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

An ALMA Survey of CO isotopologue emission from Protoplanetary Disks in Chamaeleon I

The mass of a protoplanetary disk limits the formation and future growth of any planet. Masses of protoplanetary disks are usually calculated from measurements of the dust continuum emission by assuming an interstellar gas-to-dust ratio. To investigate the utility of CO as an alternate probe of disk mass, we use ALMA to survey $^{13}$CO and C$^{18}$O J = $3-2$ line emission from a sample of 93 protoplanetary disks around stars and brown dwarfs with masses from 0.03 -- 2 M$_{\odot}$ in the nearby Chamaeleon I star-forming region. We detect $^{13}$CO emission from 17 sources and C$^{18}$O from only one source. Gas masses for disks are then estimated by comparing the CO line luminosities to results from published disk models that include CO freeze-out and isotope-selective photodissociation. Under the assumption of a typical ISM CO-to-H$_2$ ratios of $10^{-4}$, the resulting gas masses are implausibly low, with an average gas mass of $\sim$ 0.05 M$_{Jup}$ as inferred from the average flux of stacked $^{13}$CO lines. The low gas masses and gas-to-dust ratios for Cha I disks are both consistent with similar results from disks in the Lupus star-forming region. The faint CO line emission may instead be explained if disks have much higher gas masses, but freeze-out of CO or complex C-bearing molecules is underestimated in disk models. The conversion of CO flux to CO gas mass also suffers from uncertainties in disk structures, which could affect gas temperatures. CO emission lines will only be a good tracer of the disk mass when models for C and CO depletion are confirmed to be accurate.Comment: accepted for publication in Ap

Brain perfusion patterns are altered in chronic knee pain:a spatial covariance analysis of arterial spin labelling MRI

Chronic musculoskeletal pain is a common problem globally. Current evidence suggests that maladapted central pain pathways are associated with pain chronicity, for example, in postoperative pain after knee replacement. Other factors such as low mood, anxiety, and tendency to catastrophize are also important contributors. We aimed to investigate brain imaging features that underpin pain chronicity based on multivariate pattern analysis of cerebral blood flow (CBF), as a marker of maladaptive brain changes. This was achieved by identifying CBF patterns that discriminate chronic pain from pain-free conditions and by exploring their explanatory power for factors thought to drive pain chronification. In 44 chronic knee pain and 29 pain-free participants, we acquired both CBF and T1-weighted data. Participants completed questionnaires related to affective processes and pressure and cuff algometry to assess pain sensitization. Two factor scores were extracted from these scores representing negative affect and pain sensitization. A spatial covariance principal component analysis of CBF identified 5 components that significantly discriminated chronic pain participants from controls, with the unified network achieving 0.83 discriminatory accuracy (area under the curve). In chronic knee pain, significant patterns of relative hypoperfusion were evident in anterior default-mode and salience network hubs, while hyperperfusion was seen in posterior default mode, thalamus, and sensory regions. One component correlated positively with the pain sensitization score (r = 0.43, P = 0.006), suggesting that this CBF pattern reflects neural activity changes encoding pain sensitization. Here, we report a distinct chronic knee pain-related representation of CBF, pointing toward a brain signature underpinning central aspects of pain sensitization

Experiences and perceptions of natural hazards among international migrants living in Valparaiso, Chile

International migrants are a socially vulnerable group within the context of disasters. However, disasters research focusing on this group is limited. This problem is the primary focus of the present study. Aim: To explore responses, behaviors and experiences concerning natural hazards among migrants living in Valparaíso, Chile. Methods: Following a constructivist paradigm, we conducted a case study. We interviewed twenty migrants. The interviews were analyzed using thematic analysis. The study was peer-reviewed by Universidad del Desarrollo Ethics Committee. Results: Participants described intense emotional reactions when facing disasters that reduced their coping ability. Their limited knowledge about natural hazards and how to react, explain in part their responses and the difficulties they face. Participants compared their reactions with the behaviors exhibited by the local Chilean population who displayed very little fear and seemed to be used to these events. Finally, despite sharing the same native language, Spanish, preparation activities and warnings appear not to be reaching them. Conclusions: There is an urgent need to implement culturally sensitive preparation strategies, through migrants´ existing social networks, to address their needs and concerns and to enable them to cope with natural hazards. Emotional reactions appear to play an essential role in their response to natural disasters and should also be recognized and validated

The JCMT Gould Belt Survey: Evidence for radiative heating in Serpens MWC 297 and its influence on local star formation

We present SCUBA-2 450micron and 850micron observations of the Serpens MWC 297 region, part of the JCMT Gould Belt Survey of nearby star-forming regions. Simulations suggest that radiative feedback influences the star-formation process and we investigate observational evidence for this by constructing temperature maps. Maps are derived from the ratio of SCUBA-2 fluxes and a two component model of the JCMT beam for a fixed dust opacity spectral index of beta = 1.8. Within 40 of the B1.5Ve Herbig star MWC 297, the submillimetre fluxes are contaminated by free-free emission with a spectral index of 1.03+-0.02, consistent with an ultra-compact HII region and polar winds/jets. Contamination accounts for 73+-5 per cent and 82+-4 per cent of peak flux at 450micron and 850micron respectively. The residual thermal disk of the star is almost undetectable at these wavelengths. Young Stellar Objects are confirmed where SCUBA-2 850micron clumps identified by the fellwalker algorithm coincide with Spitzer Gould Belt Survey detections. We identify 23 objects and use Tbol to classify nine YSOs with masses 0.09 to 5.1 Msun. We find two Class 0, one Class 0/I, three Class I and three Class II sources. The mean temperature is 15+-2K for the nine YSOs and 32+-4K for the 14 starless clumps. We observe a starless clump with an abnormally high mean temperature of 46+-2K and conclude that it is radiatively heated by the star MWC 297. Jeans stability provides evidence that radiative heating by the star MWC 297 may be suppressing clump collapse.Comment: 24 pages, 13 figures, 7 table

The JCMT Gould Belt Survey: A First Look at the Auriga–California Molecular Cloud with SCUBA-2

We present 850 and 450 μm observations of the dense regions within the Auriga–California molecular cloud using SCUBA-2 as part of the JCMT Gould Belt Legacy Survey to identify candidate protostellar objects, measure the masses of their circumstellar material (disk and envelope), and compare the star formation to that in the Orion A molecular cloud. We identify 59 candidate protostars based on the presence of compact submillimeter emission, complementing these observations with existing Herschel/SPIRE maps. Of our candidate protostars, 24 are associated with young stellar objects (YSOs) in the Spitzer and Herschel/PACS catalogs of 166 and 60 YSOs, respectively (177 unique), confirming their protostellar nature. The remaining 35 candidate protostars are in regions, particularly around LkHα 101, where the background cloud emission is too bright to verify or rule out the presence of the compact 70 μm emission that is expected for a protostellar source. We keep these candidate protostars in our sample but note that they may indeed be prestellar in nature. Our observations are sensitive to the high end of the mass distribution in Auriga–Cal. We find that the disparity between the richness of infrared star-forming objects in Orion A and the sparsity in Auriga–Cal extends to the submillimeter, suggesting that the relative star formation rates have not varied over the Class II lifetime and that Auriga–Cal will maintain a lower star formation efficiency

The JCMT Gould Belt Survey: constraints on prestellar core properties in Orion A North

We employ SCUBA-2 (Submillimetre Common-User Bolometer Array 2) observations of the Orion A North molecular cloud to derive column density and temperature maps. We apply a novel, Hessian-based structural identification algorithm for detection of prestellar cores to these data, allowing for automated generation of the prestellar mass function. The resulting mass function is observed to peak at $1.39^{+0.18}_{{-}0.19} M_{\odot}$, indicating a star-forming efficiency lower limit of ∼14 per cent when compared with the Orion nebula Cluster initial mass function (IMF) peak. Additionally, the prestellar mass function is observed to decay with a high-mass powerlaw exponent $\alpha = 2.53^{+0.16}_{{-}0.14}$, indicating approximate functional similarity with the Salpeter IMF ($\alpha = 2.35$). This result, when combined with the results of previous investigations suggests a regional dependence of the star-forming efficiency

Design and validation of an STR hexaplex assay for DNA profiling of grapevine cultivars

Although the analysis of length polymorphism at STR loci has become a method of choice for grape cultivar identification, the standardization of methods for this purpose lags behind that of methods for DNA profiling in human and animal forensic genetics. The aim of this study was thus to design and validate a grapevine STR protocol with a practically useful level of multiplexing. Using free bioinformatics tools, published primer sequences, and nucleotide databases, we constructed and optimized a primer set for the simultaneous analysis of six STR loci (VVIi51, scu08vv, scu05vv, VVMD17, VrZAG47, and VrZAG83) by multiplex PCR and CE with laser-induced fluorescence, and tested it on 90 grape cultivars. The new protocol requires subnanogram quantities of the DNA template and enables automated, high-throughput genetic analysis with reasonable discriminatory power. As such, it represents a step toward further standardization of grape DNA profiling.Peer reviewe