Strain accumulation in the Santa Barbara Channel, 1971-1987

Geophysical evidence suggests a significant amount of north-south convergence occurs across the Santa Barbara Channel. Tectonic studies indicate a discrepancy between observed fault slip in California and the North American-Pacific plate motion. Newer plate motion models (NUVEL-1) yield a lower rate of convergence. Global Positioning System (GPS) data collected in the Santa Barbara Channel in 1987, when combined with 1971 trilateration measurements, should be sufficient to resolve the present-day convergence rate. In early 1987. from January 3 to 7, GPS data were collected at 14 sites in California and at 5 additional stations throughout North America. The data can be used to estimate the rate of crustal deformation (convergence) ocurring across the Santa Barbara Channel. The GPS baselines were computed with the Bernese 2nd generation software. A comparison was made between baseline lengths obtained with the Burnese and MIT softwares. Baseline changes from 1971 to January, 1987 (GPS-Bernese) across the Santa Barbara Channel were computed. A uniform strain model was calculated from the baseline changes. The present-day rate of convergence across the Santa Barbara Channel was determined to be 8 to 10 mm/yr. This conclusion is obtained from changes in the baseline length measured with a 1971 trilateration survey and a January, 1987, GPS survey. The rapid convergence rate, in addition to the history of large seismic events, suggests this region is a prime target for future geodetic and geophysical studies

Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States

The pharmaceutical industry spends roughly 15 billion dollars annually on detailing – providing gifts, information, samples, trips, honoraria and other inducements – to physicians in order to encourage them to prescribe their drugs. In response, several states in the United States adopted policies that restrict detailing. Some states banned gifts from pharmaceutical companies to doctors, other states simply required physicians to disclose the gifts they receive, while most states allowed unrestricted detailing. We exploit this geographic variation to examine the relationship between gift regulation and the diffusion of four newly marketed medications. Using a dataset that captures 189 million psychotropic prescriptions written between 2005 and 2009, we find that uptake of new costly medications was significantly lower in states with marketing regulation than in areas that allowed unrestricted pharmaceutical marketing. In states with gift bans, we observed reductions in market shares ranging from 39% to 83%. Policies banning or restricting gifts were associated with the largest reductions in uptake. Disclosure policies were associated with a significantly smaller reduction in prescribing than gift bans and gift restrictions. In states that ban gift-giving, peer influence substituted for pharmaceutical detailing when a relatively beneficial drug came to market and provided a less biased channel for physicians to learn about new medications. Our work suggests that policies banning or limiting gifts from pharmaceutical representatives to doctors are likely to be more effective than disclosure policies alone

Socioeconomic Status and the Increased Prevalence of Autism in California.

The prevalence of autism has increased precipitously—roughly 10-fold in the past 40 years—yet no one knows exactly what caused this dramatic rise. Using a large and representative dataset that spans the California birth cohorts from 1992 through 2000, we examine individual and community resources associated with the likelihood of an autism diagnosis over time. This allows us to identify key social factors that have contributed to increased autism prevalence. While individual-level factors, such as birth weight and parental education, have had a fairly constant effect on likelihood of diagnosis over time, we find that community-level resources drive increased prevalence. This study suggests that neighborhoods dynamically interact with the people living in them in different ways at different times to shape health outcomes. By treating neighborhoods as dynamic, we can better understand the changing socioeconomic gradient of autism and the increase in prevalence

Age of Diagnosis for Autism: Individual and Community Factors across 10 Birth Cohorts

The incidence of autism rose dramatically between 1992 and 2001, while the age at which children were first diagnosed declined. During this period the size and composition of the autism caseload has changed, but little is known about whether the factors associated with the timing of diagnosis may also have shifted. Using a multilevel analysis strategy, the individual and community-level factors associated with age of diagnosis were modelled across 10 birth cohorts of California children

Estimated Autism Risk and Older Reproductive Age

The prevalence of autism, a developmental disorder characterized by serious impairments in social interaction and language development as well as stereotyped and repetitive behaviors, has increased dramatically over the past 2 decades from approximately 4 to 40 cases per 10 000. The cause of the increase is unknown, as is the etiology of autism. Evidence from twin studies suggests that autism is likely a genetic disorder. However, genetic causes for the vast majority of autism cases have not yet been identified through molecular genetic research. In addition, dozens of previous studies have identified a wide range of perinatal and parental risk factors. Despite these studies, our understanding of even the most basic of these factors, parental age, is muddled

Medical school gift restriction policies and physician prescribing of newly marketed psychotropic medications: difference-in-differences analysis

Objective: To examine the effect of attending a medical school with an active policy on restricting gifts from representatives of pharmaceutical and device industries on subsequent prescribing behavior. Design: Difference-in-differences approach. Setting: 14 US medical schools with an active gift restriction policy in place by 2004. Participants: Prescribing patterns in 2008 and 2009 of physicians attending one of the schools compared with physicians graduating from the same schools before the implementation of the policy, as well as a set of contemporary matched controls. Main outcome measure: Probability that a physician would prescribe a newly marketed medication over existing alternatives of three psychotropic classes: lisdexamfetamine among stimulants, paliperidone among antipsychotics, and desvenlafaxine among antidepressants. None of these medications represented radical breakthroughs in their respective classes. Results: For two of the three medications examined, attending a medical school with an active gift restriction policy was associated with reduced prescribing of the newly marketed drug. Physicians who attended a medical school with an active conflict of interest policy were less likely to prescribe lisdexamfetamine over older stimulants (adjusted odds ratio 0.44, 95% confidence interval 0.22 to 0.88; P=0.02) and paliperidone over older antipsychotics (0.25, 0.07 to 0.85; P=0.03). A significant effect was not observed for desvenlafaxine (1.54, 0.79 to 3.03; P=0.20). Among cohorts of students who had a longer exposure to the policy or were exposed to more stringent policies, prescribing rates were further reduced. Conclusion: Exposure to a gift restriction policy during medical school was associated with reduced prescribing of two out of three newly introduced psychotropic medications

The Spatial Structure of Autism in California, 1993-2001

This article identifies significant high-risk clusters of autism based on residence at birth in California for children born from 1993 to 2001. These clusters are geographically stable. Children born in a primary cluster are at four times greater risk for autism than children living in other parts of the state. This is comparable to the difference between males and females and twice the risk estimated for maternal age over 40. In every year roughly 3% of the new caseload of autism in California arises from the primary cluster we identify-a small zone 20 km by 50 km. We identify a set of secondary clusters that support the existence of the primary clusters. The identification of robust spatial clusters indicates that autism does not arise from a global treatment and indicates that important drivers of increased autism prevalence are located at the local level

Comparison of Communications Styles Amongst Students in Allied Health Professions Programs: How Do Our Students Communicate with Other Healthcare Providers?

Background: Optimal patient outcomes require communication between providers in multiple professions to initiate referrals, communicate patient treatment, and coordinate care. While there is a clear need for increased understanding of the terminology, skills, and scopes of practice of professional colleagues, these tools are of limited effectiveness if there is poor interpersonal communication between team members. Multiple bodies for Interprofessional Practice and Education (IPP/IPE) identify communication skills as an integral part of education. In fact, the third competency domain set down by the Interprofessional Education Collaborative, Interprofessional Communication, states that professionals should, “Recognize how one’s own uniqueness, including experience level, expertise, culture, power, and hierarchy within the healthcare team, contributes to effective communication, conflict resolution, and positive interprofessional working relationships” [1].Methods and Findings: As part of a required interprofessional competence course, first-year students in ten health professions programs completed the Personal Coaching Style Inventory (PSCI) to self-identify personal communication styles. A series of one-way analysis of variance (ANOVA) analyses followed by Tukey post-hoc analyses were performed in order to identify significant differences in PSCI component scores between programs. Within groups, students discussed personal and cohort-wide findings as they impact teamwork. The majority of students identified with the Mediator style. Differences in style were also found in relation to profession, gender, and race. The activity prompted discussion of varied roles in team dynamics, and how differences in style could affect interprofessional teamwork.Conclusions: Self-awareness of personal communication styles as well as predominant styles of other health professions may enhance interprofessional communication\skills. The skill with which students approach their team roles in heterogeneous groups following graduation has the potential to increase team functionality and patient outcomes

Plume characterization of the SPT-100

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/76626/1/AIAA-1996-3298-655.pd

Social Influence and the Autism Epidemic

Despite a plethora of studies, we do not know why autism incidence has increased rapidly over the past two decades. Using California data, this study shows that children living very close to a child previously diagnosed with autism are more likely to be diagnosed with autism. An underlying social influence mechanism involving information diffusion drives this result, contributing to 16% of the increase in prevalence over 2000–2005. We eliminate competing explanations (i.e., residential sorting, environmental toxicants, and viral transmission) through seven tests and show that information diffusion simultaneously contributed to the increased prevalence, spatial clustering, and decreasing age of diagnosis