Community dimensions and HPSA practice location: 30 years of family medicine training

BACKGROUND AND OBJECTIVES: Our objective was to assess practicing family physicians\u27 confidence and participation in a range of community-related activities. Additionally, we assessed the strength of the relationship between the physicians\u27 reported medical school and residency training in community-related activities and their current community activities, as well as whether they were practicing in an underserved location. METHODS: All 347 graduates of the University of Massachusetts Family Medicine Residency were surveyed about practice location and type, involvement and training in community work, confidence in community-related skills, and sociodemographic characteristics. Analyses were conducted by residency graduation decade (1976-1985, 1986-1995, and 1996-2005). RESULTS: Earlier graduates (19761985) were significantly more likely to engage in an array of community-related activities, but recent graduates (1996-2005) were more likely to report having been trained in these skills. There was a significant positive association between practice in an underserved area and confidence in issues related to sociocultural aspects of care. While recent graduates were more likely to locate both initial and current practices in a Health Professions Shortage Area (HPSA), 20.6% of all graduates reported an initial practice in a HPSA. CONCLUSIONS: While family physician involvement in community-related activities increases with years out of residency, a higher proportion of recent graduates report having learned community-related skills while in medical school. Physician relocation tends to be away from HPSA toward non-HPSA sites

Family medicine residency characteristics associated with practice in a health professions shortage area

BACKGROUND AND OBJECTIVES: While some family medicine residency programs are designed to train residents in community health centers (CHCs) for future careers serving underserved populations, there are few outcome studies on such programs. Our residency program provides three options for ambulatory health center training, but otherwise residents participate in the same curriculum. We analyzed relationships between ambulatory training site and likelihood of practice in health professions shortage areas (HPSAs). METHODS: We sent a mail survey to all graduates of one family medicine residency about practice locations, types, and populations; influences on practice choice; and sociodemographic characteristics. RESULTS: Training in a CHC had a statistically significant association with the likelihood of practice in an HPSA for both initial and current practice. Training in a rural residency site was associated with initial and current rural practice. Logistic regression analysis showed that physicians who completed ambulatory training in the CHC were nearly six times more likely to report having practiced initially and four times more likely to cite current practice in an HPSA. CONCLUSIONS: Outpatient CHC residency training increases the likelihood of practice in an underserved setting. This finding has policy implications for supporting workforce training in practice settings that care for underserved populations

Atomic Data Revisions for Transitions Relevant to Observations of Interstellar, Circumgalactic, and Intergalactic Matter

Measurements of element abundances in galaxies from astrophysical spectroscopy depend sensitively on the atomic data used. With the goal of making the latest atomic data accessible to the community, we present a compilation of selected atomic data for resonant absorption lines at wavelengths longward of 911.753 Å (the H I Lyman limit), for key heavy elements (heavier than atomic number 5) of astrophysical interest. In particular, we focus on the transitions of those ions that have been observed in the Milky Way interstellar medium (ISM), the circumgalactic medium (CGM) of the Milky Way and/or other galaxies, and the intergalactic medium (IGM). We provide wavelengths, oscillator strengths, associated accuracy grades, and references to the oscillator strength determinations. We also attempt to compare and assess the recent oscillator strength determinations. For about 22% of the lines that have updated oscillator strength values, the differences between the former values and the updated ones are ≳ 0.1 dex. Our compilation will be a useful resource for absorption line studies of the ISM, as well as studies of the CGM and IGM traced by sight lines to quasars and gamma-ray bursts. Studies (including those enabled by future generations of extremely large telescopes) of absorption by galaxies against the light of background galaxies will also benefit from our compilation

Petrologic monitoring at Volcán de Fuego, Guatemala

Paroxysmal activity represents an end-member in the common range of activity at mafic arc volcanoes, characterised by rapid transitions across the effusive-explosive interface and thus posing significant challenges to hazard assessment. Conceptual models to explain changes in the frequency and magnitude of these paroxysmal events are based either on magma recharge or an increase in gas flux, largely framed in the context of two-phase flow. Gas- and magma-driven models are both viable mechanisms to explain the varying styles of paroxysmal behaviour observed in mafic systems; however, each has different implications for future activity. We present time series petrologic data for ash and lava samples collected at Volcán de Fuego, Guatemala, during paroxysmal eruptions between 2011 and 2018. We show that a step-change in glass composition occurred between 2015 and 2016, reflecting an increase in magma temperature and a reduction in pre-eruptive crystallisation, concurrent with an escalation in the frequency of paroxysmal activity. There was no change in the bulk or phase compositions during this period. To explain these observations, we propose that the increase in frequency of paroxysmal eruptions is modulated by the supply of exsolved volatiles from lower crustal degassing magmas, without invoking repeated transfer of new, primitive magma to a shallow reservoir. Protracted lava effusion, accompanied by more vigorous and more frequent Strombolian explosions and gas ‘chugging’, prior to the transition to sustained fountaining suggests that gas retention in crystal-rich magma may modulate the height of the magma column as gas supply increases. Slow decompression associated with effusion may determine the timing of effusive to explosive transitions in mafic arc systems more generally. A large paroxysmal eruption of Fuego on 3 June 2018, notable for the rapid escalation in eruptive intensity several hours into the eruption, produced ash with a range of textures and glass compositions consistent with magma evacuation over a range of depths and decompression rates. Given the protracted repose time between paroxysms before this event, we suggest that a shallow crystallised plug degraded, and ultimately failed, several hours into the eruption of 3 June 2018, triggering top-down decompression of magma in the conduit synchronous with the observed rapid acceleration in eruption rate. Ultimately, we propose that the frequency of paroxysms at Fuego is broadly proportional to the gas supply rate, while the range in glass compositions is related to the repose time prior to eruptive activity. Our data illustrate the potential of petrologic monitoring to distinguish between gas- and magma-driven paroxysm triggers and to anticipate future events, especially when interpreted in the context of geophysical observations and implemented within community-based ash collection initiatives

Transient trimethylaminuria related to menstruation

BACKGROUND: Trimethylaminuria, or fish odor syndrome, includes a transient or mild malodor caused by an excessive amount of malodorous trimethylamine as a result of body secretions. Herein, we describe data to support the proposal that menses can be an additional factor causing transient trimethylaminuria in self-reported subjects suffering from malodor and even in healthy women harboring functionally active flavin-containing monooxygenase 3 (FMO3). METHODS: FMO3 metabolic capacity (conversion of trimethylamine to trimethylamine N-oxide) was defined as the urinary ratio of trimethylamine N-oxide to total trimethylamine. RESULTS: Self-reported Case (A) that was homozygous for inactive Arg500stop FMO3, showed decreased metabolic capacity of FMO3 (i.e., ~10% the unaffected metabolic capacity) during 120 days of observation. For Case (B) that was homozygous for common [Glu158Lys; Glu308Gly] FMO3 polymorphisms, metabolic capacity of FMO3 was almost ~90%, except for a few days surrounding menstruation showing < 40% metabolic capacity. In comparison, three healthy control subjects that harbored heterozygous polymorphisms for [Glu158Lys; Glu308Gly] FMO3 or homozygous for wild FMO3 showed normal (> 90%) metabolic capacity, however, on days around menstruation the FMO3 metabolic capacity was decreased to ~60–70%. CONCLUSION: Together, these results indicate that abnormal FMO3 capacity is caused by menstruation particularly in the presence, in homozygous form, of mild genetic variants such as [Glu158Lys; Glu308Gly] that cause a reduced FMO3 function

Detection of Dust in High-Velocity Cloud Complex C -- Enriched Gas Accreting onto the Milky Way

We present the detection of dust depletion in Complex C, a massive, infalling, low-metallicity high-velocity cloud in the northern Galactic hemisphere that traces the ongoing accretion of gas onto the Milky Way. We analyze a very high signal-to-noise HST/COS spectrum of AGN Mrk 817 formed by coadding 165 individual exposures taken under the AGN STORM 2 program, allowing us to determine dust-depletion patterns in Complex C at unprecedented precision. By fitting Voigt components to the O I, S II, N I, Si II, Fe II, and Al II absorption and applying ionization corrections from customized Cloudy photoionization models, we find sub-solar elemental abundance ratios of [Fe/S]=-0.42+/-0.08, [Si/S]=-0.29+/-0.05, and [Al/S]=-0.53+/-0.08. These ratios indicate the depletion of Fe, Si, and Al into dust grains, since S is mostly undepleted. The detection of dust provides an important constraint on the origin of Complex C, as dust grains indicate the gas has been processed through galaxies, rather than being purely extragalactic. We also derive a low metallicity of Complex C of [S/H]=-0.51+/-0.16 (31% solar), confirming earlier results from this sightline. We discuss origin models that could explain the presence of dust in Complex C, including Galactic fountain models, tidal stripping from the Magellanic Clouds or other satellite galaxies, and precipitation of coronal gas onto dust-bearing ``seed" clouds.Comment: 8 pages, 3 figures, accepted for publication in ApJ Letters. This version has been updated with proof correction