Accuracy Assessment of NLCD 2011 percent impervious cover for selected USA Metropolitan Areas.

The emergence of high-resolution land cover data has created the opportunity to assess the accuracy of impervious cover (IC) provided by the National Land Cover Database (NLCD). We assessed the accuracy of the 900 m2 NLCD2011 %IC for 18 metropolitan areas throughout the conterminous United States using reference data from 1 m2 land cover data developed as part of the United States Environmental Protection Agency's EnviroAtlas project. Agreement was assessed from two perspectives: 1) sensitivity to the size of the assessment unit used for the comparison, and 2) utility of NLCD %IC to serve as a proxy for high-resolution IC. The former perspective was considered because statistical relationships can be sensitive to assessment unit size and shape, and the latter perspective was considered because high resolution (reference) %IC data are not available nationwide. The utility of NLCD %IC as a proxy for the high resolution data was assessed for seven lattice (square) cell sizes ranging from 1 ha to 200 ha using four EnviroAtlas IC indicators: 1) %IC per 100 ha (1 km2); 2) %IC by Census block group; 3) %IC within a 15 m (radius) of the riparian zone, and; 4) %IC within a 50 m (radius) of the riparian zone. Agreement was quantified as per assessment unit deviation (NLCD %IC - reference %IC) and summarized as Mean Absolute Deviation (MAD) and Mean Deviation (MD) both within and across the 18 metropolitan areas. Ordinary least squares (OLS) regression (y = reference %IC and x = NLCD %IC) was also used to evaluate the quality of the NLCD %IC data. MAD was ≤ 5% for six of the seven lattice cell sizes. MAD was also ≤ 5% for Census block groups > 100 ha and for both riparian units. These results suggest that uncertainty attributable to the measurement of %IC was no greater than the uncertainty related to the effect of IC on aquatic resources that have been derived from studies of aquatic condition (e.g., benthic fauna) over a range of %IC. Overall, agreement was variable from one metropolitan area to the next. Agreement improved as assessment unit size increased and declined as the level of urbanization (NLCD %IC) increased. NLCD %IC tended to underestimate reference %IC overall, but NLCD %IC was sometimes greater than reference %IC in urbanized settings.

A novel electron-microscopic method for measurement of mineral content in enamel lesions.

OBJECTIVE: To assess Scanning Electron Microscopy in Back-Scattered Emission mode (BSE-SEM) for measurement of lesion mineral content as a function of depth. Direct comparison is made with Transverse Micro-Radiography (TMR) and Surface Micro-Hardness (SMH) on carious and erosive lesions. DESIGN: Caries lesions prepared from sound bovine enamel at 37 °C and pH 4.6 in unsaturated (7d) or part-saturated (8d, 4.1 mM Ca2+, 8 mM Pi) lactic acid /methyl cellulose gel system, followed by TMR analysis. Erosive lesions prepared from sound bovine enamel (1% citric acid, pH3.8, room temperature) for 5, 10, 15 or 20 min at n = 10 per treatment group. SMH readings (Vickers diamond, 1.9 N, 20 s) were taken from acid-treated and reference areas of each sample. BSE-SEM performed on polished cross-sections of lesioned samples (Jeol JSM6490LV SEM; high vacuum, 10 keV beam voltage, magnification x500 with constant working distance of 10 mm). Under identical SEM conditions, polished standards i.e. MgF2, alumina, Mg, Al and Si provided a calibration plot of BSE-SEM signal vs. atomic number (z¯). Mineral content vs. depth plots were derived from the cross-sectional BSE-SEM data. RESULTS: Cross-sectional BSE-SEM images clearly differentiate between caries and erosive lesions. Comparison of caries lesion mineral loss from BSE-SEM with TMR data showed good correlation (R2 = 0.98). Similarly, comparison of BSE-SEM data from erosive lesions showed good correlation (R2 = 0.99) with hardness loss data from SMH. CONCLUSION: BSE-SEM provides a relatively rapid and cost-effective method for the assessment of mineral content in demineralised tooth enamel and is applicable to both caries and erosive lesions.

Answering funding preferences for medical school graduates in underserved areas.

We describe here a feasible and data-based approach for obtaining important information about the percentage of our medical school graduates who primarily provide health care to the medically underserved. The logic and data used in our methodology have been acceptable to funding agencies. After making the initial investment in developing this approach, we can execute it at low cost to respond to relevant inquiries about the practice activities of our graduates. Other programs that can produce a computerized listing of post-residency graduates' practice locations can follow the procedure outlined above to demonstrate qualification for funding preferences.

Teaching practice management during residency.

BACKGROUND AND OBJECTIVES: Practice management is a required component in family practice residency education. A few studies have reported that recently graduated primary care physicians indicated that their practice management training was inadequate. Our study describes the current nature of practice management education in family practice residencies and the perceptions of residency directors about the effectiveness of their program's practice management curriculum. METHODS: Surveys were mailed to 421 family practice residency directors, who were asked about their program's curriculum approach to teaching practice management, as well as their evaluation of the effectiveness of the curriculum. After two mailings, 213 surveys (51%) were returned. RESULTS: Eighteen percent of the respondents provided less than the required 60 hours of practice management curricular time. Residency directors indicated that managed care has had a significant effect on their curriculum. Directors' ratings of the effectiveness of their curriculum were associated with more curricular time and specifically with active learning activities. Although directors reported that managed care had affected how they teach practice management, managed care penetration was not associated with perceived curriculum effectiveness. CONCLUSIONS: Family practice residency program directors described a variety of approaches to teaching practice management. Active learning strategies seem to be important curricular components, although further study is needed about the most-effective methods to prepare physicians for post-residency practice.

The Illinois elder abuse system: program description and administrative findings.

In this article we describe the Illinois statewide elder abuse social service program, which is unusual in its comprehensive approach to the assessment and documentation of reported cases of abuse and its extensive data monitoring system. Descriptive information on the number and types of cases of elder abuse reported to the system are presented, along with information on the amount of social work time and administrative effort spent on substantiating abuse reports and providing services. Financial exploitation, emotional abuse, and neglect were the most common types of abuse reported, although emotional abuse was the type most frequently substantiated. The most frequent reasons for case closure were (a) victim entered long-term care, and (b) the workers' assessment that the victim was not at risk for future abuse. A detailed description of the comprehensive assessment and substantiation process is provided.

Estimating cancer screening indicators in the primary care setting.

The software "Profile: A Cancer Risk Profile of Your Patient Practice" was used to estimate cancer screening activities in a primary care practice. "Profile" is a public health tool that does not track the screening histories of individual patients, but rather, using a sampling strategy, provides estimates for the entire practice of the age and sex specific number of screening eligible patients, the number screened, and the number that should have been screened, based on National Cancer Institute/American Cancer Society (NCI/A CS) guidelines. This report describes "Profile," and the results it generated from a sample of medical records. Primary care providers who seek to integrate primary and secondary cancer prevention activities into their routine practices will find it useful to have an objective estimate of their current level of such activities.

A matter of integrity.

Catholic healthcare providers today can live out their vision and values only if they become public policy advocates. They must learn how to shape effective public policy to help heal the ailing U.S. healthcare system. Although from a political perspective they might feel ill-equipped to advocate in the public policy arena, Catholic healthcare providers are richly endowed from the perspective of their tradition of social teaching. They must uphold the common good as a primary criterion in healthcare reform. Two important issues provide an extraordinary opportunity and challenge for Catholic healthcare leaders to demonstrate their commitment to the common good: euthanasia and healthcare reform.

Needs of the poor call for action on behalf of justice.

Catholic health facilities are a special representation or incarnation of the Church. Our response to the medically indigent is perhaps the paradigmatic way we can mediate Christ and Christian values. In the last century the Church's social teaching has reiterated the understanding that Christ identifies with the poor and the underprivileged. The fundamental challenge seems to be how to move this "option for the poor" rom theological scholarship and reflection to healthcare ministry. Poverty and the lack of access to healthcare need to be seen not simply as the problem of individuals but as structural problems. Witnessing, education, and acting on behalf of the poor require the whole healthcare community's cooperation. Individual efforts are multiplied when they are a real part of a "corporate culture" genuinely committed to the poor. One such corporate effort was undertaken by the Sisters of Bon Secours when they developed their Ministerial Stand on Care of the Poor in 1984. A task force published 32 recommendations to aid facility managers in carrying out the statement. Mission committees were formed at Bon Secours Health System facilities to oversee implementation of the recommendations. They promote and evaluate innovative programs to address care of the poor initiatives for the local community.

The health care system vs women and the poor.

This three-part article discusses some unresolved socioeconomic issues in the primary health care system. The first section centers on the socioeconomic impact of primary health care delivery on poor persons and some women, and the second section analyzes the implications of this impact. This third section reviews the system's response.