Quality Indicators for Major Depressive Disorder in Adults: A Review of Performance Measures by the American College of Physicians.

Major depressive disorder (MDD) is a severe mood disorder that affects at least 8.4% of the adult population in the United States. Characteristics of MDD include persistent sadness, diminished interest in daily activities, and a state of hopelessness. The illness may progress quickly and have devastating consequences if left untreated. Eight performance measures are available to evaluate screening, diagnosis, and successful management of MDD. However, many performance measures do not meet the criteria for validity, reliability, evidence, and meaningfulness.The American College of Physicians (ACP) embraces performance measurement as a means to externally validate the quality of care of practices, medical groups, and health plans and to drive reimbursement processes. However, a plethora of performance measures that provide low or no value to patient care have inundated physicians, practices, and systems and burdened them with collecting and reporting of data. The ACP's Performance Measurement Committee (PMC) reviews performance measures using a validated process to inform regulatory and accreditation bodies in an effort to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden. Out of 8 performance measures, the PMC found only 1 measure (suicide risk assessment) that was valid at all levels of attribution. This paper presents a review of MDD performance measures and highlights opportunities to improve performance measures addressing MDD management.

Quality Indicators for Osteoporosis in Adults: A Review of Performance Measures by the American College of Physicians.

Primary osteoporosis is characterized by decreasing bone mass and density and reduced bone strength that leads to a higher risk for fracture, especially hip and spine fractures. The prevalence of osteoporosis in the United States is estimated at 12.6% for adults older than 50 years. Although it is most frequently diagnosed in White and Asian females, it still affects males and females of all ethnicities. Osteoporosis is considered a major health issue, which has prompted the development and use of several performance measures to assess and improve the effectiveness of screening, diagnosis, and treatment. These performance measures are often used in accountability, public reporting, and/or payment programs. However, the reliability, validity, evidence, attribution, and meaningfulness of performance measures have been questioned. The purpose of this paper is to present a review of current performance measures on osteoporosis and inform physicians, payers, and policymakers in their selection of performance measures for this condition. The Performance Measurement Committee identified 6 osteoporosis performance measures relevant to internal medicine physicians, only 1 of which was found valid at all levels of attribution. This paper also proposes a performance measure concept to address a performance gap for the initial approach to therapy for patients with a new diagnosis of osteoporosis based on the current American College of Physicians guideline.

Fluorescently Labeling Amino Acids in a Deep Eutectic Solvent.

The increased use of deep eutectic solvents (DESs) in recent years has been significant and provides new approaches to sample collection and preparation. At the same time, the use of these new solvents to prepare samples can present challenges for subsequent analyses. Common analytical approaches, such as fluorescent labeling, may not be compatible with the solvents. In this work, we explore how effective three traditional fluorescent labels can be at derivatizing amino acids in the most common DESs, formed from choline chloride and ethylene glycol. We demonstrate that the unique solvent characteristics of the DESs still allow for two of the fluorophores, fluorescein isothiocyanate and 5-carboxyfluorescein succinimidyl ester, to effectively label amino acids. Initial optimizations of the reaction conditions demonstrate that we can effectively label both d- and l-amino acids, in solution with concentrations of amino acids down to 4 µM. Capillary electrophoretic separations following this preparation can detect as little as 50 nM. This is possible without removal of any DES from the sample matrix. These results represent the first complete fluorescent labeling reaction in a DES and subsequent capillary electrophoretic separation of the analytes.

Influence of Body Mass Index on Eating Habits and Food Choice Determinants Among Brazilian Women During the COVID-19 Pandemic.

Changes in emotional state due to the COVID-19 pandemic may potentially modify eating habits, which may differ as a function of body mass index (BMI). Using a self-reported, questionnaire-based survey we evaluated Brazilian women during the pandemic for: (i) the influence of BMI on changes in eating habits, food choice determinants, and psychological symptoms; (ii) associations between eating habits, food choice determinants and psychological symptoms. General characteristics, anthropometric data, eating habits before and during the pandemic, food choice determinants and psychological symptoms during the pandemic were collected between June and September, 2020. Participants (n = 1,183) were normal weight (60.4%), overweight (26.2%) and obese (13.4%). A higher frequency of "cooking" (72.3-77.6%, p = 0.004) and "use of delivery service" (29.8-48.8%, p < 0.001) was reported during, in comparison to before the pandemic. Additionally, a higher prevalence of "snacking" (57.1-63.8%, p = 0.005) and "eating at table" (78.5-82.7%, p < 0.001) was reported during the pandemic, while the number of participants reporting "dieting" decreased (28.7-20.4%, p < 0.001). "Health", "natural concerns" and "need and hunger" were less important determinants for participants with overweight/obesity compared to normal weight. Regression analysis indicated that (i) "health", "natural concerns" and "affect regulation"; (ii) "health", "pleasure", "convenience", and "natural concerns"; and (iii) "visual appeal" and "pleasure" were the food choice determinants more associated with eating habits among women with normal weight, overweight, and obesity, respectively. In conclusion, eating habits were modified during the pandemic despite BMI, whereas food choice determinants differed between overweight/obesity and normal weight women.

Poor Eating Habits and Selected Determinants of Food Choice Were Associated With Ultraprocessed Food Consumption in Brazilian Women During the COVID-19 Pandemic.

Background: The aim of this study was to investigate possible associations between food consumption and eating habits and food choice determinants in women during COVID-19 pandemic. Methods: This is a cross-sectional survey conducted in Brazil between June and September, 2020, during which time social distancing measures were in place. Results: Participants (n = 629) were aged 34.0 years and mostly within normal weight according to BMI (60.4%). "Snacking" and "liking" associated with increased energy (ß = 164.27 and ß = 110.24) and carbohydrate intake (ß = 1.97 and ß = 1.80), and with reduced protein intake (ß = -1.54 and ß = -1.18). In contrast, "dieting" and "weight control" associated with reduced energy (ß = -162.57 and ß = -111.49) and carbohydrate intake (ß = -2.78 and ß = -2.07), and with increased protein intake (ß = 3.78 and ß = 1.65). "Dieting" (ß = 7.27), "need and hunger" (ß = 3.34), and "health" (ß = 4.94) associated with an increased consumption of unprocessed and minimally processed foods, whereas "replacing main meals with snacks" (ß = -8.98), "snacking" (ß = -6.92) and binge eating symptoms (ß = -0.34) associated with reduced consumption of foods within this processing level. In contrast, "use of delivery services" (ß = 3.39), "replacing main meals with snacks" (ß = 5.49), "visual appeal" (ß = 2.17), "social norms" (ß = 2.19) and "affect regulation" (ß = 2.01) associated with increased ultraprocessed food consumption. Overall, associations were more frequent and pronounced when analyzing food consumption by processing level rather than by macronutrient intake. Conclusion: Some eating habits and food choice determinants ("snacking," "replacing meals with snacks," "use of delivery services") observed during the COVID-19 pandemic were associated with an unhealthy diet (high energy and carbohydrate consumption, increased ultraprocessed food consumption and reduced unprocessed/minimally processed foods consumption) in Brazilian women.

Efecto antinociceptivo de estriol y Glicina max l. (soya) en ratas ovariectomizadas / Antinociceptive effect of estriol and Glicina max l. (soya) in ovariectomized rats

Objetivo: Demostrar el efecto protector del estriol y Glicina max L. (soya) frente al dolor nociceptivo, en ratas ovariectomizadas. Diseño: Estudio experimental. Lugar: Bioterio de la Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Material biológico: Ratas hembras albinas Holtzman de 2,5 a 3 meses de edad. Métodos: Las 29 ratas fueron agrupadas aleatoriamente: grupo 1 (n=8), no ovariectomizadas, tratadas con solución salina (0,1 mL/kg); grupo 2 (n=7), ovariectomizadas y tratadas con solución salina (0,1 mL/kg); grupo 3 (n=7), ovariectomizadas y tratadas con estriol (0,2 mg/kg); grupo 4 (n=7), ovariectomizadas y tratadas con Glycine max L. (60 mg/kg). Se realizó una prueba basal de dolor térmico en el hornillo a todos los animales, así como tres días después del tratamiento farmacológico. Principales medidas de resultados: Se usó el porcentaje de eficiencia antinociceptiva máxima (porcentaje EAM). Resultados: Se encontró que el porcentaje EAM fue mayor en el grupo de ratas no ovariectomizadas (1,6 por ciento) que en el grupo de las ovariectomizadas (0,8 por ciento). Por otro lado, el porcentaje EAM en ratas ovariectomizadas con solución salina (0,8 por ciento) fue menor al compararlo con el grupo de las tratadas con estriol (5,8 por ciento); así también, el porcentaje EAM del grupo de ovariectomizadas tratadas con Glicina max L. (4,2 por ciento) fue superior al grupo de ovariectomizadas tratadas con solución salina (0,8 por ciento), pero esta no fue superior a las del grupo tratadas con estriol. Conclusiones: El estriol y la Glicina max L. ejercieron un papel protector frente al dolor nociceptivo térmico en ratas ovariectomizadas.

Objective: To determine the protective effect of estriol and Glycine max L. (soybean) compared to nociceptive pain in ovariectomized rats. Design: Experimental study. Setting: Faculty of Medicine bioterium, Universidad Nacional Mayor de San Marcos, Lima, Peru. Biological material: Holtzman albino female rats 2,5 to 3 months of age. Methods: The 29 rats were grouped randomly: group 1 (n = 8) non ovariectomized rats treated with saline (0.1 mL/kg); group 2 (n = 7) ovariectomized rats treated with saline (0.1 mL / kg); group 3 (n = 7) ovariectomized rats treated with estriol (0.2 mg/kg); group 4 (n = 7) ovariectomized rats treated with Glycine max L. (60 mg/kg). We determined baseline hotplate thermal pain as well as three days after treatment. Main outcome measures: Antinociceptive maximum efficacy (percentage AME). Results: We found that percentage EAM was higher in the non ovariectomized rats group (1.6 per cent) than in the ovariectomized group (0.8 per cent). Furthermore, the percentage of EAM in ovariectomized rats treated with saline (0.8 per cent) compared with the group treated with estriol (5.8 per cent) and also the percentage of EAM in the Glycine max L. group (4.2 per cent) was higher than in the ovariectomized group treated with saline (0.8 per cent) but not higher than the group treated with estriol. Conclusions: Estriol and Glycine max L. have protective role against thermal nociceptive pain in ovariectomized rats.

Nanobacteria-like particles: a threat to cell cultures

The main goal of this study is to alert researchers who work with cell cultures for the risk of contamination by structures called nanobacteria (NB). NB are tiny structures with size varying from 80 to 500 nm, commonly occurring in clusters and producing a biofilm which contains carbonate or hydroxyl apatite. The most likely source of cell culture contamination by such organisms is serum used as supplement in culture media. The presence of NB leads to a progressive culture deterioration with accumulation of granules (probably phagocytized NB) in cytoplasmic vacuoles, an increasing number of dead cells in the supernatant and degeneration of cells that remained attached to the bottom of the vessel. NB can also be found in culture supernatants where they are found in clusters with variable size and displaying brownian movement. In this study, 19 cell lineages, 8 batches of sera and 1 batch of growth supplement from different sources were analyzed. Samples from sera were cultured in Eagle's Minimum Essential Medium (E-MEM) or incubated directly at 37°C. Tests carried out to detect the presence of extracellular bacteria, Mycoplasma sp and viruses were all negative. Analysis by scanning electron microscopy (SEM) revealed tiny oval structures less than 500 nm in size, isolated or in small groups, in all material analyzed except in one fetal bovine serum batch.

O principal objetivo deste estudo é alertar aos pesquisadores que trabalham com cultivos celulares sobre o risco de contaminação por estruturas denominadas nanobactérias (NB). NB são estruturas muito pequenas cujo tamanho varia de 80 a 500 nm e que comumente ocorrem em agrupamentos, produzindo biofilme de carbonato ou hidroxiapatita. A fonte mais provável de contaminação dos cultivos celulares por tais organismos é o soro utilizado como suplemento nos meios de cultura. A presença de NB leva a uma progressiva deterioração do cultivo com acúmulo de grânulos (provavelmente NB fagocitadas) em vacúolos citoplasmáticos, um número cada vez maior de células mortas no sobrenadante e degeneração das células que permaneceram aderidas à superfície do frasco de cultura. NB podem ser encontradas também em sobrenadantes de cultivos onde são observadas em agrupamentos de tamanho variável com movimento browniano. Neste estudo, 19 linhagens celulares, 8 lotes de soro e 1 lote de suplemento de diferentes procedências foram analisados. Amostras de soros foram cultivadas em Meio Essencial Mínimo de Eagle (E-MEM) ou incubados diretamente a 37°C. Testes efetuados para detectar a presença de bactérias extracelulares, Mycoplasma sp e vírus foram todos negativos. Análise por microscopia eletrônica de varredura (SEM) revelou minúsculas estruturas ovóides com tamanho inferior a 500 nm, isoladas ou em pequenos agrupamentos, em todos os materiais analisados exceto em um lote de soro fetal bovino.