From obligation to opportunity: future of patient-reported outcome measures at the Veterans Health Administration.

Patient-reported outcome (PRO) measures are particularly important in mental health services because patients are the central and essential source of information about their mental health status. PRO measures have the potential to engage patients in meaningful and focused conversations during clinical encounters, but unfortunately they often do not serve this purpose in mental health care. Administration of routine outcome measures has often been viewed by clinicians as an obligatory quality improvement process that takes time away from the clinical encounter. This commentary describes current practical barriers to using PRO measures in practice. Then, focusing specifically on the Veterans Health Administration, a unit of the U.S. Department of Veterans Affairs (VA), we propose processes within which PRO measures in mental health services could support the clinical encounter and enhance patient-centered mental health care. With the increasing number of Accountable Care Organizations and other integrated health-care systems that focus on mental health-care delivery, VA has an opportunity to leverage its long-standing electronic medical record technologies and integrated health system to serve as a model for incorporating PRO measures into mental health-care practices. This commentary provides a vision for the future of mental health delivery by incorporating PRO measures at the VA and in other health-care systems.

In vitro grown pollen tubes of Nicotiana alata actively synthesise a fucosylated xyloglucan.

Nicotiana alata pollen tubes are a widely used model for studies of polarized tip growth and cell wall synthesis in plants. To better understand these processes, RNA-Seq and de novo assembly methods were used to produce a transcriptome of N. alata pollen grains. Notable in the reconstructed transcriptome were sequences encoding proteins that are involved in the synthesis and remodelling of xyloglucan, a cell wall polysaccharide previously not thought to be deposited in Nicotiana pollen tube walls. Expression of several xyloglucan-related genes in actively growing pollen tubes was confirmed and xyloglucan epitopes were detected in the wall with carbohydrate-specific antibodies: the major xyloglucan oligosaccharides found in N. alata pollen grains and tubes were fucosylated, an unusual structure for the Solanaceae, the family to which Nicotiana belongs. Finally, carbohydrate linkages consistent with xyloglucan were identified chemically in the walls of N. alata pollen grains and pollen tubes grown in culture. The presence of a fucosylated xyloglucan in Nicotiana pollen tube walls was thus confirmed. The consequences of this discovery to models of pollen tube growth dynamics and more generally to polarised tip-growing cells in plants are discussed.