Emergency department usage patterns among residents of Hardin, Jefferson, and Orange Counties in southeast Texas

Emergency departments (EDs) have been called the net below the safety net due to their long history of providing care to the uninsured and others lacking access to the healthcare system. In past years, those with Medicaid and, more recently, those with Medicare, are also utilizing the ED as a medical home for routine primary care. There are many reasons for this but the costs to the community have become increasingly burdensome. ^ To evaluate how often the ED is being utilized for primary care, we applied a standardized tool, the New York University Algorithm, to over 43,000 ED visits when no hospitalization was required made by Hardin, Jefferson, and Orange County residents over a 12 month period. We compared our results to Harris County, where studies using the same framework have been performed, and found that sizeable segments of the population in both areas are utilizing the ED for non-emergent primary care that could be treated in a more cost-effective community setting. ^ We also analyzed our dataset for visit-specific characteristics. We found evidence of two possible health care disparities: (1) Blacks had a higher rate of primary care-related ED visits in relation to their percentage of the population when compared to other racial/ethnic groups; and (2) when form of payment is considered, the uninsured were more likely to have a primary care-related ED visit than any other group. These findings suggest a lack of community-based primary care services for the medically needy in Southeast Texas. ^ We believe that studies such as this are warranted elsewhere in Texas as well. We plan to present our findings to local policy makers, who should find this information helpful in identifying gaps in the safety net and assist them in better allocating scarce community resources. ^

Geochemical and physical sediment properties of sediment cores from the Portuguese shelf

Marine sediments from the Portuguese shelf are influenced by environmental changes in the surrounding continental and marine environment. These are largely controlled by the North Atlantic Oscillation, but additional impacts may arise from episodic tsunamis. In order to investigate these influences, a high resolution multi-proxy study has been carried out on a 5.4 m long gravity core and five box cores from the Tagus prodelta on the western Portuguese margin, incorporating geochemical (Corg/Ntotal ratios, d13Corg, d15N, d18O, Corg and CaCO3 content) and physical sediment properties (magnetic susceptibility, grain-size). Subsurface data of the five box cores indicate no major effect of early postdepositional alteration. Surface data show a higher fraction of terrigenous organic material close to the river mouth and in the southern prodelta. Gravity core GeoB 8903 covers the last 3.2 kyrs with a temporal resolution of at least 0.1 cm/yr. Very high sedimentation rates between 69 and 140 cm core depth indicate a possible disturbance of the record by the AD1755 tsunami, although no evidence for a disturbance is observed in the data. Sea surface temperature and salinity on the prodelta, the local budget of marine NO3- as well as the provenance of organic matter remained virtually constant during the past 3.2 kyrs. A positive correlation between magnetic susceptibility (MS) and North Atlantic Oscillation (NAO) is evident for the past 250 years, coinciding with a negative correlation between mean grain-size and NAO. This is assigned to a constant riverine supply of fine material with high MS, which is diluted by the riverine input of a coarser, low-MS component during NAO negative, high-precipitation phases. End-member modelling of the lithic grain-size spectrum supports this, revealing a third, coarse lithic component. The high abundance of this coarse end-member prior to 2 kyr BP is interpreted as the result of stronger bottom currents, concentrating the coarse sediment fraction by winnowing. As continental climate was more arid prior to 2 kyr BP (Subboreal), the coarse end-member may also consist of dust from local sources. A decrease in grain-size and CaCO3 content after 2 kyr BP is interpreted as a result of decreasing wind strength. The onset of a fining trend and a further decrease in CaCO3 around AD900 occurs simultaneous to climatic variations, reconstructed from eastern North Atlantic records. A strong increase in MS between AD1400 and AD1500 indicates higher lithic terrigenous input, caused by deforestation in the hinterland.

Molar gas ratios and stable oxygen and nitrogen isotopes of air entrapped in ice, North America

The molar ratios of atmospheric gases change during dissolution in water due to differences in their relative solubilities. We exploited this characteristic to develop a tool to clarify the origin of ice formations in permafrost regions. Extracted from ice, molar gas ratios can distinguish buried glacier ice from intrasedimental ground ice formed by freezing groundwaters. An extraction line was built to isolate gases from ice by melting and trapping with liquid He, followed by analysis of N2, O2, Ar, 18O-O2 and 15N-N2, by continuous flow mass spectrometry. The method was tested using glacier ice, aufeis ice (river icing) and intrasedimental ground ice from sites in the Canadian Arctic. O2/Ar and N2/Ar ratios clearly distinguish between atmospheric gas in glacial ice and gases from intrasedimental ground ice, which are exsolved from freezing water. 615NN2 and 618OO2 in glacier ice, aufeis ice and intrasedimental ground ice do not show clear distinguishing trends as they are affected by various physical processes during formation such as gravitational settling, excess air addition, mixing with snow pack, and respiration.

Nd isotope data for planktonic foraminifera from within and around sapropels S1 and S5 from ODP Site 160-967

The development of widespread anoxic conditions in the deep oceans is evidenced by the accumulation and preservation of organic-carbon-rich sediments, but its precise cause remains controversial. The two most popular hypotheses involve (1) circulation-induced increased stratification resulting in reduced oxygenation of deep waters or (2) enhanced productivity in the surface ocean, increasing the raining down of organic matter and overwhelming the oxic remineralization potential of the deep ocean. In the periodic development of deep-water anoxia in the Pliocene-Pleistocene Mediterranean Sea, increased riverine runoff has been implicated both as a source for nutrients that fuel enhanced photic-zone productivity and a source of a less dense freshwater cap leading to reduced circulation, basin-wide stagnation, and deep-water oxygen starvation. Monsoon-driven increases in Nile River discharge and increased regional precipitation due to enhanced westerly activity-two mechanisms that represent fundamentally different climatic driving forces-have both been suggested as causes of the altered freshwater balance. Here we present data that confirm a distinctive neodymium (Nd) isotope signature for the Nile River relative to the Eastern Mediterranean-providing a new tracer of enhanced Nile outflow into the Mediterranean in the past. We further present Nd isotope data for planktonic foraminifera that suggest a clear increase in Nile discharge during the central intense period of two recent anoxic events. Our data also suggest, however, that other regional freshwater sources were more important at the beginning and end of the anoxic events. Taken at face value, the data appear to imply a temporal link between peaks in Nile discharge and enhanced westerly activity.

Iron and manganese in bottom sediments and interstitial waters sampled in the White Sea on August 21-30, 2003

Iron and manganese in bottom sediments studied along the sublatitudinal transect from Kandalaksha to Arkhangelsk are characterized by various contents and speciations depending on sedimentation environment, grain size of sediments, and diagenetic processes. The latter include redistribution of reactive forms leading to enrichment in Fe and Mn of surface sediments, formation of films, incrustations, and ferromanganese nodules. Variations in total Fe content (2-8%) are accompanied by changes in concentration of its reactive forms (acid extraction) and concentration of dissolved Fe in interstitial waters (1-14 µM). Variations in Mn content in bottom sediments (0.03-3.7%) and interstitial waters (up to 500 µM) correspond to high diagenetic mobility of this element. Changes in oxidation degree of chemical elements result in redox stratification of sediment strata with maximum concentrations of Fe, Mn, and sulfides. Organic matter of bottom sediments with considerable terrestrial constituent is oxidized by bottom water oxygen mainly at the sediment surface or in anaerobic conditions within the sediment strata. The role of inorganic components in organic matter oxidation changes from surface layer bottom sediments (where manganese oxyhydroxide dominates among oxidants) to deeper layers (where sulfate of interstitial water serves as the main oxidant). Differences in river runoff and hydrodynamics are responsible for geochemical asymmetry of the transect. The deep Kandalaksha Bay serves as a sediment trap for manganese (Mn content in sediments varies within 0.5-0.7%), whereas the sedimentary environment in the Dvina Bay promotes its removal from bottom sediments (Mn 0.05%).

Geochemistry, isotopic ratios and mineral composition of samples from ODP Leg 163 sites

Thirty-five samples from the drill core of the three Leg 163 sites (Sites 988, 989, and 990) off the southeast coast of Greenland were analyzed for 27 major, minor, and trace elements by X-ray fluorescence (XRF) and for 25 trace elements, including 14 rare-earth elements (REEs), by an inductively coupled plasma source mass spectrometer (ICP/MS). Sr- and Nd-isotope data are reported for seven samples and oxygen-isotope data are reported for 19 plagioclase separates. In addition, a reconnaissance survey of the composition of the main mineral phases, plagioclase, pyroxene, and oxides was determined on an electron microprobe to provide the basic information required for petrogenetic modeling. Olivine pseudomorphs are present in many of the samples, but in no case was an olivine grain found that was fresh enough to give a reliable analysis. The chemical and isotopic data recorded here were determined to provide a comparison with the larger data sets acquired by the Edinburgh, Copenhagen, and Leicester laboratories from both Legs 152 and 163 drill cores. This will permit a detailed comparison of the North Atlantic flood basalt province as a whole with the better known Columbia River, Deccan, and Karoo continental flood basalt provinces, for which substantial chemical data sets are already available at Washington State University.

Barium in seawater and sediments from the Artic Ocean

As part of ongoing circulation studies in the Arctic, seawater samples for dissolved Ba concentrations were obtained during Sep.-Oct., 1992 at several locations in the Bering Strait, Eastern Chukchi and Southern Beaufort Seas. The results reveal a dynamic rang (10 to 150 nmol/kg) for this element in the Arctic equal to or greater than that in combined Atlantic, Indian and Pacific oceans. Lowest levels are observed in surface waters, with values tending to decrease northwards in the direction of currents generally flowing frorn the Bering Strait along the Alaskan coast. Low surfacc concentrations tend to be accompanied by relatively enriched near bottom levels. On the basis of these spatial distributions, hydrographic observations and a knowledge of its behavior in other marine settings, it appears that Ba can be significantly depleted from surface waters as a result of the highly seasonal biological aclivities over Arctic marginal shelves. Removal at the surface is counteracted to some extent by regeneration at depth or in the sediments and by riverine inputs. The biologically related drawdown is likely to enhance the contrast between 'background' surface Ba levels in the Arctic and waters imprinted by regeneration and/or rivers, These preliminary findings suggest that Ba holds particular promise for tracing river waters and the ventilation of halodine waters hy laterally sinking brines produced during ice formation over the shelves.

Physical and chemical oceanography in the Arctic Ocean

Data from sections across the Eurasian Basin of the Arctic Ocean occupied by the German Research Vessel Polarstern in 1987 and by the Swedish icebreaker Oden in 1991 are used to derive information on the freshwater balance of the Arctic Ocean halocline and on the sources of the deep waters of the Nansen, Amundsen and Makarov basins. Salinity, d18O and mass balances allow separation of the river-runoff and the sea-ice meltwater fractions contained in the Arctic halocline. This provides the basis for tracking the river-runoff signal from the shelf seas across the central Arctic Ocean to Fram Strait. The halocline has to be divided into at least three lateral regimes: the southern Nansen Basin with net sea-ice melting, the northern Nansen Basin and Amundsen Basin with net sea-ice formation and increasing river-runoff fractions, and the Canadian Basin with minimum sea-ice meltwater and maximum river-runoff fractions and water of Pacific origin. In the Canadian Basin, silicate is used as a tracer to identify Pacific water entering through Bering Strait and an attempt is made to quantify its influence on the halocline waters of the Canadian Basin. For this purpose literature data from the CESAR and LOREX ice camps are used. Based on mass balances and depending on the value of precipitation over the area of the Arctic Ocean the average mean residence time of the river-runoff fraction contained in the Arctic Ocean halocline is determined to be about 14 or 11 years. Water column inventories of river-runoff and sea-ice meltwater are calculated for a section just north of Fram Strait and implications for the ice export rate through Fram Strait are discussed. Salinity, tritium, 3He and the d18O ratio of halocline waters sampled during the 1987 Polarstern cruise to the Nansen Basin are used to estimate the mean residence time of the river-runoff component in the halocline and on the shelves of the Arctic Ocean. These estimates are done by comparing ages of the halocline waters based on a combination of tracers yielding different time information: the tritium 'vintage' age which records the time that has passed since the river-runoff entered the shelf and the tritium/3He age which reflects the time since the shelf waters left the shelf. The difference between the ages determined by these two methods is about 3 to 6 years. Correction for the initial tritium/3He age of the shelf waters (about 0.5 to 1.5 years) yields a mean residence time of the river-runoff on the shelves of about 3.5 ± 2 years. Comparison of the 18O/16O ratios of shelf water, Atlantic water and the deep waters of the Arctic Ocean indicate that the sources of the deep and bottom waters of the Eurasian Basin are located in the Barents and Kara seas.

Element contents and isotope composition of sediments and basalts from DSDP Site 78-543

Twenty-four piston core sediment samples and 13 sediments and 3 basalts from DSDP Leg 78 Site 543 were analyzed for Sr, Nd and Pb isotopic compositions. The results show sediment with highly radiogenic Pb (206Pb/204Pb up to 19.8) and rather radiogenic Sr and unradiogenic Nd has been deposited in the region since the Cretaceous. The source of this sediment is probably the Archean Guiana Highland, which is drained by the Orinoco River. Pb and Sr isotopic compositions and sediment thickness decrease and 143Nd/144Nd increases northward due to a decrease in turbiditic component. This decrease is partly due to the damming action of basement ridges. Rare earth concentrations in the sediments are somewhat low, due to the abundance of detrital and biogenic components in the sediment and rapid sedimentation rates. Both positive and negative Ce anomalies occur in the surface sediments, but only positive Ce anomalies occur in the Site 543 sediments. It is unlikely that sediment subducted to the source region of Lesser Antilles arc magmas could be the cause of negative Ce anomalies in those magmas. Isotopic compositions of Site 543 basalts show some effect of contamination by seawater-basalt reaction products and sediments. Beyond this, however, they are typical of "normal" depleted MORB.