Trends and Regional Variation in Hip, Knee and Shoulder Replacement

Analyzes patterns in underuse or overuse of joint replacements among Medicare beneficiaries by geographic regions and race/ethnicity. Explores underlying factors and highlights the need for physician and patient education and shared decision making

Improving Patient Decision-Making in Health Care

Outlines regional variations within Minnesota in rates of patients with similar conditions receiving elective surgery, the concept of shared decision making, treatment choices for eight conditions, and steps for ensuring patients make informed decisions

Interferometric weak value deflections: quantum and classical treatments

We derive the weak value deflection given in a paper by Dixon et al. (Phys. Rev. Lett. 102, 173601 (2009)) both quantum mechanically and classically. This paper is meant to cover some of the mathematical details omitted in that paper owing to space constraints

Vortex migration in protoplanetary disks

We consider the radial migration of vortices in two-dimensional isothermal gaseous disks. We find that a vortex core, orbiting at the local gas velocity, induces velocity perturbations that propagate away from the vortex as density waves. The resulting spiral wave pattern is reminiscent of an embedded planet. There are two main causes for asymmetries in these wakes: geometrical effects tend to favor the outer wave, while a radial vortensity gradient leads to an asymmetric vortex core, which favors the wave at the side that has the lowest density. In the case of asymmetric waves, which we always find except for a disk of constant pressure, there is a net exchange of angular momentum between the vortex and the surrounding disk, which leads to orbital migration of the vortex. Numerical hydrodynamical simulations show that this migration can be very rapid, on a time scale of a few thousand orbits, for vortices with a size comparable to the scale height of the disk. We discuss the possible effects of vortex migration on planet formation scenarios.Comment: 13 pages, 13 figures, accepted for publication in Ap

The Role of Interest in Fostering Sixth Grade Students' Identities As Competent Learners

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72489/1/0362-6784.00153.pd

The Origin of Cornbelt Maize: The Isozyme Evidence

Historical records show t hat the Midwestern dent corns of the United States originated from hybridization of two landraces, Northern Flint and Southern Dent. We examined the origin of Southern and Midwestern Dents by means of isozyme electrophoresis. Isozyme genotypes were determined for 23 loci in 12 plants each of 32 accessions of Southern Dent. Previously published isozyme data for maize landraces of Mexico and North America and for U.S. Midwestern Dents were included for comparative purposes. The data show that Northern Flint and Southern Dent are among the isozymically most divergent maize landraces. Nei’s genetic identities between populations of these two landraces are very low for conspecific populations (ca. 0.80). Southern Dent of the southeastern U.S. appears closely related to similar dent corns of southern Mexico, supporting a previously published hypothesis that U.S. Southern Dent is largely derived from the dent corns of southern Mexico. The Midwestern Dents, which resulted from crosses of Southern Dent and Northern Flint, are much more like Southern Dent than Northern Flint in their isozyme profile. Similarly, public inbreds show greater affinity to Southern Dent with the exception of sweet corn lines, which resemble Northern Flint in their isozyme allele frequencies. North American public inbreds do not contain appreciable isozymic variation beyond that found in Northern Flint and Southern Dent

Tracking the Care of Patients with Severe Chronic Illness - The Dartmouth Atlas of Health Care 2008

In 2001 the Institute of Medicine (IOM) issued Crossing the Quality Chasm, a report that sent a wake-up call to patients, providers, and policy makers about the poor quality of American health care. The IOM argued that one of the central drivers of poor quality has been the unsystematic and fragmentary nature of our health care delivery system. Nowhere are the system’s failings more apparent than in the care of the chronically ill. More than 90 million Americans live with at least one chronic illness, and seven out of ten Americans die from chronic disease. Among the Medicare population, the toll is even greater: about nine out of ten deaths are associated with just nine chronic illnesses, including congestive heart failure, chronic lung disease, cancer, coronary artery disease, renal failure, peripheral vascular disease, diabetes, chronic liver disease, and dementia

Preliminary Survey of Chemical Contaminants in Water, Sediment, and Aquatic Biota at Selected Sites in Northeastern Florida Bay and Canal C-111

Several actions are under way to alter water management capabilities and practices in south Florida in order to restore a more natural hydroperiod for the Everglades. Because relatively little research has been conducted on contaminants entering Florida Bay, we undertook a preliminary study in June 1995 to determine contaminant concentrations in surface water, sediment, and biota prior to major changes in water management. The areas studied were the C-111 canal (five sites) beginning just above water control structure S-197 and extending to Manatee Bay (part of the Biscayne Bay system), Shell Creek (three sites), the mouth of Taylor River, Trout Creek (two sites), and a site near the Key Largo Ranger Station. Hydrographic observations were made at each site, and samples of water and sediment were collected at each of the five areas except the Key Largo site. Bioresidues were determined for indigenous oysters collected from the C-111 canal and Shell Creek and for transplanted oysters exposed at the Key Largo site, the C-111 canal, Shell Creek, Taylor River, and Trout Creek for 5-29 days. Water samples were analyzed for selected organochlorine pesticides and metals; sediments were analyzed for the same compounds and for polycyclic aromatic hydrocarbons (PAHs). Fish filets and shucked oysters were analyzed for selected organochlorine pesticides, polychlorinated biphenyl (PCB) congeners, and metals. Other than low dissolved oxygen at some C-111 canal sites, water quality was generally good. Most contaminants were below water and sediment quality guidelines designed to protect aquatic life, and contaminant concentrations in oysters were low. Threshold effect levels were exceeded for some organochlorine pesticides and PAHs in some sediment samples, but all values measured were below probable effect levels. Low concentrations of organochlorine pesticides were detected in sediments from the C-111 canal, Shell Creek, Taylor River, and Trout Creek; except for Taylor River, low concentrations of PCB congeners and PAHs were detected from the same areas. The only organochlorine pesticide detected in filets from seven fish was 3.2 v-g DDE/kg (wet weight) in a sea catfish. Total mercury concentrations in filets of four species of fishes ranged from 0.53 to 1.3 μg/g, wet weight, which falls within a limited consumption advisory by the State of Florida

The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle

Background: Routine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes. Within Child and Adolescent Mental Health Services (CAMHS) in the UK the adoption of ROM in CAMHS has been supported by both national and local initiatives (such as government strategies, local commissioning policy, and research). Methods: With the aim of assessing how these policies and initiatives may have influenced the uptake of ROM within two different CAMHS we report the findings of two case-note audits: a baseline audit conducted in January 2011 and a re-audit conducted two years later in December 2012-February 2013. Results: The findings show an increase in both the single and repeated use of outcome measures from the time of the original audit, with repeated use (baseline and follow-up) of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) scale increasing from 10% to 50% of cases. Re-audited case-notes contained more combined use of different outcome measures, with greater consensus on which measures to use. Outcome measures that were applicable across a wide range of clinical conditions were more likely to be used than symptom-specific measures, and measures that were completed by the clinician were found more often than measures completed by the service user. Conclusions: The findings show a substantial improvement in the use of outcome measures within CAMHS. These increases in use were found across different service organisations which were subject to different types of local service priorities and drivers