Characteristics of primary care office visits to nurse practitioners, physician assistants and physicians in United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross-sectional analysis.

UNLABELLED: BACKGROUND: Primary care, an essential determinant of health system equity, efficiency, and effectiveness, is threatened by inadequate supply and distribution of the provider workforce. The Veterans Health Administration (VHA) has been a frontrunner in the use of nurse practitioners (NPs) and physician assistants (PAs). Evaluation of the roles and impact of NPs and PAs in the VHA is critical to ensuring optimal care for veterans and may inform best practices for use of PAs and NPs in other settings around the world. The purpose of this study was to characterize the use of NPs and PAs in VHA primary care and to examine whether their patients and patient care activities were, on average, less medically complex than those of physicians. METHODS: This is a retrospective cross-sectional analysis of administrative data from VHA primary care encounters between 2005 and 2010. Patient and patient encounter characteristics were compared across provider types (PA, NP, and physician). RESULTS: NPs and PAs attend about 30% of all VHA primary care encounters. NPs, PAs, and physicians fill similar roles in VHA primary care, but patients of PAs and NPs are slightly less complex than those of physicians, and PAs attend a higher proportion of visits for the purpose of determining eligibility for benefits. CONCLUSIONS: This study demonstrates that a highly successful nationwide primary care system relies on NPs and PAs to provide over one quarter of primary care visits, and that these visits are similar to those of physicians with regard to patient and encounter characteristics. These findings can inform health workforce solutions to physician shortages in the USA and around the world. Future research should compare the quality and costs associated with various combinations of providers and allocations of patient care work, and should elucidate the approaches that maximize quality and efficiency.

Thermodynamic and dynamic contributions to future changes in regional precipitation variance: focus on the Southeastern United States

© 2014, Springer-Verlag Berlin Heidelberg.The frequency and severity of extreme events are tightly associated with the variance of precipitation. As climate warms, the acceleration in hydrological cycle is likely to enhance the variance of precipitation across the globe. However, due to the lack of an effective analysis method, the mechanisms responsible for the changes of precipitation variance are poorly understood, especially on regional scales. Our study fills this gap by formulating a variance partition algorithm, which explicitly quantifies the contributions of atmospheric thermodynamics (specific humidity) and dynamics (wind) to the changes in regional-scale precipitation variance. Taking Southeastern (SE) United States (US) summer precipitation as an example, the algorithm is applied to the simulations of current and future climate by phase 5 of Coupled Model Intercomparison Project (CMIP5) models. The analysis suggests that compared to observations, most CMIP5 models (~60 %) tend to underestimate the summer precipitation variance over the SE US during the 1950–1999, primarily due to the errors in the modeled dynamic processes (i.e. large-scale circulation). Among the 18 CMIP5 models analyzed in this study, six of them reasonably simulate SE US summer precipitation variance in the twentieth century and the underlying physical processes; these models are thus applied for mechanistic study of future changes in SE US summer precipitation variance. In the future, the six models collectively project an intensification of SE US summer precipitation variance, resulting from the combined effects of atmospheric thermodynamics and dynamics. Between them, the latter plays a more important role. Specifically, thermodynamics results in more frequent and intensified wet summers, but does not contribute to the projected increase in the frequency and intensity of dry summers. In contrast, atmospheric dynamics explains the projected enhancement in both wet and dry summers, indicating its importance in understanding future climate change over the SE US. The results suggest that the intensified SE US summer precipitation variance is not a purely thermodynamic response to greenhouse gases forcing, and cannot be explained without the contribution of atmospheric dynamics. Our analysis provides important insights to understand the mechanisms of SE US summer precipitation variance change. The algorithm formulated in this study can be easily applied to other regions and seasons to systematically explore the mechanisms responsible for the changes in precipitation extremes in a warming climate.

Perceived cannabis use norms and cannabis use among adolescents in the United States.

Due to changes in cannabis policies, concerns about cannabis use (CU) in adolescents have increased. The population of nonwhite groups is growing quickly in the United States. We examined perceived CU norms and their association with CU and CU disorder (CUD) for White, Black, Hispanic, Native-American, Asian-American, Native Hawaiian/Pacific Islander (NH/PI), and mixed-race adolescents. Data were from adolescents (12-17 years) in the 2004-2012 National Surveys on Drug Use and Health (N = 163,837). Substance use and CUD were assessed by computer-assisted, self-interviewing methods. Blacks, Hispanics, Native-Americans, and mixed-race adolescents had greater odds of past-year CU and CUD than Whites. Among past-year cannabis users (CUs), Hispanics and Native-Americans had greater odds of having a CUD than Whites. Asian-Americans had the highest prevalence of perceived parental or close friends' CU disapproval. Native-Americans and mixed-race adolescents had lower odds than Whites of perceiving CU disapproval from parents or close friends. In adjusted analyses, adolescent's disapproval of CU, as well as perceived disapproval by parents or close friends, were associated with a decreased odds of CU in each racial/ethnic group, except for NHs/PIs. Adolescent's disapproval of CU was associated with a decreased odds of CUD among CUs for Whites (personal, parental, and close friends' disapproval), Hispanics (personal, parental, and close friends' disapproval), and mixed-race adolescents (personal, close friends' disapproval). Racial/ethnic differences in adolescent CU prevalence were somewhat consistent with adolescents' reports of CU norm patterns. Longitudinal research on CU health effects should oversample nonwhite adolescents to assure an adequate sample for analysis and reporting.

A Firm Perspective of Anti-dumping and Countervailing Duty Cases in the United States

The role played by firms in the prosecution of anti-dumping and countervailing duty cases in the United States is understudied. This article provides greater understanding of the challenges faced by firms during the process of prosecuting anti-dumping and countervailing duty cases in the United States. This is achieved by applying a theoretical model of corporate political activity to data collected through interviews with 24 trade attorneys in Washington, D.C., practising in the area of antidumping and countervailing duty law. Anti-dumping and countervailing duty cases are found to require significant resource commitments from firms in the participating industries, as well as requiring individual firms to make a number of strategic decisions. The value of an affirmative decision and imposition of duties to the domestic and foreign industry is found to be more nuanced than previous studies have suggested. Non-duty effects of AD and CVD cases are also confirmed. Finally a clearer understanding of the role of individual firms in anti-dumping and countervailing duty cases is shown to have the potential to improve how industry influence is taken account of in future research.

Biological influence on the morphology and micromorphology of selected Podzols (Spodosols) and Cambisols (Inceptisols) from the Eastern United States and Northeast Scotland

Biological activities greatly influence the formation of many soils, especially forest soils under cool humid climates. The objective of this study was to investigate the effects of vegetation and soil biota on the formation of selected soils. Field morphology, micromorphology, and carbon and organic matter analysis were determined on six Podzols (Spodosols) and two Cambisols (Inceptisols) from the eastern United States and north-east Scotland. Humification of plant material by soil fauna and fungi occurs in all organic horizons. Thick organic coatings are observed on soil peds and rock fragments from the E1 to the Bs horizon in a Haplic Podzol from Clingmans Dome Mt., TN. Thin sections reveal large accumulations of root material in different stages of decomposition in the spodic horizons of a Haplic Podzol from Whiteface Mt., NY. Organic carbon ranges from 5.4 to 8.5% in the spodic B horizons of the Whiteface Mt. Podzol. Earthworms and enchytraeids have a great effect on the structure of the surface and subsurface horizons in the Dystric Cambisols from Huntly and Clashindarroch Forests, Scotland and a Cambic Podzol from the Corrie Burn Basin, Scotland. Podzols from Speymouth Forest, Scotland (Gleyic Podzol), Cling-mans Dome Mt., and Whiteface Mt. have thick organic horizons. The Podzols from the Flatwoods in Georgia, the Pine Barrens in New Jersey, the Corrie Burn Basin, and the Cambisol from Huntly Forest have only A horizons at the surface. The Clashindarroch Forest soil has a very thin organic horizon. Warm and humid climates and sandy parent material are responsible for thick E horizons and lack of thick organic horizons in the Flatwoods (Carbic Podzol) and Pine Barrens (Ferric Podzol) soils. Earthworms and enchytraeids thrive in the Corrie Burn Basin and Huntly Forest soils due to the vegetation and the highly weathered basic parent material. The site at Clashindarroch once carried oak, and then birch forest, both of which produce a mild litter and also encourage earthworm and enchytraeids. This fauna is responsible for much mixing of the topsoil. The present conifer vegetation will eventually produce a deep litter and cause podzolization.

Nonmarket Capabilities and the Prosecution of Trade Remedy Cases in the United States

The study investigates the prosecution of US trade remedy cases as examples of administrative government agency investigations and seeks to identify key capabilities for effective corporate political strategy targeting these institutions. Trade remedy cases are important policy tools, designed to protect domestic firms from ‘unfair’ import competition. The research contributes to the growing literature on corporate political activity and its links with superior outcomes in the marketplace. Three capabilities are identified: the capability to collect market/non-market intelligence, the capability to build and shape the administrative record, and the capability to align business practice with the US trade remedy institutions.

Potential output in a rapidly developing economy: the case of China and a comparison with the United States and the European Union

The authors use a growth accounting framework to examine growth of the rapidly developing Chinese economy. Their findings support the view that, although feasible in the intermediate term, China's recent pattern of extensive growth is not sustainable in the long run. The authors believe that China will be able to sustain a growth rate of 8 to 9 percent for an extended period if it moves from extensive to intensive growth. They next compare potential growth in China with historical developments in the United States and the European Union. They discuss the differences in production structure and level of development across the three economies that may explain the countries' varied intermediate-term growth prospects. Finally, the authors provide an analysis of "green" gross domestic product and the role of natural resources in China's growth. © 2009, The Federal Reserve Bank of St. Louis.

Beyond the United States and Japan: Testing Yamagishi's emancipation theory of trust across 31 nations

We examined the relationship between Individualism/Collectivism and generalized social trust across 31 European nations participating in the European Social Survey. Using multi-level regression analyses, the current study provides the first empirical investigation of the effects of cultural norms of Individualism/Collectivism on generalized social trust while accounting for individuals' own cultural orientations within the same analysis. The results provide clear support for Yamagishi and Yamagishi (1994) emancipation theory of trust, showing a significant and positive relationship between Individualism/Collectivism and generalized social trust, over and above the effect of a country political history of communism and ethnic heterogeneity. Having controlled for individual effects of Individualism/Collectivism it is clear that the results of the current analysis cannot be reduced to an individual-level explanation, but must be interpreted within the context Of macrosocial processes. We conclude by discussing potential mechanisms that could explain why national individualism is more likely to foster trust among people than collectivism.