Characteristics of Californias EMT and Paramedic Workforce

Since the beginning of the COVID-19 pandemic employers have experienced great difficulty recruiting and retaining emergency medical technicians (EMTs) and paramedics. This situation highlights the need to learn more about the supply, distribution, and demographic characteristics of EMTs and paramedics as well as the pipeline of new EMTs and paramedics that are trained in the state. This report synthesizes findings from analyses of multiple sources of data describing California's EMTs and paramedics. The report also acknowledges limitations of these data sources and makes recommendations for filling gaps in the availability of data that are critical to understanding this segment of the emergency medical services (EMS) workforce and strengthening its ability to meet Californians' needs for emergency medical services

Strategies for Improving the Diversity of the Health Professions

Evaluates programs and strategies that were designed to increase the number of underrepresented African Americans, Native Americans, and Latinos in the health professions in California. Includes recommendations

California Physicians: Who They Are, How They Practice

The number of licensed physicians in California has grown steadily over the past 20 years, increasing 44% between 1993 and 2013, and has outpaced the state's 23% growth in population. Demand for physicians is expected to increase as the population ages. Ensuring access to care is a concern, as one-third of the state's physicians are over age 60. California Physicians: Who They Are, How They Practice describes the physician market in California

Communication Sciences and Disorders Graduate Students\u27 Strengths and Vulnerabilities Related to Resilience: A Survey of Graduate Programs

Burnout in health care professionals may pose a threat to the quality of care provided in any setting. The purpose of this project was to examine dimensions related to future resilience in CSD graduate students. METHODS: In this project, 146 master’s degree students from Communication Sciences and Disorders (CSD) programs in the Midwest completed an online survey regarding lifestyle stresses affecting resilience, and patterns in five areas correlated with resilience. RESULTS: Top lifestyle stresses affecting academics were general stress, maintaining mental health, and sleep difficulties. Notably, more than half of the participants reported feeling rested three or fewer days per week. Further, CSD students reported significantly higher incidence of general stress, mental health conditions, chronic health conditions, concern for a friend or family member’s struggles, and sleep difficulty than college age peers. Positive factors identified related to resilience in CSD students included presence of professional networks and mentoring, maintaining positivity, opportunities for reflecting on strengths and weaknesses, and having a sense meaning in life. Respondent areas of resilience vulnerability were reduced optimism on a daily basis, limited sense of life balance, and hesitancy to discuss life issues or accommodation needs with faculty. Implications are discussed regarding CSD graduate programs’ roles in fostering resilience. CONCLUSION: Professional programs can support and promote the development of personal and professional resilience in students training for healthcare professions. This survey project provides a starting point to describe patterns in CSD master’s programs within the Midwestern region of the US

The effect of early child care attendance on childhood asthma and wheezing: A meta-analysis.

ObjectiveResearch evidence offers mixed results regarding the relationship between early child care attendance and childhood asthma and wheezing. A meta-analysis was conducted to synthesize the current research evidence of the association between early child care attendance and the risk of childhood asthma and wheezing.MethodPeer reviewed studies published from 1964-January 2017 were identified in MEDLINE, CINAL, and EMBASE using MeSH headings relevant to child care and asthma. Two investigators independently reviewed the selected articles from this search. All relevant articles that met our inclusion criteria were selected for further analysis. Data were extracted from studies that had sufficient data to analyze the odds of asthma or wheezing among children who attended child care.ResultsThe meta-analysis of 32 studies found that (1) early child care attendance is protective against asthma in children 3-5 years of age but not for children with asthma 6 years of age or older. (2) Early child care attendance increases the risk of wheezing among children 2 years of age or younger, but not the risk of wheezing for children over 2 years of age.ConclusionsThis meta-analysis shows that early child care attendance is not significantly associated with the risk of asthma or wheeze in children 6 years of age or older

An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial.

BackgroundColorectal cancer is the fourth most commonly diagnosed cancer in the United States. Approximately 3-10% of the population has an increased risk for colorectal cancer due to family history and warrants more frequent or intensive screening. Yet, < 50% of that high-risk population receives guideline-concordant care. Systematic collection of family health history and decision support may improve guideline-concordant screening for patients at increased risk of colorectal cancer. We seek to test the effectiveness of a web-based, systematic family health history collection tool and decision support platform (MeTree) to improve risk assessment and appropriate management of colorectal cancer risk among patients in the Department of Veterans Affairs primary care practices.MethodsIn this ongoing randomized controlled trial, primary care providers at the Durham Veterans Affairs Health Care System and the Madison VA Medical Center are randomized to immediate intervention or wait-list control. Veterans are eligible if assigned to enrolled providers, have an upcoming primary care appointment, and have no conditions that would place them at increased risk for colorectal cancer (such as personal history, adenomatous polyps, or inflammatory bowel disease). Those with a recent lower endoscopy (e.g. colonoscopy, sigmoidoscopy) are excluded. Immediate intervention patients put their family health history information into a web-based platform, MeTree, which provides both patient- and provider-facing decision support reports. Wait-list control patients access MeTree 12 months post-consent. The primary outcome is the risk-concordant colorectal cancer screening referral rate obtained via chart review. Secondary outcomes include patient completion of risk management recommendations (e.g. colonoscopy) and referral for genetic consultation. We will also conduct an economic analysis and an assessment of providers' experience with MeTree clinical decision support recommendations to inform future implementation efforts if the intervention is found to be effective.DiscussionThis trial will assess the feasibility and effectiveness of patient-collected family health history linked to decision support to promote risk-appropriate screening in a large healthcare system such as the Department of Veterans Affairs.Trial registrationClinicalTrials.gov, NCT02247336 . Registered on 25 September 2014

Neutrophil Elastase Promotes Interleukin-1 beta Secretion from Human Coronary Endothelium

The endothelium is critically involved in the pathogenesis of atherosclerosis by producing pro-inflammatory mediators, including IL-1β. Coronary arteries from patients with ischemic heart disease express large amounts of IL-1β in the endothelium. However, the mechanism by which endothelial cells (ECs) release IL-1β remains to be elucidated. We investigated neutrophil elastase (NE), a potent serine protease detected in vulnerable areas of human carotid plaques, as a potential “trigger” for IL-1β processing and release. This study tested the hypothesis that NE potentiates the processing and release of IL-1β from human coronary endothelium. We found that NE cleaves the pro-isoform of IL-1β in ECs and causes significant secretion of bioactive IL-1β via extracellular vesicles. This release was attenuated significantly by inhibition of neutrophil elastase but not caspase-1. Transient increases in intracellular Ca2+ levels were observed prior to secretion. Inside ECs, and after NE treatment only, IL-1β was detected within LAMP-1-positive multivesicular bodies. The released vesicles contained bioactive IL-1β. In vivo, in experimental atherosclerosis, NE was detected in mature atherosclerotic plaques, predominantly in the endothelium, alongside IL-1β. This study reveals a novel mechanistic link between NE expression in atherosclerotic plaques and concomitant pro-inflammatory bioactive IL-1β secretion from ECs. This could reveal additional potential anti-IL-1β therapeutic targets and provide further insights into the inflammatory process by which vascular disease develops

Examining the impact of genetic testing for type 2 diabetes on health behaviors: study protocol for a randomized controlled trial

Abstract Background We describe the study design, procedures, and development of the risk counseling protocol used in a randomized controlled trial to evaluate the impact of genetic testing for diabetes mellitus (DM) on psychological, health behavior, and clinical outcomes. Methods/Design Eligible patients are aged 21 to 65 years with body mass index (BMI) ≥27 kg/m2 and no prior diagnosis of DM. At baseline, conventional DM risk factors are assessed, and blood is drawn for possible genetic testing. Participants are randomized to receive conventional risk counseling for DM with eye disease counseling or with genetic test results. The counseling protocol was pilot tested to identify an acceptable graphical format for conveying risk estimates and match the length of the eye disease to genetic counseling. Risk estimates are presented with a vertical bar graph denoting risk level with colors and descriptors. After receiving either genetic counseling regarding risk for DM or control counseling on eye disease, brief lifestyle counseling for prevention of DM is provided to all participants. Discussion A standardized risk counseling protocol is being used in a randomized trial of 600 participants. Results of this trial will inform policy about whether risk counseling should include genetic counseling. Trial registration ClinicalTrials.gov Identifier NCT0106054

Measurements from the RV Ronald H. Brown and related platforms as part of the Atlantic Tradewind Ocean-Atmosphere Mesoscale Interaction Campaign (ATOMIC)

© The Author(s), 2021. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Quinn, P. K., Thompson, E. J., Coffman, D. J., Baidar, S., Bariteau, L., Bates, T. S., Bigorre, S., Brewer, A., de Boer, G., de Szoeke, S. P., Drushka, K., Foltz, G. R., Intrieri, J., Iyer, S., Fairall, C. W., Gaston, C. J., Jansen, F., Johnson, J. E., Krueger, O. O., Marchbanks, R. D., Moran, K. P., Noone, D., Pezoa, S., Pincus, R., Plueddemann, A. J., Poehlker, M. L., Poeschl, U., Melendez, E. Q., Royer, H. M., Szczodrak, M., Thomson, J., Upchurch, L. M., Zhang, C., Zhang, D., & Zuidema, P. Measurements from the RV Ronald H. Brown and related platforms as part of the Atlantic Tradewind Ocean-Atmosphere Mesoscale Interaction Campaign (ATOMIC). Earth System Science Data, 13(4), (2021): 1759-1790, https://doi.org/10.5194/essd-13-1759-2021.The Atlantic Tradewind Ocean-Atmosphere Mesoscale Interaction Campaign (ATOMIC) took place from 7 January to 11 July 2020 in the tropical North Atlantic between the eastern edge of Barbados and 51∘ W, the longitude of the Northwest Tropical Atlantic Station (NTAS) mooring. Measurements were made to gather information on shallow atmospheric convection, the effects of aerosols and clouds on the ocean surface energy budget, and mesoscale oceanic processes. Multiple platforms were deployed during ATOMIC including the NOAA RV Ronald H. Brown (RHB) (7 January to 13 February) and WP-3D Orion (P-3) aircraft (17 January to 10 February), the University of Colorado's Robust Autonomous Aerial Vehicle-Endurant Nimble (RAAVEN) uncrewed aerial system (UAS) (24 January to 15 February), NOAA- and NASA-sponsored Saildrones (12 January to 11 July), and Surface Velocity Program Salinity (SVPS) surface ocean drifters (23 January to 29 April). The RV Ronald H. Brown conducted in situ and remote sensing measurements of oceanic and atmospheric properties with an emphasis on mesoscale oceanic–atmospheric coupling and aerosol–cloud interactions. In addition, the ship served as a launching pad for Wave Gliders, Surface Wave Instrument Floats with Tracking (SWIFTs), and radiosondes. Details of measurements made from the RV Ronald H. Brown, ship-deployed assets, and other platforms closely coordinated with the ship during ATOMIC are provided here. These platforms include Saildrone 1064 and the RAAVEN UAS as well as the Barbados Cloud Observatory (BCO) and Barbados Atmospheric Chemistry Observatory (BACO). Inter-platform comparisons are presented to assess consistency in the data sets. Data sets from the RV Ronald H. Brown and deployed assets have been quality controlled and are publicly available at NOAA's National Centers for Environmental Information (NCEI) data archive (https://www.ncei.noaa.gov/archive/accession/ATOMIC-2020, last access: 2 April 2021). Point-of-contact information and links to individual data sets with digital object identifiers (DOIs) are provided herein.NOAA's Climate Variability and Predictability Program provided funding under NOAA CVP NA19OAR4310379, GC19-301, and GC19-305. The Joint Institute for the Study of the Atmosphere and Ocean (JISAO) supported this study under NOAA cooperative agreement NA15OAR4320063. Additional support was provided by the NOAA's Uncrewed Aircraft Systems (UAS) Program Office, NOAA's Physical Sciences Laboratory, and NOAA AOML's Physical Oceanography Division. The NTAS project is funded by the NOAA's Global Ocean Monitoring and Observing Program (CPO FundRef number 100007298), through the Cooperative Institute for the North Atlantic Region (CINAR) under cooperative agreement NA14OAR4320158