The Influence of Patient-Centeredness on Minority and Socioeconomically-Disadvantaged Patients’ Trust in their Physicians: An Evidence-Based Structural Equation Modeling Investigation

The purpose of this investigation was to determine the effect of physician patient-centeredness on patient trust across randomly selected groups of patients from an inner city medical practice serving a preponderance of minority and socioeconomically-disadvantaged patients. METHODS: A two-factor multigroup structural equation modeling design was employed, with randomly selected test (N = 300) and cross-validation (N = 300) samples of medical practice patients. Equality constraints were established to test the invariance of effects across groups. The model was compared to its unconstrained counterpart to further test its trustworthiness. An additional 5,000 nonparametric bootstrapped samples for each group were generated to further cross-validate and assess the stability of effect estimates. RESULTS: The model fit well. Physician patient-centeredness significantly influenced patient trust, explaining 82 percent of its variability. When physician patient-centeredness increased by one unit, the predicted value for patient trust increased by 1.043 units (.903 standardized). Patient-centered physician behaviors increased patients’ confidence in and likelihood to recommend their physician. This pattern of effects held across the test and cross-validation groups. The hypothesized model was sustained when compared to its competing counterpart. CONCLUSIONS: Evidence supported the factor and structural validity of the model. This study offers a plausible two-factor model for the measurement and improvement of patient-centeredness, and concomitantly, patient trust in an inner city medical clinic serving minority and socioeconomically-disadvantaged patients. In addition to quality improvement and outcome measurement, the results have implications for improving patient-centeredness, patient trust, the patient–provider relationship, medical education, and reducing health care disparities

New Study Underway to Estimate the Impact of Lesser Scaup on Arkansas’ Baitfish Industry

The baitfish industry is an important economic enterprise for many aquaculture producers in Arkansas. The industry generates approximately $30 million annually in farm-gate sales of these small fish that include fathead minnows, goldfish and golden shiners. Diving ducks known as scaup, or “Bluebills,” spend late fall through early spring in Arkansas and Mississippi on deep water wetlands, rivers, and aquaculture ponds. The notion that scaup are consuming an abundance of baitfish in Arkansas ponds has concerned commercial growers for several years

New Study Underway to Estimate the Impact of Lesser Scaup on Arkansas’ Baitfish Industry

The baitfish industry is an important economic enterprise for many aquaculture producers in Arkansas. The industry generates approximately $30 million annually in farm-gate sales of these small fish that include fathead minnows, goldfish and golden shiners. Diving ducks known as scaup, or “Bluebills,” spend late fall through early spring in Arkansas and Mississippi on deep water wetlands, rivers, and aquaculture ponds. The notion that scaup are consuming an abundance of baitfish in Arkansas ponds has concerned commercial growers for several years

Predicting consistent foraging ecologies of migrating waterbirds: Using stable isotope and parasite measurements as indicators of landscape use

The emergence of novel human pathogens is frequently linked with zoonotic events and human-wildlife interactions that promote disease transmission. Consequently, surveillance of wildlife populations for candidate diseases that could spread to humans is beneficial, but requires widespread collections of numerous samples. A legitimate means to acquire large sample sizes of waterfowl is through cooperation between researchers and hunters, who also work in concert with natural resource managers, landowners, and agricultural entities -e.g., aquaculture facilities. In addition to understanding the occurrence and spread of parasites and pathogens by birds, these samples can be used to answer questions about the ecology of various waterbird species. Body mass and morphometric data on hunter-donated specimen are useful for understanding bird condition and other dynamics of birds; however, when breast meat is removed prior to the acquisition of specimen weight, samples might not be as desirable. Here, we evaluate the utility of data obtained from a bird species that might be targeted by hunters and subsequently used to learn about their disease dynamics. Lesser Scaup (Aythya affinis) collected at aquaculture facilities were assessed for their stable isotope concentrations and parasites communities to learn about the birds’ foraging ecology. Discriminant analyses designed to classify birds by the aquaculture pond type from which they were collected included isotope data, Principal Components derived from parasite community data of 7 types, and birds’ body mass. We compared these to Double-crested Cormorants (Nannopterum auritum) feeding on catfish and found the two waterbird species exhibited different infracommunities of parasites Furthermore, some scaup demonstrated fish aquaculture pond type fidelity. Bird body mass was an important metric to include in analytical models when all parasite datatypes were not available. However, the combination of stable isotope concentrations and parasite infracommunity data (that includes prevalence, abundance, volume, and energy use) in models resulted in host ecology differentiation equal or better than models where bird body mass was included. Hunter-derived samples should be encouraged as a means for sample acquisition and be considered as an approach for aquaculture-wildlife conflict management as the information that can be obtained through these samples is multifaceted

Scaup Depredation on Arkansas Baitfish and Sportfish Aquaculture

Lesser scaup (Aythya affinis) and greater scaup (A. marila), hereafter scaup, consume a variety of aquatic invertebrates, plants, and occasionally small fish. Scaup have foraged on commercial aquaculture farms in the southern United States for decades. However, the types, abundance, and rate of fish exploitation by scaup on baitfish and sportfish farms are not well documented. Thus, information is needed to understand how fish and other foods influence scaup use of aquatic resources, and any potential economic effects of depredation of fish. From November–March in winters 2016–2017 and 2017–2018, we conducted 1,458 pond surveys to estimate the abundance and distribution of scaup on Arkansas baitfish and sportfish farms that commercially produce species such as golden shiners (Notemigonus crysoleucas), fathead minnows (Pimephales promelas), goldfish (Carassius auratus), and sunfish (Lepomis spp.). We also collected and processed 531 foraging scaup and quantified the proportion of scaup consuming fish and the proportion of their diet obtained from fish. Fish consumption was highly variable between years. In our survey area, we estimated total fish consumption at 1,400 kg and 60,500 kg for winters 2016–2017 and 2017–2018, respectively. Sunfish ponds experienced the maximum loss (18,000 fish/ha) during winter 2017–2018, while goldfish ponds experienced a loss of just 2,600 fish/ha during the same winter. The estimates of baitfish and sportfish loss to scaup revealed potential management strategies for minimizing fish loss and can inform economic analysis of the financial impact of scaup on producers

Foraging Ecology and Distribution of Scaup (Aythya spp.) on Arkansas Commercial Baitfish and Sportfish Farms

Lesser Scaup (Aythya affinis)and Greater Scaup (Aythya marila) have been reported to consume substantial quantities of golden shiners (Notemigonus crysoleucas), fathead minnows (Pimephales promelas), goldfish (Carassius auratus), and sunfish (Lepomis spp.) produced on Arkansas commercial baitfish and sportfish farms. The goals of this study were to investigate foraging ecology and distribution of Scaup at these facilities, and use this information to assist producers in administering bird harassment efforts more efficiently. During typical wintering period for Scaup in Arkansas (November-March), we conducted approximately 1,400 pond surveys to estimate abundance and distribution of scaup on farms in 2016-2017 and 2017-2018. Information related to pond size, fish species, fish size, and stocking density, were also obtained to enable a more detailed analysis of Scaup use. We also collected 561 Scaup from these facilities to quantify the proportion of diet obtained from fish. There was an increase in Scaup abundance and fish consumption between the first to the second winter, likely attributed to cooler temperatures during the second winter. Our distribution model predicted an increased probability of Scaup use on larger ponds containing high densities of fish, while diet analysis indicated increased fish consumption during colder winter periods. Our results can be used by farm managers to designate resources for bird harassment to particular locations and times of the winter when scaup are more likely to negatively impact the fish crop

Evolutionary Relationships and Range Evolution of Greenhood Orchids (Subtribe Pterostylidinae): Insights From Plastid Phylogenomics

Australia harbours a rich and highly endemic orchid flora with over 90% of native species found nowhere else. However, little is known about the assembly and evolution of Australia’s orchid flora. Here, we used a phylogenomic approach to infer evolutionary relationships, divergence times and range evolution in Pterostylidinae (Orchidoideae), the second largest subtribe in the Australian orchid flora, comprising the genera Pterostylis and Achlydosa. Phylogenetic analysis of 75 plastid genes provided well-resolved and supported phylogenies. Intrageneric relationships in Pterostylis were clarified and monophyly of eight of 10 sections supported. Achlydosa was found to not form part of Pterostylidinae and instead merits recognition at subtribal level, as Achlydosinae. Pterostylidinae were inferred to have originated in eastern Australia in the early Oligocene, coinciding with the complete separation of Australia from Antarctica and the onset of the Antarctic Circumpolar Current, which led to profound changes in the world’s climate. Divergence of all major lineages occurred during the Miocene, accompanied by increased aridification and seasonality of the Australian continent, resulting in strong vegetational changes from rainforest to more open sclerophyllous vegetation. The majority of extant species were inferred to have originated in the Quaternary, from the Pleistocene onwards. The rapid climatic oscillations during the Pleistocene may have acted as important driver of speciation in Pterostylidinae. The subtribe underwent lineage diversification mainly within its ancestral range, in eastern Australia. Long-distance dispersals to southwest Australia commenced from the late Miocene onwards, after the establishment of the Nullarbor Plain, which constitutes a strong edaphic barrier to mesic plants. Range expansions from the mesic into the arid zone of eastern Australia (Eremaean region) commenced from the early Pleistocene onwards. Extant distributions of Pterostylidinae in other Australasian regions, such as New Zealand and New Caledonia, are of more recent origin, resulting from long-distance dispersals from the Pliocene onwards. Temperate eastern Australia was identified as key source area for dispersals to other Australasian regions

The Canada-UK Deep Submillimetre Survey: The Survey of the 14-hour field

We have used SCUBA to survey an area of 50 square arcmin, detecting 19 sources down to a 3sigma sensitivity limit of 3.5 mJy at 850 microns. We have used Monte-Carlo simulations to assess the effect of source confusion and noise on the SCUBA fluxes and positions, finding that the fluxes of sources in the SCUBA surveys are significantly biased upwards and that the fraction of the 850 micron background that has been resolved by SCUBA has been overestimated. The radio/submillmetre flux ratios imply that the dust in these galaxies is being heated by young stars rather than AGN. We have used simple evolution models based on our parallel SCUBA survey of the local universe to address the major questions about the SCUBA sources: (1) what fraction of the star formation at high redshift is hidden by dust? (2) Does the submillimetre luminosity density reach a maximum at some redshift? (3) If the SCUBA sources are proto-ellipticals, when exactly did ellipticals form? However, we show that the observations are not yet good enough for definitive answers to these questions. There are, for example, acceptable models in which 10 times as much high-redshift star formation is hidden by dust as is seen at optical wavelengths, but also acceptable ones in which the amount of hidden star formation is less than that seen optically. There are acceptable models in which very little star formation occurred before a redshift of three (as might be expected in models of hierarchical galaxy formation), but also ones in which 30% of the stars have formed by this redshift. The key to answering these questions are measurements of the dust temperatures and redshifts of the SCUBA sources.Comment: 41 pages (latex), 17 postscript figures, to appear in the November issue of the Astronomical Journa

The burden and characteristics of enteric fever at a healthcare facility in a densely populated area of Kathmandu

Enteric fever, caused by Salmonella enterica serovars Typhi and Paratyphi A (S. Typhi and S. Paratyphi A) remains a major public health problem in many settings. The disease is limited to locations with poor sanitation which facilitates the transmission of the infecting organisms. Efficacious and inexpensive vaccines are available for S. Typhi, yet are not commonly deployed to control the disease. Lack of vaccination is due partly to uncertainty of the disease burden arising from a paucity of epidemiological information in key locations. We have collected and analyzed data from 3,898 cases of blood culture-confirmed enteric fever from Patan Hospital in Lalitpur Sub-Metropolitan City (LSMC), between June 2005 and May 2009. Demographic data was available for a subset of these patients (n = 527) that were resident in LSMC and who were enrolled in trials. We show a considerable burden of enteric fever caused by S. Typhi (2,672; 68.5%) and S. Paratyphi A (1,226; 31.5%) at this Hospital over a four year period, which correlate with seasonal fluctuations in rainfall. We found that local population density was not related to incidence and we identified a focus of infections in the east of LSMC. With data from patients resident in LSMC we found that the median age of those with S. Typhi (16 years) was significantly less than S. Paratyphi A (20 years) and that males aged 15 to 25 were disproportionately infected. Our findings provide a snapshot into the epidemiological patterns of enteric fever in Kathmandu. The uneven distribution of enteric fever patients within the population suggests local variation in risk factors, such as contaminated drinking water. These findings are important for initiating a vaccination scheme and improvements in sanitation. We suggest any such intervention should be implemented throughout the LSMC area.This work was supported by The Wellcome Trust, Euston Road, London, United Kingdom. MFB is supported by the Medical Research Council (grant G0600718). SB is supported by an OAK foundation fellowship through Oxford University