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Rural And Nonrural Primary Care Physician Practices Increasingly Rely On Nurse Practitioners
The use of nurse practitioners (NPs) in primary care is one way to address growing patient demand and improve care delivery. However, little is known about trends in NP presence in primary care practices, or about how state policies such as scope-of-practice laws and expansion of eligibility for Medicaid may encourage or inhibit the use of NPs. We found increasing NP presence in both rural and nonrural primary care practices in the period 2008-16. At the end of the period, NPs constituted 25.2 percent of providers in rural and 23.0 percent in nonrural practices, compared to 17.6 percent and 15.9 percent, respectively, in 2008. States with full scope-of-practice laws had the highest NP presence, but the fastest growth occurred in states with reduced and restricted scopes of practice. State Medicaid expansion status was not associated with greater NP presence. Overall, primary care practices are embracing interdisciplinary provider configurations, and including NPs as providers can strengthen health care delivery.
Journal Article
Entrances and exits
The man who brought the kavorka to the 'Seinfeld' show through one of the most remarkable and beloved television characters ever invented, Kramer, shares the extraordinary life of a comedy genius - the way he came into himself as an artist, the ups and downs as a human being, and the road he has traveled in search of understanding.
Book
Zinc Isotope Ratios as Indicators of Diet and Trophic Level in Arctic Marine Mammals
Carbon and nitrogen stable isotope ratios of bone collagen are an established method for dietary reconstruction, but this method is limited by the protein preservation. Zinc (Zn) is found in bioapatite and the isotopic compositions of this element constitute a very promising dietary indicator. The extent of fractionation of Zn isotopes in marine environments, however, remains unknown. We report here on the measurement of zinc, carbon and nitrogen isotopes in 47 marine mammals from the archaeological site of Arvik in the Canadian Arctic. We undertook this study to test and demonstrate the utility of Zn isotopes in recent mammal bone minerals as a dietary indicator by comparing them to other isotopic dietary tracers. We found a correlation between δ66Zn values and trophic level for most species, with the exception of walruses, which may be caused by their large seasonal movements. δ6Zn values can therefore be used as a dietary indicator in marine ecosystems for both modern and recent mammals.
Journal Article
High-resolution isotope dietary analysis of Mesolithic and Neolithic humans from Franchthi Cave, Greece
Franchthi Cave, in the Greek Peloponnese, is a well-known Paleolithic, Mesolithic and Neolithic site, with several human burials. In many parts of Europe there is clear evidence from archaeological and isotopic studies for a diet change between the Mesolithic and Neolithic periods. This is especially the case in coastal contexts where there is often a shift from predominantly marine food diets in the Mesolithic to terrestrial (presumably domesticated) foods in the Neolithic. However, at Franchthi Cave previous isotope research did not show changes in diets between these two periods, and also showed relatively little input from marine foods in diets in either time period, despite the coastal location of the site and the presence of marine shellfish and fish, including tuna. High-resolution compound specific amino acid isotope analysis reported here from humans from the Lower Mesolithic and Middle Neolithic periods confirms the previous bulk isotope results in showing little or no consumption of marine foods in either time period. However, it is important to note that our isotopic sample does not come from episodes when tuna is abundant and therefore do not cover the whole range of known diets from the site. Conversely, in our sample there is some evidence of marine food consumption (likely seaweed) by sheep in the Neolithic period. We also report here five direct AMS radiocarbon dates for the five analyzed humans from the site.
Journal Article
Isotopic evidence for the diets of European Neanderthals and early modern humans
We report here on the direct isotopic evidence for Neanderthal and early modern human diets in Europe. Isotopic methods indicate the sources of dietary protein over many years of life, and show that Neanderthals had a similar diet through time ([almost equal to]120,000 to [almost equal to]37,000 cal BP) and in different regions of Europe. The isotopic evidence indicates that in all cases Neanderthals were top-level carnivores and obtained all, or most, of their dietary protein from large herbivores. In contrast, early modern humans ([almost equal to]40,000 to [almost equal to]27,000 cal BP) exhibited a wider range of isotopic values, and a number of individuals had evidence for the consumption of aquatic (marine and freshwater) resources. This pattern includes Oase 1, the oldest directly dated modern human in Europe ([almost equal to]40,000 cal BP) with the highest nitrogen isotope value of all of the humans studied, likely because of freshwater fish consumption. As Oase 1 was close in time to the last Neanderthals, these data may indicate a significant dietary shift associated with the changing population dynamics of modern human emergence in Europe.
Journal Article
Empowering students as self-directed learners of qualitative research methods : transformational practices for instructors and students
\"Qualitative research instructors seek information to help students actively engage in qualitative inquiry. They desire to learn about innovative, constructivist approaches that connect and empower students as a community of learners. Empowering Students as Self-Directed Learners of Qualitative Research Methods meets these needs with practices and approaches instructors may use to position students as active, empowered, self-directed learners who learn to do qualitative research by doing qualitative research. Students will find this book useful because it includes authentic student work, student reflections, factual classroom scenarios depicting professors guiding students as they devise research questions and determine the qualitative genre to best answer those questions as well as a chapter that includes a checklist to help students plan, revise, and edit the academic writing critical for communicating qualitative research. The book blends the thoughts of international scholars with the voices of students of qualitative research methods who participated in the transformative practices described in the book. The collective ideas meet the instructional, cultural, and psychological needs of diverse learners, including students from various disciplines, exceptionally able students, those with creative and artistic aptitudes, those from marginalized populations, English language learners, and those who struggle to master qualitative research methods\"-- Provided by publisher.
Book
Back to the future: The advantage of studying key events in human evolution using a new high resolution radiocarbon method
Radiocarbon dating is the most widely applied dating method in archaeology, especially in human evolution studies, where it is used to determine the chronology of key events, such as the replacement of Neanderthals by modern humans in Europe. However, the method does not always provide precise and accurate enough ages to understand the important processes of human evolution. Here we review the newest method developments in radiocarbon dating (‘Radiocarbon 3.0’), which can lead us to much better chronologies and understanding of the major events in recent human evolution. As an example, we apply these new methods to discuss the dating of the important Palaeolithic site of Bacho Kiro (Bulgaria).
Journal Article