Access to outpatient services in rural communities changes after hospital closure.

OBJECTIVE: Between January 2005 and July 2020, 171 rural hospitals closed across the United States. Little is known about the extent that other providers step in to fill the potential reduction in access from a rural hospital closure. The objective of this analysis is to evaluate the trends of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) in rural areas prior to and following hospital closure. DATA SOURCES/STUDY SETTING: We used publicly available data from Centers for Medicare and Medicaid Provider of Services files, Cecil G. Sheps Center rural hospital closures list, and Small Area Income and Poverty Estimates. STUDY DESIGN: We described the trends over time in the number of hospitals, hospital closures, FQHC sites, and RHCs in rural and urban ZIP codes, 2006-2018. We used two-way fixed effects and pooled generalized linear models with a logit link to estimate the probabilities of having any RHC and any FQHC within 10 straight-line miles. DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: Compared to hospitals that never closed, the predicted probability of having any FQHC within 10 miles increased post closure by 5.95 and 11.57 percentage points at 1 year and 5 years, respectively (p < 0.05). The predicted probability of having any RHC within 10 miles was not significantly different following rural hospital closure. A percentage point increase in poverty rate was associated with a 1.98 and a 1.29 percentage point increase in probabilities of having an FQHC or RHC, respectively (p < 0.001). CONCLUSIONS: In areas previously served by a rural hospital, there is a higher probability of new FQHC service-delivery sites post closure. This suggests that some of the potential reductions in access to essential preventive and diagnostic services may be filled by FQHCs. However, many rural communities may have a persistent unmet need for preventive and therapeutic care.

Parthenogenesis in a captive Asian water dragon (Physignathus cocincinus) identified with novel microsatellites.

Reptiles show varying degrees of facultative parthenogenesis. Here we use genetic methods to determine that an isolated, captive female Asian water dragon produced at least nine offspring via parthenogenesis. We identified microsatellites for the species from shotgun genomic sequences, selected and optimized primer sets, and tested all of the offspring for a set of seven microsatellites that were heterozygous in the mother. We verified that the seven loci showed high levels of polymorphism in four wild Asian water dragons from Vietnam. In all cases, the offspring (unhatched, but developed eggs, or hatched young) had only a single allele at each locus, and contained only alleles present in the mother's genotype (i.e., were homozygous or hemizygous). The probability that our findings resulted from the female mating with one or more males is extremely small, indicating that the offspring were derived from a single female gamete (either alone or via duplication and/or fusion) and implicating parthenogenesis. This is the first documented case of parthenogenesis in the Squamate family Agamidae.

DNA-protein cross-links in erythrocytes of freshwater fish exposed to hexavalent chromium or divalent nickel.

DNA-protein cross-links (DPXs) in fish erythrocytes represent a potential biomarker for exposure to metal cations, such as hexavalent chromium (Cr[VI]) and divalent nickel (Ni[II]). Species-specific sensitivities to DPX formation were studied by coexposure of juvenile specimens of rainbow trout, hybrid bluegill, and channel catfish to waterborne metals, such as Cr(VI) and Ni(II). In a species comparison, 4 days of exposure to 2 ppm Cr(VI) induced highest DPXs in bluegill erythrocytes, followed by trout and catfish, at 186%, 97%, and 48% above controls, respectively. A similar pattern of species sensitivity was observed following co-exposure of the fish to 15 ppm Ni(II) for 4 days, with 237%, 124%, and 82% increased DPXs above control bluegill, trout, and catfish, respectively. Biological stability of Cr(VI)-induced DPXs was demonstrated in Cr(VI)-exposed bluegill, as DPX levels remained elevated for up to 20 days after discontinuation of exposure. Similar results were found following exposure of catfish to Ni(II), with detectable DPXs found 10 days after acute exposure. In both bluegill and catfish, a continued increase in DPX formation in erythrocytes was seen for 5-10 days after Cr(VI) was removed from tank water, suggesting that residual Cr(VI) may be involved in DPX formation following acute exposure of fish.

Waterborne and dietary hexavalent chromium exposure causes DNA-protein crosslink (DPX) formation in erythrocytes of largemouth bass (Micropterus salmoides).

Formation of DNA-protein crosslinks (DPXs) was demonstrated in erythrocytes from fathead minnows (Pimephales promelas) and largemouth bass (Micropterus salmoides) exposed to hexavalent chromium [Cr(VI)], a known carcinogenic and mutagenic metal contaminant of many industrial waterways. Tank water exposure of 2-3 in. fathead minnows to 2 ppm Cr(VI) led to significant DPX formation in erythrocytes, with over 140-200% elevations above background levels at 3-4 days, respectively. Largemouth bass exposed similarly were found to have 62% elevation of DPX levels after 4 days. When largemouth bass were fed a diet of minnows injected with 20 microg Cr(VI) for 5 days, a significant (p<0.01) increase of DPXs in erythrocytes was observed, with 80% elevation above erythrocytes from bass fed minnows injected only with saline. However, when largemouth bass were fed a diet exclusively of minnows exposed to 2 ppm Cr(VI) for 21 days, there was no significant difference in DPX levels compared to bass fed control (unexposed) minnows. This study provides evidence that DPX formation occurs in erythrocytes of fathead minnows exposed under controlled conditions to low ppm Cr(VI) concentrations, which is at or below concentrations previously assigned no observable effect levels. Furthermore, it appears that both waterborne and high dose dietary exposure to Cr(VI) can lead to DPX formation in erythrocytes of predatory fish species such as bass. However, it is unlikely that a bioconcentration of chromium in the food chain would be a major concern at these low ppm levels of exposure. Further, it may be difficult to achieve dietary Cr(VI) levels high enough to elicit DPXs in predatory fish under most environmental exposure scenarios.