Congressional Briefing: A Geographically Targeted Approach for a Preceptor Tax Incentive Using Primary Care Health Professional Shortage Areas

This congressional briefing outlines federal policy implications, following state level use of HPSAs in targeted incentives for healthcare workforce development also published by the Commonwealth Policy Institute

Congressional Briefing: Increasing access to medicare-funded physician residency slots

The Fiscal Year (FY) 2022 Inpatient Prospective Payment System (IPPS) final rule designated the Centers for Medicare & Medicaid to implement 1,000 new Medicare-funded physician residency slots to qualifying hospitals authorized by the Consolidated Appropriations Act (CAA) of 2021, phasing in 200 slots per year over five years.However, in its first round of allocation of 200 slots in 2023, only 5 rural hospitals in the country received slots, despite Section 126 of the CAA. In this brief, we discuss potential solutions to address this allocation shortfall

A Geographically Targeted Approach for a Preceptor Tax Incentive Using Primary Care Health Professional Shortage Areas (HPSAs)

Years before the COVID-19 pandemic brought on a health care shortage in Kentucky, its rural areas were already struggling to obtain and attract primary care medical practitioners. Even though the number of medical school graduates in the U.S. has steadily increased throughout the years, there is a general disinterest in rural or small-town practice, and legislators throughout the country have pondered ways to address this issue plaguing communities. Versions of Preceptor Tax Incentive legislation in Kentucky have been proposed in the General Assembly to address care shortages in the state, however, all have been unsuccessful at truly targeting rural areas where preceptors are needed the most. After interviews with Kentucky and Georgia policymakers, Kentucky AHEC officials, medical providers, and other stakeholders, we concluded that a more targeted approach to preceptor tax incentive legislation was needed using Primary Care Health Professional Shortage Areas (HPSAs), which are geographic areas, population groups, or health care facilities that have been designated by the Health Resources and Services Administration as having a shortage of primary care health professionals. This new structure creates a nonrefundable income tax credit to be claimed by any non-compensated, community-based, Kentucky-licensed primary care preceptor practicing in one of Kentucky’s HRSA-designated Primary Care Health Professional Shortage Areas (HPSAs) and supervising 3rd and 4th year medical/osteopathic students, physician assistant students, and advanced practice registered nurse students. Since research shows that where medical students do their clinical rotations influences where they ultimately decide to practice, it is vital that there are plenty of primary care preceptors in rural and underserved areas to expose students to this kind of unique work environment. Increasing the number of primary care preceptors in rural communities would curb primary care shortages in the long-term and lead more medical students to practice in these areas once they graduate. Published briefs in the Commonwealth Policy papers are intended to provide specific examples of novel policies which may be applicable in multiple states and provinces of the U.S., in addition to providing “trickle up” solutions to the Congressional level

CHARACTERIZING PSYCHOBEHAVIORAL RISKS IN SURVIVORS OF MULTIPLE PRIMARY CANCERS

Background: As the population ages and cancer survival improves, the incidence of multiple primary cancers (MPC) is increasing. Several studies have documented poorer health outcomes among adults with MPC compared to single-cancer survivors. However, there is a paucity of research focused on understanding factors linking MPC to poor health outcomes and identifying individual (e.g. personality, sociodemographic, clinical) factors that increase risk. Purpose: The purpose of this study was to test a psychobehavioral stress-response model to identify factors associated with MPC health outcomes. We aimed to: 1) test the hypothesized model, examining linear relations among six latent variables: perceived stress, psychological response, behavioral response, financial toxicity, social health, and physical health; 2) explore associations between individual characteristics and upstream latent variables; and 3) describe self-management behaviors of MPC survivors. Methods: This cross-sectional study included MPC survivors recruited through a regional tumor registry whose first cancers (stages I-III) were diagnosed within 1-10 years. Data were collected via 1) a battery of validated questionnaires to measure latent variables and covariates; 2) tumor registry records; and 3) medical records. Structural equation modeling was performed to fit and modify the measurement model, specify the full SEM, and identify significant covariates. Descriptive statistics were conducted to characterize self-management. Results: 211 participants completed questionnaires. Data fit a four-factor modified measurement model linking self-management, distress, financial toxicity, and functional health. Overweight BMI, graduate education, less neuroticism, and increased social support predicted better self-management. Poorer self-management, greater neuroticism, and lower social support predicted increased distress. Greater distress predicted financial toxicity. Greater distress and financial toxicity predicted poorer functional health. Scores for positive self-management were generally high; obesity rates were above published norms. Conclusions: MPC survivors with higher risk BMI, less education, greater neuroticism, and lower social support should be considered at risk for poorer self-management and negative health outcomes. Self-management behaviors and distress are potentially modifiable intervention targets to reduce financial toxicity and improve functional health. Future research should evaluate the model with a focus on developing the science of MPC self-management and financial toxicity and include longitudinal assessments to identify critical times of increased vulnerability during MPC survivorship

Accuracy and consistency of grass pollen identification by human analysts using electron micrographs of surface ornamentation

• Premise of the study: Humans frequently identify pollen grains at a taxonomic rank above species. Grass pollen is a classic case of this situation, which has led to the development of computational methods for identifying grass pollen species. This paper aims to provide context for these computational methods by quantifying the accuracy and consistency of human identification. • Methods: We measured the ability of nine human analysts to identify 12 species of grass pollen using scanning electron microscopy images. These are the same images that were used in computational identifications. We have measured the coverage, accuracy, and consistency of each analyst, and investigated their ability to recognize duplicate images. • Results: Coverage ranged from 87.5% to 100%. Mean identification accuracy ranged from 46.67% to 87.5%. The identification consistency of each analyst ranged from 32.5% to 87.5%, and each of the nine analysts produced considerably different identification schemes. The proportion of duplicate image pairs that were missed ranged from 6.25% to 58.33%. • Discussion: The identification errors made by each analyst, which result in a decline in accuracy and consistency, are likely related to psychological factors such as the limited capacity of human memory, fatigue and boredom, recency effects, and positivity bias

ISBS 2018 AUCKLAND CONFERENCE AUT MILLENNIUM TEACHERS DAY

Dr Sarah Kate Millar is coordinating the New Zealand Biomechanics Teachers Day. Teachers will have the opportunity to work side-by-side with leading biomechanics instructors/researcher from across the world. There will be a focus on creating hands-on experiential learning opportunities to achieve science and physical education outcomes. Sarah-Kate Millar is a senior lecturer at AUT (AUT) in the area of sports coaching and in particular skill acquisition. Dr. Kim Hébert-Losier is a Senior Lecturer in Applied Biomechanics and Injury Prevention at the University of Waikato. Dr Laura-Anne M Furlong is a Lecturer in Biomechanics, currently based in the School of Sport, Exercise and Health Sciences at Loughborough University, and the National Centre for Sports and Exercise Medicine. Dr Philip Fink is Senior Lecturer in motor control and biomechanics at the School of Sport, Exercise and Nutrition at Massey University. Dr Duane Knudson is a Professor in the Department of Health & Human Performance at Texas State University. Suzie Belcher is currently working with Netball New Zealand as part of their national Injury prevention team, NetballSmart

Wildfire activity enhanced during phases of maximum orbital eccentricity and precessional forcing in the Early Jurassic

Fire regimes are changing due to both anthropogenic climatic drivers and vegetation management challenges, making it difficult to determine how climate alone might influence wildfire activity. Earth has been subject to natural-background climate variability throughout its past due to variations in Earth’s orbital parameters (Milkankovitch cycles), which provides an opportunity to assess climate-only driven variations in wildfire. Here we present a 350,000 yr long record of fossil charcoal from mid-latitude (~35°N) Jurassic sedimentary rocks. These results are coupled to estimates of variations in the hydrological cycle using clay mineral, palynofacies and elemental analyses, and lithological and biogeochemical signatures. We show that fire activity strongly increased during extreme seasonal contrast (monsoonal climate), which has been linked to maximal precessional forcing (boreal summer in perihelion) (21,000 yr cycles), and we hypothesize that long eccentricity modulation further enhances precession-forced fire activity

Longitudinal clusters of pain and stiffness in polymyalgia rheumatica: 2-year results from the PMR Cohort study

Objectives. To investigate potential subgroups of primary care diagnosed patients with polymyalgia rheumatica (PMR) based on self-reported pain and stiffness severity over time.Methods. 652 people with an incident PMR diagnosis were recruited from English general practices and completed a baseline postal questionnaire. They were followed-up with a further six questionnaires over a two-year period. 446 people completed 2-year follow-up. Pain and stiffness were reported on 0-10 numerical rating scales. Latent class growth analysis was used to estimate the joint trajectories of pain and stiffness overtime. A combination ofstatistical and clinical considerations was used to choose the number of clusters. Characteristics of the classes were described. Results. Five clusters were identified. One cluster represented the profile of ‘classical’ PMR symptoms and one represented sustained symptoms that may not be PMR. The other three clusters displayed a partial recovery, a recovery followed by worsening and a slow, but sustained recovery. Those displaying classical PMR symptoms were in better overall health at diagnosis than the other groups.Conclusions. PMR is a heterogeneous condition, with a number of phenotypes. The spectrum of presentation, as well as varying responses to treatment, may be related to underlying health status at diagnosis. Future research should seek to stratify patients at diagnosis to identify those likely to have a poor recovery and in need of an alternative treatment pathway. Clinicians should be aware of the different experiences of patients and monitor symptoms closely, even where there is initial improvement

Diagnostic delay for giant cell arteritis – a systematic review and meta-analysis

Background Giant cell arteritis (GCA), if untreated, can lead to blindness and stroke. The study’s objectives were to (1) determine a new evidence-based benchmark of the extent of diagnostic delay for GCA and (2) examine the role of GCA-specific characteristics on diagnostic delay. Methods Medical literature databases were searched from inception to November 2015. Articles were included if reporting a time-period of diagnostic delay between onset of GCA symptoms and diagnosis. Two reviewers assessed the quality of the final articles and extracted data from these. Random-effects meta-analysis was used to pool the mean time-period (95% confidence interval (CI)) between GCA symptom onset and diagnosis, and the delay observed for GCA-specific characteristics. Heterogeneity was assessed by I 2 and by 95% prediction interval (PI). Results Of 4128 articles initially identified, 16 provided data for meta-analysis. Mean diagnostic delay was 9.0 weeks (95% CI, 6.5 to 11.4) between symptom onset and GCA diagnosis (I 2 = 96.0%; P < 0.001; 95% PI, 0 to 19.2 weeks). Patients with a cranial presentation of GCA received a diagnosis after 7.7 (95% CI, 2.7 to 12.8) weeks (I 2 = 98.4%; P < 0.001; 95% PI, 0 to 27.6 weeks) and those with non-cranial GCA after 17.6 (95% CI, 9.7 to 25.5) weeks (I 2 = 96.6%; P < 0.001; 95% PI, 0 to 46.1 weeks). Conclusions The mean delay from symptom onset to GCA diagnosis was 9 weeks, or longer when cranial symptoms were absent. Our research provides an evidence-based benchmark for diagnostic delay of GCA and supports the need for improved public awareness and fast-track diagnostic pathways

Reduction in school individualized education program (IEP) services during the COVID-19 pandemic

PurposeThe COVID-19 pandemic created novel challenges for school systems and students, particularly students with disabilities. In the shift to remote/distance learning, this report explores the degree to which children with disabilities did not receive the special education and related services defined in their individualized education program (IEP).MethodsPatients attending an outpatient tertiary care center for neurodevelopmental disabilities in Maryland were surveyed on the impact of the pandemic on educational services provision.ResultsNearly half (46%) of respondents qualified for special education and related services through an IEP before the start of the COVID-19 pandemic. Among those with IEPs, 48% attested to reduced frequency and/or duration of special education and/or related services during the pandemic. The reduction was greatest in occupational therapy services (47%), followed physical therapy services (46%), and special education services (34%).ConclusionThis survey of children with disabilities observes a substantial reduction in IEP services reported in their completed surveys. To address the observed reduction in IEP services, we sought additional education for clinicians on the rights of students with disabilities in anticipation of students’ re-entry to the classroom. A special education law attorney provided an instructional session on compensatory education and recovery services to prepare clinicians to properly inform parents about their rights and advocate for patients with unmet IEP services during the pandemic