Does the Family Practice Residency Program at Genesys Regional Medical Center Prepare Their Residents for an Office Based Primary Care Practice?

Increasingly, physicians are being scrutinized and held accountable for their medical decisions by governmental regulatory agencies, third party insurance carriers, non-professional groups, and the general public. Given the scrutiny, graduate medical education programs, or residency training programs as they are called, must ensure that they are adequately preparing their residents for prevention, recognition, and management of a broad spectrum of disease problems in the ambulatory care setting. The family practice residency program at Genesys Regional Medical Center in Grand Blanc, Michigan, formerly St. Joseph Hospital (SJH) of Flint, had as its primary ambulatory care training site the Family Health Care Center at SJH campus. A questionnare was mailed to 123 family practice graduates asking them to rate how well they were trained at the SJH/Family Health Center to manage 24 of the most commonly seen patient problems in the ambulatory care setting. They were also asked to rate and comment on how well the Research Practice Management (RPM) rotation prepared them to manage the business side of their office practice. Forty-three percent of the SJH graduates responded to the questionnaire, rating their overall experience with the top 20 most commonly seen ambulatory problems as very good. The areas of training that dealt with patient counseling and behavioral problems, along with RPM rotation were rated less than expected by this author, but the graduates who completed the questionnaire offered possible remedies for improving the ambulatory curriculum.Master'sCollege of Arts and Sciences: Public AdministrationUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/117698/1/Drabek.pd

Ground-based detection of a cloud of methanol from Enceladus: When is a biomarker not a biomarker?

Saturn's moon Enceladus has vents emerging from a sub-surface ocean, offering unique probes into the liquid environment. These vents drain into the larger neutral torus in orbit around Saturn. We present a methanol (CH3OH) detection observed with IRAM 30-m from 2008 along the line-of-sight through Saturn's E-ring. Additionally, we also present supporting observations from the Herschel public archive of water (ortho-H2O; 1669.9 GHz) from 2012 at a similar elongation and line-of-sight. The CH3OH 5(1,1)-4(1,1) transition was detected at 5.9 sigma confidence. The line has 0.43 km/s width and is offset by +8.1 km/s in the moon's reference frame. Radiative transfer models allow for gas cloud dimensions from 1750 km up to the telescope beam diameter ~73000 km. Taking into account the CH3OH lifetime against solar photodissociation and the redshifted line velocity, there are two possible explanations for the CH3OH emission: methanol is primarily a secondary product of chemical interactions within the neutral torus that (1) spreads outward throughout the E-ring or (2) originates from a compact, confined gas cloud lagging Enceladus by several km/s. We find either scenario to be consistent with significant redshifted H2O emission (4 sigma) measured from the Herschel public archive. The measured CH3OH:H2O abundance (> 0.5 per cent) significantly exceeds the observed abundance in the direct vicinity of the vents (~0.01 per cent), suggesting CH3OH is likely chemically processed within the gas cloud with methane (CH4) as its parent species.Comment: 16 pages, 4 figures, accepted for publication in the International Journal of Astrobiology (IJA

The JCMT dense gas survey of the Perseus Molecular Cloud

We present the results of a large-scale survey of the very dense gas in the Perseus molecular cloud using HCO+ and HCN (J = 4 - 3) transitions. We have used this emission to trace the structure and kinematics of gas found in pre- and protostellar cores, as well as in outflows. We compare the HCO+/HCN data, highlighting regions where there is a marked discrepancy in the spectra of the two emission lines. We use the HCO+ to identify positively protostellar outflows and their driving sources, and present a statistical analysis of the outflow properties that we derive from this tracer. We find that the relations we calculate between the HCO+ outflow driving force and the Menv and Lbol of the driving source are comparable to those obtained from similar outflow analyses using 12CO, indicating that the two molecules give reliable estimates of outflow properties. We also compare the HCO+ and the HCN in the outflows, and find that the HCN traces only the most energetic outflows, the majority of which are driven by young Class 0 sources. We analyse the abundances of HCN and HCO+ in the particular case of the IRAS 2A outflows, and find that the HCN is much more enhanced than the HCO+ in the outflow lobes. We suggest that this is indicative of shock-enhancement of HCN along the length of the outflow; this process is not so evident for HCO+, which is largely confined to the outflow base.Comment: 25 pages, 14 figures, 9 table

The Effect of Molecular Contamination on the Emissivity Spectral Index in Orion A

The emissivity spectral index is a critical component in the study of the physical properties of dust grains in cold and optically thin interstellar star forming regions. Since submillimeter astronomy is an ideal tool to measure the thermal emission of those dust grains, it can be used to characterize this important parameter. We present the SCUBA-2 shared risks observations at 450 μm and 850 μm of the Orion A molecular cloud obtained at the James-Clerk-Maxwell telescope. Previous studies showed that molecular emission lines can also contribute significantly to the measured fluxes in those continuum bands. We use HARP 12CO 3-2 maps to evaluate the total molecular line contamination in the SCUBA-2 maps and its effect on the determination of the spectral index in highly contaminated areas. With the corrected fluxes, we have obtained new spectral index maps for different regions of the well-known integral-shaped filament. This work is part of an ongoing effort to characterize the properties of star forming regions in the Gould belt with the new instruments available at the JCMT

The James Clerk Maxwell telescope dense gas survey of the Perseus molecular cloud

This is the final version of the article. Available from the publisher via the DOI in this record.We present the results of a large-scale survey of the very dense (n > 106 cm-3) gas in the Perseus molecular cloud using HCO+ and HCN (J = 4 → 3) transitions. We have used this emission to trace the structure and kinematics of gas found in pre- and protostellar cores, as well as in outflows. We compare the HCO+/HCN data, highlighting regions where there is a marked discrepancy in the spectra of the two emission lines. We use the HCO+ to identify positively protostellar outflows and their driving sources, and present a statistical analysis of the outflow properties that we derive from this tracer. We find that the relations we calculate between the HCO+ outflow driving force and the Menv and Lbol of the driving source are comparable to those obtained from similar outflow analyses using 12CO, indicating that the two molecules give reliable estimates of outflow properties. We also compare the HCO+ and the HCN in the outflows, and find that the HCN traces only the most energetic outflows, the majority of which are driven by young Class 0 sources. We analyse the abundances of HCN and HCO+ in the particular case of the IRAS 2A outflows, and find that the HCN is much more enhanced than the HCO+ in the outflow lobes. We suggest that this is indicative of shock enhancement of HCN along the length of the outflow; this process is not so evident for HCO+, which is largely confined to the outflow base. © 2014 The Authors Published by Oxford University Press on behalf of the Royal Astronomical Society.SLW-S and JH are funded by the Science and Technology Facilities Council of the UK. The James Clerk Maxwell Telescope is operated by the Joint Astronomy Centre on behalf of the Science and Technology Facilities Council of the United Kingdom, the National Research Council of Canada and (until 2013 March 31) the Netherlands Organisation for Scientific Researc

HCO+ detection of dust-depleted gas in the inner hole of the LkCa 15 pre-transitional disk

LkCa 15 is an extensively studied star in the Taurus region, known for its pre-transitional disk with a large inner cavity in the dust continuum and normal gas accretion rate. The most popular hypothesis to explain the LkCa 15 data invokes one or more planets to carve out the inner cavity, while gas continues to flow across the gap from the outer disk onto the central star. We present spatially unresolved HCO+ J = 4 → 3 observations of the LkCa 15 disk from the James Clerk Maxwell telescope (JCMT) and model the data with the ProDiMo code. We find that: (1) HCO+ line-wings are clearly detected, certifying the presence of gas in the cavity within ≲50 au of the star. (2) Reproducing the observed line-wing flux requires both a significant suppression of cavity dust (by a factor ≥ 104 compared to the interstellar medium (ISM)) and a substantial increase in the gas scale-height within the cavity (H0/R0 ∼ 0.6). An ISM dust-to-gas ratio (d:g = 10-2) yields too little line-wing flux, regardless of the scale-height or cavity gas geometry, while a smaller scale-height also under-predicts the flux even with a reduced d:g. (3) The cavity gas mass is consistent with the surface density profile of the outer disk extended inwards to the sublimation radius (corresponding to mass Md ∼ 0.03 M⊙), and masses lower by a factor ≥10 appear to be ruled out.Publisher PDFPeer reviewe

Spectroscopy of Stellar-Like Objects Contained in the Second Byurakan Survey. I

The results of spectroscopic observations of 363 star-like objects from the Second Byurakan Survey (SBS) are reported. This SBS's subsample has proven to be a rich source of newly identified quasars, Seyfert type galaxies, degenerate stars and hot subdwarfs. In the subsample here studied, we identified 35 new QSOs, 142 White Dwarfs (WDs) the majority of which, 114 are of DA type, 55 subdwarfs (29 of which are sdB-type stars), 10 HBB, 16 NHB, 54 G-type and 25 F-type stars, two objects with composite spectra, four Cataclismic Variables (CV), two peculiar emission line stars, 17 objects with continuous spectra, as well as one planetary nebula. Among the 35 QSOs we have found two Broad Absorption Line (BAL) QSOs, namely SBS 1423+500 and SBS 1435+500A. Magnitudes, redshifts, and slit spectra for all QSOs, also some typical spectra of the peculiar stars are presented. We estimate the minimum surface density of bright QSOs in redshift range 0.3<z<2.2 to be 0.05 per sq. deg. for B<17.0 and 0.10 per sq. deg. for B<17.5.Comment: 22 pages, 3 tables, 4 figures, PASP in pres

Collective Decision Dynamics in the Presence of External Drivers

We develop a sequence of models describing information transmission and decision dynamics for a network of individual agents subject to multiple sources of influence. Our general framework is set in the context of an impending natural disaster, where individuals, represented by nodes on the network, must decide whether or not to evacuate. Sources of influence include a one-to-many externally driven global broadcast as well as pairwise interactions, across links in the network, in which agents transmit either continuous opinions or binary actions. We consider both uniform and variable threshold rules on the individual opinion as baseline models for decision-making. Our results indicate that 1) social networks lead to clustering and cohesive action among individuals, 2) binary information introduces high temporal variability and stagnation, and 3) information transmission over the network can either facilitate or hinder action adoption, depending on the influence of the global broadcast relative to the social network. Our framework highlights the essential role of local interactions between agents in predicting collective behavior of the population as a whole.Comment: 14 pages, 7 figure

Molecular line contamination in the SCUBA-2 450 {\mu}m and 850 {\mu}m continuum data

Observations of the dust emission using millimetre/submillimetre bolometer arrays can be contaminated by molecular line flux, such as flux from 12CO. As the brightest molecular line in the submillimetre, it is important to quantify the contribution of CO flux to the dust continuum bands. Conversion factors were used to convert molecular line integrated intensities to flux detected by bolometer arrays in mJy per beam. These factors were calculated for 12CO line integrated intensities to the SCUBA-2 850 {\mu}m and 450 {\mu}m bands. The conversion factors were then applied to HARP 12CO 3-2 maps of NGC 1333 in the Perseus complex and NGC 2071 and NGC 2024 in the Orion B molecular cloud complex to quantify the respective 12CO flux contribution to the 850 {\mu}m dust continuum emission. Sources with high molecular line contamination were analysed in further detail for molecular outflows and heating by nearby stars to determine the cause of the 12CO contribution. The majority of sources had a 12CO 3-2 flux contribution under 20 per cent. However, in regions of molecular outflows, the 12CO can dominate the source dust continuum (up to 79 per cent contamination) with 12CO fluxes reaching \sim 68 mJy per beam.Comment: Accepted 2012 April 19 for publication in MNRAS. 21 pages, 13 figures, 3 table