It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Thursday, April 04, 2024
Fuel Cells: Oxidation processes of phosphoric acid revealed by tender X-rays
HELMHOLTZ-ZENTRUM BERLIN FÜR MATERIALIEN UND ENERGIE
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THE ILLUSTRATION SHOWS FOUR DIFFERENT OXIDATION PATHWAYS (1-4) OF AQUEOUS PHOSPHORIC ACID (H3PO3), WHICH COULD BE ELUCIDATED BY XANES AT BESSY II. ALL THESE REACTIONS DEPEND ON THE HUMIDITY PRESENT.
The interactions between phosphoric acid and the platinum catalyst in high-temperature PEM fuel cells are more complex than previously assumed. Experiments at BESSY II with tender X-rays have decoded the multiple oxidation processes at the platinum-electrolyte interface. The results indicate that variations in humidity can influence some of these processes in order to increase the lifetime and efficiency of fuel cells.
Hydrogen fuel cells convert chemical energy from hydrogen into electrical energy through separate reactions of hydrogen fuels and oxidizing agents (oxygen). Among hydrogen fuel cells, high-temperature polymer electrolyte membrane fuel cells (HT-PEMFCs) are attractive for micro-stationary electricity sources. One disadvantage of these HT-PEMFCs is that the phosphoric acid (H3PO4) proton conductor leaches out of the H3PO4-doped polybenzimidazole membrane and poisons the platinum catalyst. Recent studies show further complications during the operation of the HT-PEMFC, where some of H3PO4 might be reduced to H3PO3, which may further poison the platinum catalysts, leading to a significant loss of performance.
Complex processes and interactions
An earlier study by Prof. Dr Marcus Bär's team showed that opposite processes also take place at the interface between Pt and aqueous H3PO3 and that the interactions between the platinum catalyst and the H3PO3/H3PO4 are very complex: while H3PO3 can lead to poisoning of the platinum catalyst, at the same time platinum might catalyzes the oxidation of H3PO3back to H3PO4.
Experiments under realistic conditions
In order to investigate the oxidation behaviour of aqueous H3PO3 under conditions close to HT-PEMFCs working conditions, Bär's team has now analysed the chemical processes using an in-housed designed heatable electrochemical cell compatible for in situ tender X-ray studies at the OÆSE end-station recently set up in the Energy Materials In-situ Laboratory Berlin (EMIL). They used intense X-ray light in the tender X-ray energy range (2 keV – 5 keV), which is provided by the EMIL beamline at the X-ray source BESSY II. In this energy range, X-ray absorption near-edge structure spectroscopy (XANES) at the P K-edge is used to monitor oxidation processes from H3PO3 to H3PO4.
Different oxidation reactions examined
"We have thus uncovered different processes for this oxidation reaction, including platinum-catalysed chemical oxidation, electrochemical oxidation under positive potential bias at the platinum electrode, and heat-promoted oxidation. These in situ spectroscopic results are also confirmed by ion-exchange chromatography and in situ electrochemical characterisations," explains Enggar Wibowo, first author of the study and a PhD candidate in Bär’s team. "Remarkably, all of these oxidation pathways involve reactions with water, which shows that the humidity inside the fuel cell has a significant influence on these processes."
Humidity as a factor for improvements
In addition, the results also point to possible improvements of the operating conditions of HT-PEM fuel cells, e.g. by controlling the humidification to oxidise the H3PO3 back to H3PO4. “Corresponding adjustments to the operation conditions of HT-PEMFCs could be implemented to prevent catalyst poisoning by H3PO3 and enhance efficiency of those fuel cells,” Wibowo points out.
Outlook to BESSY III
"The work clarifies a key degradation pathway of fuel cells and is a contribution on the way to an H2-based energy supply," says Prof. Dr.-Ing. Marcus Bär. "It also shows the great benefit of tender X-rays, and we are looking forward to BESSY III, which aims to close the "tender X-ray" gap," he adds.
Elucidating the Complex Oxidation Behavior of Aqueous H3PO3 on Pt Electrodes via In Situ Tender X-ray Absorption Near-Edge Structure Spectroscopy at the P K-Edge
WOMENS HEALTH
Extending Medicaid coverage after birth may increase postpartum treatment for depression, anxiety
A new study found that extending Medicaid eligibility for birthing people increase treatment for perinatal mood and anxiety disorder by more than 20 percentage points, compared to birthing people with commercial insurance
Extending postpartum Medicaid eligibility extensions may increase treatment for perinatal mood and anxiety disorders (PMADs), a leading cause of perinatal illness and mortality, according to a new study led by Boston University School of Public Health (BUSPH) and Brown University researchers.
Published in the journal Health Affairs, the study found that retaining Medicaid coverage after birth increased outpatient mental health and medication treatment for PMADs by 20.5 percentage points, compared to birthing people who received commercial coverage. Retaining postpartum Medicaid also appeared to significantly lower patients’ out-of-pocket spending for mental healthcare.
The majority of US states have now extended postpartum Medicaid coverage to 12 months through the American Rescue Plan Act, but the new findings provide critical data and insight into the role of Medicaid coverage on perinatal mental health, and why Medicaid extensions are so important for the health of low-income birthing people postpartum. Without this coverage, many people would otherwise become uninsured or struggle to pay for high-cost commercial insurance and medical care. Untreated PMADs can increase birthing people’s risk of substance use, depression, anxiety, and suicide, as well as developmental delays among their newborns. Estimates show that one in three pregnancy-related deaths occur between six weeks and one year after childbirth.
“We know that maternal mental health conditions are a leading cause of maternal morbidity and mortality, and postpartum mood and anxiety disorders are the most commonly occurring maternal mental health condition,” says study lead and corresponding author Dr. Sarah Gordon, assistant professor of health law, policy & management at BUSPH, and who served as a senior advisor on health policy for the US Department of Health and Human Services from 2021-2024. “Evidence-based treatments are available and effective, but underutilized. Insufficient health insurance coverage is one reason for low treatment rates among the postpartum population that extending postpartum Medicaid coverage can address.”
For the study, Dr. Gordon and colleagues utilized data on insurance claims and income, as well as birth records in Colorado between 2014-2019, before Colorado extended Medicaid eligibility. The researchers compared postpartum PMAD treatment among patients with incomes at or below 138 percent of the federal poverty level (FPL) and who were eligible to remain in Medicaid after 60 days postpartum, to patients with incomes above 138 percent of the FPL, who were ineligible to receive Medicaid beyond 60 days postpartum and enrolled in commercial insurance.
Compared to birthing people with commercial health insurance, remaining on Medicaid for 12 months postpartum was also linked to a 16 percentage point increase in patients filling a prescription medication for depression or anxiety, and a 7.3 percentage point increase in patients receiving at least one outpatient mental health visit. Retaining Medicaid beyond 60 days postpartum was associated with almost a 20 percentage point increase in “continuous” postpartum treatment, which is considered three or more outpatient mental health visits or prescription refills.
This extended Medicaid coverage also alleviated healthcare costs for birthing people, lowering out-of-pocket costs by $40.84 for outpatient mental health visits, and by $3.24 for each prescription refill, compared to costs for commercially insured birthing people.
Medicaid-insured birthing people may have higher PMAD treatment rates because of more affordable care, and fewer gaps in coverage that likely occur among birthing people who became ineligible for Medicaid. The researchers say these findings underscore the fact that commercial insurance is not an equal alternative for low-income postpartum people, and losing Medicaid eligibility can be detrimental to both health and finances.
“Our findings suggest that postpartum Medicaid extensions are likely an important policy lever to promote postpartum maternal mental health by lowering barriers to accessing treatment,” Dr. Gordon says. “However, mental health screening and referrals, availability of providers, and quality of mental healthcare are also critical to supporting the mental health of postpartum people.”
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About Boston University School of Public Health
Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.
Extended Postpartum Medicaid In Colorado Associated With Increased Treatment For Perinatal Mood And Anxiety Disorders
ARTICLE PUBLICATION DATE
1-Apr-2024
COI STATEMENT
Dr. Gordon was a senior adviser on health policy in the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services from 2021-2024.
Women with serious mental illness want pregnancy information, resources from mental health providers
UNIVERSITY OF CALIFORNIA - LOS ANGELES HEALTH SCIENCES
Women with serious mental illness (SMI) who are pregnant or planning a pregnancy face gaps in information, support and resources in mental health services, new research suggests.
The findings, published April 1 in the peer-reviewed journal Health Affairs, highlight the need to integrate pregnancy and parenting interventions, education, and other resources for women with SMI into mental health services.
Policies that increase mental health provider and clinic capacity to address pregnancy and parenting can dramatically improve care for women living with mental illness, which would ultimately advance maternal and child outcomes, said Dr. Nichole Goodsmith, psychiatrist and health services researcher at Veterans Affairs Greater Los Angeles Healthcare System, and assistant clinical professor of psychiatry at the David Geffen School of Medicine at UCLA.
“Our study suggests that the topic of pregnancy may be under-discussed in mental health care, leading to a missed opportunity to understand patients’ pregnancy goals and desires and offer appropriate support and services,” said Goodsmith, the study’s senior author who conducted the research while in the National Clinician Scholars Program at UCLA. “The women we spoke to wanted more information on the potential impact of their psychiatric medications on fertility, pregnancy, fetal development, and breastfeeding. The mothers we interviewed expressed needing more parenting support and resources—things like parenting classes, on-site childcare during mental health visits, and referrals for resources like baby supplies.”
The researchers conducted telephone interviews with 22 reproductive-age women being served at four Los Angeles County Department of Mental Health outpatient clinics in 2020 and 2021. Most participants were Black or Latina and had children.
Among the findings, few women recalled discussions of pregnancy with their mental health providers, and those who did described them as “quick conversations.” In addition, many were dissatisfied with the information they received about potential safety concerns of taking their psychiatric medications in pregnancy.
As for parenting, most described their mental health providers as helpful and supportive, though some were concerned that even talking about their mental health symptoms could lead to losing custody of their children.
The study has some limitations, the researchers write. It was conducted in a large, urban safety-net mental health system, so the findings may not apply to other locations or populations, it surveyed only English-speaking women did not include other languages or gender identities.
But the findings shed light on the need to build mental health providers’ capacity to discuss and address their patients’ pregnancy- and parenting-related needs.
“Overall, results underscore the need for greater integration of pregnancy and parenting interventions, education, support, and resources into mental health services for women living with SMI,” the researchers write. “Incorporating educational content related to pregnancy and parenting into academic, professional, and continuing education curriculums can help close this knowledge gap.”
Additional authors are Karissa Fenwick, Kristina Cordasco, and Alison Hamilton of Veterans Affairs (VA) Greater Los Angeles Healthcare System; Emily Dossett of the University of Southern California, and Rebecca Gitlin of the Los Angeles County Department of Mental Health.
The project was funded by the National Clinician Scholars Program at UCLA, the Veterans Affairs (VA) Office of Academic Affiliations through the Health Services Research Fellowship Program (TPH 65-000-15), the VA Research Career Scientist (VA Health Services Research and Development Grant No. RCS 21-135), the VA Office of Academic Affiliations, and a K12 (K12HS26407) career development award from the Agency for Healthcare Research and Quality and the Patient-Centered Outcomes Research Institute.
Addressing Pregnancy And Parenting In Mental Health Care: Perspectives Of Women With Serious Mental Illness
ARTICLE PUBLICATION DATE
1-Apr-2024
First time moms with breech pregnancies experience reduced risk of complications if they plan caesarean rather than vaginal delivery - but have increased risk of uterus rupture in subsequent pregnancies
PLOS
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MATERNAL OUTCOMES OF PLANNED MODE OF DELIVERY FOR TERM BREECH.
First time moms with breech pregnancies experience reduced risk of complications if they plan cesarean rather than vaginal delivery - but have increased risk of uterus rupture in subsequent pregnancies
Article Title: Maternal outcomes of planned mode of delivery for term breech in nulliparous women
Author Countries: Denmark
Funding: This study was supported by grants from the Health Research Foundation of Region Zealand and Carsten Lenstrup’s research foundation for Danish obstetrics. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Maternal outcomes of planned mode of delivery for term breech in nulliparous women
ARTICLE PUBLICATION DATE
3-Apr-2024
Paper: Policy reforms urgently needed to mitigate racial disparities in perinatal mental health conditions
UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN, NEWS BUREAU
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SIGNIFICANT REFORMS IN U.S. HEALTH CARE AND ECONOMIC POLICIES ARE NEEDED TO MITIGATE THE DISPARITIES IN PERINATAL MENTAL HEALTH DIAGNOSES AND TREATMENT THAT PLACE WOMEN OF COLOR AT GREATER RISK OF MORTALITY AND MORBIDITY, ACCORDING TO SOCIAL WORK PROFESSOR KAREN M. TABB, THE SENIOR AUTHOR OF A PAPER PUBLISHED IN HEALTH AFFAIRS.
CHAMPAIGN, Ill. — A team of researchers is calling for comprehensive changes to U.S. health care and social policies to improve diagnosis and treatment of perinatal mental health conditions and mitigate the dramatic disparities that put women of color at significantly greater risks of morbidity and mortality compared with white women.
In a commentary published in the journal Health Affairs, the researchers proposed seven comprehensive changes to health care and economic policies to mitigate the burden of undiagnosed and untreated perinatal mental health challenges that are greatest among racial minority populations.
The researchers’ recommendations include a national training and certification program for health care providers; payment models that enable women to obtain services through community-based providers; paid family leave; expanded funding for perinatal psychiatry access programs; and access to safe, legal abortions and contraception. They also proposed poverty-mitigation strategies such as reinstating the federal child tax credit and implementing a universal basic income program.
The team said their recommendations are a call for reproductive justice – which includes rights to bodily autonomy, decisions to have or not have children and to live in safe, healthy environments.
During Health Affairs’ virtual briefing on April 3, University of Illinois Urbana-Champaign social work professor Karen M. Tabb Dina, the senior and corresponding author of the commentary, spoke about the urgent need for a comprehensive strategy to improve maternal health outcomes and promote equity.
“Perinatal mental health challenges are a microcosm for the U.S. health care system, bringing into focus gaps in equity, access, research data and social determinants of health,” said Tabb Dina, who is co-principal investigator on a grant-funded project that is examining the impact of racial bias and discrimination on women’s health care interactions during the perinatal period, defined as the time before and after giving birth.
While the team acknowledged that the reforms proposed are significant, they said that none of these are unattainable – “the challenges lie in who we value and how we choose to demonstrate that.”
“Broadening our understanding of what constitutes perinatal mental illness and wellness, and grounding our understanding in reproductive justice would lead to policies that close some of these gaps,” said first author Dr. Emily C. Dossett, a professor of psychiatry and the behavioral sciences and of obstetrics in the Keck School of Medicine at the University of Southern California. Dossett is also the medical director of CHAMP for Moms – Child Access to Mental Health and Psychiatry, a consultation and educational service for pediatric primary care providers based at the University of Mississippi Medical Center.
Their co-authors were Dr. Alison M. Stuebe, a professor of maternal and child health, and of obstetrics and gynecology at the University of North Carolina-Chapel Hill School of Medicine; and Twylla Dillion, the executive director of HealthConnect One, a Chicago-based nonprofit focused on training community birth workers and research.
A 2022 report by the U.S. Centers for Disease Control and Prevention indicated that mental health conditions – including suicide and overdoses associated with substance use – are the leading cause of pregnancy-related death. However, more than 80% of these deaths are preventable, the report said.
Current policy and research, which focus primarily on postpartum depression, should be expanded to include other mental health conditions that can predate conception and continue after labor and delivery or miscarriage, the team suggested. Likewise, research samples must include greater diversity in race and ethnicity, gender and sexual orientation, and non-English speaking individuals.
Women’s health care needs are often not prioritized as high as those of their infants and children by many well-funded maternal health programs such as home visits and family case managers, which tend to view the “baby as the candy and the mother as the wrapper,” Stuebe has said.
However, community- and patient-centered care, such as doulas and birth centers, has shown promise at improving maternal health outcomes. To begin scaling up these services, HealthConnect One and several other doula programs have partnered on the Doula Data + Compensation Consortium, a crowdsourced organization specifically designed to gather research data on the health outcomes associated with these services.
Community-based care may be more cost-effective, and alternative payment models such as bundled payments and capitation that prioritize value-based care over fee-for-service care would make services more accessible to women in need, the researchers proposed. Moreover, research has shown that community birth centers protect women of color against the discriminatory treatment and trauma they frequently experience in traditional clinical settings, the team said.
Additionally, they called for broader funding for perinatal psychiatry access programs that would enable nonspecialty providers to consult by phone with behavioral health clinicians for help diagnosing, treating and managing pregnant and postpartum women’s mental health care. The Health Resources and Services Administration is currently funding these programs in more than 20 states, and they have consistently demonstrated more equitable access to care and cost savings, the team wrote.
Accordingly, the team called for reinstatement of the 2021 federal child tax credit, which had striking effects on recipients’ mental health, particularly Black and Hispanic families. Almost 50% of the reduction in depressive symptoms and about 70% of the decrease in anxiety symptoms were associated with recipients’ improved capacity to afford food and housing.
Likewise, the team proposed implementing and evaluating a universal basic income program for perinatal families as research has found that these programs significantly improve recipients’ mental health. Cash-based, unconditional universal basic income programs that uncouple childbearing from the receipt of benefits also support recipients’ reproductive rights to decide to have or not have children, as well as parents’ rights to raise their families in safe, healthy environments, the researchers said.
Finally, the team advocated workplace policies that support families – specifically, paid parental leave and high-quality child care. Currently, four states offer paid family leave policies that allow parents up to 12 weeks off during the first year after birth or adoption. Preliminary data suggest these policies are associated with improvements in maternal mental health, while struggles with access to affordable child care negatively impact parents’ mental and physical well-being, the team said.
Perinatal mental health: The need for broader understanding and policies that meet the challenges
ARTICLE PUBLICATION DATE
3-Apr-2024
Socioecologic factors and racial differences in breast cancer prognostic scores
JAMA Network Open
JAMA NETWORK
About The Study: The findings of this study suggest that the consequences of structural racism extend beyond inequities in health care to drive disparities in breast cancer outcome. Additional research is needed with more comprehensive social and environmental measures to better understand the influence of social determinants on aggressive estrogen receptor-positive tumor biology among racial and ethnic minoritized women from disadvantaged and historically marginalized communities.
Authors: Gregory S. Calip, Pharm.D., M.P.H., Ph.D., of the University of Southern California in Los Angeles, is the corresponding author.
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.
JOURNAL
JAMA Network Open
Depression during pregnancy is tied to increased emergency department visits for infants after birth
Rutgers Health study finds that infants whose mothers have mild and moderate to severe depressive symptoms had more emergency department visits than those who had no symptoms
Mild and moderate to severe perinatal depressive symptoms among new mothers are associated with the increased use of emergency rooms to treat their infants, according to Rutgers Health research.
The study, published in the April issue of Health Affairs, examines the association between the severity of perinatal depression and the use of emergency departments in the first year of an infant’s life.
Perinatal mental health conditions affect up to 20 percent of pregnant or postpartum people and are associated with a wide range of adverse outcomes for the child, including increased use of a hospital’s emergency department.
Using the emergency department can be costly, especially for Medicaid, which is billed for disproportionately more pediatric emergency department visits compared with private insurance.
While perinatal people may experience a broad range of depression symptom severity, there is little research examining the relationship between symptom severity and health care use and emergency department use. To address this gap, Slawa Rokicki, an assistant professor at the Rutgers School of Public Health, reviewed data in New Jersey, a state with universal maternal depression screening.
Rokicki, who linked birth record data for the years 2016-2018 to hospital discharge records for infants in their first year of life, found that infants of mothers with moderate to severe depressive symptoms had 21 percent more emergency department visits than those who had no depression, while infants of mothers with mild symptoms had 10 percent more emergency department visits.
According to the study, for infants whose delivery was paid for by Medicaid, the total emergency department charges in the first year were 43 percent higher for infants with mothers with moderate to severe depression and 19 percent higher for mothers with mild symptoms compared to those with no symptoms.
“The large disparities among Medicaid beneficiaries suggests opportunities for that program to optimize screening and referrals for perinatal depression, with potential cost-saving benefits in reducing nonemergency pediatric emergency department visits,” said Rokicki.
The study’s findings suggest that universal screening of perinatal people at delivery may be beneficial in identifying those who may be at risk of postpartum depression before they leave the hospital. “This is critical because postpartum people often face multiple barriers to postpartum care and most people with perinatal mental health conditions are not diagnosed,” said Rokicki.
Additionally, routine screening in emergency departments may also help identify parental mental health conditions and connect individuals to resources.
“We know from prior research that postpartum depression screenings in pediatric emergency departments are feasible,” said Rokicki.
Rokicki said emergency department screens need to follow patient-centered, nonstigmatizing approaches as those in the emergency department who screen positive for depression are likely to be part of a socially vulnerable population.
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