Access to Pediatric Type 1 Diabetes Care in Montana

Introduction: Management of Type 1 Diabetes (T1D) requires significant family effort and specialty support. We aimed to understand how living in a rural state impacts families’ experiences during and after diagnosis.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2023/1013/thumbnail.jp

The Iceland Microcontinent and a continental Greenland-Iceland-Faroe Ridge

The breakup of Laurasia to form the Northeast Atlantic Realm was the culmination of a long period of tectonic unrest extending back to the Late Palaeozoic. Breakup was prolonged and complex and disintegrated an inhomogeneous collage of cratons sutured by cross-cutting orogens. Volcanic rifted margins formed, which are blanketed by lavas and underlain variously by magma-inflated, extended continental crust and mafic high-velocity lower crust of ambiguous and probably partly continental provenance. New rifts formed by diachronous propagation along old zones of weakness. North of the Greenland-Iceland-Faroe Ridge the newly forming rift propagated south along the Caledonian suture. South of the Greenland-Iceland-Faroe Ridge it propagated north through the North Atlantic Craton along an axis displaced ~ 150 km to the west of the northern rift. Both propagators stalled where the confluence of the Nagssugtoqidian and Caledonian orogens formed a transverse barrier. Thereafter, the ~ 400-km-wide latitudinal zone between the stalled rift tips extended in a distributed, unstable manner along multiple axes of extension that frequently migrated or jumped laterally with shearing occurring between them in diffuse transfer zones. This style of deformation continues to the present day. It is the surface expression of underlying magma-assisted stretching of ductile mid- and lower continental crust which comprises the Icelandic-type lower crust that underlies the Greenland-Iceland-Faroe Ridge. This, and probably also one or more full-crustal-thickness microcontinents incorporated in the Ridge, are capped by surface lavas. The Greenland-Iceland-Faroe Ridge thus has a similar structure to some zones of seaward-dipping reflectors. The contemporaneous melt layer corresponds to the 3–10 km thick Icelandic-type upper crust plus magma emplaced in the ~ 10–30-km-thick Icelandic-type lower crust. This model can account for seismic and gravity data that are inconsistent with a gabbroic composition for Icelandic-type lower crust, and petrological data that show no reasonable temperature or source composition could generate the full ~ 40-km thickness of Icelandic-type crust observed. Numerical modeling confirms that extension of the continental crust can continue for many tens of Myr by lower-crustal flow from beneath the adjacent continents. Petrological estimates of the maximum potential temperature of the source of Icelandic lavas are up to 1450 °C, no more than ~ 100 °C hotter than MORB source. The geochemistry is compatible with a source comprising hydrous peridotite/pyroxenite with a component of continental mid- and lower crust. The fusible petrology, high source volatile contents, and frequent formation of new rifts can account for the true ~ 15–20 km melt thickness at the moderate temperatures observed. A continuous swathe of magma-inflated continental material beneath the 1200-km-wide Greenland-Iceland-Faroe Ridge implies that full continental breakup has not yet occurred at this latitude. Ongoing tectonic instability on the Ridge is manifest in long-term tectonic disequilibrium on the adjacent rifted margins and on the Reykjanes Ridge, where southerly migrating propagators that initiate at Iceland are associated with diachronous swathes of unusually thick oceanic crust. Magmatic volumes in the NE Atlantic Realm have likely been overestimated and the concept of a monogenetic North Atlantic Igneous Province needs to be reappraised. A model of complex, piecemeal breakup controlled by pre-existing structures that produces anomalous volcanism at barriers to rift propagation and distributes continental material in the growing oceans fits other oceanic regions including the Davis Strait and the South Atlantic and West Indian oceans

Frameworks for Understanding Access to Pediatric Specialty Care in Maine

Date of Presentation: March 23rd, 2023 Presented by: James Bohnhoff, MD, MS General Pediatrician, Physician Investigator MH Department of Pediatrics | MHIR Center for Interdisciplinary Population and Health Research CME available for 1 year after presentation CME Text Code: 84171https://knowledgeconnection.mainehealth.org/pediatrics_gr/1015/thumbnail.jp

General and subspecialist pediatrician perspectives on barriers and strategies for referral: a latent profile analysis

BACKGROUND: Children in need of pediatric subspecialty care may encounter multiple barriers, and multiple strategies have been suggested to improve access. The purpose of this study was to describe the perceptions of general and subspecialty pediatric physicians regarding barriers to subspecialty care and the value of strategies to improve subspecialty access. METHODS: We surveyed a national sample of 1680 general pediatricians and pediatric subspecialists in May and June 2020 regarding 11 barriers to subspecialty care and 9 strategies to improve access to subspecialty care, selected from recent literature. Using latent profile analysis, respondents were grouped according to the degree to which they believed each of the barriers impacted access to subspecialty care. Using chi-squared tests, we compared the profiles based on respondent characteristics and perspectives on strategies to improve access. RESULTS: The response rate was 17%. In 263 responses completed and eligible for inclusion, the barriers most frequently described as major problems were wait times (57%), lack of subspecialists (45%) and difficulty scheduling (41%). Respondents were classified into 4 profiles: Broad concerns, Subspecialist availability concerns, Clinician communication concerns, and Few concerns. These profiles varied significantly by respondent specialty (p \u3c .001, with medical subspecialists overrepresented in the Clinician communication profile, psychiatrists in the subspecialist availability profile, and surgeons in the few concerns profile); and by respondents\u27 typical wait time for appointments (p \u3c .001, with physicians with the longest wait times overrepresented in the subspecialist availability profile). CONCLUSIONS: We found specific profiles in clinician views regarding barriers to subspecialty care which were associated with perspectives on strategies aimed at overcoming these barriers. These results suggest that health systems aiming to improve subspecialty access should first identify the barriers and preferences specific to local clinicians

Killing them softly: failure by fatigue in the wave-swept macroalga Mazzaella

Repeated force application typifies the lives of many plants and seaweeds. Winds repeatedly blow through the branches of trees; waves regularly crash over nearshore seaweeds, with algal thalli commonly breaking or tattering as a result. To date, however, much biomechanical investigation of plant and macroalgal tissues has focused on single applications of force, bending branches until they crack and pulling algal blades until they rupture. In the case of wave-swept seaweeds, such pull-to-break tests have found individual waves often not forceful enough to account for observed rates of algal breakage. I have investigated an alternative explanation for breakage of algal blades: failure may occur by fatigue, with damage accumulating over the course of smaller, repeated loadings. In laboratory tests on the red macroalga Mazzaella, I have quantified the process of fatigue, from initial formation of small cracks through eventual specimen fracture. Susceptibility to fatigue failure varied with species and life history stage. Most of the loading cycles to failure for any given specimen were associated with crack initiation, with cracks forming after80-90% of the cycles required for failure had passed. Furthermore, a tradeoff between reproduction and crack formation, as well as a cost of endophyte infection, was discovered; cracks frequently formed in association withreproductive structures and endophytes. Extrapolation of fatigue behavior measured in the laboratory suggests an important role for fatigue failure in breakage observed in the field. Large, female gametophyte fronds are predicted mostliable to fail by fatigue in the field, whereas at the other extreme, small, male gametophytes are unlikely to fracture from fatigue. An ongoing field study is assessing these predictions

Failure by fatigue in the field: a model of fatigue breakage for the macroalga Mazzaella, with validation

Seaweeds inhabiting the extreme hydrodynamic environment of wave-swept shores break frequently. However, traditional biomechanical analyses, evaluating breakage due to the largest individual waves, have perennially underestimated rates of macroalgal breakage. Recent laboratory testing has established that some seaweeds fail by fatigue, accumulating damage over a series of force impositions. Failure by fatigue may thus account, in part, for the discrepancy between prior breakage predictions, based on individual not repeated wave forces, and reality. Nonetheless, the degree to which fatigue breaks seaweeds on wave-swept shores remains unknown. Here, we developed a model of fatigue breakage due to wave-induced forces for the macroalga Mazzaella flaccida. To test model performance, we made extensive measurements of M. flaccida breakage and of wave-induced velocities experienced by the macroalga. The fatigue-breakage model accounted for significantly more breakage than traditional prediction methods. For life history phases modeled most accurately, 105% (for female gametophytes) and 79% (for tetrasporophytes) of field-observed breakage was predicted, on average. When M. flaccida fronds displayed attributes such as temperature stress and substantial tattering, the fatigue-breakage model underestimated breakage, suggesting that these attributes weaken fronds and lead to more rapid breakage. Exposure to waves had the greatest influence on model performance. At the most wave-protected sites, the model underpredicted breakage, and at the most wave-exposed sites, it overpredicted breakage. Overall, our fatigue-breakage model strongly suggests that, in addition to occurring predictably in the laboratory, fatigue-induced breakage of M. flaccida occurs on wave-swept shores