Performance of Primary Care Physicians and Other Providers on Key Process Measures in the Treatment of Diabetes

OBJECTIVE Studies have shown that patients without a consistent primary care provider have inferior outcomes. However, little is known about the mechanisms for these effects. This study aims to determine whether primary care physicians (PCPs) provide more frequent medication intensification, lifestyle counseling, and patient encounters than other providers in the primary care setting. RESEARCH DESIGN AND METHODS This retrospective cohort study included 584,587 encounters for 27,225 patients with diabetes and elevated A1C, blood pressure, and/or LDL cholesterol monitored for at least 2 years. Encounters occurred at primary care practices affiliated with two teaching hospitals in eastern Massachusetts. RESULTS Of the encounters documented, 83% were with PCPs, 13% were with covering physicians, and 5% were with midlevel providers. In multivariable analysis, the odds of medication intensification were 49% (P < 0.0001) and 26% (P < 0.0001) higher for PCPs than for covering physicians and midlevel providers, respectively, whereas the odds of lifestyle counseling were 91% (P < 0.0001) and 21% (P = 0.0015) higher. During visits with acute complaints, covering physicians were even less likely, by a further 52% (P < 0.0001), to intensify medications, and midlevel providers were even less likely, by a further 41% (P < 0.0001), to provide lifestyle counseling. Compared with PCPs, the hazard ratios for time to the next encounter after a visit without acute complaints were 1.11 for covering physicians and 1.19 for midlevel providers (P < 0.0001 for both). CONCLUSIONS PCPs provide better care through higher rates of medication intensification and lifestyle counseling. Covering physicians and midlevel providers may enable more frequent encounters when PCP resources are constrained

A next-generation inverse-geometry spallation-driven ultracold neutron source

The physics model of a next-generation spallation-driven high-current ultracold neutron (UCN) source capable of delivering an extracted UCN rate of around an-order-of-magnitude higher than the strongest proposed sources, and around three-orders-of-magnitude higher than existing sources, is presented. This UCN-current-optimized source would dramatically improve cutting-edge UCN measurements that are currently statistically limited. A novel "Inverse Geometry" design is used with 40 L of superfluid $^4$He (He-II), which acts as a converter of cold neutrons (CNs) to UCNs, cooled with state-of-the-art sub-cooled cryogenic technology to $\sim$1.6 K. Our design is optimized for a 100 W maximum heat load constraint on the He-II and its vessel. In our geometry, the spallation target is wrapped symmetrically around the UCN converter to permit raster scanning the proton beam over a relatively large volume of tungsten spallation target to reduce the demand on the cooling requirements, which makes it reasonable to assume that water edge-cooling only is sufficient. Our design is refined in several steps to reach $P_{UCN}=2.1\times10^9\,/$s under our other restriction of 1 MW maximum available proton beam power. We then study effects of the He-II scattering kernel as well as reductions in $P_{UCN}$ due to pressurization to reach $P_{UCN}=1.8\times10^9\,/$s. Finally, we provide a design for the UCN extraction system that takes into account the required He-II heat transport properties and implementation of a He-II containment foil that allows UCN transmission. We estimate a total useful UCN current from our source of $R_{use}=5\times10^8\,/$s from a 18 cm diameter guide 5 m from the source. Under a conservative "no return" approximation, this rate can produce an extracted density of $>1\times10^4\,/$cm$^3$ in $<$1000~L external experimental volumes with a $^{58}$Ni (335 neV) cut-off potential.Comment: Submitted to Journal of Applied Physic

Life path analysis: scaling indicates priming effects of social and habitat factors on dispersal distances

1. Movements of many animals along a life-path can be separated into repetitive ones within home ranges and transitions between home ranges. We sought relationships of social and environmental factors with initiation and distance of transition movements in 114 buzzards Buteo buteo that were marked as nestlings with long-life radio tags. 2. Ex-natal dispersal movements of 51 buzzards in autumn were longer than for 30 later in their first year and than 35 extra-natal movements between home ranges after leaving nest areas. In the second and third springs, distances moved from winter focal points by birds that paired were the same or less than for unpaired birds. No post-nuptial movement exceeded 2 km. 3. Initiation of early ex-natal dispersal was enhanced by presence of many sibs, but also by lack of worm-rich loam soils. Distances travelled were greatest for birds from small broods and with relatively little short grass-feeding habitat near the nest. Later movements were generally enhanced by the absence of loam soils and short grassland, especially with abundance of other buzzards and probable poor feeding habitats (heathland, long grass). 4. Buzzards tended to persist in their first autumn where arable land was abundant, but subsequently showed a strong tendency to move from this habitat. 5. Factors that acted most strongly in ½-km buffers round nests, or round subsequent focal points, usually promoted movement compared with factors acting at a larger scale. Strong relationships between movement distances and environmental characteristics in ½-km buffers, especially during early ex-natal dispersal, suggested that buzzards became primed by these factors to travel far. 6. Movements were also farthest for buzzards that had already moved far from their natal nests, perhaps reflecting genetic predisposition, long-term priming or poor habitat beyond the study area

Rehabilitation measures can restore postural balance in osteosarcopenia

Imbalance (or postural balance, postural instability), is one of the most common complaints of osteosarcopenia patients. The aim of the work is to evaluate the effectiveness and feasibility of using modern computerized HUBER systems with biological feedback function in the restoration of postural balance in osteosarcopenia. Material and methods. 40 osteosarcopenia women aged 56.7 ± 2.3 years have been examined. The methods used: X-ray absorptiometry (DEXA), HUBER platform; balancing platform hemisphere “OsportBosu” without biofeedback function; complex "Insight TM", Algometry; ROM, inclinometry; EMG; thermography; heart rate variability. The results of the treatment performed showed an increase in the parameters under study in all observation groups. Conclusions. Rehabilitation measures with the use of apparatus biofeedback treatment are a highly effective method in the medical maintenance and prevention of postural disorders in patients with osteosarcopenia and other disorders

Stable Coexistence of an Invasive Plant and Biocontrol Agent: A Parameterized Coupled Plant-Herbivore Model

1. Coupled plant-herbivore models, allowing feedback from plant to herbivore populations and vice versa, enable us to predict the impact of biocontrol agents on their target weed populations; however, they are rarely used in biocontrol studies. We describe the population biology of the invasive plant Echium plantagineum and the weevil Mogulones larvatus, a biocontrol agent, in Australia. In order to understand the dynamics of this plant-herbivore system, a series of coupled models of increasing complexity was developed. 2. A simple model was extended to include a seed bank, density-dependent plant fecundity, competition between weevil larvae and plant tolerance of herbivory, where below a threshold plants could compensate for larval feeding. Parameters and functional forms were estimated from experimental and field data. 3. The plant model, in the absence of the weevil, exhibited stable dynamics and provided a good quantitative description of field densities before the weevil was introduced. 4. In the coupled plant-herbivore model, density dependence in both plant fecundity and weevil larval competition stabilized the dynamics. Without larval competition the model was unstable, and plant tolerance of herbivory exacerbated this instability. This was a result of a time delay in plant response to herbivore densities. 5. Synthesis and applications. The coupled plant-herbivore model allowed us to predict whether stable coexistence of target plant and biocontrol agents was achievable at an acceptable level. We found this to be the case for the Echium-Mogulones system and believe that similar models would be of use when assessing new agents in this and other invasive plant biocontrol systems. Density dependence in new biocontrol agents should be assessed in order to determine whether it is likely to result in the aims of classical biocontrol: low, stable and sustainable populations of plant and herbivore. Further work should be done to characterize the strength of density dependence according to the niche occupied by the biocontrol agent, for example the strength and functional form of density dependence in stem borers may be quite different to that of defoliators

Quantifying Dispersal of European Culicoides (Diptera: Ceratopogonidae) Vectors between Farms Using a Novel Mark-Release-Recapture Technique

Studying the dispersal of small flying insects such as Culicoides constitutes a great challenge due to huge population sizes and lack of a method to efficiently mark and objectively detect many specimens at a time. We here describe a novel mark-release-recapture method for Culicoides in the field using fluorescein isothiocyanate (FITC) as marking agent without anaesthesia. Using a plate scanner, this detection technique can be used to analyse thousands of individual Culicoides specimens per day at a reasonable cost. We marked and released an estimated 853 specimens of the Pulicaris group and 607 specimens of the Obsoletus group on a cattle farm in Denmark. An estimated 9,090 (8,918-9,260) Obsoletus group specimens and 14,272 (14,194-14,448) Pulicaris group specimens were captured in the surroundings and subsequently analysed. Two (0.3%) Obsoletus group specimens and 28 (4.6%) Pulicaris group specimens were recaptured. The two recaptured Obsoletus group specimens were caught at the release point on the night following release. Eight (29%) of the recaptured Pulicaris group specimens were caught at a pig farm 1,750 m upwind from the release point. Five of these were recaptured on the night following release and the three other were recaptured on the second night after release. This is the first time that movement of Culicoides vectors between farms in Europe has been directly quantified. The findings suggest an extensive and rapid exchange of disease vectors between farms. Rapid movement of vectors between neighboring farms may explain the the high rate of spatial spread of Schmallenberg and bluetongue virus (BTV) in northern Europe

Use of ultrasound densitometry for the assess of structural and functional disorders of bone tissue and prediction of fractures risk

To determine the dependence of lumbar spine compression degree on BMD state and the patients’ age. The relationship of BMD state, the patients’ age and the degree of compression of the vertebrae were studied. Correlation and regression analysis of the relationship between SOS index, score of compression and patients' age have been examined. Results. The data obtained allowed us to develop a mathematical model for predicting BMD reduction and the severity of vertebral compression fractures. Conclusions. Ultrasonic indexes of bone mineral density may be used not only for its screening assessment in general population of different ages, but also in assessing the degree of structural and functional changes of BT, predicting the severity of low-energy osteoporosis fractures. It will help to assign treatment in preclinical stage, and carry out prevention of compression fractures

The functional response of a generalist predator

Peer reviewedPublisher PD