Assessing Idaho Rural Family Physician Scope of Practice Over Time

Context: An important consideration determining health outcomes is to have an adequate supply of physicians to address the health needs of the community. Purpose: The purpose of this investigation was to assess scope of practice factors for Idaho rural family physicians in 2012 and to compare these results to findings from a 2007 study. Methods: The target population in this study was rural family physicians in Idaho counties with populations of fewer than 50,000. Identical surveys and methods were utilized in both 2007 and 2012. Results: The physician survey was mailed to 252 rural physicians and was returned by 89 for a response rate of 35.3%. Parametric and non-parametric statistical analyses were conducted to analyze the 2012 results and to assess changes in scope of practice across the time periods. Discussion: The percentage of rural family physicians in Idaho in 2012 who provided prenatal care, vaginal deliveries and nursing home care was significantly lower than the results from the 2007 survey. Female physicians were more likely to provide prenatal care and vaginal deliveries than males in 2012. Male physicians were more likely to provide emergency room coverage and esophagogastroduodenoscopy or colonoscopy services than females in 2012. Younger physicians were found to be more likely to provide inpatient admissions and mental health services in 2012 than older physicians. Employed physicians were more likely to provide Cesarean sections, other operating room services and emergency room coverage in 2012 than non-employed physicians. Further research is needed to assess the root causes of these changes

Air Pollution Exposure Assessment for Epidemiologic Studies of Pregnant Women and Children: Lessons Learned from the Centers for Children’s Environmental Health and Disease Prevention Research

The National Children’s Study is considering a wide spectrum of airborne pollutants that are hypothesized to potentially influence pregnancy outcomes, neurodevelopment, asthma, atopy, immune development, obesity, and pubertal development. In this article we summarize six applicable exposure assessment lessons learned from the Centers for Children’s Environmental Health and Disease Prevention Research that may enhance the National Children’s Study: a) Selecting individual study subjects with a wide range of pollution exposure profiles maximizes spatial-scale exposure contrasts for key pollutants of study interest. b) In studies with large sample sizes, long duration, and diverse outcomes and exposures, exposure assessment efforts should rely on modeling to provide estimates for the entire cohort, supported by subject-derived questionnaire data. c) Assessment of some exposures of interest requires individual measurements of exposures using snapshots of personal and microenvironmental exposures over short periods and/or in selected microenvironments. d) Understanding issues of spatial–temporal correlations of air pollutants, the surrogacy of specific pollutants for components of the complex mixture, and the exposure misclassification inherent in exposure estimates is critical in analysis and interpretation. e) “Usual” temporal, spatial, and physical patterns of activity can be used as modifiers of the exposure/outcome relationships. f) Biomarkers of exposure are useful for evaluation of specific exposures that have multiple routes of exposure. If these lessons are applied, the National Children’s Study offers a unique opportunity to assess the adverse effects of air pollution on interrelated health outcomes during the critical early life period

Climate Change, Tropospheric Ozone and Particulate Matter, and Health Impacts

We review how climate change could affect future concentrations of tropospheric ozone and particulate matter (PM), and what changing concentrations could mean for population health, as well as studies projecting the impacts of climate change on air quality and the impacts of these changes on morbidity/mortality. Climate change could affect local to regional air quality through changes in chemical reaction rates, boundary layer heights that affect vertical mixing of pollutants, and changes in synoptic airflow patterns that govern pollutant transport. Sources of uncertainty are the degree of future climate change, future emissions of air pollutants and their precursors, and how population vulnerability may change in the future. Given the uncertainties, projections suggest that climate change will increase concentrations of tropospheric ozone, at least in high-income countries when precursor emissions are held constant, increasing morbidity/mortality. There are few projections for low- and middle-income countries. The evidence is less robust for PM, because few studies have been conducted. More research is needed to better understand the possible impacts of climate change on air pollution-related health impacts

Primordial Black Holes: sirens of the early Universe

Primordial Black Holes (PBHs) are, typically light, black holes which can form in the early Universe. There are a number of formation mechanisms, including the collapse of large density perturbations, cosmic string loops and bubble collisions. The number of PBHs formed is tightly constrained by the consequences of their evaporation and their lensing and dynamical effects. Therefore PBHs are a powerful probe of the physics of the early Universe, in particular models of inflation. They are also a potential cold dark matter candidate.Comment: 21 pages. To be published in "Quantum Aspects of Black Holes", ed. X. Calmet (Springer, 2014

Sloan Digital Sky Survey Imaging of Low Galactic Latitude Fields: Technical Summary and Data Release

The Sloan Digital Sky Survey (SDSS) mosaic camera and telescope have obtained five-band optical-wavelength imaging near the Galactic plane outside of the nominal survey boundaries. These additional data were obtained during commissioning and subsequent testing of the SDSS observing system, and they provide unique wide-area imaging data in regions of high obscuration and star formation, including numerous young stellar objects, Herbig-Haro objects and young star clusters. Because these data are outside the Survey regions in the Galactic caps, they are not part of the standard SDSS data releases. This paper presents imaging data for 832 square degrees of sky (including repeats), in the star-forming regions of Orion, Taurus, and Cygnus. About 470 square degrees are now released to the public, with the remainder to follow at the time of SDSS Data Release 4. The public data in Orion include the star-forming region NGC 2068/NGC 2071/HH24 and a large part of Barnard's loop.Comment: 31 pages, 9 figures (3 missing to save space), accepted by AJ, in press, see http://photo.astro.princeton.edu/oriondatarelease for data and paper with all figure

The Oxford-Dartmouth Thirty Degree Survey I: Observations and Calibration of a Wide-Field Multi-Band Survey

The Oxford Dartmouth Thirty Degree Survey (ODTS) is a deep, wide, multi-band imaging survey designed to cover a total of 30 square degrees in BVRi'Z, with a subset of U and K band data, in four separate fields of 5-10 deg^2 centred at 00:18:24 +34:52, 09:09:45 +40:50, 13:40:00 +02:30 and 16:39:30 +45:24. Observations have been made using the Wide Field Camera on the 2.5-m Isaac Newton Telescope in La Palma to average limiting depths (5 sigma Vega, aperture magnitudes) of U=24.8, B=25.6, V=25.0, R=24.6, and i'=23.5, with observations taken in ideal conditions reaching the target depths of U=25.3, B=26.2, V=25.7, R=25.4, and i'=24.6. The INT Z band data was found to be severely effected by fringing and, consequently, is now being obtained at the MDM observatory in Arizona. A complementary K-band survey has also been carried out at MDM, reaching an average depth of K_{5\sigma}~18.5. At present, approximately 23 deg^2 of the ODTS have been observed, with 3.5 deg^2 of the K band survey completed. This paper details the survey goals, field selection, observation strategy and data reduction procedure, focusing on the photometric calibration and catalogue construction. Preliminary photometric redshifts have been obtained for a subsample of the objects with R <= 23. These results are presented alongside a brief description of the photometric redshift determination technique used. The median redshift of the survey is estimated to be z~0.7 from a combination of the ODTS photometric redshifts and comparison with the redshift distributions of other surveys. Finally, galaxy number counts for the ODTS are presented which are found to be in excellent agreement with previous studies.Comment: 18 pages, 21 figures, Accepted for publication in MNRA

A systematic review of different models of home and community care services for older persons

<p>Abstract</p> <p>Background</p> <p>Costs and consumer preference have led to a shift from the long-term institutional care of aged older people to home and community based care. The aim of this review is to evaluate the outcomes of case managed, integrated or consumer directed home and community care services for older persons, including those with dementia.</p> <p>Methods</p> <p>A systematic review was conducted of non-medical home and community care services for frail older persons. MEDLINE, PsycINFO, CINAHL, AgeLine, Scopus and PubMed were searched from 1994 to May 2009. Two researchers independently reviewed search results.</p> <p>Results</p> <p>Thirty five papers were included in this review. Evidence from randomized controlled trials showed that case management improves function and appropriate use of medications, increases use of community services and reduces nursing home admission. Evidence, mostly from non-randomized trials, showed that integrated care increases service use; randomized trials reported that integrated care does not improve clinical outcomes. The lowest quality evidence was for consumer directed care which appears to increase satisfaction with care and community service use but has little effect on clinical outcomes. Studies were heterogeneous in methodology and results were not consistent.</p> <p>Conclusions</p> <p>The outcomes of each model of care differ and correspond to the model's focus. Combining key elements of all three models may maximize outcomes.</p