Is family medicine meeting the HIV/AIDS challenge? A national survey of family physicians' beliefs, clinical competence, and experience regarding HIV disease

A national sample of family physicians was surveyed to (1) assess family physicians' beliefs about the human immunodeficiency virus (HIV) and individuals at risk for infection, their clinical competence regarding HIV-related issues, and their experiences with HIV disease; (2) present conclusions to the American Academy of Family Physicians (AAFP) to effect the development of an early clinical care protocol and a continuing medical education curriculum; and (3) collect base-line data for use in the evaluation of an early clinical care protocol and a continuing medical education curriculum, in the case that such programs are developed and disseminated. After considering retired or deceased respondents, of the 2,660 physicians surveyed, 1,678 (63.7%) responded. The resulting sample was representative of the active members of the AAFP. About 77% of the respondents were unable to accurately identify the universal precautions for blood and body fluids to prevent occupational transmission of HIV or hepatitis B virus (HBV). Residency trained and board certified physicians expressed fewer "external constraints," such as fear of losing patients, obviating them from providing treatment to individuals with HIV disease (p =.004 and p $<$.001, respectively). These physicians also manifested fewer "internal constraints" to the provision of HIV treatment, such as fear of becoming infected (p $<$.001 and p =.012, respectively). Residency trained physicians also expressed a greater comfort with discussing sexually-related topics with their patients than did non-residency trained physicians (p $<$.001). There were 67.1% of the physicians surveyed who reported never providing treatment to an individual with HIV disease. Residency trained and board certified physicians expressed a greater likelihood to provide treatment to HIV-infected patients (p $<$.001) than non-residency trained and non-board certified physicians.^ Among the various primary care specialties, family medicine is especially vulnerable to the current challenges of HIV/AIDS. These challenges are augmented by the epidemiologic pattern that characterizes AIDS. For the past several years, we have seen AIDS in this country assume a similar pattern to that seen in most other countries; HIV is becoming increasingly prevalent in the heterosexual population as well as in locations removed from metropolitan centers. This current phase of the epidemic generates greater pressures upon primary care physicians, particularly family physicians, to become better acquainted with the means to provide early care to HIV/AIDS patients and to prevent HIV/AIDS among their patients. Family medicine is especially appropriate for providing care to HIV patients because family medicine involves treatment to all age groups and conditions; other primary care specialties focus on limited patient populations or specific conditions. Family physicians should be armed with the expertise to confront HIV/AIDS. However, family physicians' clinical competence and experience with HIV is not known. The data collected in this survey describes their competencies, attitudes, and experiences. ^

Measuring value in cancer-related health care: A case study in head and neck cancer

In the current climate of escalating health care costs, defining value and accurately measuring it are two critical issues affecting not only the future of cancer care in particular but also the future of health care in general. Specifically, measuring and improving value in cancer-related health care are critical for continued advancements in research, management, and overall delivery of care. However, in oncology, most of this research has focused on value as it relates to insurance industry and payment reform, with little attention paid to value as the output of clinical interventions that encompass integrated clinical teams focusing on the entire cycle of care and measuring objective outcomes that are most relevant to patients. ^ In this study, patient-centered value was defined as health outcomes achieved per dollar spent, and calculated using objective functional outcomes and total care costs. The analytic sample comprised patients diagnosed with three common head and neck cancers—cancer of the larynx, oral cavity, and oropharynx—who were treated in an integrated tertiary care center over an approximately 10-year period. The results of this study provide initial empirical data that can be used to assess and ultimately to help improve the quality and value of head and neck cancer care, and more importantly they can be used by patients and clinicians to make better-informed decisions about care, particularly what therapeutic services and outcomes matter the most to patients.^

Carbon and carbonate analyses of DSDP Leg 27 samples

Leg 27 sediments were analyzed for total carbon and acid-insoluble (organic) carbon using a LECO acid-base Analyzer. The 3-cc sediment samples were first dried at 105°-110°C and then ground to a homogeneous powder. The ground sediment was redried and two samples, a 0.1-g and a 0.5-g sample, were then weighed into LECO clay crucibles. The 0.5-g sample was acidified with diluted hydrochloric acid and washed with distilled water. The sample was then dried and analyzed for acid-insoluble carbon, listed in the table as "organic" carbon. The 0.1-g sample was analyzed for total carbon without further treatment. If the result showed less than 10% CaCO3, an additional 0.5-g sample was analyzed for greater accuracy. The calcium carbon percentages were calculated as follows: (% total C-% organic C) * 8.33 = % CaCO3. Although other carbonates may be present, all acid-soluble carbon was calculated as calcium carbonate. All results are given in weight percent.

Palynological record and radiocarbon dates for sediment core T89-16, Congo River mouth

We present a high-resolution reconstruction of tropical palaeoenvironmental changes for the last deglacial transition (18 to 9 cal. kyr BP) based on integrated oceanic and terrestrial proxies from a Congo fan core. Pollen, grass cuticle, Pediastrum and dinoflagellate cyst fluxes, sedimentation rates and planktonic foraminiferal d18O ratios, uK37 sea-surface temperature and alkane/alkenone ratio data highlight a series of abrupt changes in Congo River palaeodischarge. A major discharge pulse is registered at around 13.0 cal. kyr BP which we attribute to latitudinal migration of the Intertropical Convergence Zone (ITCZ) during deglaciation. The data indicate abrupt and short-lived changes in the equatorial precipitation regime within a system of monsoonal dynamics forced by precessional cycles. The phases of enhanced Congo discharge stimulated river-induced upwelling and enhanced productivity in the adjacent ocean.

Revised age models and foraminiferal records obtained for the Last Interglacial period in six marine sediment cores

The dataset contains the revised age models and foraminiferal records obtained for the Last Interglacial period in six marine sediment cores: - the Southern Ocean core MD02-2488 (age model, sea surface temperatures, benthic d18O and d13C for the period 136-108 ka), - the North Atlantic core MD95-2042 (age model, planktic d18O, benthic d18O and d13C for the period 135-110 ka), - the North Atlantic core ODP 980 (age model, planktic d18O, sea surface temperatures, seawater d18O, benthic d18O and d13C, ice-rafted detritus for the period 135-110 ka), - the North Atlantic core CH69-K09 (age model, planktic d18O, sea surface temperatures, seawater d18O, benthic d18O and d13C, ice-rafted detritus for the period 135-110 ka), - the Norwegian Sea core MD95-2010 (age model, percentage of Neogloboquadrina pachyderma sinistral, sea surface temperatures, benthic d18O, ice-rafted detritus for the period 134-110 ka), - the Labrador Sea core EW9302-JPC2 (age model, percentage of Neogloboquadrina pachyderma sinistral, sea surface temperatures, benthic d18O for the period 134-110 ka).

Probability inundation map for a scenario combining storm surge and sea-level rise

Coastal managers require reliable spatial data on the extent and timing of potential coastal inundation, particularly in a changing climate. Most sea level rise (SLR) vulnerability assessments are undertaken using the easily implemented bathtub approach, where areas adjacent to the sea and below a given elevation are mapped using a deterministic line dividing potentially inundated from dry areas. This method only requires elevation data usually in the form of a digital elevation model (DEM). However, inherent errors in the DEM and spatial analysis of the bathtub model propagate into the inundation mapping. The aim of this study was to assess the impacts of spatially variable and spatially correlated elevation errors in high-spatial resolution DEMs for mapping coastal inundation. Elevation errors were best modelled using regression-kriging. This geostatistical model takes the spatial correlation in elevation errors into account, which has a significant impact on analyses that include spatial interactions, such as inundation modelling. The spatial variability of elevation errors was partially explained by land cover and terrain variables. Elevation errors were simulated using sequential Gaussian simulation, a Monte Carlo probabilistic approach. 1,000 error simulations were added to the original DEM and reclassified using a hydrologically correct bathtub method. The probability of inundation to a scenario combining a 1 in 100 year storm event over a 1 m SLR was calculated by counting the proportion of times from the 1,000 simulations that a location was inundated. This probabilistic approach can be used in a risk-aversive decision making process by planning for scenarios with different probabilities of occurrence. For example, results showed that when considering a 1% probability exceedance, the inundated area was approximately 11% larger than mapped using the deterministic bathtub approach. The probabilistic approach provides visually intuitive maps that convey uncertainties inherent to spatial data and analysis.

Radiocarbon dates and dinoflagellate cysts of sediment core DP30PC

To obtain insight into character and potential forcing of short-term climatic and oceanographic variability in the southern Italian region during the "Roman Classical Period" (60 BC-AD 200), climatic and environmental reconstructions based on a dinoflagelate cyst record from a well dated site in the Gulf of Taranto located at the distal end of the Po-river discharge plume have been established with high temporal resolution. Short-term fluctuations in accumulation rates of the Adriatic Surface Water species Lingulodinium machaerophorum, the freshwater algae Concentricystes and species resistant to aerobic degradation indicate that fluctuations in the trophic state of the upper waters are related to river discharge of northern and eastern Italian rivers which in turn are strongly related to precipitation in Italy. The dinoflagellate cyst association indicates that local sea surface temperatures which in this region are strongly linked to local air temperatures were slightly higher than today. We reconstruct that sea surface temperatures have been relatively high and stable between 60 BC-AD 90 and show a decreasing trend after AD 90. Fluctuations in temperature and river discharge rates have a strong cyclic character with main cyclicities of 7-8 and 11 years. We argue that these cycles are related to variations of the North Atlantic Oscillation climate mode. A strong correlation is observed with global variation in Delta14C anomalies suggesting that solar variability might be one of the major forcings of the regional climate. Apart from cyclic climate variability we observed a good correlation between non-cyclic temperature drops and global volcanic activity indicating that the latter forms an additional major forcing factor of the southern Italian climate during the Roman Classical Period.