, RCC1. Ran interactions with RCC1 contribute to formation of a nuclear:cytoplasmic (N:C) Ran protein gradient in interphase cells. In previous work, we showed that the Ran protein gradient is disrupted in fibroblasts from Hutchinson-Gilford progeria syndrome (HGPS) patients. The Ran gradient disruption in these cells is caused by nuclear membrane association of a mutant form of Lamin A, which induces a global reduction in heterochromatin marked with Histone H3K9me3 and Histone H3K27me3. Here, we have tested the hypothesis that heterochromatin controls the Ran gradient. Chemical inhibition and depletion of the histone methyltransferases (HMTs) G9a and GLP in normal human fibroblasts reduced heterochromatin levels and caused disruption of the Ran gradient, comparable to that observed previously in HGPS fibroblasts. HMT inhibition caused a defect in nuclear localization of TPR, a high molecular weight protein that, owing to its large size, displays a Ran-dependent import defect in HGPS. We reasoned that pathways dependent on nuclear import of large proteins might be compromised in HGPS. We found that nuclear import of ATM requires the Ran gradient, and disruption of the Ran gradient in HGPS causes a defect in generating nuclear γ-H2AX in response to ionizing radiation. Our data suggest a lamina-chromatin-Ran axis is important for nuclear transport regulation and contributes to the DNA damage response.

Obsessive-Compulsive Personality Symptoms Predict Poorer Response to Gamma Ventral Capsulotomy for Intractable OCD.

Gamma ventral capsulotomy (GVC) is a radiosurgical procedure which aims to create lesions in the ventral part of the anterior limb of the internal capsule (ALIC). It has been used as a treatment option for patients with intractable obsessive-compulsive disorder (OCD) who do not respond to several first-line treatments attempts. However, changes in personality disorder symptoms after GVC have not been investigated. The aims of this study are to investigate changes in personality disorder symptoms after GVC and to search for baseline personality disorder symptoms that may predict clinical response to GVC. Fourteen treatment-intractable OCD patients who underwent GVC completed the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) at baseline and one year after the procedure. Wilcoxon signed-rank test was performed to investigate personality disorder symptom changes before and after surgery. Linear regression models were utilized to predict treatment response, using baseline personality disorder symptoms as independent variables. We did not observe any quantitative changes in personality disorder symptoms after GVC, compared with baseline. Higher severity of obsessive-compulsive personality disorder symptoms at baseline was correlated with worse treatment response after GVC for OCD (ß = -0.085, t-value = -2.52, p-value = 0.027). These findings advocate for the safety of the GVC procedure in this specific population of intractable OCD patients, in terms of personality disorder symptom changes. They also highlight the importance of taking into account the severity of obsessive-compulsive personality disorder symptoms when GVC is indicated for intractable OCD patients.

The Heartrate Reaction to Acute Stress in Horned Passalus Beetles (Odontotaenius disjunctus) is Negatively Affected by a Naturally-Occurring Nematode Parasite.

There are many events in the lives of insects where rapid, effective stress reactions are needed, including fighting conspecifics to defend territories, evading predators, and responding to wounds. A key element of the stress reaction is elevation of heartrate (HR), for enhancing distribution of blood (hemolymph) to body compartments. We conducted two experiments designed to improve understanding of the insect stress reaction and how it is influenced by parasitism in a common beetle species (Odontotaenius disjunctus). By non-destructively observing heartbeat frequency before, during and after applying a stressor (physical restraint) for 10 min, we sought to determine: (1) the exact timing of the cardiac stress reaction; (2) the magnitude of heartrate elevation during stress; and (3) if the physiological response is affected by a naturally-occurring nematode parasite, Chondronema passali. Restraint caused a dramatic increase in heartrate, though not immediately; maximum HR was reached after approximately 8 min. Average heartrate went from 65.5 beats/min to a maximum of 81.5 (24.5% increase) in adults raised in the lab (n = 19). Using wild-caught adults (n = 77), average heartrates went from 54.9 beats/min to 74.2 (35.5% increase). When restraint was removed, HR declined after ~5 min, and reached baseline 50 min later. The nematode parasite did not affect baseline heartrates in either experiment, but in one, it retarded the heartrate elevation during stress, and in the other, it reduced the overall magnitude of the elevation. While we acknowledge that our results are based on comparisons of beetles with naturally-occurring parasite infections, these results indicate this parasite causes a modest reduction in host cardiac output during acute stress conditions.

What does immunology have to do with brain development and neuropsychiatric disorders?

Introduction: Neural development is an enormously complex and dynamic process. From very early in brain development 'immune cells' play a key role in a number of processes including the formation and refinement of neural circuits, as well as sexual differentiation. There is a growing body of evidence that the immune system also plays an important role in the pathobiology of several neurodevelopmental and neuropsychiatric disorders. Objective: The goal of this article is to review the currently available data concerning the role of the 'immune system' in normal brain development, as well as its role in the pathobiology of neurodevelopmental and neuropsychiatric disorders. Methodology: We conducted a traditional literature search using PubMed and recent special issues of journals to locate relevant review articles. Results: The cellular and molecular processes that make up our 'immune system' are crucial to normal brain development and the formation and maintenance of neural circuits. It is also increasingly evident that the immune system and neuroinflammation play important roles in the pathobiology of at least a subset of individuals with Autism Spectrum Disorder (ASD), schizophrenia, obsessive-compulsive disorder, Tourette syndrome and mood disorders, such as depression, as well as autoimmune and neurodegenerative disorders. Emerging evidence also points to the importance of the 'gut-brain axis' and an individual's microbiome, which can impact an individual's somatic and mental well-being. Conclusions: There are multidirectional interconnections across multiple biological systems in our brains and bodies that are mediated in part by the immune system. At present, however, the 'promise' of this field remains greater than the 'deliverables'. Time will tell whether novel interventions will be developed that will make a positive difference in the care of our patients. It is also possible that valid biomarkers will emerge that will guide a more personalized approach to treatment.

Introdução: O desenvolvimento neural é um processo extremamente complexo e dinâmico. Tao pronto se inicia o desenvolvimento do cérebro, as "células imunológicas" desempenham um papel fundamental em vários processos, incluindo a formação e aperfeiçoamento de circuitos neurais, bem como a diferenciação sexual. Há um crescente corpo de evidências de que o sistema imunológico também desempenha um papel importante na fisiopatologia de diversos transtornos neurodesenvolvimentais e neuropsiquiátricos. Objetivo: O objetivo deste artigo é revisar os dados atualmente disponíveis sobre o papel do "sistema imunológico" em relação ao desenvolvimento normal do cérebro, bem como a fisiopatogenia dos transtornos de neurodesenvolvimento e neuropsiquiátricos. Metodologia: Foi realizada uma pesquisa bibliográfica tradicional para localizar artigos de revisão relevantes. Resultados: Os processos celulares e moleculares que compõem o nosso "sistema imunológico" são cruciais para o desenvolvimento normal do cérebro e a formação e manutenção de circuitos neurais. É cada vez mais evidente que o sistema imunológico e neuroinflamação desempenham papéis importantes na etiopatogenia de pelo menos um subconjunto de indivíduos com autismo, esquizofrenia, transtorno obsessivo-compulsivo, síndrome de Tourette, depressão e transtornos do humor, bem como distúrbios autoimunes e neurodegenerativos. Evidências emergentes também apontam para a importância do eixo intestino-cerebral e do microbioma de um indivíduo em relação à sua saúde e bem-estar somático e mental. Conclusões: Existem interconexões multidirecionais entre múltiplos sistemas biológicos em nossos cérebros e corpos que são mediados em parte pelo sistema imunológico. No momento, no entanto, a "promessa" desse campo continua sendo maior do que os "resultados finais". O tempo dirá se novas intervenções serão desenvolvidas que farão uma diferença positiva no cuidado de nossos pacientes. Também é possível que surjam biomarcadores válidos que orientarão uma abordagem mais personalizada ao tratamento.

Implementation of a care management model for depression at two primary care clinics.

The Mayo clinic participated in the Depression Improvement Across Minnesota, Offering a New Direction model at two Mayo Family Clinics, that is, the Rochester Northwest and Northeast sites. Although the Northwest and Northeast clinics demonstrated the best 6-month remission rates in the state during the first year of implementation, they were retrospectively found to differ on several process issues and on measures related to the populations served. Six-month remission rates were significantly better at Northwest clinic; yet, Northeast clinic had more patient contacts. Differences in rates of activation into care management, care management accessibility, and differences in maintaining contact with patients at 6 months may explain some of these results.