Sources of Geographic Variation in Health Care: Evidence From Patient Migration

We study the drivers of geographic variation in U.S. health care utilization, using an empirical strategy that exploits migration of Medicare patients to separate the role of demand and supply factors. Our approach allows us to account for demand differences driven by both observable and unobservable patient characteristics. Within our sample of over-65 Medicare beneficiaries, we find that 40–50% of geographic variation in utilization is attributable to demand-side factors, including health and preferences, with the remainder due to place-specific supply factors.National Institute on Aging (R01-AG032449)National Institute on Aging (P01-AG19783)National Science Foundation (U.S.) (Grant 1151497)National Science Foundation (U.S.) (Grant 1260411)Neubauer Family FoundationUniversity of Chicago. Booth School of Business (Initiative on Global Markets

The exotic \u3ci\u3eAgrilus cyanescens\u3c/i\u3e (Ratzeburg) (Coleoptera: Buprestidae) is discovered in Oregon

In two separate occurrences, graduates of the Oregon Forest Pest Detector program discovered the exotic Agrilus cyanescens (Ratzeburg) (Coleoptera: Buprestidae) in Portland, Oregon, damaging a backyard shrub, Lonicera involucrata (Rich.) Banks ex Spreng. (Caprifoliaceae). Although first detected in the USA 99 years ago, the known occurrence nearest to Oregon is in Utah

Injustice perceptions about pain: parent–child discordance is associated with worse functional outcomes

Pain is experienced within and influenced by social environments. For children with chronic pain, the child–parent relationship and parental beliefs about pain are particularly important and may influence pain outcomes. Pain-related injustice perceptions have recently been identified as an important cognitive–emotional factor for children with pain. The current study aimed to better understand the pain-related injustice perceptions of children with chronic pain and their parents. The sample consisted of 253 pediatric chronic pain patients (mean age = 14.1 years, 74% female) presenting to a tertiary pain clinic. Patients completed measures of pain intensity, pain-related injustice perceptions, stress, functional disability, and quality of life. Parents completed a measure of pain-related injustice perceptions about their child's pain. Child–parent dyads were categorized into 1 of 4 categories based on the degree of concordance or discordance between their scores on the injustice measures. One-way analysis of variances examined differences in pain intensity, stress, functional disability, and quality of life across the 4 dyad categories. Our findings indicated that both the degree (concordant vs discordant) and direction (discordant low child–high parent vs discordant high child–low parent) of similarity between child and parent injustice perceptions were associated with child-reported pain intensity, stress, functional disability, and quality of life. The poorest outcomes were reported when children considered their pain as highly unjust, but their parents did not. These findings highlight the important role of parents in the context of pain-related injustice perceptions in pediatric chronic pain

Meta-Techniques for Faculty Development: A Continuous Improvement Model for Building Capacity to Facilitate in a Large Interprofessional Program

Literature regarding faculty development in uniprofessional healthcare programs is prolific; however, little has been written about instructional programs designed for faculty delivering interprofessional education (IPE). In this paper, we describe the genesis, content, and improvement of a faculty development workshop which exemplifies a meta teaching model and was designed to serve faculty facilitators in a rapidly growing IPE program. Evaluations following initial delivery of the workshops in fall 2018 returned high faculty satisfaction ratings and feedback suggesting a need for even more pedagogical training with a stronger emphasis on meta techniques and less on a review of student content. In response, program developers incorporated additional teaching techniques in the spring 2019 training. Faculty evaluations in spring 2019 reflected even greater satisfaction with the increased focus on “meta skills”. The faculty development program described in this paper supports the need for a structured training process for faculty facilitating in IPE programs

We Eat, We Live, We Repeat: Reimagining Food Heritage through Foodways and Sustainable Food Practices

The purpose of this co-authored, mixed methods descriptive research study was to examine how the intersection of foodways and sustainable food practices helps define the food heritages of St. Louis area residents. While prior research examines these concepts separately, and even shows connections with other factors such as health and discrimination, none look at all of these concepts together—a gap this research fills. To that end, this dissertation describes the intersection of cultural foodways and connection to sustainability in seeking a definition of food heritage and a path towards sustainable food heritage for St. Louis residents. Purposeful sampling using the Food Heritage and Sustainability Survey, completed by 621 St. Louis area residents, and interviews from 14 community leaders provided the dataset for this study. Survey results were analyzed using both univariate and multivariate statistical tests and interview transcripts were interpreted using thematic analysis. The quantitative results showed that an egoistic value orientation played a major role in how food heritage is defined. The qualitative results produced three major themes: Foodscapes and foodways are founded upon inequity, Food is about human connection, and Sustainable food practices help people reimagine their food heritage. When taken together, the quantitative and qualitative results both showed that actions surrounding sustainable food practices and awareness of foodways, including food injustices, were major contributors to St. Louis residents’ definition of food heritage. However, the qualitative and quantitative results differed in their conclusions of whether foodways influenced food heritage or vice versa. These results provide substantial material for future research, including a further examination into the connection between an egoistic value orientation and food heritage, and using heritage-aligned interventions to increase sustainable food practices

The value of monitoring wildlife roadkill

The number of wildlife-vehicle collisions has an obvious value in estimating the direct effects of roads on wildlife, i.e. mortality due to vehicle collisions. Given the nature of the data—species identification and location—there is, however, much wider ecological knowledge that can be gained by monitoring wildlife roadkill. Here, we review the added value and opportunities provided by these data, through a series of case studies where such data have been instrumental in contributing to the advancement of knowledge in species distributions, population dynamics, and animal behaviour, as well as informing us about health of the species and of the environment. We propose that consistently, systematically, and extensively monitoring roadkill facilitates five critical areas of ecological study: (1) monitoring of roadkill numbers, (2) monitoring of population trends, (3) mapping of native and invasive species distributions, (4) animal behaviour, and (5) monitoring of contaminants and disease. The collection of such data also offers a valuable opportunity for members of the public to be directly involved in scientific data collection and research (citizen science). Through continuing to monitor wildlife roadkill, we can expand our knowledge across a wide range of ecological research areas, as well as facilitating investigations that aim to reduce both the direct and indirect effects of roads on wildlife populations

Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents

Purpose The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. Predictors of patient endorsement of suicidality and provider documentation of follow-up were examined. Methods A prospective cohort study was conducted to examine the implementation of a CDSS that screened adolescent patients for suicidality and provided follow-up recommendations to providers. The intervention was implemented for patients aged 12–20 years in two primary care clinics in Indianapolis, Indiana. Results The sample included 2,134 adolescent patients (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Just over 6% of patients screened positive for suicidality. A positive endorsement of suicidality was more common among patients who were female, depressed, and seen by an adolescent−medicine board-certified provider as opposed to general pediatric provider. Providers documented follow-up action for 83% of patients who screened positive for suicidality. Documentation of follow-up action was correlated with clinic site and Hispanic race. The majority of patients who endorsed suicidality (71%) were deemed not actively suicidal after assessment by their provider. Conclusions Incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care is feasible and well utilized by providers. Female gender and depressive symptoms are consistently associated with suicidality among adolescents, although not all suicidal adolescents are depressed. Universal use of a multi-item suicide screener that assesses recency might more effectively identify suicidal adolescents

Distinguishing pedigree relationships via multi-way identity by descent sharing and sex-specific genetic maps

The proportion of samples with one or more close relatives in a genetic dataset increases rapidly with sample size, necessitating relatedness modeling and enabling pedigree-based analyses. Despite this, relatives are generally unreported and current inference methods typically detect only the degree of relatedness of sample pairs and not pedigree relationships. We developed CREST, an accurate and fast method that identifies the pedigree relationships of close relatives. CREST utilizes identity by descent (IBD) segments shared between a pair of samples and their mutual relatives, leveraging the fact that sharing rates among these individuals differ across pedigree configurations. Furthermore, CREST exploits the profound differences in sex-specific genetic maps to classify pairs as maternally or paternally related—e.g., paternal half-siblings—using the locations of autosomal IBD segments shared between the pair. In simulated data, CREST correctly classifies 91.5%–100% of grandparent-grandchild (GP) pairs, 80.0%–97.5% of avuncular (AV) pairs, and 75.5%–98.5% of half-siblings (HS) pairs compared to PADRE’s rates of 38.5%–76.0% of GP, 60.5%–92.0% of AV, 73.0%–95.0% of HS pairs. Turning to the real 20,032 sample Generation Scotland (GS) dataset, CREST identified seven pedigrees with incorrect relationship types or maternal/paternal parent sexes, five of which we confirmed as mistakes, and two with uncertain relationships. After correcting these, CREST correctly determines relationship types for 93.5% of GP, 97.7% of AV, and 92.2% of HS pairs that have sufficient mutual relative data; the parent sex in 100% of HS and 99.6% of GP pairs; and it completes this analysis in 2.8 h including IBD detection in eight threads