The Melanocortin Receptor Accessory Protein 2 (MRAP2) is an important regulator of energy homeostasis and its loss causes severe obesity in rodents. MRAP2 mediates its action in part through the potentiation of the MC4R, however, it is clear that MRAP2 is expressed in tissues that do not express MC4R, and that the deletion of MRAP2 does not recapitulate the phenotype of Mc4r KO mice. Consequently, we hypothesized that other GPCRs involved in the control of energy homeostasis are likely to be regulated by MRAP2. In this study we identified PKR1 as the first non-melanocortin GPCR to be regulated by MRAP2. We show that MRAP2 significantly and specifically inhibits PKR1 signaling. We also demonstrate that PKR1 and MRAP2 co-localize in neurons and that Mrap2 KO mice are hypersensitive to PKR1 stimulation. This study not only identifies new partners of MRAP2 but also a new pathway through which MRAP2 regulates energy homeostasis.DOI: http://dx.doi.org/10.7554/eLife.12397.001

OBJECTIVES To identify the perceived organizational resources required by healthcare workers to deliver geriatric primary care in a geriatric patient aligned care team (GeriPACT). DESIGN Cross‐sectional observational study using deductive analyses of qualitative interviews conducted with GeriPACT team members. SETTING GeriPACTs practicing at eight geographically dispersed Department of Veterans Affairs (VA) healthcare systems. PARTICIPANTS GeriPACT clinicians, nurses, clerical associates, clinical pharmacists, and social workers (n = 67). MEASUREMENTS Semistructured qualitative interviews conducted in person, transcribed, and then analyzed using the PACT Resources Framework. RESULTS Using the PACT Resources Framework, we identified facility‐, clinic‐, and team‐level resources critical for GeriPACT implementation. Resources within each level reflect how the needs of older adults with complex comorbidity intersect with general population primary care medical home practice. GeriPACT implementation is facilitated by attention to patient characteristics such as cognitive impairment, ambulatory limitations, or social support services in staffing and resourcing teams. CONCLUSION Models of geriatric primary care such as GeriPACT must be implemented with an eye toward the most effective use of our most limited resource‐trained geriatricians. In contrast to much of the literature on medical home teams serving a general adult population, interviews with GeriPACT members emphasize how patient needs inform all aspects of practice design including universal accessibility, near real‐time response to patient needs, and ongoing interdisciplinary care coordination. Examination of GeriPACT implementation resources through the lens of traditional primary care teams illustrates the importance of tailoring primary care design to the needs of older adults with complex comorbidity.

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This study used a qualitative observational design to identify the team-, clinic-, and system-level resources necessary for effective geriatric medical home (i.e., GeriPACT) implementation and to differentiate the needs of GeriPACT compared to traditional PACT. Analysis of 80 interviews conducted with team members from 8 geographically dispersed GeriPACTs identified needs that may be unrecognized by primary care leadership, including: clinical space to accommodate caregivers and patients with impaired visual, mobility, cognitive, or hearing acuity; greater utilization of caregiver support programs and social workers to facilitate aging-in-place; age-sensitive clinical reminders; team member continuity and direct phone lines to reduce patient anxiety; and longer standard appointment lengths to reflect clinical complexity. In contrast to traditional primary care teams, GeriPACTs are not simply “PACTs for older adults”: GeriPACT members articulate population-specific resources that require support from facility leadership to accommodate the complex, age- clinical and social resources needed to support aging-in-place.