Are Dutch patients willing to be seen by a physician assistant instead of a medical doctor?

Background The employment of physician assistants (PAs) is a strategy to improve access to care. Since the new millennium, a handful of countries have turned to PAs as a means to bridge the growing gap between the supply and demand of medical services. However, little is known about this new workforce entity from the patient’s perspective. The objective of this study was to assess the willingness of Dutch patients to be treated by a PA or a medical doctor (MD) under various time constraints and semi-urgent medical scenarios. Methods A total of 450 Dutch adults were recruited to act as surrogate patients. A convenience sample was drawn from patients in a medical office waiting room in a general hospital awaiting their appointments. Each participant was screened to be naive as to what a PA and a nurse practitioner are and then read a definition of a PA and an MD. One of three medical scenarios was assigned to the participants in a patterned 1-2-3 strategy. Patients were required to make a trade-off decision of being seen after 1 hour by a PA or after 4 hours by a doctor. This forced-choice method continued with the same patient two more times with 30 minutes and 4 hours and another one of 2 hours versus 4 hours for the PA and MD, respectively. Results Surrogate patients chose the PA over the MD 96 % to 98 % of the time (depending on the scenario). No differences emerged when analysed by gender, age, or parenthood status. Conclusion Willingness to be seen by a PA was tested a priori to determine whether surrogate Dutch patients would welcome this new health-care provider. The findings suggest that employing PAs, at least in concept, may be an acceptable strategy for improving access to care with this population

Gridded global surface ozone metrics for atmospheric chemistry model evaluation

The concentration of ozone at the Earth's surface is measured at many locations across the globe for the purposes of air quality monitoring and atmospheric chemistry research. We have brought together all publicly available surface ozone observations from online databases from the modern era to build a consistent data set for the evaluation of chemical transport and chemistry-climate (Earth System) models for projects such as the Chemistry-Climate Model Initiative and Aer-Chem-MIP. From a total data set of approximately 6600 sites and 500 million hourly observations from 1971-2015, approximately 2200 sites and 200 million hourly observations pass screening as high-quality sites in regionally representative locations that are appropriate for use in global model evaluation. There is generally good data volume since the start of air quality monitoring networks in 1990 through 2013. Ozone observations are biased heavily toward North America and Europe with sparse coverage over the rest of the globe. This data set is made available for the purposes of model evaluation as a set of gridded metrics intended to describe the distribution of ozone concentrations on monthly and annual timescales. Metrics include the moments of the distribution, percentiles, maximum daily 8-hour average (MDA8), sum of means over 35 ppb (daily maximum 8-h; SOMO35), accumulated ozone exposure above a threshold of 40 ppbv (AOT40), and metrics related to air quality regulatory thresholds. Gridded data sets are stored as netCDF-4 files and are available to download from the British Atmospheric Data Centre (doi:10.5285/08fbe63d-fa6d-4a7a-b952-5932e3ab0452). We provide recommendations to the ozone measurement community regarding improving metadata reporting to simplify ongoing and future efforts in working with ozone data from disparate networks in a consistent manner

Vascular interstitial cells in retinal arteriolar annuli are altered during hypertension

The authors thank Veronica Melgarejo, Lorena Noya, and Angel Vazquez for technical assistance. Supported by grants from Instituto de Salud Carlos III (PI12/00605, PI16/00719, SAF2014-59945-R, and Red de Investigación Renal REDinREN 12/0021/0013), Spain; Fundação para a Ciência e a Tecnologia (SFRH/BPD/102573/2014, SFRH/BD/95330/2013), Ministerio da Educação e Ciência, Portugal; and Fondo Europeo de Desarrollo Regional (FEDER).Supported by grants from Instituto de Salud Carlos III (PI12/00605, PI16/00719, SAF2014-59945-R, and Red de Investigacion Renal REDinREN 12/0021/0013), Spain; Fundacao para a Ciencia e a Tecnologia (SFRH/BPD/102573/2014, SFRH/BD/95330/2013), Ministerio da Educacao e Ciencia, Portugal; and Fondo Europeo de Desarrollo Regional (FEDER).PURPOSE. It has been suggested that arteriolar annuli localized in retinal arterioles regulate retinal blood flow acting as sphincters. Here, the morphology and protein expression profile of arteriolar annuli have been analyzed under physiologic conditions in the retina of wildtype, β-actin-Egfp, and Nestin-gfp transgenic mice. Additionally, to study the effect of hypertension, the KAP transgenic mouse has been used. METHODS. Cellular architecture has been studied using digested whole mount retinas and transmission electron microscopy. The profile of protein expression has been analyzed on paraffin sections and whole mount retinas by immunofluorescence and histochemistry. RESULTS. The ultrastructural analysis of arteriolar annuli showed a different cell population found between endothelial and muscle cells that matched most of the morphologic criteria established to define interstitial Cajal cells. The profile of protein expression of these vascular interstitial cells (VICs) was similar to that of interstitial Cajal cells and different from the endothelial and smooth muscle cells, because they expressed b-actin, nestin, and CD44, but they did not express CD31 and a-SMA or scarcely express F-actin. Furthermore, VICs share with pericytes the expression of NG2 and platelet-derived growth factor receptor beta (PDGFR-β). The high expression of Ano1 and high activity of nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase observed in VICs was diminished during hypertensive retinopathy suggesting that these cells might play a role on the motility of arteriolar annuli and that this function is altered during hypertension. CONCLUSIONS. A novel type of VICs has been described in the arteriolar annuli of mouse retina. Remarkably, these cells undergo important molecular modifications during hypertensive retinopathy and might thus be a therapeutic target against this disease

Detection of the mosquito-borne flaviviruses, West Nile, Dengue, Saint Louis Encephalitis, Ilheus, Bussuquara, and Yellow Fever in free-ranging black howlers (Alouatta caraya) of Northeastern Argentina

Several medically important mosquito-borne flaviviruses have been detected in Argentina in recent years: Dengue (DENV), St. Louis encephalitis (SLEV), West Nile (WNV) and Yellow Fever (YFV) viruses. Evidence of Bussuquara virus (BSQV) and Ilheus virus (ILHV) activity were found, but they have not been associated with human disease. Non-human primates can act as important hosts in the natural cycle of flaviviruses and serological studies can lead to improved understanding of virus circulation dynamics and host susceptibility. From July–August 2010, we conducted serological and molecular surveys in free–ranging black howlers (Alouatta caraya) captured in northeastern Argentina. We used 90% plaque-reduction neutralization tests (PRNT90) to analyze 108 serum samples for antibodies to WNV, SLEV, YFV, DENV (serotypes 1and 3), ILHV, and BSQV. Virus genome detection was performed using generic reverse transcription (RT)-nested PCR to identify flaviviruses in 51 antibody-negative animals. Seventy animals had antibodies for one or more flaviviruses for a total antibody prevalence of 64.8% (70/108). Monotypic (13/70, 19%) and heterotypic (27/70, 39%) patterns were differentiated. Specific neutralizing antibodies against WNV, SLEV, DENV-1, DENV-3, ILHV, and BSQV were found. Unexpectedly, the highest flavivirus antibody prevalence detected was to WNV with 9 (8.33%) monotypic responses. All samples tested by (RT)-nested PCR were negative for viral genome. This is the first detection of WNV-specific antibodies in black howlers from Argentina and the first report in free-ranging non-human primates from Latin-American countries. Given that no animals had specific neutralizing antibodies to YFV, our results suggest that the study population remains susceptible to YFV. Monitoring of these agents should be strengthened to detect the establishment of sylvatic cycles of flaviviruses in America and evaluate risks to wildlife and human health.Fil: Morales, Maria Alejandra. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Virales Humanas; ArgentinaFil: Fabbri, Cintia M.. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Virales Humanas; ArgentinaFil: Zunino, Gabriel Eduardo. Universidad Nacional de General Sarmiento. Instituto del Conurbano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Kowalewski, Miguel Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia". Estación Biológica de Usos Múltiples (Sede Corrientes); ArgentinaFil: Luppo, Victoria C.. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Virales Humanas; ArgentinaFil: Enría, Delia A.. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Virales Humanas; ArgentinaFil: Levis, Silvana C.. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Virales Humanas; ArgentinaFil: Calderón, Gladys Ethel. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbran". Instituto Nacional de Enfermedades Virales Humanas; Argentin

ЗБІРНИК ТЕЗ ВСЕУКРАЇНСЬКОЇ НАУКОВО-ТЕХНІЧНОЇ КОНФЕРЕНЦІЇ «СТАЛИЙ РОЗВИТОК ГЛОБАЛЬНОЇ СИСТЕМИ ЗВ’ЯЗКУ, НАВІГАЦІЇ, СПОСТЕРЕЖЕННЯ ТА ОРГАНІЗАЦІЇ ПОВІТРЯНОГО РУХУ CNS/ATM─ 2023»

ЗБІРНИК ТЕЗ ВСЕУКРАЇНСЬКОЇ НАУКОВО-ТЕХНІЧНОЇ КОНФЕРЕНЦІЇ «СТАЛИЙ РОЗВИТОК ГЛОБАЛЬНОЇ СИСТЕМИ ЗВ’ЯЗКУ, НАВІГАЦІЇ, СПОСТЕРЕЖЕННЯ ТА ОРГАНІЗАЦІЇ ПОВІТРЯНОГО РУХУ CNS/ATM─ 2023

Physician assistant education:five countries

BACKGROUND: Physician assistant (PA) education has undergone substantial change since the late 1960s. After four decades of development, other countries have taken a page from the American experience and launched their own instructional initiatives. The diversity in how different countries approach education and produce a PA for their nation's needs provides an opportunity to make comparisons. The intent of this study was to document and describe PA programs in Australia, Canada, the United Kingdom, The Netherlands, and the United States. METHODS: We reviewed the literature and contacted a network of academics in various institutions to obtain primary information. Each contact was asked a set of basic questions about the country, the PA program, and the deployment of graduates. Information on US PA programs was obtained from the Physician Assistant Education Association. RESULTS: At year's end 2010, the following was known about PA development: Australia, one program; Canada, four programs; United Kingdom, four programs; The Netherlands, five programs; the United States, 154 programs. Trends in program per capita growth remain the largest in the United States, followed by The Netherlands and Canada. The shortest program length was 24 months and the longest, 36 months. Outside the United States, almost all programs are situated in an academic health center ([AHC] defined as a medical university, a teaching hospital, and a nursing or allied health school), whereas only one-third of US PA programs are in AHCs. All non-US programs receive public/government funding whereas American programs are predominately private and depend on tuition to fund their programs. CONCLUSION: The PA movement is a global phenomenon. How PAs are being educated, trained, and deployed is known only on the basic level. We identify common characteristics, unique aspects, and trends in PA education across five nations, and set the stage for collaboration and analysis of optimal educational strategies. Additional information is needed on lesser-known PA programs outside these five countries

Physician assistant job satisfaction: a narrative review of empirical research

PURPOSE: To examine physician assistant (PA) job satisfaction and identify factors predicting job satisfaction and identify areas of needed research. With a global PA movement underway and a half-century in development, the empirical basis for informing employers of approaches to improve job satisfaction has not received a careful review. METHODS: A narrative review of empirical research was undertaken to inform stakeholders about PA employment with a goal of improved management. The a priori criteria included published studies that asked PAs about job satisfaction. Articles addressing PA job satisfaction, written in English, were reviewed and categorized according to the Job Characteristics Model. RESULTS: Of 68 publications reviewed, 29 met criteria and were categorized in a Job Characteristics Model. Most studies report a high degree of job satisfaction when autonomy, income, patient responsibility, physician support, and career advancement opportunities are surveyed. Age, sex, specialty, and occupational background are needed to understand the effect on job satisfaction. Quality of studies varies widely. CONCLUSIONS: Employers may want to examine their relationships with PAs periodically. The factors of job satisfaction may assist policymakers and health administrators in creating welcoming professional employment environments. The main limitation: no study comprehensively evaluated all the antecedents of job satisfaction. PAs seem to experience job satisfaction supported by low attrition rates and competitive wages. Contributing factors are autonomy, experienced responsibility, pay, and supportive supervising physician. A number of intrinsic rewards derived from the performance of the job within the social environment, along with extrinsic rewards, may contribute to overall job satisfaction. PA job satisfaction research is underdeveloped; investigations should include longitudinal studies, cohort analyses, and economic determinants

Commentaries on health services research

Physician associates are new to the United Kingdom and set to expand in numbers. Little is known about the patient's perspective. A qualitative study, using semistructured interviews with thematic analysis, was undertaken with 30 volunteer patients of 430 who had consulted PAs in six general practices. Patients' conditions ranged from minor illnesses to those requiring immediate hospital admission. Understanding the PA role varied from certain and correct, to uncertain, to certain and incorrect (in which the patient believed the PA to be a physician). Most, but not all, reported positive experiences and outcomes of their consultation, with some choosing to consult the physician. Those with negative experiences described problems when the limits of the role were reached, delaying prescriptions or requiring additional physician consultations. Trust and confidence were derived from trust in the National Health Service (NHS), the general practice, and the PA. Willingness to consult a PA was contingent on the patient's assessment of the severity or complexity of the problem and the desire for provider continuity. Patients saw PAs as an appropriate general practitioner substitute. Patients' experience could inform delivery redesign

Titanium compacts produced by the pulvimetallurgical hydride-dehydride method for biomedical applications

Titanium powder production by the hydride-dehydride method has been developed as a non-expensive process. In this work, commercially pure grade two Ti specimens were hydrogenated. The hydrided material was milled in a planetary mill. The hydrided titanium powder was dehydrided and then sieved to obtain a particle size between 37 and 125 νm in order to compare it with a commercial powder produced by chemical reduction with a particle size lower than 150 νm. Cylindrical green compacts were obtained by uniaxial pressing of the powders at 343 MPa and sintering in vacuum. The powders and the density of sintered compacts were characterized, the oxygen content was measured and in vivo tests were performed in the tibia bones of Wistar rats in order to evaluate their biocompatibility. No differences were observed between the materials which were produced either with powders obtained by the hydride-dehydride method or with commercial powders produced by chemical reduction regarding modifications in compactation, sintering and biological behaviour.Fil: Barreiro, M. M.. Universidad de Buenos Aires. Facultad de Odontología; ArgentinaFil: Grana, Daniel Rodolfo. Universidad del Salvador; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Kokubu, G. A.. Universidad del Salvador; ArgentinaFil: Luppo, M. I.. Comisión Nacional de Energía Atómica. Centro Atómico Constituyentes; ArgentinaFil: Mintzer, S.. Comisión Nacional de Energía Atómica. Centro Atómico Constituyentes; ArgentinaFil: Vigna, G.. Comisión Nacional de Energía Atómica. Centro Atómico Constituyentes; Argentin