Identification of origins and influencing factors of environmental odor episodes using trajectory and proximity analyses.

It is challenging for the governmental agencies to provide an instant response and to systematically analyze the huge number of odor complaints which are received frequently by them. This study aimed to establish a data analysis framework featuring trajectory and proximity analyses to confirm odor origins, assess impact areas, and identify determinants and mechanisms of odor episodes based on odor reports. The investigation used 273 odor complaints reported in northern Collierville, Tennessee, between January 1st, 2019 and December 15th, 2020. The location of each complaint was geocoded in Google Map, and the backward wind trajectories were calculated using the web-based Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model. The nearby Eplex Landfill and Collierville Northwest Sewage Treatment Plant were targeted for the analyses. Odor impacts were evaluated with temporal and spatial characteristics of reported odor episodes. Logistic models were performed to identify weather parameters that significantly influenced odor occurrence. The field inspections indicated two periods targeting different sources. Period 1: from January 1st, 2019 to October 31st, 2020, the landfill appeared as the major source; Period 2: from November 1st, 2020 to December 15th, 2020, the sewage plant emerged as the major source. In Period 1, 65% of the complaints had wind transporting from the landfill, and 88% occurred at residences within 500 m of the landfill. In Period 2, 33% of the complaints had wind that blew from the sewage plant and 85% occurred at residences within 1000 m from the sewage plant. The likelihood of an odor episode day was significantly associated with wind speed [Odds Ratio (OR) = 0.66, 95% Confidence Interval (CI): 0.56-0.77], temperature (OR = 0.97, 95% CI: 0.95-0.98), and rainfall (OR = 1.02, 95% CI: 1.00-1.04). The odor issue in Collierville reflected poor zoning between the odor sources and residential areas. Separation distances of 500 m and 1000 m from the landfill and sewage facilities, respectively, are suggested to prevent odor issues. The proposed data analysis framework can be adopted by governmental agencies for fast responses to odor complaints, odor assessment, and environmental odor management.

Medical decision making: guide to improved CPT coding.

BACKGROUND: The Current Procedural Terminology (CPT) coding system for office visits, which has been in use since 1995, has not been well studied, but it is generally agreed that the system contains much room for error. In fact, the available literature suggests that only slightly more than half of physicians will agree on the same CPT code for a given visit, and only 60% of professional coders will agree on the same code for a particular visit. In addition, the criteria used to assign a code are often related to the amount of written documentation. The goal of this study was to evaluate two novel methods to assess if the most appropriate CPT code is used: the level of medical decision making, or the sum of all problems mentioned by the patient during the visit. METHODS: The authors-a professional coder, a residency faculty member, and a PGY-3 family medicine resident-reviewed 351 randomly selected visit notes from two residency programs in the Northeast Tennessee region for the level of documentation, the level of medical decision making, and the total number of problems addressed. The authors assigned appropriate CPT codes at each of those three levels. RESULTS: Substantial undercoding occurred at each of the three levels. Approximately 33% of visits were undercoded based on the written documentation. Approximately 50% of the visits were undercoded based on the level of documented medical decision making. Approximately 80% of the visits were undercoded based on the total number of problems which the patient presented during the visit. Interrater agreement was fair, and similar to that noted in other coding studies. CONCLUSIONS: Undercoding is not only common in a family medicine residency program but it also occurs at levels that would not be evident from a simple audit of the documentation on the visit note. Undercoding also occurs from not exploring problems mentioned by the patient and not documenting additional work that was performed. Family physicians may benefit from minor alterations in their documentation of office visit notes.

The origins of the universe: why is there something rather than nothing?

Perhaps the greatest mystery is why the universe exists in the first place. How is it possible for something to emerge from nothing, or has a universe in some form always existed? This question of origins-both of the universe as a whole and of the fundamental laws of physics-raises profound scientific, philosophical, and religious questions, culminating in the most basic existential question of all: Why are we here? Discussion of this and related questions is presented in this paper.

An interactive approach to teaching practice management to family practice residents.

Three years ago, our residency program began a new approach to teaching practice management to our second- and third-year residents. The underlying principles for the new curriculum involved a realization that our residents lacked basic business understanding and that they would likely learn more effectively through a hands-on approach. The new curriculum, which we describe in this article, is in large part built around the establishment of a mock practice during the second year of residency. Although the curriculum is still evolving, initial response and evaluation have been encouraging.

Ethics of research involving humans: uniform processes for disparate categories?

The Australian Health Ethics Committee's National Statement on Ethical Conduct in Research Involving Humans (1999) expanded the health and medical focus of preceding statements by including all disciplines of research. The Statement purports to promote a uniformly high ethical standard for this expanded range of research, and is endorsed by, inter alia, the Australian Academy of the Humanities, the Australian Academy of Science, and the Academy of Social Sciences in Australia. High ethical standards should apply to all research involving humans. However, uniformity in the review processes of disparate research endeavors is not a necessary condition for uniformly high ethical standards. Bringing the ethical review of all research under a model which has developed within the context of health and medical research ethics for over thirty years may be inappropriate and at times incoherent. The language, methods, nature and products of research in areas such as the Humanities are often very different from those of health, medical and other sciences. The Behavioral and Social Sciences Ethics Review Committee at The University of Queensland (UQ) had, since the mid-1980s, considered that the guidelines of the time did, in fact, cover all aspects of human experimentation. We describe the ways in which this position was implemented, how issues raised by the new wording in the National Statement have been recently managed by UQ's research ethics committees, and point to outstanding questions.

Clinical inquiries. Do patients at high risk of Alzheimer's disease benefit from early treatment?

Yes, but the extent of the benefit is unclear. Treating patients with early-stage Alzheimer's disease yields statistically significant, though perhaps not clinically significant, improvement in cognition and global function. In a few cases, it may delay loss of function and need for long-term care. Treating patients with mild cognitive impairment (MCI)-the most likely precursor to Alzheimer's disease-with cholinesterase inhibitors seems to have an initial, but perhaps unsustained, benefit over no treatment. Withdrawing anticholinergic drugs from patients taking them promises to reduce symptoms of MCI, but is unlikely to reduce rates of Alzheimer's.

Nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease is a common condition associated with metabolic syndrome. It is the most common cause of elevated liver enzymes in U.S. adults, and is diagnosed after ruling out other causes of steatosis (fatty infiltration of liver), particularly infectious hepatitis and alcohol abuse. Liver biopsy may be considered if greater diagnostic and prognostic certainty is desired, particularly in patients with diabetes, patients who are morbidly obese, and in patients with an aspartate transaminase to alanine transaminase ratio greater than one, because these patients are at risk of having more advanced disease. Weight loss is the primary treatment for obese patients with nonalcoholic fatty liver disease. Medications used to treat insulin resistance, hyperlipidemia, and obesity have been shown to improve transaminase levels, steatosis, and histologic findings. However, no treatments have been shown to affect patient-oriented outcomes.