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There is a recent convergence of three trends that are transforming behavioral health care: 1) patient engagement and activation; 2) electronic capture of patient-reported outcomes integrated directly into the patients’ electronic health record to be used for measurement-based care; and 3) patient-facing health information technology, centering around patient portals, that empowed patients by providing them access to parts of their medical record. Though each component of this model is currently available; they have yet to achieve widespread standard of care. This paper will discuss general considerations to be explored when implementing electronic capture of patient-reported outcomes and multifunctional patient portals in the context of a general behavioral health clinic. First, it presents strategies for implementing electronic data capture of standard behavioral health measures including the process for selecting instruments, setting technical algorithms for standard patient selection, psychometric considerations, and workflow analysis. Electronic data capture can occur through electronic patient portals, about which there is extensive debate within behavioral health. This paper reviews recent research on allowing patients access to their mental health notes. It also presents some original research on providers’ views of note access and secure messaging. Finally, the paper makes recommendations for both future research and clinical practice. The field would benefit from expanding beyond the single focus on note reading and should explore the potential of patient portals as multicomponent Patient Centered Health Information Technology Homes. These homes can serve as an electronic bridge between clinic and home to help patients achieve their health and wellness goals. The overarching aim of this paper is to provide a vision of how this home might work -as well as its impact on clinical care for people suffering mental disorders.

The study of perceptual flexibility in speech depends on a variety of tasks that feature a large degree of variability between participants. Of critical interest is whether measures are consistent within an individual or across stimulus contexts. This is particularly key for individual difference designs that aredeployed to examine the neural basis or clinical consequences of perceptual flexibility. In the present set of experiments, we assess the split-half reliability and construct validity of five measures of perceptual flexibility: three of learning in a native language context (e.g., understanding someone with a foreign accent) and two of learning in a non-native context (e.g., learning to categorize non-native speech sounds). We find that most of these tasks show an appreciable level of split-half reliability, although construct validity was sometimes weak. This provides good evidence for reliability for these tasks, while highlighting possible upper limits on expected effect sizes involving each measure.

Listeners perceive speech sounds categorically. While group-level differences in categorical perception have been observed in children or individuals with reading disorders, recent findings suggest that typical adults vary in how categorically they perceive sounds. The current study investigated neural sources of individual variability in categorical perception of speech. Fifty-seven participants rated phonetic tokens on a visual analogue scale; categoricity and response consistency were measured and related to measures of brain structure from MRI. Increased surface area of the right middle frontal gyrus predicted more categorical perception of a fricative continuum. This finding supports the idea that frontal regions are sensitive to phonetic category-level information and extends it to make behavioral predictions at the individual level. Additionally, more gyrification in bilateral transverse temporal gyri predicted less consistent responses on the task, perhaps reflecting subtle variation in language ability across the population.

Understanding household-level transmission pathways of fecal pathogens can provide insight for developing effective strategies to reduce diarrheal illness in low- and middle-income countries. We applied whole bacterial community analysis to investigate pathways of bacterial transmission in 50 rural Bangladeshi households. SourceTracker was used to quantify the shared microbial community in household reservoirs (stored drinking water, soil, and hands) and estimate the percentage of fecal-associated bacteria from child and mothers’ feces in these reservoirs. Among the reservoirs studied, most bacterial transfer occurred between mothers’ and children’s hands and between mothers’ hands and stored water. The relative percentage of human fecal-associated bacteria in all household reservoirs was low. We also quantified the number of identical amplicon sequence variants within and between individual households to assess bacterial community exchange in the domestic environment. Intra-household sharing of bacteria between mothers’ and children’s hands and between hands and soil was significantly greater than inter-household sharing., Graphical abstract Image 1, Highlights • 16S rRNA gene sequencing was used to examine bacterial communities in households. • Low levels of fecal contamination were found on hands, in soil, and stored water. • High proportion of bacteria was shared between mothers and their children.

The design of catalytic distillation (CD) columns is a challenging task because of the superposition of chemical reaction and distillation in one apparatus. In this work, a method to design a cost-optimal CD column for chemical systems with large number of components and chemical reactions is presented. The method is based on the following steps: (1) estimation of the number of theoretical stages and catalyst volume by the decomposition of the CD column into a sequence of chemical reactors and non-reactive distillation columns, (2) estimation of the column diameter and operating conditions using an equilibrium stage model, and (3) design of the column applying an optimisation algorithm and using a rigorous non-equilibrium stage model to represent the CD process. The method is applied to determine the optimal column configuration and operating conditions for the synthesis of tert-amyl ethyl ether from ethanol and isoamylenes. Eight components and four chemical reactions were selected to represent the chemical system in the simulations.

Background Tubal ligation (TL) is considered a very efficient contraceptive method. However, some patients complain of a variety of postoperative symptoms. The objective of this study was to investigate whether ovarian reserve may change after tubal ligation. Study Design This was a prospective cohort study of 80 fertile women who underwent TL. Ovarian reserve was evaluated by measuring pre- and postoperative (1 year after surgery) serum anti-Mullerian hormone (AMH) levels and transvaginal antral follicular count (AFC). Potential confounding factors were age, body mass index (BMI), smoking, surgical technique and prior contraceptive methods. The Wilcoxon test was used to compare pre- and postoperative (12 months) AMH and AFC, and simple and multiple linear regression were used to evaluate confounding factors. Results Fifty-two patients completed the study protocol. The median AMH level was 1.43 ng/mL (interquartile range 0.63–2.62) preoperatively and 1.30 ng/mL (interquartile range 0.53–2.85) after 12 months (p=.23). The mean AFC was 8.0 (interquartile range 5.0–14.0) and 11.0 (interquartile range 7.0–15.0) before and after TL, respectively (p=.12). These differences were not statistically significant. Use of a hormonal contraceptive method prior to TL was significantly associated with a postoperative increase in AMH. Conclusions This study suggests that ovarian reserve is not altered by TL.

Statins are the most widely used drugs for the treatment of hypercholesterolemia. In spite of their overall favorable safety profile, they do possess serious myotoxic potential, whose molecular origin has remained equivocal. Here, we demonstrate in cultivated myoblasts and skeletal muscle cells that cerivastatin at nanomolar concentrations interferes with selenoprotein synthesis and evokes a heightened vulnerability of the cells toward oxidative stressors. A correspondingly increased vulnerability was found with atorvastatin, albeit at higher concentrations than with cerivastatin. In selenium-saturated cells, cerivastatin caused a largely indiscriminate suppression of selenoprotein biosynthesis and reduced the steady state-levels of glutathione peroxidase 1 (GPx1) and selenoprotein N (SelN). Selenite, ebselen, and ubiquinone were unable to prevent the devitalizing effect of statin treatment, despite the fact that the cellular baseline resistance against tert-butyl hydroperoxide was significantly increased by picomolar sodium selenite. Mevalonic acid, in contrast, entirely prevented the statin-induced decrease in peroxide resistance. These results indicate that muscle cells may be particularly susceptible to a statin-induced suppression of essential antioxidant selenoproteins, which provides an explanation for the disposition of these drugs to evoke adverse muscular side-effects.

Sialadenopathy, inflammation of the salivary glands, is a rare anesthetic complication. This case conference describes a patient who developed sialadenopathy of the sublingual glands after placement of a laryngeal mask airway during a brief surgical procedure. The patient's history is detailed, the surgical and anesthetic procedures are described, and a discussion follows, which describes the different causes of this inflammatory process. In the comment, the physiology of the salivary glands is described in detail.

Both precipitation and ultrafiltration processes were investigated for their potential to produce protein products from aqueous wrinkled pea extracts. As far as the maximum possible protein yield and the protein content of the products are concerned there was virtually no difference between protein recovery by precipitation processes (heat-, acid- and heat-acid-precipitation) and ultrafiltration. In all cases protein concentrates with protein contents ⩾70% were obtained and about 60–65% of the dissolved protein was recovered. The functional properties of the products differed in dependence on the process used for their recovery. The products obtained by ultrafiltration were superior to those obtained by precipitation, in particular with regard to their solubility, their fat-binding capacity, their emulsifying activity and their foam-forming capacity. In this respect the products could be compared to commercially produced protein isolates from soybeans and smooth peas. In some cases they were even superior to these.

The pharmacokinetics of gestodene (GEST) was determined in 12 healthy women (age 22 to 34 years), following single dose administration of 0.075 mg GEST. The same preparation was also administered during one treatment cycle after a wash-out phase of 1 week. After single dose administration, maximum concentrations of GEST in the serum were 4.9 ± 2.5 ng / ml . Post maximum drug levels declined biphasically with half-lives of 0.2 ± 0.2 h and 14.9 ± 6.7 h , respectively. The apparent clearance was calculated to be 0.8 ± 0.4 ml × min −1 × kg −1 . The free fraction of GEST was 1.3 ± 0.3 % and the fractions bound to SHBG and albumin were 64.3 ± 10.7 % and 34.4 ± 10.4 %, respectively. The results showed that there was a gradual decrease in serum trough levels of GEST during the cycle, due to a concomitant and equally high decrease in SHBG concentrations in the serum of about 26 %. At the end of one treatment cycle, the free fraction of GEST increased to 1.8 ± 0.5 %, the SHBG-bound fraction decreased to 57.0 ± 10.2 % and the albumin-bound fraction increased to 41.3 ± 9.9 %. Total serum clearance increased during the same time period from a mean value of 0.8 to about 1.2 ml × min −1 × kg −1 . The clearance of unbound GEST, however, remained unchanged. An examination of the free GEST concentrations revealed the same time course of GEST trough levels during the cycle as the simulated curve. This was derived from the pharmacokinetic parameters which were obtained after single dose administration. Thus, the present study showed that the pharmacokinetics of GEST can be fully explained on the basis of single dose pharmacokinetics and the changes in serum protein binding which were caused by a reduction of SHBG levels in the serum during chronic treatment with GEST. There was no evidence of GEST inhibiting its own metabolism.