International medical graduates in family medicine in the United States of America: an exploration of professional characteristics and attitudes

BACKGROUND: The number of international medical graduates (IMGs) entering family medicine in the United States of America has steadily increased since 1997. Previous research has examined practice locations of these IMGs and their role in providing care to underserved populations. To our knowledge, research does not exist comparing professional profiles, credentials and attitudes among IMG and United States medical graduate (USMG) family physicians in the United States. The objective of this study is to determine, at the time when a large influx of IMGs into family medicine began, whether differences existed between USMG and IMG family physicians in regard to personal and professional characteristics and attitudes that may have implications for the health care system resulting from the increasing numbers of IMGs in family medicine in the United States. METHODS: This is a secondary data analysis of the 1996–1997 Community Tracking Study (CTS) Physician Survey comparing 2360 United States medical graduates and 366 international medical graduates who were nonfederal allopathic or osteopathic family physicians providing direct patient care for at least 20 hours per week. RESULTS: Compared to USMGs, IMGs were older (p < 0.001) and practised in smaller (p = 0.0072) and younger practices (p < 0.001). Significantly more IMGs practised in metropolitan areas versus rural areas (p = 0.0454). More IMG practices were open to all new Medicaid (p = 0.018) and Medicare (p = 0.0451) patients, and a greater percentage of their revenue was derived from these patients (p = 0.0020 and p = 0.0310). Fewer IMGs were board-certified (p < 0.001). More IMGs were dissatisfied with their overall careers (p = 0.0190). IMGs and USMGs did not differ in terms of self-rated ability to deliver high-quality care to their patients (p = 0.4626). For several of the clinical vignettes, IMGs were more likely to order tests, refer patients to specialists or require office visits than USMGs. CONCLUSION: There are significant differences between IMG and USMG family physicians' professional profiles and attitudes. These differences from 1997 merit further exploration and possible follow-up, given the increased proportion of family physicians who are IMGs in the United States

Use of rubberised backfills for improving the seismic response of integral abutment bridges

Reuse of the 1.5 billion waste tyres that are produced annually is a one of the major worldwide challenges, as waste tyres are toxic and cause pollution to the environment. In recognition of this problem, this paper introduces the reuse of tyres, in the form of derived aggregates in mixtures with granulated soil materials, as previous studies indicated the potential benefits of these materials in the seismic performance of structures. The objective of the present research study is to investigate whether use of rubberised backfills benefits the seismic response of Integral Abutment Bridges (IABs) by enhancing soil-structure interaction (SSI) effects. Numerical models including typical integral abutments on surface foundation with nonlinear conventional backfill material and its alternative form as soil-rubber mixtures are analysed and their response parameters are compared. The research is conducted on the basis of parametric analysis, which aims to evaluate the influence of different rubber-soil mixtures on the dynamic response of the abutment-backfill system under various seismic excitations, accounting for dynamic soil-abutment interaction. The results provide evidence that the use of rubberised backfill leads to reductions in the backfill settlements, the horizontal displacements of the bridge deck, the residual horizontal displacements of the top of the abutment and the pressures acting on the abutment, up to 55%, 18%, 43% and 47% respectively, with respect to a conventional backfill comprising of clean sand. Considerable amount of decrease in bending moments and shear forces on the abutment wall is also observed. Therefore, rubberised backfills offer promising solution to mitigate the earthquake risk, towards economic design with minimal damage objectives for the resilience of transportation networks

Measurement of D+- and D0 production in deep inelastic scattering using a lifetime tag at HERA

The production of D-+/-- and D-0-mesons has been measured with the ZEUS detector at HERA using an integrated luminosity of 133.6 pb(-1). The measurements cover the kinematic range 5 < Q(2) < 1000 GeV2, 0.02 < y < 0.7, 1.5 < p(T)(D) < 15 GeV and |eta(D)| < 1.6. Combinatorial background to the D-meson signals is reduced by using the ZEUS microvertex detector to reconstruct displaced secondary vertices. Production cross sections are compared with the predictions of next-to-leading-order QCD, which is found to describe the data well. Measurements are extrapolated to the full kinematic phase space in order to obtain the open-charm contribution, F-2(c (c) over bar), to the proton structure function, F-2

Elemental compositions of PM2.5 and TSP in Lijiang, southeastern edge of Tibetan Plateau during pre-monsoon period

PM2.5 and total suspended particulate (TSP) samples were collected at Lijiang, southeastern Tibetan Plateau, China. Sixteen elements (Al, Si, S, K, Ca, Cr, Mn, Ti, Fe, Ni, Zn, As, Br, Sb, Pb and Cu) were analyzed to investigate their elemental compositions during the pre-monsoon period. The results showed that Ca was the most abundant element in both PM2.5 and TSP samples. The enrichment factors (EFs) of Si, Ti, Ca, Fe, K and Mn were all below 10 for both PM2.5 and TSP, and these elements also had lower PM2.5/TSP ratios (0.32-0.34), suggesting that they were mainly derived from crustal sources. Elements Cu, Zn, S, Br and Sb showed strong enrichment in PM2.5 and TSP samples, with their PM2.5/TSP ratios ranging from 0.66 to 0.97, indicating that they were enriched in the fine fractions and influenced by anthropogenic sources. Analysis of the wind field at 500 hPa and calculations of back trajectories indicated that Al, Si, Ca, Ti, Cr, Mn and Fe can be influenced by transport from northwestern China during the dust-storm season, and that S, K, Ni, Br and Pb reached high concentrations during westerly transport from south Asia. Combined with the principle component analysis and correlation analysis, elements of PM2.5 samples were mainly from crustal sources, biomass burning emissions and regional traffic-related sources.</p

Chemical composition and sources of PM2.5 and TSP collected at Qinghai Lake during summertime

PM2.5 and total suspended particulate (TSP) samples were collected from June to September 2010 at Qinghai Lake, northeastern Tibetan Plateau. The concentrations of major water-soluble ions, 10 elements, elemental carbons (ECs) and organic carbons (OCs) were quantified. Mass concentrations of PM2.5 and TSP were 21.27&plusmn;10.70&mu;gm-3 and 41.47&plusmn;20.25&mu;gm-3, respectively, and the mean ratio of PM2.5/TSP was 0.51. The greatest anion and cation in both PM2.5 and TSP samples were SO42- and Ca2+, respectively. Crustal elements, such as Ca, Fe and K, were the main elements in our aerosol samples, and their enrichment factors (EFs) were lower than 10. EFs for Pb, As, and Zn were greater than 10, indicating that they were influenced by anthropogenic sources. EC concentrations were 0.33&plusmn;0.17&mu;gm-3 and 0.47&plusmn;0.28&mu;gm-3, whereas OC concentrations were 1.49&plusmn;0.63&mu;gm-3 and 2.30&plusmn;0.95&mu;gm-3 in PM2.5 and TSP, respectively. Based on the calculated ratios of EC/TC and K+/EC, most of the ECs were found to be related to biomass burning emissions. Because of the pollution from local sources, the ratios of OC/EC were 4.77&plusmn;1.32 and 5.23&plusmn;1.39 in PM2.5 and TSP, respectively, which were lower than those of other remote sites. Salt particles produced by the salty lake reacted with acid gases and caused most of the nitrates and a small fraction of sulfate to be distributed in coarse mode; Cl deficit was also observed in our aerosol samples. Results of backward trajectories and correlation analysis show that the concentrations of SO42-, OCs, As, Pb, and Zn, were influenced by the long-distance transport from eastern China.</p

The impact of biomass burning on total suspended particulate matter in the southeastern Tibetan Plateau

To investigate the impact of biomass burning (BB) emissions on total suspended particulate (TSP) in the southeastern Tibetan Plateau (TP), BB tracers (including levoglucosan, mannosan, and galactosan) were measured at Lulang (a remote site, &sim;3300 m above sea level) during the period 2015&ndash;2016. The concentrations of levoglucosan and mannosan showed large variability of more than 8-fold (range: 0.029&ndash;0.253 &mu;g m&minus;3) and 6-fold (range: 0.01&ndash;0.061 &mu;g m&minus;3), respectively. The highest seasonal average concentrations of levoglucosan (0.131 &plusmn; 0.073 &mu;g m&minus;3) and mannosan (0.028 &plusmn; 0.019 &mu;g m&minus;3) were observed during the winter season. The BB contributions to the TSP organic carbon (OC) and TSP mass were estimated with positive matrix factorization (PMF) by using BB tracers, inorganic ions, elements, OC, and EC. The BB contributions to the TSP OC and TSP mass were quite substantial in winter with 26% and 14%, respectively. The results evidenced a major contribution of BB to the aerosol OC during winter season. Major potential source distributions of BB were identified, which included the pollution bands along the Indo-Gangetic Plain, the Yarlung Tsangpo River Valley and the interior of the TP. In addition to the long-range transport of BB, the sources of anthropogenic emissions (residential BB for cooking and heating) in the TP may be an important contributor. The results facilitated understanding of the characteristics and effects of BB in the TP.</p

Physicochemical characteristics of black carbonaerosol and its radiative impact in a pollutedurban area of China

Black carbon (BC) aerosol plays an important role in the Earth&rsquo;s radiative balance. An intensive measurement campaign was conducted at Xi&rsquo;an, China, from December 2012 to January 2013 to investigate the sources and physicochemical characteristics of refractory BC (rBC) and its direct radiative forcing at the surface. The overall average rBC concentration for the campaign was 8.0 &plusmn; 7.1 &mu;g m 3. Source apportionment based on positive matrix factorization showed that traffic was the dominant rBC source (46.0%), followed by coal burning (33.9%) and biomass burning (20.1%). The rBC mass size distributions were monomodal and lognormal with larger mass median diameters for coal burning source (215 nm) compared with the traffic source (189 nm). Coal burning rBC was more strongly associated with sulfate than traffic rBC, suggesting a higher cloud condensation nuclei activity. The slope of a robust linear regression between rBC and carbon monoxide (CO) for all samples was 5.9 &mu;g m 3 ppm 1, and the slope for the coal burning source (4.5 &mu;g m 3 ppm 1) was larger than that for the traffic source (2.7 &mu;g m 3 ppm 1). The net rBC emission during winter of 2009 was estimated to be 4.5 Gg based on the relationship between rBC and CO. A Tropospheric Ultraviolet and Visible radiation model showed that the average daytime value for the clear-sky direct radiative forcing due to rBC from 23 December 2012 to 31 January 2013 was 47.7 &plusmn; 28.9 W m 2, which amounted to an average of 45.7% of the total surface atmospheric aerosol forcing.</p