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

Development and validation of a new glaucoma screening test using temporally modulated flicker

Purpose Describing the psychometric characteristics and diagnostic accuracy of the Accelerator 4‐Alternative Forced‐Choice Flicker Test prototype (A4FTp) for detecting chronic open angle glaucoma (COAG). Methods A4FTp measures temporally‐modulated flicker thresholds in regions of the visual field with high susceptibility to glaucomatous loss. We initially evaluated its psychometric properties on 20 normals (aged 33.8 ± 8.5 years) who were tested multiple times over a period of 3 months. All subjects underwent four repetitions for shorter (T8) and longer (T12) staircase termination criteria, to determine the most suitable threshold criterion. Four randomly selected subjects underwent a total of 10 repetitions to study test‐retest repeatability and learning effects. To determine its diagnostic accuracy, one eye of 40 participants with COAG and 38 normal controls were tested with the A4FTp in comparison with the Frequency Doubling Technology (FDT; C20‐5 programme) and iVue Spectral Domain Optical Coherence Tomography (SD‐OCT). Tests were conducted in a random order with results masked to the clinician conducting the reference ophthalmic examination. The accuracy of each test was determined by analysis of the area under the receiver operator characteristic curve (AUROC). Results A4FTp flicker thresholds were stable, with standard deviations of only 0.52 decilog (dL) for T8, increasing to 1.32 dL for T12, and no significant flicker sensitivity threshold improvement over the 10 repeat runs. T8 was superior to T12 on several other measures, so it was used for the remaining comparisons. In terms of diagnostic accuracy, the mean AUROC for the three tests were A4FTp [T8 criterion; 0.82, 95% confidence interval (0.73–0.92)]; SD‐OCT [any RNFL parameter p < 1% level; 0.90 (0.83–0.97)]; and FDT [one or more locations missed at p < 5% level; 0.91 (0.82–0.96)]. There was no statistical difference in AUROC between A4FTp and SD‐OCT (p = 0.18) or FDT (p = 0.12). The A4FTp test duration averaged just over 2 min per eye, taking approximately one‐third of the time for completion of the HFA SITA 24‐2 algorithm (conducted as part of the reference examination) and twice the time for the suprathreshold FDT. Conclusion Test accuracy for the A4FTp was comparable to those of the FDT and SD‐OCT for the detection of COAG. Time taken to complete the A4FTp was relatively short and initial results are promising. With further refinement, the A4FTp could have a future role in glaucoma detection

Computational estimation of scene structure through texture gradient cues

Analyzing the depth structure implied in two-dimensional images is one of the most active research areas in computer vision. Here, we propose a method of utilizing texture within an image to derive its depth structure. Though most approaches for deriving depth from a single still image utilize luminance edges and shading to estimate scene structure, relatively little work has been done to utilize the abundant texture information in images. Our new approach begins by analyzing the two cues of local spatial frequency and orientation distributions of the textures within an image, which are used to compute the local slant information across the image. The slant and frequency information are merged to create a unified depth map, providing an important channel for image structure information that can be combined with other available cues. The capabilities of the algorithm are illustrated for a variety of images of planar and curved surfaces under perspective projection, in most of which the depth structure is effortlessly perceived by human observers. Since these operations are readily implementable in neural hardware in early visual cortex, they therefore represent a model of the human perception of the depth structure of images from texture gradient cues

The improvement of contrast sensitivity with practice is not compatible with a sensory threshold account

In forced-choice detection, incorrect responses are routinely ascribed to internal noise, because experienced psychophysical observers do not act as if they have a sensory threshold, below which all perceived intensities would be identical. To determine whether inexperienced observers have sensory thresholds, we examined psychometric functions (percent correct vs log contrast) for detection and detection in full-field, dynamic visual noise. Over 5 days, neither type of psychometric function changed shape, but both shifted leftwards, indicating increased sensitivity. These results are not consistent with a lowered sensory threshold, which would decrease psychometric slope. They are consistent with a combination of reduced internal additive noise and improved filtering of external noise

A Brücke-Bartley effect for contrast

Accurate derivation of the psychophysical (a.k.a. transducer) function from just-noticeable differences requires accurate knowledge of the relationship between the mean and variance of apparent intensities. Alternatively, a psychophysical function can be derived from estimates of the average between easily discriminable intensities. Such estimates are unlikely to be biased by the aforementioned variance, but they are notoriously variable and may stem from decisional processes that are more cognitive than sensory. To circumvent minimise cognitive pollution, we used amplitude-modulated contrast. As the spatial or temporal (carrier) frequency increased, estimates of average intensity became less variable across observers, converging on values that were closer to mean power (i.e. contrast 2) than mean contrast. Simply put, apparent contrast increases when physical contrast flickers. This result is analogous to Brücke's finding that brightness increases when luminance flickers. It implies an expansive transduction of contrast in the same way that Brücke's finding implies an expansive transduction of luminance

Estimating the Impacts of Storage Dry Matter Losses on Switchgrass Production

This poster estimates dry matter losses as a function of harvest method, storage treatment, and time in storage. We then calculate the cost to store switchgrass bales under alternate harvest method and storage treatment scenarios; and determine the breakeven harvest method and storage treatment as a function of biomass price and time in storage.Biomass, bioenergy crops, function form, sustainable systems, Farm Management, Production Economics, Q10, Q42,

Alternative derivation of the relativistic contribution to perihelic precession

An alternative derivation of the first-order relativistic contribution to perihelic precession is presented. Orbital motion in the Schwarzschild geometry is considered in the Keplerian limit, and the orbit equation is derived for approximately elliptical motion. The method of solution makes use of coordinate transformations and the correspondence principle, rather than the standard perturbative approach. The form of the resulting orbit equation is similar to that derived from Newtonian mechanics and includes first-order corrections to Kepler's orbits due to general relativity. The associated relativistic contribution to perihelic precession agrees with established first-order results. The reduced radius for the circular orbit is in agreement to first-order with that calculated from the Schwarzschild effective potential. The method of solution is understandable by undergraduate students.Comment: 12 pages, 2 figures. Accepted for publication in the American Journal of Physic

ATLAS solar pointing operations

The ATLAS-series of Spacelab missions are comprised of a diverse group of scientific instruments including instruments for studying the sun and how the sun's energy changes across an eleven-year solar cycle. The ATLAS solar instruments are located on one or more pallets in the Orbiter payload bay and use the Orbiter as a pointing platform for their examinations of the sun. One of the ATLAS instruments contained a sun sensor which allowed scientists and engineers on the ground to see the pointing error of the sun with respect to the instrument and correct for the error based upon the information coming from the ATLAS 1 and ATLAS 2 missions with particular attention given to identifying the sources of pointing discrepancies of the solar instruments and to describe the crew and ground controller procedures that were developed to correct for these discrepancies. The Orbiter pointing behavior from the ATLAS 1 and ATLAS 2 flights presented in this paper can be applied to future flights which use the Orbiter as a pointing platform