Medical Students\u27 Knowledge of Midwifery Practice After Didactic and Clinical Exposure

Information concerning the student outcomes of interdisciplinary education is limited. The purpose of this study was to identify the knowledge of third‐year medical students regarding the practice of certified nurse‐midwives (CNMs). A 1‐page survey instrument was developed and pretested. The instrument was administered as a pre‐ and posttest at the beginning and end of 7 Obstetrics and Gynecology rotations at 2 medical school clinical campuses of a large Midwestern medical school. Direct interaction with CNMs improved knowledge of collaborative practice arrangements and roles. This was particularly evident in knowledge areas related to CNM prescriptive authority. The medical students who had direct experience with CNMs expressed more interest in working with them in the future than those who lacked the exposure. Collaborative, interdisciplinary education of medical students appeared to promote improved understanding of roles and capabilities

Nineteenth-Century Patterns Of Railroad Development On The Great Plains

The North American Great Plains experienced rapid settlement and economic growth from 1870 to 1914. The advance of settlement and the development of local economy, while generally contiguous, were by no means uniform. Soil conditions, underground water supplies, the network of rivers and streams, rainfall, and growing season are all attributes of the physical environment that vary across the plains both longitudinally and latitudinally. In addition, the extent of effective settlement in the Mississippi River valley, the natural starting point for westward expansion onto the plains, varied considerably in 1865. Given these economic and environmental preconditions, it is not surprising that settlement on the Great Plains after 1870 varied in timing and degree. Although the physical geography of the area must be taken into account, the differences in the timing and amount of economic development of the region were largely due to the uneven expansion of the railroad network after 1870. Some areas were heavily over endowed with railroad facilities, while others received barely adequate, or even niggardly, treatment at the hands of railroad businessmen and entrepreneurs. The construction and operation of railroads on the plains were governed in part by strategic, managerial, financial, and institutional forces that produced a transport system with no necessary relationship to the contemporary or potential economic landscape of the Canadian and American Great Plains. This article examines the process of corporate railroad decision making in the larger context of investments, developmental strategies, and operational considerations, and explores the spatial evolution of four major railroad systems from their origins to 1915. These railroads, two American and two Canadian, demonstrate various strategies of system development. Generalizations drawn from a brief historical overview, combined with insights from other analyses of entrepreneurial and business practices of nineteenth-century railroads and their leaders, suggest a hypothetical sequence of railroad system development at the level of the corporation in nineteenth century North America. TERMINOLOGY Within the context of railroad systems, from both an investment and an operational point of view, several concepts and terms have been developed by business and economic historians to facilitate the understanding of investor and corporate decision making. As these ideas will be applied to the development of the four Great Plains railroads considered here, some brief definitions are warranted. First, in order to understand the investment strategies pursued by individual capitalists and entrepreneurs, it is useful to differentiate, as Arthur M. Johnson and Barry E. Supple have done, between developmental and opportunistic investments and investment strategies in the nineteenth-century railroad business. A developmental investment strategy is one in which an \u27investor looks to long-term growth in a booming region for the economic rewards from capital investment. Opportunistic investments, on the other hand, have relatively shorter time horizons, the context of which was not so much future income growth as the securing of profits from available markets whether for goods, for railroad services, or for stocks and bonds. There is a continuum from developmental to opportunistic investment, and while any individual\u27s current motives can be placed somewhere along this continuum, those motives, or the criteria for subsequent investment decisions, could easily change with time or with changes in other financial and economic factors not necessarily bearing directly on railroading. Local merchants and farmers committed their capital to early local railroad companies as a means of increasing their business profits. Distant investors often purchased railroad bonds and debentures with a view to stable, long-term developmental profits. By the late nineteenth century, many railroads had come under the control of strictly financial, large-scale capitalist interests. Often located at some distance from their railroads, financiers used their properties for much broader strategic purposes, manipulating the securities, freight rates, connections, and through routes almost at will. As often as opportunistic profits were made-through financial wizardry, shady construction contracts, or dealings in railroad lands-great fortunes disappeared overnight in the aftermath of bank failures, overextension, or bankruptcy and receivership

Nineteenth-Century Patterns Of Railroad Development On The Great Plains

The North American Great Plains experienced rapid settlement and economic growth from 1870 to 1914. The advance of settlement and the development of local economy, while generally contiguous, were by no means uniform. Soil conditions, underground water supplies, the network of rivers and streams, rainfall, and growing season are all attributes of the physical environment that vary across the plains both longitudinally and latitudinally. In addition, the extent of effective settlement in the Mississippi River valley, the natural starting point for westward expansion onto the plains, varied considerably in 1865. Given these economic and environmental preconditions, it is not surprising that settlement on the Great Plains after 1870 varied in timing and degree. Although the physical geography of the area must be taken into account, the differences in the timing and amount of economic development of the region were largely due to the uneven expansion of the railroad network after 1870. Some areas were heavily over endowed with railroad facilities, while others received barely adequate, or even niggardly, treatment at the hands of railroad businessmen and entrepreneurs. The construction and operation of railroads on the plains were governed in part by strategic, managerial, financial, and institutional forces that produced a transport system with no necessary relationship to the contemporary or potential economic landscape of the Canadian and American Great Plains. This article examines the process of corporate railroad decision making in the larger context of investments, developmental strategies, and operational considerations, and explores the spatial evolution of four major railroad systems from their origins to 1915. These railroads, two American and two Canadian, demonstrate various strategies of system development. Generalizations drawn from a brief historical overview, combined with insights from other analyses of entrepreneurial and business practices of nineteenth-century railroads and their leaders, suggest a hypothetical sequence of railroad system development at the level of the corporation in nineteenth century North America. TERMINOLOGY Within the context of railroad systems, from both an investment and an operational point of view, several concepts and terms have been developed by business and economic historians to facilitate the understanding of investor and corporate decision making. As these ideas will be applied to the development of the four Great Plains railroads considered here, some brief definitions are warranted. First, in order to understand the investment strategies pursued by individual capitalists and entrepreneurs, it is useful to differentiate, as Arthur M. Johnson and Barry E. Supple have done, between developmental and opportunistic investments and investment strategies in the nineteenth-century railroad business. A developmental investment strategy is one in which an \u27investor looks to long-term growth in a booming region for the economic rewards from capital investment. Opportunistic investments, on the other hand, have relatively shorter time horizons, the context of which was not so much future income growth as the securing of profits from available markets whether for goods, for railroad services, or for stocks and bonds. There is a continuum from developmental to opportunistic investment, and while any individual\u27s current motives can be placed somewhere along this continuum, those motives, or the criteria for subsequent investment decisions, could easily change with time or with changes in other financial and economic factors not necessarily bearing directly on railroading. Local merchants and farmers committed their capital to early local railroad companies as a means of increasing their business profits. Distant investors often purchased railroad bonds and debentures with a view to stable, long-term developmental profits. By the late nineteenth century, many railroads had come under the control of strictly financial, large-scale capitalist interests. Often located at some distance from their railroads, financiers used their properties for much broader strategic purposes, manipulating the securities, freight rates, connections, and through routes almost at will. As often as opportunistic profits were made-through financial wizardry, shady construction contracts, or dealings in railroad lands-great fortunes disappeared overnight in the aftermath of bank failures, overextension, or bankruptcy and receivership

Thinking outside the curve, part II: modeling fetal-infant mortality

<p>Abstract</p> <p>Background</p> <p>Greater epidemiologic understanding of the relationships among fetal-infant mortality and its prognostic factors, including birthweight, could have vast public health implications. A key step toward that understanding is a realistic and tractable framework for analyzing birthweight distributions and fetal-infant mortality. The present paper is the second of a two-part series that introduces such a framework.</p> <p>Methods</p> <p>We propose estimating birthweight-specific mortality within each component of a normal mixture model representing a birthweight distribution, the number of components having been determined from the data rather than fixed <it>a priori</it>.</p> <p>Results</p> <p>We address a number of methodological issues related to our proposal, including the construction of confidence intervals for mortality risk at any given birthweight within a component, for odds ratios comparing mortality within two different components from the same population, and for odds ratios comparing mortality within analogous components from two different populations. As an illustration we find that, for a population of white singleton infants, the odds of mortality at 3000 g are an estimated 4.15 times as large in component 2 of a 4-component normal mixture model as in component 4 (95% confidence interval, 2.04 to 8.43). We also outline an extension of our framework through which covariates could be probabilistically related to mixture components. This extension might allow the assertion of approximate correspondences between mixture components and identifiable subpopulations.</p> <p>Conclusions</p> <p>The framework developed in this paper does not require infants from compromised pregnancies to share a common birthweight-specific mortality curve, much less assume the existence of an interval of birthweights over which all infants have the same curve. Hence, the present framework can reveal heterogeneity in mortality that is undetectable via a contaminated normal model or a 2-component normal mixture model.</p

Engaging Florida Residents: Motivations and Impacts of Community Gardens in Tampa Bay

While the impacts of community gardens have been well documented, research has mainly been concentrated in only a few urban areas of the United States. This paper highlights the social impacts of community gardens on west central Florida individuals, families, and communities. We use theories of community engagement to explore relationships between members and their larger spheres of influence. In this study, we surveyed 75 members of eight community gardens in Tampa Bay and used geographic information systems (GIS) mapping to show spatial distribution of gardens and members. Findings highlight multilevel impacts of community engagement in social, educational, and altruistic domains. Community gardens promote community engagement among members. The impacts of community gardens extend beyond the membership structure

Antecedents of Infant Mortality: An Analysis of Risk Factors in Rural and Urban Arkansas

This research examines the relationship between social and biological characteristics of the infant and mother and the probability of infant survival through the first year of life. The research also includes a consideration of the influence of residence (rural vs. urban). Employing linked birth and death certificate data for Arkansas (1985-1989), a logit model was estimated to assess the impact of social and biological factors on the probability of survival. The results indicate that metropolitan residence is positively associated with infant survival, but only at a marginal significance level. Other notable results include the importance of prenatal care and a lack of significance of race when other factors are controlled

Individualised risk assessment for diabetic retinopathy and optimisation of screening intervals: a scientific approach to reducing healthcare costs.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.To validate a mathematical algorithm that calculates risk of diabetic retinopathy progression in a diabetic population with UK staging (R0-3; M1) of diabetic retinopathy. To establish the utility of the algorithm to reduce screening frequency in this cohort, while maintaining safety standards.The cohort of 9690 diabetic individuals in England, followed for 2 years. The algorithms calculated individual risk for development of preproliferative retinopathy (R2), active proliferative retinopathy (R3A) and diabetic maculopathy (M1) based on clinical data. Screening intervals were determined such that the increase in risk of developing certain stages of retinopathy between screenings was the same for all patients and identical to mean risk in fixed annual screening. Receiver operating characteristic curves were drawn and area under the curve calculated to estimate the prediction capability.The algorithm predicts the occurrence of the given diabetic retinopathy stages with area under the curve =80% for patients with type II diabetes (CI 0.78 to 0.81). Of the cohort 64% is at less than 5% risk of progression to R2, R3A or M1 within 2 years. By applying a 2 year ceiling to the screening interval, patients with type II diabetes are screened on average every 20 months, which is a 40% reduction in frequency compared with annual screening.The algorithm reliably identifies patients at high risk of developing advanced stages of diabetic retinopathy, including preproliferative R2, active proliferative R3A and maculopathy M1. Majority of patients have less than 5% risk of progression between stages within a year and a small high-risk group is identified. Screening visit frequency and presumably costs in a diabetic retinopathy screening system can be reduced by 40% by using a 2 year ceiling. Individualised risk assessment with 2 year ceiling on screening intervals may be a pragmatic next step in diabetic retinopathy screening in UK, in that safety is maximised and cost reduced by about 40%.Icelandic Research Counci

Bayesian 2-Stage Space-Time Mixture Modeling with Spatial Misalignment of the Exposure in Small Area Health Data

We develop a new Bayesian two-stage space-time mixture model to investigate the effects of air pollution on asthma. The two-stage mixture model proposed allows for the identification of temporal latent structure as well as the estimation of the effects of covariates on health outcomes. In the paper, we also consider spatial misalignment of exposure and health data. A simulation study is conducted to assess the performance of the 2-stage mixture model. We apply our statistical framework to a county-level ambulatory care asthma data set in the US state of Georgia for the years 1999-2008

Quantifying the impact of an extreme climate event on species diversity in fragmented temperate forests: the effect of the October 1987 storm on British broadleaved woodlands

We report the impact of an extreme weather event, the October 1987 severe storm, on fragmented woodlands in southern Britain. We analysed ecological changes between 1971 and 2002 in 143 200-m2 plots in 10 woodland sites exposed to the storm with an ecologically equivalent sample of 150 plots in 16 non-exposed sites. Comparing both years, understorey plant species-richness, species composition, soil pH and woody basal area of the tree and shrub canopy were measured. We tested the hypothesis that the storm had deflected sites from the wider national trajectory of an increase in woody basal area and reduced understorey species-richness associated with ageing canopies and declining woodland management. We also expected storm disturbance to amplify the background trend of increasing soil pH, a UK-wide response to reduced atmospheric sulphur deposition. Path analysis was used to quantify indirect effects of storm exposure on understorey species richness via changes in woody basal area and soil pH. By 2002, storm exposure was estimated to have increased mean species richness per 200 m2 by 32%. Woody basal area changes were highly variable and did not significantly differ with storm exposure. Increasing soil pH was associated with a 7% increase in richness. There was no evidence that soil pH increased more as a function of storm exposure. Changes in species richness and basal area were negatively correlated: a 3.4% decrease in richness occurred for every 0.1-m2 increase in woody basal area per plot. Despite all sites substantially exceeding the empirical critical load for nitrogen deposition, there was no evidence that in the 15 years since the storm, disturbance had triggered a eutrophication effect associated with dominance of gaps by nitrophilous species. Synthesis. Although the impacts of the 1987 storm were spatially variable in terms of impacts on woody basal area, the storm had a positive effect on understorey species richness. There was no evidence that disturbance had increased dominance of gaps by invasive species. This could change if recovery from acidification results in a soil pH regime associated with greater macronutrient availability."Organismic and Evolutionary Biolog