U-Pb zircon geochronology and phase equilibria modelling of HP-LT rocks in the Ossa-Morena Zone, Portugal.

The Ossa-Morena Zone (OMZ) has a complex geological history including both Cadomian and Variscan orogenic events. Therefore, the OMZ plays an important role in understanding the geodynamic evolution of Iberia. However, the P-T-t evolution of the OMZ is poorly documented. Here, we combine structural and metamorphic analyses with new geochronological data and geochemical analyses of mafic bodies in Ediacaran metasediments (in Iberia known as Série Negra) to constrain the geodynamic evolution of the OMZ. In the studied mafic rocks, two metamorphic stages were obtained by phase equilibria modelling: (1) a high-pressure/low-temperature event of 1.0 ± 0.1 GPa and 470-510 °C, and (2) a medium-pressure/higher-temperature event of 0.6 ± 0.2 GPa and 550-600 °C. The increase in metamorphic temperature is attributed to the intrusion of the Beja Igneous Complex (around 350 Ma) and/or the Évora Massif (around 318 Ma). New U-Pb dating on zircons from the mafic rocks with tholeiitic affinity yields an age between 815 and 790 Ma. If the zircons crystallised from the tholeiitic magma, their age would set a minimum age for the pre-Cadomian basement. The ca. 800 Ma protolith age of HP-LT tholeiitic dykes with a different metamorphic history than the host Série Negra lead us to conclude that: (1) the HP-LT mafic rocks and HP-LT marbles with dykes were included in the Ediacaran metasediments as olistoliths; (2) the blueschist metamorphism is older than 550 Ma (between ca. 790 Ma and ca. 550 Ma, e.g., Cadomian).

"I Just Felt Like I Was Stuck in the Middle": Physician Assistants' Experiences Communicating With Terminally Ill Patients and Their Families in the Acute Care Setting.

CONTEXT: Terminally ill hospitalized patients and their families consistently rank effective communication and shared decision-making among their top priorities. Advance practice providers such as physician assistants (PAs) are increasingly providing care in the hospital setting and are often called to communicate with patients and families. A first step to improving PA communication is to better understand PAs' current experiences in their daily practices. OBJECTIVES: This study aimed to explore roles PAs serve in communicating with terminally ill patients/families; PAs' attitudes and opinions about communication roles; and perceived barriers and facilitators of communication with patients/families in the hospital setting. METHODS: Five focus groups were conducted with PAs practicing on adult medical services at three acute care hospitals of an academic medical center in Bronx, New York. An open-ended question guide was used. An inductive thematic analysis strategy was used to examine the data from transcribed audiotapes of focus group sessions to identify emergent concepts and themes. RESULTS: The overarching theme that emerged was being stuck in the middle. PAs experienced ambiguity around their roles and responsibilities in communications between the medical team as well as patients and families; gaps in knowledge and skills; and organizational or structural deficits in the patient care systems that placed them in uncomfortable situations. CONCLUSION: Interventions aimed at improving PA communication with terminally ill patients and their families should target institutional structures, systems, and culture around roles and responsibilities in addition to skill and knowledge gaps to be most effective.

Mobile health unit for minority obesity education: local residents' attitudes and perceptions.

OBJECTIVE: To provide educational material to the Bronx community in their places of recreation as well as uncover attitudes and perceptions about the obesity epidemic. METHODS: Our medical team equipped a mobile health unit, called Vehicle Assisted Nutrition (VAN), with educational material and drove it to seven recreation sites in the Bronx. At these sites, participants completed a short survey, and our staff took body mass index (BMI) measurements. The medical team also distributed patient education materials pertaining to lifestyle modification and obesity. BMI and survey responses were compared and analyzed with statistical software. RESULTS: Obesity rates at these sites averaged 29.9% normal weight, 40.2% overweight, 18% class-1 obese and 11% class-2 obese or greater. Only 22.2% of normal weight, 23.3% of overweight and 43.6% of class-1 obese respondents stated that their weight was a problem (p<0.001). Most (80.6%) of the class-2 obese or greater respondents, however, stated that their weight was a problem (p<0.001). More than 44% of normal weight, 59.4% of overweight, 71.3 of class-1 obese and 90.3% of the class-2 obese or greater participants stated they were willing to do something about it (p=0.006). Of those surveyed, 37.5% of the normal weight, 54.7% of the overweight, 56.9% of the class-1 obese and 63.6% of the class-2 obese or greater indicated that they would like our help (p=0.035). More than 66% of normal weight, 41.8% of the overweight, 56.9% of the class-1 obese, and 68.9% of the class-2 obese or greater stated that they would be interested in a class to lose weight (p=0.008). CONCLUSION: Medical practitioners need to recognize the role of patients' attitudes about weight loss and clarify for patients the definitions of exercise.

Initiating abortion training in residency programs: issues and obstacles.

OBJECTIVES: Early abortion is a common outpatient procedure, but few family medicine residencies provide abortion training. We wished to assess experiences and obstacles among residency programs that have worked to establish early abortion services. METHODS: From 2001-2004, 14 faculty participated in a collaborative program to initiate abortion training at seven family medicine residencies. Ten focus groups with all trainees were followed by individual semi-structured interviews with a smaller group (n=9) that explored the progress and obstacles they experienced. Individual interviews were recorded and analyzed to identify major themes and sub-themes related to initiating abortion training. RESULTS: Five of seven sites established abortion training. Five major themes were identified: (1) establishing support, (2) administration, (3) finance, (4) legal matters, and (5) security/demonstrators. Faculty from sites where training was ultimately established rated the sub-themes of billing/reimbursement, obtaining staff support, and state/hospital regulations as most difficult. Gaining support from within the department and institution was most difficult for the two sites that could not establish training. None experienced difficulty with security/demonstrators. CONCLUSIONS: Developing the clinical and administrative capacity to provide early abortion services in family medicine residency programs is feasible. Support from leadership within departments and from the wider institution is important for implementation.

Iron isotope fractionation and the oxygen fugacity of the mantle.

The oxygen fugacity of the mantle exerts a fundamental influence on mantle melting, volatile speciation, and the development of the atmosphere. However, its evolution through time is poorly understood. Changes in mantle oxidation state should be reflected in the Fe3+/Fe2+ of mantle minerals, and hence in stable iron isotope fractionation. Here it is shown that there are substantial (1.7 per mil) systematic variations in the iron isotope compositions (delta57/54Fe) of mantle spinels. Spinel delta57/54Fe values correlate with relative oxygen fugacity, Fe3+/sigmaFe, and chromium number, and provide a proxy of changes in mantle oxidation state, melting, and volatile recycling.

Community-based screening for cardiovascular disease and diabetes using HbA1c.

BACKGROUND: Persons from inner-city immigrant and mixed-ethnic communities are known to be at high risk for cardiovascular disease and diabetes. Such communities may also be underserved for preventive medical care. The authors hypothesized that hemoglobin A1c (HbA1c) could be used as a screening test for a community-based program to detect new cases of diabetes and persons at risk for diabetes and cardiovascular disease. METHODS: Screenings took place in churches, group homes, shelters, community centers, and street corners of the Bronx. Screening data included history of diabetes, age, ethnicity, body mass index, blood pressure, lipid panel, random glucose, and HbA1c. Data were analyzed for number of cases of new diabetes (HbA1c > or =7%), for patients at risk for diabetes (HbA1c 6%-6.99%), and for associations between HbA1c and other variables. The effect of location of screening and self-reported ethnicity on outcome variables was also analyzed. RESULTS: Seven hundred four persons were screened in 25 different sessions. HbA1c and lipid profile were obtained on 539 persons, which formed the cohort for analysis. Mean HbA1c for the cohort was 6.00%. Thirty-two percent of the cohort had HbA1c of more than 6%, and 11.4% had HbA1c of more than 7%. Excluding known diabetics (13% of cohort), 24% had HbA1c of more than 6%, and 3.4% had HbA1c of more than 7%. HbA1c was significantly correlated with total cholesterol, triglycerides, low-density lipoprotein, systolic blood pressure, body mass index, and age; in all cases, correlation coefficients were higher with HbA1c than with random glucose. In addition, significantly higher cardiovascular disease risk factors were found in persons with HbA1c of more than 6%; 6% may be a threshold value for the metabolic syndrome. Mean HbA1c was higher in persons from the South Bronx (which has a higher poverty rate) than the North Bronx (6.08% v 5.74%, p=0.013). There were no statistically significant differences between self-reported ethnic groupings. CONCLUSIONS: There was a high prevalence of undiagnosed diabetes, and of patients at risk for diabetes, in this community setting. Community-based screening can be used as a method for identifying high percentages of patients at risk for diabetes or with undiagnosed diabetes in an inner city, immigrant, mixed-ethnic population.