Sampling Procedures for the Collection of Electronic Health Record Data From Federally Qualified Health Centers, 2021-2022 National Ambulatory Medical Care Survey.

As part of modernization efforts, in 2021 the National Ambulatory Medical Care Survey (NAMCS) began collecting electronic health records (EHRs) for ambulatory care visits in its Health Center (HC) Component. As a result, the National Center for Health Statistics (NCHS)needed to adjust the approaches used in the sampling design for the HC Component. This report provides details on these changes to the 2021-2022 NAMCS.

Factors Associated With Variation in Pediatric Systemic Lupus Erythematosus Care Delivery.

OBJECTIVE: Patients with pediatric systemic lupus erythematosus (pSLE) and mixed connective tissue disease (MCTD) receive only a fraction of recommended care. Using published quality indicators and guidelines, we developed a 13-item pediatric lupus care index (p-LuCI) to quantify the proportion of recommended clinical evaluations and comorbidity prevention interventions completed and the timeliness of follow-up. Our objective was to assess baseline index performance and identify sources of p-LuCI variation. METHODS: We performed a cross-sectional study in patients with pSLE or MCTD and analyzed the performance of individual p-LuCI process metrics and calculated the overall p-LuCI score. We identified factors associated with the p-LuCI using multivariable linear regression with clustering by provider. RESULTS: For 110 patients (99 with pSLE and 11 with MCTD), the median p-LuCI was 65.2% (interquartile range: 9.1-92.3%). Component performance ranged from 27.3% (on-time scheduling) to 95.4% (steroid-sparing treatment). Patients with p-LuCI scores above the median had higher scores across all 13 components. Higher p-LuCI scores were independently associated with disease-modifying antirheumatic drug use (ß = 14.3 [95% confidence interval (CI), 1.5-27.2]), nephritis (ß = 10.4 [95% CI, 5.1-15.8]), higher provider pSLE/MCTD volume (ß = 3.1 [95% CI, 1.9-4.2] per patient), assignment to rheumatology fellow trainee (ß = 36.3 [95% CI, 17.3-55.2]), and disease duration of less than 1 year (ß = 12.6 [95% CI, 0.7-24.5]). Differences by race, ethnicity, and/or insurance were not observed. CONCLUSION: Using an index of recommended pSLE care metrics, we identified significant variation in performance by disease, treatment, and provider characteristics. The p-LuCI may be useful to assess care quality at the patient, provider, and practice levels and to identify areas in need of greater standardization.

Profiling gene expression in the human dentate gyrus granule cell layer reveals insights into schizophrenia and its genetic risk.

Specific cell populations may have unique contributions to schizophrenia but may be missed in studies of homogenate tissue. Here laser capture microdissection followed by RNA sequencing (LCM-seq) was used to transcriptomically profile the granule cell layer of the dentate gyrus (DG-GCL) in human hippocampus and contrast these data to those obtained from bulk hippocampal homogenate. We identified widespread cell-type-enriched aging and genetic effects in the DG-GCL that were either absent or directionally discordant in bulk hippocampus data. Of the ~9 million expression quantitative trait loci identified in the DG-GCL, 15% were not detected in bulk hippocampus, including 15 schizophrenia risk variants. We created transcriptome-wide association study genetic weights from the DG-GCL, which identified many schizophrenia-associated genetic signals not found in transcriptome-wide association studies from bulk hippocampus, including GRM3 and CACNA1C. These results highlight the improved biological resolution provided by targeted sampling strategies like LCM and complement homogenate and single-nucleus approaches in human brain.

Insights into myalgic encephalomyelitis/chronic fatigue syndrome phenotypes through comprehensive metabolomics.

The pathogenesis of ME/CFS, a disease characterized by fatigue, cognitive dysfunction, sleep disturbances, orthostatic intolerance, fever, irritable bowel syndrome (IBS), and lymphadenopathy, is poorly understood. We report biomarker discovery and topological analysis of plasma metabolomic, fecal bacterial metagenomic, and clinical data from 50 ME/CFS patients and 50 healthy controls. We confirm reports of altered plasma levels of choline, carnitine and complex lipid metabolites and demonstrate that patients with ME/CFS and IBS have increased plasma levels of ceramide. Integration of fecal metagenomic and plasma metabolomic data resulted in a stronger predictive model of ME/CFS (cross-validated AUC = 0.836) than either metagenomic (cross-validated AUC = 0.745) or metabolomic (cross-validated AUC = 0.820) analysis alone. Our findings may provide insights into the pathogenesis of ME/CFS and its subtypes and suggest pathways for the development of diagnostic and therapeutic strategies.