Development of NAMASTE (New Anxiety Management Algorithm Standardizing Treatment Experience) and Implementation in Primary Care.

Evidence-based depression treatment in primary care is well established. However, clinicians are less likely to be trained to diagnose and treat anxiety disorder, which is frequently comorbid, poses an independent risk for suicidality, and complicates disease management. The University of North Carolina's Internal Medicine Clinic developed a measurement-guided approach to identifying and treating anxiety disorder using the seven-item Generalized Anxiety Disorder Scale, treatment algorithms, medication charts, case-based training for best practices, onsite behavioral counseling, and psychiatric consultation. NAMASTE (new anxiety management algorithm standardizing treatment experience) offers a treatment approach for primary care and addresses a major unmet need in public health and medical education.

Sex Ratios and Mating Status of the Horn Fly on Pastured Cattle as a Function of Repellent-Oil Treatments.

Haematobia irritans (L.) (Diptera: Muscidae) were netted from pastured cattle in California over two summers, with the goal of documenting on-host sex ratios and mating success as they might vary with repellent applications. Sex ratios were calculated from 100 adults per herd per date, and mating status of females (n = 30 per herd per date) was assessed by dissection of spermathecae. Flies were collected before, during, and after 2-wk treatment periods with each of two repellent-oil mixtures: a 15% mixture of fatty acids (C8, C9, C10) in mineral oil or a 2% solution of geraniol in mineral oil. During the treatment period, flies were collected 3-4 d after the prior treatment and immediately before the next treatment. A separate herd used in the second year was untreated. Overall, the proportion female was 0.65 ± 0.01 (mean ± SE) (range 0.28-0.81). Sex ratios were not altered over time by treatments with either repellent. Overall, proportion of females mated was 0.744 ± 0.018 (range 0.40-1.00). Mating status was significantly affected by the two repellent treatments, which did not differ from each other. For treatment herds, proportion mated before treatment was 0.789 ± 0.039, dropping significantly to 0.659 ± 0.038 during the treatment period, and rebounding to 0.750 ± 0.035 after treatments ceased. Treatments probably killed or repelled the existing heterogeneous fly population, and during treatment relatively more flies were unmated recent arrivals.

Effects of Fatty Acid and Geraniol Repellent-Oil Mixtures Applied to Cattle on Blood Feeding and Reproductive Parameters in Field Populations of Haematobia irritans (Diptera: Muscidae).

California pastured cattle were treated with 250 ml of a 15% mixture of fatty acids (C8-C9-C10) or 125 ml of 2% geraniol in a mineral oil carrier to assess impacts on horn flies, Haematobia irritans (L.) (Diptera: Muscidae) over two summers. Horn flies were netted from cattle every 3-4 d for 2 wk before treatment, 2 wk during treatment (four treatments, with flies collected before each treatment), and 2 wk after treatments ceased. Blood meal weights were estimated by hemoglobin assay of excised abdomens. Other females were dissected to determine the number of active ovarioles and the stage of primary follicle development. Depending on year and herd, pretreatment males contained an average of 0.6-1.0 mg of blood, while females contained 1.7-2.7 mg. Pretreatment egg development (least developed oocytes were stage 1 and fully developed eggs were stage 5) averaged 3.7-4.3, and number of active ovarioles averaged 18.1 to 19.6/female. During treatment periods, significant reductions in blood weight were noted for females, but usually not for males, and females also often exhibited reduced mean oocyte stage and number of active ovarioles. Peaks in proportions of young nulliparous females (oocyte stages 1 or 2) were seen during some repellent application periods. This suggested older females had been killed or driven off from the local population by the treatments, and flies on cattle included more young flies that likely were recent arrivals. The repellent-oil mixture thus impacted blood feeding, reproductive fitness, and probably age structure in the field.

Field trials of fatty acids and geraniol applied to cattle for suppression of horn flies, Haematobia irritans (Diptera: Muscidae), with observations on fly defensive behaviors.

Adult horn fly populations were tracked on cattle for 2-week periods before, during and after multiple treatments (every 3-4days) with two repellents in a mineral oil carrier. Cattle were sprayed four times in a two-week period either with 2% geraniol (125ml/cow) or a 15% mixture of short chain fatty acids (C8-C9-C10)(250ml/cow), and there were untreated control cattle. Trials were conducted in California and North Carolina for 3 summers. Short-term fly counts (same day) on treated cattle were reduced by 61-99%, depending on material and trial, and the fatty acid mixture provided better control than geraniol. Horn fly counts were suppressed for 1-3 d and rebounded somewhat after both treatments. Consecutive treatments showed evidence of persistent impact in California where herds were more isolated. Rebounds to pre-treatment levels 3-4 d after treatment occurred more often in North Carolina, where other infested cattle were closer to treated herds. By 3-4 d post-treatment, horn flies were reduced by 29-61% in California and 0-83% in North Carolina, relative to pre-treatment. Background behavior frequencies were assessed from hundreds of counts on untreated, infested California cattle, where horn flies were the only abundant biting fly. Behavior averages were 16.5 tail flicks, 7.6 skin twitches, 1.2 head throws, or 0.2 leg stamps per 2min observation period. At horn fly densities from about 200 to more than 1000 flies per animal (moderate to high numbers), fly defensive behaviors on control cattle were poorly related (or unrelated) to fly numbers. Immediately after repellent application, however, flies were almost absent and behavior frequencies dropped distinctly. Cattle fly defensive behaviors therefore seem to be quite sensitive to low (less than 100 flies/animal) horn fly densities, and behaviors would be a poor quantitative tool to track fly stress at moderate densities and above. Both geraniol and the fatty acids show promise for horn fly control, especially in organic agriculture. Treatments at 1-2 d intervals probably would keep infestations below the economic threshold (200 flies/cow).

Estimating Field Densities of Haematobia irritans (Diptera: Muscidae) Using Direct Visual Field Counts Versus Photographic Assessments.

Horn flies, Haematobia irritans (L.), were photographed on cattle and then immediately estimated visually in the field on pastured beef cattle in southern California. Horn flies were counted in the pictures later on a computer screen. For 479 counts on individual cattle, the concordance correlation coefficient between the visual and photo-based assessments was 0.790, but was better for the higher half of the counts (0.732) than for the lower half of the counts (0.217). Major axis regression indicated that visual estimates were consistently higher than the number of flies counted in the pictures across the entire density range. Based on average raw means, the visual estimates averaged 21% higher than the photo counts. Visual estimates included flies on the belly and lower legs that could not be seen in a photo, and lower densities may have been more susceptible to such error. Where flies can be seen well, e.g. for very tame animals, the visual estimates were much faster and more cost-efficient and were sufficient to track relative horn fly abundance changes.

Temperature governs on-host distribution of the northern fowl mite, Ornithonyssus sylviarum (Acari: Macronyssidae).

The northern fowl mite, Ornithonyssus sylviarum (Canestri & Fanzago), is an ectoparasite of more than 70 species of North American wild birds, but it has a particularly significant impact on chickens, where it is a permanent resident of vent feathers. Improved control practices depend on a better understanding of host-mite relationships. ISA Brown hens were inoculated experimentally with northern fowl mite adults, and northern fowl mite populations developed naturally. Using a fast-response microprobe, temperatures of individual vent feathers (n = 15) were recorded at 5-mm increments along the length of the feather shaft. Immediately after temperatures were recorded, the individual feathers were quickly clipped at the skin surface and then flash-frozen between 2 small blocks of dry ice, freezing all northern fowl mite stages in situ. The feathers then were cut into 5-mm sections for careful mite enumeration by life stage. There were no overall differences among life stages in the distributions on the feather. Mite positions on feathers (distance from skin) varied distinctly with feather zone temperatures, as well as with ambient and average temperatures over the prior 24 hr. Ambient temperature at time of sampling affected the positions of the 2 mobile categories, adults and larvae/nymphs, but showed no statistical relationship with egg distribution. In contrast, ambient 24-hr temperature influenced the positions of all life stages. On-host feather temperatures reflected ambient temperatures. Feathers collected on hot days (ambient temperatures of 23-33 C) provided a narrow and quite warm range of temperature conditions for mites (often >30-36 C). Temperatures on cool days (ambient temperatures of <23 C) provided much wider on-host temperature ranges for mites to occupy (13-35 C). Mites were farther from the skin on warmer days. When mites had a broad range of temperatures, the feather temperature zone occupied by all life stages averaged 28-29 C. Mites move to occupy favorable temperature conditions on-host. When further out on feathers in warm weather, and under thermal stress, northern fowl mites either move off host or are dislodged. They then become a human pest, are noticed by farmers, and are more likely to disperse.

Evaluation of a depression screening and treatment program in primary care for patients with diabetes mellitus: insights and future directions.

PURPOSE: To evaluate a collaborative depression care program by assessing adherence to the program by internal medicine clinic (IMC) staff, and the program's effectiveness in treating depression in patients with diabetes mellitus. We also describe the rate of depression among patients with diabetes in the IMC. DATA SOURCES: Data for this program were obtained from a de-identified disease registry and included 1312 outpatient IMC visits in adult patients with diabetes between March 2011 and September 2011. CONCLUSIONS: Collaborative depression care results in high rates of screening for and identification of depression, high rates of antidepressant utilization, and improved depression scores; however, more focused interventions are needed to improve diabetes outcomes in patients with depression and diabetes. IMPLICATIONS FOR PRACTICE: The results indicate that the multidisciplinary IMC staff can work together with patients to identify and monitor depression within primary care. This study provides valuable information about models of depression care that can be implemented and evaluated in a clinical setting.

Musca autumnalis (Diptera: Muscidae) and the host-specific nematode Paraiotonchium autumnale (Tylenchida: Iotonchiidae) in southern California.

Musca autumnalis DeGeer were collected in the summer and fall of 2011 and 2012 from a beef cattle herd in southern California Visual counts of Musca spp. on cattle faces were documented, and sweep net samples of face flies and other Diptera were also collected from cattle faces. Face flies dominated in the net collections, and 5-30 flies per face were common between early July and October 2011. Adult female M. autumnalis were dissected and examined for the presence of the host-specific nematode Paraiotonchium autumnale (Nickle). Overall, 67 of 887 (7.6%) adult face fly females were parasitized. M. autumnalis' ability to survive in such a southerly latitude (34 degree N) could reflect the rather temperate weather (coastal effects) and frequently irrigated pastures at the experimental site in southern California Preliminary observations suggest that face flies disappear from cattle during winter, despite generally favorable temperatures for fly activity. This is a possible indication of diapause and should be examined further.

Self-care confidence mediates the relationship between perceived social support and self-care maintenance in adults with heart failure.

BACKGROUND: Social support may be associated with heart failure (HF) self-care; however, the mechanisms are not well understood. We examined the association between perceived support and self-care behaviors and whether self-care confidence mediates these relationships. METHODS: Cross-sectional survey of HF patients seen in outpatient clinic settings. Our outcome (HF self-care maintenance and self-care management) and mediator (HF self-care confidence) variables were assessed with the Self-Care of Heart Failure Index. Perceived emotional/informational support was assessed with the Medical Outcomes Study social support survey. We performed regression analyses to examine associations between perceived support and HF self-care behaviors. Mediation analysis was performed according to the Baron and Kenny method. RESULTS: We surveyed 150 HF patients (mean age 61 y; 51% female; 43% black). More emotional/informational support was associated with better self-care maintenance (ß = 0.13; P = .04). More emotional/information support was associated with better self-care management in unadjusted (ß = 0.23; P = .04), but not adjusted (ß = 0.20, P = .10), analysis. Self-care confidence mediates the association between perceived support and self-care maintenance (percent change in ß coefficient was 32%) and management (percent change in ß coefficient was 20%). CONCLUSION: Perceived emotional/informational support is associated with better self-care maintenance and possibly better self-care management. Greater self-care confidence is one mediating mechanism.