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

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

The Alchemist

JOURThis is the final version of the article. It was first published by IOP Publishing for the Royal Astronomical Society via http://dx.doi.org/10.3847/0004-637X/817/2/167We present a first look at the SCUBA-2 observations of three sub-regions of the Orion B molecular cloud: LDN 1622, NGC 2023/2024, and NGC 2068/2071, from the JCMT Gould Belt Legacy Survey. We identify 29, 564, and 322 dense cores in L1622, NGC 2023/2024, and NGC 2068/2071 respectively, using the SCUBA-2 850 μm map, and present their basic properties, including their peak fluxes, total fluxes, and sizes, and an estimate of the corresponding 450 μm peak fluxes and total fluxes, using the FellWalker source extraction algorithm. Assuming a constant temperature of 20 K, the starless dense cores have a mass function similar to that found in previous dense core analyses, with a Salpeter-like slope at the high-mass end. The majority of cores appear stable to gravitational collapse when considering only thermal pressure; indeed, most of the cores which have masses above the thermal Jeans mass are already associated with at least one protostar. At higher cloud column densities, above 1–2 × 1023 cm‑2, most of the mass is found within dense cores, while at lower cloud column densities, below 1 × 1023 cm‑2, this fraction drops to 10% or lower. Overall, the fraction of dense cores associated with a protostar is quite small (<8%), but becomes larger for the densest and most centrally concentrated cores. NGC 2023/2024 and NGC 2068/2071 appear to be on the path to forming a significant number of stars in the future, while L1622 has little additional mass in dense cores to form many new stars

The JCMT Gould Belt Survey: first results from the SCUBA-2 observations of the Ophiuchus molecular cloud and a virial analysis of its prestellar core population

In this paper, we present the first observations of the Ophiuchus molecular cloud performed as part of the James Clerk Maxwell Telescope (JCMT) Gould Belt Survey (GBS) with the SCUBA-2 instrument. We demonstrate methods for combining these data with previous HARP CO, Herschel, and IRAM N2H+ observations in order to accurately quantify the properties of the SCUBA-2 sources in Ophiuchus. We produce a catalogue of all of the sources found by SCUBA-2. We separate these into protostars and starless cores. We list all of the starless cores and perform a full virial analysis, including external pressure. This is the first time that external pressure has been included in this level of detail. We find that the majority of our cores are either bound or virialized. Gravitational energy and external pressure are on average of a similar order of magnitude, but with some variation from region to region. We find that cores in the Oph A region are gravitationally bound prestellar cores, while cores in the Oph C and E regions are pressure-confined. We determine that N2H+ is a good tracer of the bound material of prestellar cores, although we find some evidence for N2H+ freeze-out at the very highest core densities. We find that non-thermal linewidths decrease substantially between the gas traced by C18O and that traced by N2H+, indicating the dissipation of turbulence at higher densities. We find that the critical Bonnor-Ebert stability criterion is not a good indicator of the boundedness of our cores. We detect the pre-brown dwarf candidate Oph B-11 and find a flux density and mass consistent with previous work. We discuss regional variations in the nature of the cores and find further support for our previous hypothesis of a global evolutionary gradient across the cloud from south-west to north-east, indicating sequential star formation across the regio

Flat tax for social security

This is the final version of the article. Available from OUP via the DOI in this record.We present observations of the Cepheus Flare obtained as part of the James Clerk Maxwell Telescope (JCMT) Gould Belt Legacy Survey (GBLS) with the SCUBA-2 instrument. We produce a catalogue of sources found by SCUBA-2, and separate these into starless cores and protostars. We determine masses and densities for each of our sources, using source temperatures determined by the Herschel Gould Belt Survey. We compare the properties of starless cores in four different molecular clouds: L1147/58, L1172/74, L1251 and L1228. We find that the core mass functions for each region typically show shallower-than-Salpeter behaviour. We find that L1147/58 and L1228 have a high ratio of starless cores to Class II protostars, while L1251 and L1174 have a low ratio, consistent with the latter regions being more active sites of current star formation, while the former are forming stars less actively. We determine that if modelled as thermally supported Bonnor-Ebert spheres, most of our cores have stable configurations accessible to them. We estimate the external pressures on our cores using archival 13CO velocity dispersion measurements and find that our cores are typically pressure confined, rather than gravitationally bound. We perform a virial analysis on our cores, and find that they typically cannot be supported against collapse by internal thermal energy alone, due primarily to the measured external pressures. This suggests that the dominant mode of internal support in starless cores in the Cepheus Flare is either non-thermal motions or internal magnetic fields.KP wishes to acknowledge STFC postdoctoral support under grant numbers ST/K002023/1 and ST/M000877/1 and studentship support under grant number ST/K501943/1 while this research was carried out. The James Clerk Maxwell Telescope has historically been 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 the Netherlands Organisation for Scientific Research. Additional funds for the construction of SCUBA-2 were provided by the Canada Foundation for Innovation. The STARLINK software (Currie et al. 2014) is supported by the East Asian Observatory. This research used the services of the Canadian Advanced Network for Astronomy Research (CANFAR) which in turn is supported by CANARIE, Compute Canada, University of Victoria, the National Research Council of Canada, and the Canadian Space Agency. This research used the facilities of the Canadian Astronomy Data Centre operated by the National Research Council of Canada with the support of the Canadian Space Agency. Herschel is an ESA space observatory with science instruments provided by European-led Principal Investigator consortia and with important participation from NASA. This research has made use of the NASA Astrophysics Data System. The authors wish to recognize and acknowledge the very significant cultural role and reverence that the summit of Maunakea has always had within the indigenous Hawaiian community. We are most fortunate to have the opportunity to conduct observations from this mountai