The Effects of Patient Characteristics on Clinician’s Adherence to Preventive Practice Guidelines

ABSTRACT BACKGROUND: The existence of health disparities confirms that not all patients, regardless of differences in patient demographics, are provided quality healthcare (Agency of Health Care Research and Quality, 2003). Moreover, research suggests that health disparities may be present due to the inadequate delivery of medical services (S. Haist, J. Wilson, M. Lineberry, & C. Griffith, 2007; Van Ryn, Burgess, Malat, & Griffin, 2006). The differences in the delivery of care and services to ethnic minorities and those of low socioeconomic status warrant examining the role healthcare providers play in the causation of these health disparities (Smedley, Stith, & Nelson, 2003). OBJECTIVE: The purpose of the study is to identify differences in routine screening practices of Physician Assistants and determine if such differences are associated with patients’ race and socioeconomic status. DESIGN: One hundred and twelve (N = 112) practicing Physician Assistants (N = 142) in Kentucky were surveyed and randomly assigned to receive one of four clinical vignettes. The likelihood of offering different routine screening recommendations was examined based on patient race and socioeconomic status. MAIN MEASURES: We investigated the mean differences of selected preventative care recommendation options for vignette patients as a function of patient race and socioeconomic status. KEY RESULTS: A multivariate analysis revealed that the race of a patient had a statistically significant multivariate effect on differences in screening recommendation, (p =.017) for hypertension (HTN), p=.017, immunization, p=.002. Univariate analysis showed statistically significant differences, with the African American patient were significantly less likely to receive screening for hypertension (HTN), (M = 3.42), 95% CI [3.24, 3.59], or immunizations (M = 2.45), 95% CI [2.21, 2.69] when compared to Caucasian women (M = 3.71, 2.98), 95% CIs [3.55, 3.88], [2.76, 3.23], respectively. CONCULSION: The findings suggest that the race of the patient in the vignette influenced the likelihood of receiving screening recommendations. The findings show that care delivered by Physician Assistants (PAs), are a possible source of healthcare disparities between patients from racial/ethnic minority backgrounds and their Caucasian counterparts. Keywords: disparities, health education, race & ethnicity, socioeconomic, preventive car

Input-output relations for multiport ring cavities

Quantum input-output relations for a generic $n$-port ring cavity are obtained by modeling the ring as a cascade of $n$ interlinked beam splitters. Cavity response to a beam impinging on one port is studied as a function of the beam-splitter reflectivities and the internal phase-shifts. Interferometric sensitivity and stability are analyzed as a function of the number of ports.Comment: 6 pages, 5 figures (low-res

Renal Humoral, Genetic and Genomic Mechanisms Underlying Spontaneous Hypertension

In spite of significant progress in our knowledge of mechanisms that control blood pressure, our understanding of the pathogenesis of hypertension, its genetics, and population efforts to control blood pressure, hypertension remains the leading risk factor for mortality worldwide. It’s estimated that 1 out of every 3 adults has hypertension. Hypertension is a major risk factor for cardiovascular disease and stroke, and is considered a primary or contributing cause of death to more than 2.4 million US deaths each year. Although spontaneous hypertension has been the subject of substantial research, many critical questions remain unanswered. To investigate mechanisms underlying spontaneous hypertension, a unique rodent breeding approach was used to isolate nuclear and mitochondrial genes contributing to the disease. By diluting the nuclear genome of the Spontaneously Hypertensive Rat on a normotensive Brown Norway background while maintaining the SHR mitochondrial genome, I investigated both intrinsic and extrinsic mechanisms of the kidney and its relationship to hypertension. Chapter 2 documents the dominance of the hypertensive phenotype in our rodent colony, despite the dilution of the nuclear genome of the SHR. Chapter 3 presents data indicating that the renin-angiotensin system, particularly the location and abundance of the AT1 receptor may play an important role in the manifestation of spontaneous hypertension. Chapter 4 presents that rats in our rodent colony exhibited normal pressure-natriuresis and kidney function; however, hypertensive rats had a reduced ability to sense orally ingested sodium chloride, thus necessitating chronic elevations of arterial pressure in order to maintain sodium balance. This chronic pressure-natriuresis relationship shifts the renal function curve to the right, thus sustaining elevated blood pressure. Chapter 5 presents data that genes important for oxidative phosphorylation may play a critical role in the development of hypertension. Both nuclear and mitochondrial oxidative phosphorylation genes were downregulated in hypertensive rats compared with normotensive rats. Data presented in every chapter highlights the importance of the kidney in the pathogenesis of hypertension. Humoral, genetic and genomic mechanisms of the kidney appear to play a dominant role in the development and maintenance of the disease

How Social Emotional Development Skills Gained in High Quality Public School Prekindergarten Impact Kindergarten Academic Readiness

Longitudinal research has demonstrated that children’s emotional and social skills are linked to their early academic achievement (Wentzel & Asher, 1995). Children who have difficulty paying attention, following directions, getting along with others, and controlling negative emotions like anger and distress do not do as well in school (Arnokl et al., 1999; McClelland et al., 2000). Academic achievement in the early years of schooling appears to be built on a firm foundation of children’s social emotional skills (Ladd, Kochenderfer, & Coleman, 1997; O’Neil et al., 1997). Higher quality prekindergarten programs are associated with the early years of schooling and more positive academic outcomes in children (Burchinal et al., 2000). Investments in early childhood programs by state and federal governments have been made with a goal of improving school readiness for low income children. These investments are based on findings that show a link between program quality and children’s academic outcomes. Studies of model programs show that intensive early childhood services can improve children’s cognitive, 2 academic, and social skills with gains maintained into adulthood (Burchinal, Kainz, & Cai, in press). The purpose of this study was to create knowledge that indicates the influence of the social emotional skills children gain by completing prekindergarten. Schools in Sevier County, Tennessee that have prekindergarten classrooms in place were chosen for this study because kindergarten is the next experience children will have after pre-k. Kindergarten teachers in the schools chosen were purposefully selected as participants. Kindergarten teachers have the opportunity to make comparisons of differences in academic readiness of students who have completed prekindergarten and the students who have not been in a school environment. Kindergarten teachers may be able to conclude from classroom observation of the 2 groups if there is a difference in academic readiness. Home environments with strong parental involvement were most kindergarten teachers’ first choice for early learning and kindergarten preparation. Teachers realization that a strong home environment is not available to all children encouraged them to appreciate having a high quality public school prekindergarten as an alternative. Kindergarten teachers overall perceptions about the readiness of children who enter their classroom after completing prekindergarten were positive

Localizing merging black holes with sub-arcsecond precision using gravitational-wave lensing

The current gravitational-wave localization methods rely mainly on sources with electromagnetic counterparts. Unfortunately, a binary black hole does not emit light. Due to this, it is generally not possible to localize these objects precisely. However, strongly lensed gravitational waves, which are forecasted in this decade, could allow us to localize the binary by locating its lensed host galaxy. Identifying the correct host galaxy is challenging because there are hundreds to thousands of other lensed galaxies within the sky area spanned by the gravitational-wave observation. However, we can constrain the lensing galaxy's physical properties through both gravitational-wave and electromagnetic observations. We show that these simultaneous constraints allow one to localize quadruply lensed waves to one or at most a few galaxies with the LIGO/Virgo/Kagra network in typical scenarios. Once we identify the host, we can localize the binary to two sub-arcsec regions within the host galaxy. Moreover, we demonstrate how to use the system to measure the Hubble constant as a proof-of-principle application.Comment: 5 pages (main text) + 5 pages (methods+references), 5 figures. Accepted to MNRA