The Effects of Patient Characteristics on Clinician’s Adherence to Preventive Practice Guidelines

ABSTRACT BACKGROUND: The existence of health disparities confirms that not all patients, regardless of differences in patient demographics, are provided quality healthcare (Agency of Health Care Research and Quality, 2003). Moreover, research suggests that health disparities may be present due to the inadequate delivery of medical services (S. Haist, J. Wilson, M. Lineberry, & C. Griffith, 2007; Van Ryn, Burgess, Malat, & Griffin, 2006). The differences in the delivery of care and services to ethnic minorities and those of low socioeconomic status warrant examining the role healthcare providers play in the causation of these health disparities (Smedley, Stith, & Nelson, 2003). OBJECTIVE: The purpose of the study is to identify differences in routine screening practices of Physician Assistants and determine if such differences are associated with patients’ race and socioeconomic status. DESIGN: One hundred and twelve (N = 112) practicing Physician Assistants (N = 142) in Kentucky were surveyed and randomly assigned to receive one of four clinical vignettes. The likelihood of offering different routine screening recommendations was examined based on patient race and socioeconomic status. MAIN MEASURES: We investigated the mean differences of selected preventative care recommendation options for vignette patients as a function of patient race and socioeconomic status. KEY RESULTS: A multivariate analysis revealed that the race of a patient had a statistically significant multivariate effect on differences in screening recommendation, (p =.017) for hypertension (HTN), p=.017, immunization, p=.002. Univariate analysis showed statistically significant differences, with the African American patient were significantly less likely to receive screening for hypertension (HTN), (M = 3.42), 95% CI [3.24, 3.59], or immunizations (M = 2.45), 95% CI [2.21, 2.69] when compared to Caucasian women (M = 3.71, 2.98), 95% CIs [3.55, 3.88], [2.76, 3.23], respectively. CONCULSION: The findings suggest that the race of the patient in the vignette influenced the likelihood of receiving screening recommendations. The findings show that care delivered by Physician Assistants (PAs), are a possible source of healthcare disparities between patients from racial/ethnic minority backgrounds and their Caucasian counterparts. Keywords: disparities, health education, race & ethnicity, socioeconomic, preventive car

Scintillator-based ion beam profiler for diagnosing laser-accelerated ion beams

Next generation intense, short-pulse laser facilities require new high repetition rate diagnostics for the detection of ionizing radiation. We have designed a new scintillator-based ion beam profiler capable of measuring the ion beam transverse profile for a number of discrete energy ranges. The optical response and emission characteristics of four common plastic scintillators has been investigated for a range of proton energies and fluxes. The scintillator light output (for 1 MeV > Ep < 28 MeV) was found to have a non-linear scaling with proton energy but a linear response to incident flux. Initial measurements with a prototype diagnostic have been successful, although further calibration work is required to characterize the total system response and limitations under the high flux, short pulse duration conditions of a typical high intensity laser-plasma interaction

Researching trust in the police and trust in justice: a UK perspective

This paper describes the immediate and more distant origins of a programme of comparative research that is examining cross-national variations in public trust in justice and in the police. The programme is built around a module of the fifth European Social Survey, and evolved from a study funded by the European Commission. The paper describes the conceptual framework within which we are operating – developed in large measure from theories of procedural justice. It reviews some of the methodological issues raised by the use of sample surveys to research issues of public trust in the police, public perceptions of institutional legitimacy and compliance with the law. Finally it gives a flavour of some of the early findings emerging from the programme

Inversion of spinning sound fields

A method is presented for the reconstruction of rotating monopole source distributions using acoustic pressures measured on a sideline parallel to the source axis. The method requires no \textit{a priori} assumptions about the source other than that its strength at the frequency of interest vary sinusoidally in azimuth on the source disc so that the radiated acoustic field is composed of a single circumferential mode. When multiple azimuthal modes are present, the acoustic field can be decomposed into azimuthal modes and the method applied to each mode in sequence. The method proceeds in two stages, first finding an intermediate line source derived from the source distribution and then inverting this line source to find the radial variation of source strength. A far-field form of the radiation integrals is derived, showing that the far field pressure is a band-limited Fourier transform of the line source, establishing a limit on the quality of source reconstruction which can be achieved using far-field measurements. The method is applied to simulated data representing wind-tunnel testing of a ducted rotor system (tip Mach number~0.74) and to control of noise from an automotive cooling fan (tip Mach number~0.14), studies which have appeared in the literature of source identification.Comment: Revised version of paper submitted to JASA; five more figures; expanded content with more discussion of error behaviour and relation to Nearfield Acoustical Holograph

Draft Genome Sequence of Fructophilic Lactobacillus florum.

Herein we report the first genome sequence for Lactobacillus florum. L. florum 2F was isolated from Valencia orange leaves and is fructophilic, like other strains of this species. The draft genome of L. florum 2F contains 1,261,842 bp with a G+C content of 41.5% in 46 contigs (≥500 bp)

Cas Adaptor Proteins Coordinate Sensory Axon Fasciculation.

Development of complex neural circuits like the peripheral somatosensory system requires intricate mechanisms to ensure axons make proper connections. While much is known about ligand-receptor pairs required for dorsal root ganglion (DRG) axon guidance, very little is known about the cytoplasmic effectors that mediate cellular responses triggered by these guidance cues. Here we show that members of the Cas family of cytoplasmic signaling adaptors are highly phosphorylated in central projections of the DRG as they enter the spinal cord. Furthermore, we provide genetic evidence that Cas proteins regulate fasciculation of DRG sensory projections. These data establish an evolutionarily conserved requirement for Cas adaptor proteins during peripheral nervous system axon pathfinding. They also provide insight into the interplay between axonal fasciculation and adhesion to the substrate

Determining Transmission Loss from Measured External and Internal Acoustic Environments

An estimate of the internal acoustic environment in each internal cavity of a launch vehicle is needed to ensure survivability of Space Launch System (SLS) avionics. Currently, this is achieved by using the noise reduction database of heritage flight vehicles such as the Space Shuttle and Saturn V for liftoff and ascent flight conditions. Marshall Space Flight Center (MSFC) is conducting a series of transmission loss tests to verify and augment this method. For this test setup, an aluminum orthogrid curved panel representing 1/8th of the circumference of a section of the SLS main structure was mounted in between a reverberation chamber and an anechoic chamber. Transmission loss was measured across the panel using microphones. Data measured during this test will be used to estimate the internal acoustic environments for several of the SLS launch vehicle internal spaces

Scattering properties of Venus' surface

Radar backscatter functions Sigma-(carat)(sub 0)(phi) for incidence angles between 0 less than or equal to phi less than or equal to 4-10 deg were derived from Magellan altimetry radar echoes. The procedure includes constrained solution of a system of simultaneous equations for which the echo-spectrum and echo time profile are inputs. A practical and workable set of constraints was applied; optimization and improved results are expected as the analysis matures. The scattering functions yield information on small-scale surface structures (tens of centimeters to tens of meters) but averaged over hundreds of sq km. RMS surface slopes derived from fits of analytic functions to the Sigma-(carat)(sub 0)(phi) results were converted to map form and show patterns similar to those reported using other techniques. While all three forms are found on Venus, fit residuals imply that an exponential scattering function matches data better than either the Hagfors or Gaussian form in most areas, although the Hagfors function may be a better descriptor at some sites. Limited study of image data indicates that average backscatter cross section, and possibly its slope, can be derived at oblique angles (17 deg less than or equal to phi less than or equal to 45 deg). Offsets of the echo peak in altimetry spectra are surprisingly common and are loosely correlated with Venus topography, but no cause for this phenomenon was identified