UCLA

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BACKGROUND AND OBJECTIVES: Headache syndromes are highly prevalent, disabling, and costly. Our goals were to (1) describe headache care delivery and costs in a system and (2) identify opportunities for the system to collect, organize, or analyze health care data to facilitate value-based headache care delivery. METHODS: We performed a descriptive, retrospective cohort study using data from a large integrated health system (July 2018-July 2021). We assigned individuals into a reference (REF) or headache group based on headache-related ICD diagnoses. The primary exposure variable, applied to the headache group, was the headache specialty seen most after the incident headache diagnosis: primary care (PC), neurology (NEU), or headache subspecialist (HS). Outcomes of interest were per member per month all-cause costs, per episode costs, all-cause utilization, and headache utilization. Variables included age, sex, insurance contract, and the Adjusted Clinical Groups (ACG) concurrent risk score. We calculated univariate statistics for clinical indicators and outcomes for each group. For outcome variables, we also report these statistics after adjustment for ACG risk score. RESULTS: We identified 22,700 (14%) individuals in the headache groups and 138,818 (86%) individuals in the reference group (REF). Within the headache groups, 84% received care from PC, 14% from NEU, and 2% from HS. The average ACG risk scores increased across exposure groups. In both unadjusted and after risk adjustment analyses, total cost of care (TCOC) was highest in NEU and HS, and the largest drivers of TCOC were outpatient facility costs, followed by inpatient facility costs. HS had the highest pharmacy and professional costs. After risk adjustment, all-cause inpatient admissions and headache-related ED visits were roughly similar, although there was increasing use of outpatient PC and NEU visits across exposure groups. DISCUSSION: Individuals seen by a NEU or HS had higher medical morbidity, higher health care utilization, and higher costs than those who receive care from PC. Outcome data were either not available or not structured to determine the value of neurologic expertise in headache care or within a particular headache care pathway. To clarify neurologys value in primary headache disorders, we encourage health system leaders to adopt an economic evaluation framework.

Background: Electroconvulsive therapy (ECT) is a highly efficacious intervention for severe and intractable depression. Evidence suggests ECT provokes an initial acute inflammatory response that subsequently decreases with repeated administration. However, relationships between inflammatory changes and clinical effects are unclear. Improved understanding of these processes may provide critical insight into effective intervention for treatment-resistant depression (TRD). Methods: Plasma inflammatory markers were assessed at pre-treatment (T1), after the second ECT session (T2), and after ECT index series completion (post-treatment/T3) in TRD (n = 40). Changes were examined over time and in association with post-treatment Responder/Non-responder status (≥50% reduction in global depression severity) and percent change in affective, cognitive and neurovegetative depressive symptom domains. Results: C-reactive protein (CRP) and interleukin-6 (IL-6) increased from pre-treatment to T2, and decreased from T2 to post-treatment. Neither early (%T2-T1) nor total (%T1-T3) change in inflammation predicted clinical outcomes, however, the interaction between early/acute inflammatory response and post-treatment inflammation (relative to baseline) was associated with clinical outcomes. Larger initial increases in IL-6 predicted greater reductions in both affective and cognitive symptoms in subjects with higher post-treatment IL-6; those with lower post-treatment IL-6 trended toward the opposite. The same was found between changes in CRP and neurovegetative symptoms. Conclusions: Though preliminary, these results demonstrate how processes involved in the acute inflammatory response to ECT may differentially influence clinical outcomes depending on overall trajectory of inflammation following ECT. Findings also highlight the importance of examining symptom-specific changes in depression when studying treatment mechanisms, rather than relying solely on global measures of severity.

Purpose of review

Recent findings

Summary

Our internal sensory systems encode various gut-related sensations, such as hunger, feelings of fullness, and nausea. These internal feelings influence our eating behaviors and play a vital role in regulating energy balance. Among them, the neurological basis for nausea has been the least well characterized, which has hindered comprehension of the connection between these sensations. Single-cell sequencing, along with functional mapping, has brought clarity to the neural pathways of nausea involving the brainstem area postrema. In addition, the newly discovered nausea sensory signals have deepened our understanding of the area postrema in regulating feeding behaviors. Nausea has significant clinical implications, especially in developing drugs for weight loss and metabolism. This review summarizes recent research on the neural pathways of nausea, particularly highlighting their contribution to energy balance.

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Spatial transcriptomics technology enables the mapping of gene expression within tissues, allowing researchers to visualize the spatial distribution of RNA molecules and gain insights into cellular organization, interactions, and functions in their native environments. A variety of spatial technologies are now commercially available, each offering distinct technical parameters such as cellular resolution, detection sensitivity, gene coverage, and throughput. This wide range of options can make it challenges or create confusion for researchers to select the most appropriate platform for their specific research objectives. In this paper, we will analyze and compare seven major commercially available spatial platforms to guide researchers in choosing the most suitable option for their needs.

Precise and rapid disease detection is critical for controlling infectious diseases like COVID-19. Current technologies struggle to simultaneously identify viral RNAs and host immune antibodies due to limited integration of sample preparation and detection. Here, we present acoustofluidic integrated molecular diagnostics (AIMDx) on a chip, a platform enabling high-speed, sensitive detection of viral immunoglobulins [immunoglobulin A (IgA), IgG, and IgM] and nucleic acids. AIMDx uses acoustic vortexes and Gor'kov potential wells at a 1/10,000 subwavelength scale for concurrent isolation of viruses and antibodies while excluding cells, bacteria, and large (>200 nanometers) vesicles from saliva samples. The chip facilitates on-chip viral RNA enrichment, lysis in 2 minutes, and detection via transcription loop-mediated isothermal amplification, alongside electrochemical sensing of antibodies, including mucin-masked IgA. AIMDx achieved nearly 100% recovery of viruses and antibodies, a 32-fold RNA detection improvement, and an immunity marker sensitivity of 15.6 picograms per milliliter. This breakthrough provides a transformative tool for multiplex diagnostics, enhancing early infectious disease detection.

BACKGROUND: Neurocognitive impairment is a well-known phenomenon in schizophrenia that begins prior to psychosis onset. Connectome-wide association studies have inconsistently linked cognitive performance to resting-state functional magnetic resonance imaging. We hypothesized that a carefully selected cognitive instrument and refined population would allow identification of reliable brain-behavior associations with connectome-wide association studies. To test this hypothesis, we first identified brain-cognition correlations via a connectome-wide association study in early psychosis. We then asked, in an independent dataset, if these brain-cognition relationships would generalize to individuals who develop psychosis in the future. METHODS: The Seidman Auditory Continuous Performance Task (ACPT) effectively differentiates healthy participants from those with psychosis. Our connectome-wide association study used the HCP-EP (Human Connectome Project for Early Psychosis) (n = 183) to identify links between connectivity and ACPT performance. We then analyzed data from the NAPLS2 (North American Prodrome Longitudinal Study 2) (n = 345), a multisite prospective study of individuals at risk for psychosis. We tested the connectome-wide association study-identified cognition-connectivity relationship in both individuals at risk for psychosis and control participants. RESULTS: Our connectome-wide association study in early-course psychosis identified robust associations between better ACPT performance and higher prefrontal-somatomotor connectivity (p < .005). Prefrontal-somatomotor connectivity was also related to ACPT performance in at-risk individuals who would develop psychosis (n = 17). This finding was not observed in nonconverters (n = 196) or control participants (n = 132). CONCLUSIONS: This connectome-wide association study identified reproducible links between connectivity and cognition in separate samples of individuals with psychosis and at-risk individuals who would later develop psychosis. A carefully selected task and population improves the ability of connectome-wide association studies to identify reliable brain-phenotype relationships.

To elucidate interfacial dynamics during electrocatalytic reactions, it is crucial to understand the adsorption behavior of organic molecules on catalytic electrodes within the electric double layer (EDL). However, the EDL structure in aqueous environments remains intricate when it comes to the electrochemical amination of acetone, using methylamine as a nitrogen source. Specifically, the interactions of acetone and methylamine with the copper electrode in water remain unclear, posing challenges in the prediction and optimization of reaction outcomes. In this study, initial investigations employed impedance spectroscopy at the potential of zero charge to explore the surface preconfiguration. Here, the capacitance of the EDL was utilized as a primary descriptor to analyze the adsorption tendencies of both acetone and methylamine. Acetone shows an increase in the EDL capacitance, while methylamine shows a decrease. Experiments are interpreted using combined grand canonical density functional theory and ab initio molecular dynamics to delve into the microscopic configurations, focusing on their capacitance and polarizability. Methylamine and acetone have larger molecular polarizability than water. Acetone shows a partial hydrophobic character due to the methyl groups, forming a distinct adlayer at the interface and increasing the polarizability of the liquid interface component. In contrast, methylamine interacts more strongly with water due to its ability to both donate and accept hydrogen bonds, leading to a more significant disruption of the hydrogen bond network. This disruption of the hydrogen network decreases the local polarizability of the interface and decreases the effective capacitance. Our findings underscore the pivotal role of EDL capacitance and polarizability in determining the local reaction environment, shedding light on the fundamental processes important for electro-catalysis.