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We live in a world that is more connected than it has ever been in human history, and although that connectivity brings with it opportunities for innovation and societal advancement, [...]

For 25 years, the Graham Center has played a pivotal role in informing policy and primary care practice by producing high-quality evidence about the value, dimensions, and needs of primary care. In this article, past and current leaders of the Graham Center reflect on its history, impact, and future direction. [ABSTRACT FROM AUTHOR]

We report a new method for rapid measurement of total acid number (TAN) and TAN boiling point (BP) distribution for petroleum crude and products. The technology is based on negative ion electrospray ionization mass spectrometry (ESI-MS) for selective ionization of petroleum acid and quantification of acid structures and molecular weight distributions. A chip-based nanoelectrospray system enables microscale (

INTEREST IN ENSURING a medical home for every child in the United States sparked recent assessments of the workforce that cares for children. This includes a series of thoughtful articles [...], Pediatric workforce studies suggest that there may be a sufficient number of pediatricians for the current and projected US child population. These analyses do not fully consider the role of family medicine in the care of children. Family physicians provide 16% to 26% of visits for children, providing a medical home for one third of the child population, but face shrinking panels of children. Family medicine's role in children's health care is more stable in rural communities, for adolescents, and for underserved populations. For these populations, in particular, family medicine's role remains important. The erosion of the proportion of visits to family medicine is likely caused by the rapid rise in the number of pediatricians relative to a declining birth rate. Between 1981 and 2004, the general pediatrician population grew at 7 times the rate of the US population, and the family physician workforce grew at nearly 5 times the rate. The number of clinicians caring for children meets or exceeds most estimates of sufficiency; however, the workforce distribution is skewed, leaving certain populations and settings underserved. More than 5 million children and adolescents live in counties with no pediatrician. Unmet need, addressing health in the context of families and communities, and tackling 'millennial morbidities' represent common ground for both specialties that could lead to specific, collaborative training, research, intervention, and advocacy. Key Words child health workforce, diversity, family medicine, geographic distribution, health manpower, nonphysician clinicians, physician workforce, pediatrics, pediatric medical subspecialists Abbreviations AAP--American Academy of Pediatrics FP--family physician NAMCS--National Ambulatory Medical Care Survey MEPS--Medical Expenditure Panel Survey GP--general practitioner FTE--full-time equivalent NP--nurse practitioner PA--physician assistant CHC--Community Health Center

Comprehensive two-dimensional gas chromatography can be viewed as a traditional gas chromatography with a sophisticated 'elution-resolved' flame ionization detector (GC/FID) or a detector with separation capability. The concept of multidimensional chromatography can be extended to other detectors that also have separation capability, such as ultraviolet, infrared, and mass spectrometer. Mass spectrometry, combined with gas chromatography, GC/MS, has been a powerful separation/identification device for many years. However, if one applies the multidimensional separation concept to this combination with a nonfragmentation ionization method, GC/MS not only can be used as a separation/ identification tool, but also a two (multiple) dimensional separation device, GCxMS. In this study, a two-dimensional separation (GCxMS) study of diesel composition is demonstrated and compared with the GCxGC technique. The major advantage of GCxMS is the compound class separation. The compound groups within a compound class are also well-separated on the basis of their parent masses. Because of the exact mass operation, the specific element containing compound distribution can also be generated through the extraction of specific mass groups. For qualitative analysis, GCxMS is a technique where one experiment can generate a wide range of information. GCxMS may also perform quantitative analysis when appropriate response factors for various compound groups are available. From GCxGC to GCxMS, the power of two (multiple) dimensional separation has just started exposing its advantages for complex mixture analysis. To achieve multiple dimensional separation in different forms, many improvements remain to be made. The challenge now is to combine/accommodate two or more different techniques to solve a specific complex separation problem. The GCxMS experience has pushed this effort one step ahead toward complete application of this new concept in the analysis of complex mixtures.

Background. Medical care ecology has previously been investigated for adults, but no similar exploration has been made specifically for children. Objective. To describe proportions of children receiving care in 6 types of health care setting on a monthly basis and to identify characteristics associated with receipt of care in these settings. Methods. Nationally representative data from the 1996 Medical Expenditure Panel Survey were used to estimate the number of children per 1000 per month who received care at least once in each type of setting. Multivariate analyses assessed associations between receiving care in various settings and children's sociodemographic factors (age, sex, ethnicity, poverty, parent's education, urban or rural residence, insurance status, and whether or not the child had a usual source of care). Results. Of 1000 children aged 0 to 17 years, on average each month 167 visited a physician's office, 82 a dentist's office, 13 an emergency department, and 8 a hospital-based outpatient clinic. Three were hospitalized and 2 received professional health care in their home. Younger age was associated with increased proportions of children receiving care in all health care settings except dentists' clinics. Poverty, lack of health insurance, black race, and Hispanic ethnicity were associated with decreased receipt of care in physicians' and dentists' offices. Only age ( Conclusions. The ecology of children's medical care is similar to that of adults in the United States in that a substantial proportion of children receive health care each month, mostly in community-based, outpatient settings. In all settings except emergency departments, receipt of care varies significantly by children's age, race, ethnicity, income, health insurance status, and whether they have a usual source of care. Pediatrics 2003;111: 1024-1029; ecology, medical care, health systems, Medical Expenditure Panel Survey, primary care., ABBREVIATIONS. MEPS, Medical Expenditure Panel Survey; OR, odds ratio. In 1961, White et al (1) crystallized a patient-centered and population-based vision of health care in a seminal paper describing the [...]

Objectives. This study ascertained the separate and combined effects of having insurance and a usual source of care on receiving preventive services. Methods. Descriptive and multivariate analyses, of 1996 Medical Expenditure Panel Survey data were conducted. Results. Receipt of preventive services was strongly associated with insurance and a usual source of care. Significant differences were found between insured adults with a usual source of care, who were most likely to have received services, compared with uninsured adults without regular care, who were least likely to have received services. Those with either a usual source of care or insurance had intermediate levels of preventive services. Conclusions. Having a usual source of care and health insurance are both important to achieving national prevention goals.

Family medicine became a medical specialty in 1969, following a series of reports that recommended creating enough community-based general physicians (GPs) to counteract the increasing specialization of medicine. As of 2000, there were 71,156 family doctors in the US.

The health of Americans and their help-seeking behavior has changed little since 1960. In both 1961 and 1996, of 1,000 people surveyed, 75% to 80% had some type of symptom, about 20% to 25% saw a doctor sometime during the month, and 10% were hospitalized. These figures are remarkably stable considering the changes that have taken place in the healthcare industry since 1961.