Impact of High Deductible Health Plans on Diabetes Care Quality and Outcomes: Systematic Review

ObjectiveTo provide a review of the impact of high deductible health plans (HDHPs) on the utilizations of services required for optimal management of diabetes and subsequent health outcomes.MethodsSystematic literature review of studies published between January 1, 2000, and May 7, 2021, was conducted that examined the impact of HDHP on diabetes monitoring (eg, recommended laboratory and surveillance testing), routine care (eg, ambulatory appointments), medication management (eg, medication initiation, adherence), and acute health care utilization (eg, emergency department visits, hospitalizations, incident complications).ResultsOf the 303 reviewed articles, 8 were relevant. These studies demonstrated that HDHPs lower spending at the expense of reduced high-value diabetes monitoring, routine care, and medication adherence, potentially contributing to the observed increases in acute health care utilization. Additionally, patient out-of-pocket costs for recommended screenings doubled, and total health care expenditures increased by 49.4% for HDHP enrollees compared with enrollees in traditional health plans. Reductions in disease monitoring and routine care and increases in acute health care utilization were greatest in lower-income patients. None of the studies examined the impact of HDHPs on access to diabetes self-management education, technology use, or glycemic control.ConclusionAlthough HDHPs reduce some health care utilization and costs, they appear to do so at the expense of limiting high-value care and medication adherence. Policymakers, providers, and payers should be more cognizant of the potential for negative consequences of HDHPs on patients’ health.     

Proton magnetic resonance studies of 7 Fe ferredoxins: Lower potential of the [4 Fe–4 S] redox center than the [3 Fe–3 S] cluster

Two types of iron-sulfur clusters, [3 Fe–3 S] and [4 Fe–4 S], were identified by ¹H-NMR in ferredoxins from Thermus thermophilus, Mycobacterium smegmatis and Pseudomonas ovalis. The [4 Fe–4 S] clusters always showed the redox couples which had potentials lower than that of the [3 Fe–3 S] clusters.     

Forecasting the future suitable growth areas and constructing ecological corridors for the vulnerable species Ephedra sinica in China

Ephedra sinica is a rare and vulnerable species in China, and the habitat of Ephedra sinica is seriously threatened (by climate change and human activities). Predicting the suitable growth areas and constructing ecological corridors for Ephedra sinica in China will help to protect it scientifically. Based on 306 valid distribution records and 13 selected environmental factors, the maximum entropy (MaxEnt) model was used to simulate the potential current habitat zones and future (2050 and 2070) habitat zones of Ephedra sinica under four climate change scenarios. The minimum cumulative resistance (MCR) model was applied to extract important ecological corridors of Ephedra sinica. The results indicate that: (1) Under the current environment, the total area of the suitable habitat for Ephedra sinica in China is 42.24 × 10⁵ km², mainly distributed in Northwest China and North China. (2) Suitable area increases as the RCP rises. The center of mass of the habitat zone moved northward from Shaanxi Province to Ordos City in Inner Mongolia Autonomous Region. (3) Of the 13 environmental factors selected, the primary factor was elevation (20.8 %), followed by wettest month precipitation (18.2 %) and temperature seasonality (15.2 %). (4) Built 19 ecological corridors, with a total corridor length of 430.2 km, including seven long-distance passages and 12 short-distance corridors. All corridors are far from the artificial surface, mostly near high-altitude areas. The 19 ecological corridors constructed using the MCR model will also provide considerable importance for the survival of Ephedra sinica on a longer time scale in the future.     

Treatment-resistant depression: definition,prevalence, detection,management, and investigational interventions

Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist. Instead, a plethora of definitions have been proposed, which vary significantly in their conceptual framework. The absence of a consensus definition hampers precise estimates of the prevalence of TRD, and also belies efforts to identify risk factors, prevention opportunities, and effective interventions. In addition, it results in heterogeneity in clinical practice decision-making, adversely affecting quality of care. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have adopted the most used definition of TRD (i.e., inadequate response to a minimum of two antidepressants despite adequacy of the treatment trial and adherence to treatment). It is currently estimated that at least 30% of persons with depression meet this definition. A significant percentage of persons with TRD are actually pseudo-resistant (e.g., due to inadequacy of treatment trials or non-adherence to treatment). Although multiple sociodemographic, clinical, treatment and contextual factors are known to negatively moderate response in persons with depression, very few factors are regarded as predictive of non-response across multiple modalities of treatment. Intravenous ketamine and intranasal esketamine (co-administered with an antidepressant) are established as efficacious in the management of TRD. Some second-generation antipsychotics (e.g., aripiprazole, brexpiprazole, cariprazine, quetiapine XR) are proven effective as adjunctive treatments to antidepressants in partial responders, but only the olanzapine-fluoxetine combination has been studied in FDA-defined TRD. Repetitive transcranial magnetic stimulation (TMS) is established as effective and FDA-approved for individuals with TRD, with accelerated theta-burst TMS also recently showing efficacy. Electroconvulsive therapy is regarded as an effective acute and maintenance intervention in TRD, with preliminary evidence suggesting non-inferiority to acute intravenous ketamine. Evidence for extending antidepressant trial, medication switching and combining antidepressants is mixed. Manual-based psychotherapies are not established as efficacious on their own in TRD, but offer significant symptomatic relief when added to conventional antidepressants. Digital therapeutics are under study and represent a potential future clinical vista in this population.     

Molecular Parameterisation and the Theoretical Calculation of Electrode Potentials

The difference in reduction potentials between ortho and para-benzoquinones has been calculated. The employs gas phase ab initio and semi-empirical computations in combination with free energy perturbation theory applied to gas and solution phase Monte Carlo simulations. The effects on calculated results of altering solute electrostatic parameterisation in solution phase simulations is examined. Atom centred charges derived from the molecular electrostatic potentials, MEPs, from optimised ab initio wavefunctions and charges generated by consideration of hydrogen bonded complexes are considered. Parameterisation of hydroxyl torsions in hydroquinone molecules is treated in a physically realistic manner. The coupled torsional system of the ortho-hydrobenzoquinone molecule is described by a potential energy surface calculated using gas phase AM1 semi-empirical computations rather than the simple torsional energy functions frequently employed in such calculations. Calculated differences in electrode potentials show that the electrostatic interactions of quinone and hydroquinone molecules in aqueous solution are not well described by atom centred charges derived from ab initio calculated MEPs. Moreover, results in good agreement with the experimental reduction potential difference can be obtained by employing high level ab initio calculations and solution phase electrostatic parameters developed by consideration of hydrogen bonded complexes.     

新型平均势函数在蛋白质反向折叠中的应用

利用蛋白质主链的极性分数及主链二面角为参量,构建了一种基于蛋白质结构数据库的势函数。将该势函数应用于蛋白质反向折叠研究中,发现该函数可成功地将蛋白质分子的天然构象从构建的构象库中识别出来;将一目标序列与构象库的每一可能的构象匹配,并用该势函数计算相应的能量,结果表明对绝大多数蛋白质分子来说,天然的构象的能量值总是最低。此外,该函数还将一些序列相似性较低,而结构相似性较高的蛋白质分子识别出来。我们认     

The regulation of K+ influx in excised barley roots

The electrochemical potential differences for potassium, between excised barley (Hordeum vulgare L.) roots and external media containing 0.05 mM KCl+0.5 mM CaSO₄, were determined over a 4-h period during which initially low-K⁺ roots accumulated K⁺ by pretreatment in 50 mM KCl plus 0.5 mM CaCl₂. This pretreatment resulted in increased internal [K⁺], decreased K⁺ influx (as measured from 0.05 mM KCl+0.5 mM CaSO₄) and decreased values of . These observations indicate that the decline of K⁺ influx associated with increased internal K⁺ concentration cannot be accounted for by passive adjustment to the electrochemical gradient for this ion.     

Na+-dependent,potential-sensitive l-ascorbate transport across brush border membrane vesicles from kidney cortex

l-Ascorbate is taken up into brush border vesicles from kidney cortex of rat, rabbit and guinea pig by an efficient, Na⁺-dependent and potential-sensitive transport process. This uptake shows saturation ($\text{K}{}_{\mathrm{<mtext>m</mtext><mtext>:0.1–0.3\; mM</mtext>}}$) and is strongly stimulated by low concentrations of N₃^?. Erythorbate (d-isoascorbate) seems to be another, but poorer, substrate of the same transporter.     

中国特有植物雪落樱桃潜在分布及其生态特征

为明确中国特有植物雪落樱桃(Cerasus xueluoensis)的潜在分布与居群生态特征,利用DIVA-GIS软件及其耦合的BIOCLIM模型,首次绘制了雪落樱桃适生区分布模拟图,并对影响其分布的主导气候因子进行了定性定量分析。结果表明,雪落樱桃当前潜在适生区主要分布在亚热带长江流域1 200 m以上高海拔山区,其中渝-鄂-湘三省交界的大巴山-巫山山脉可视为现代核心分布区,湘黔交界及湘南的南岭山脉可视为雪落樱桃潜在分布的南界,陕-豫-鄂交界山区的秦岭南麓可能是其潜在分布的北界。主成分分析(PCA)筛选的主导气候因子及其贡献率依次为:年降水量(bio12)最冷季降水量(bio19)最暖季降水量(bio18)最湿季降水量(bio16),累计频率曲线进一步确定其适宜范围分别为:993.00～1 870.22、500.00～680.00、430.00～669.16和500.00～680.00mm,表明降水是影响雪落樱桃当下分布格局的主导气候限制因子。Pearson相关性分析表明,雪落樱桃分布格局在区域尺度上受海拔、经、纬度影响;最小树分析和聚类分析表明,雪落樱桃7个野生居群可划分为中西部与东部两大分支;受试者工作特征曲线(ROC) AUC值达到0.751,满足模型预测精度的基本要求。这些有助于为雪落樱桃制定科学合理的资源保护与科学引种规划。