How Physician Self-Perceptions Affect the Impact of Peer Comparison Feedback on Opioid Prescribing.

Peer comparison feedback is a promising strategy for reducing opioid prescribing and opioid-related harms. Such comparisons may be particularly impactful among underestimating clinicians who do not perceive themselves as high prescribers relative to their peers. But peer comparisons could also unintentionally increase prescribing among overestimating clinicians who do not perceive themselves as lower prescribers than peers.

The Effect Of Clinician Feedback Interventions On Opioid Prescribing.

An initial opioid prescription with a greater number of pills is associated with a greater risk for future long-term opioid use, yet few interventions have reliably influenced individual clinicians' prescribing. Our objective was to evaluate the effect of feedback interventions for clinicians in reducing opioid prescribing. The interventions included feedback on a clinician's outlier prescribing (individual audit feedback), peer comparison, and both interventions combined.

Bosnian, Iraqi, and Somali Refugee Women Speak: A Comparative Qualitative Study of Refugee Health Beliefs on Preventive Health and Breast Cancer Screening.

Introduction: The low uptake of preventive services in disadvantaged communities is a continuing challenge to public health. Women refugee communities are particularly vulnerable populations, and disparities in both preventive care and breast cancer screening have been documented sparsely. The objective of this qualitative study was to explore Bosnian, Iraqi, and Somali women refugees' beliefs about preventive care and breast cancer screening to inform future community interventions and best practices.

Decreasing disparities in breast cancer screening in refugee women using culturally tailored patient navigation.

Background: Patient navigator (PN) programs can improve breast cancer screening in low income, ethnic/racial minorities. Refugee women have low breast cancer screening rates, but it has not been shown that PN is similarly effective.

Objective: Evaluate whether a PN program for refugee women decreases disparities in breast cancer screening.

Patient navigation to improve breast cancer screening in Bosnian refugees and immigrants.

Refugee women have low breast cancer screening rates. This study highlights the culturally competent implementation and reports the outcomes of a breast cancer screening patient navigation program for refuge/immigrant women from Bosnia. Refugees/immigrant women from Bosnia age 40-79 were contacted by a Serbo-Croatian speaking patient navigator who addressed patient-reported barriers to breast cancer screening and, using individually tailored interventions, helped women obtain screening.

Perspectives on preventive health care and barriers to breast cancer screening among Iraqi women refugees.

Since the Iraq war began in 2003, over 4 million Iraqis have been displaced. Little is known about preventive cancer care in this population, but stark disparities have been documented. The purpose of this study was to assess the perspectives of Iraqi women refugees on preventive care and perceived barriers to breast cancer screening.

Coping with inflammatory breast cancer: women's experiences.

The American Cancer Society estimates that 200,000 women will be diagnosed with breast cancer each year. Among these, 1-6% will be diagnosed with a far more aggressive and little studied form, inflammatory breast cancer (IBC). Because its presenting symptoms are atypical, IBC is often mistaken for mastitis or other conditions, resulting in dangerous delay in accurate diagnosis and treatment.

Soil moisture effects on the carbon isotope composition of soil respiration.

The carbon isotopic composition (delta(13)C) of recently assimilated plant carbon is known to depend on water-stress, caused either by low soil moisture or by low atmospheric humidity. Air humidity has also been shown to correlate with the delta(13)C of soil respiration, which suggests indirectly that recently fixed photosynthates comprise a substantial component of substrates consumed by soil respiration. However, there are other reasons why the delta(13)CO(2) of soil efflux may change with moisture conditions, which have not received as much attention.

Bias and uncertainty of delta13CO 2 isotopic mixing models.

Patterns in the isotopic signal (stable C isotope composition; delta(13)C) of respiration (delta(13)C(R)) have led to important gains in understanding the C metabolism of many systems. Contained within delta(13)C(R) is a record of the C source mineralized, the metabolic pathway of C and the environmental conditions during which respiration occurred. Because gas samples used for analysis of delta(13)C(R) contain a mixture of CO(2) from respiration and from the atmosphere, two-component mixing models are used to identify delta(13)C(R).

A laboratory comparison of two methods used to estimate the isotopic composition of soil delta13CO2 efflux at steady state.

The stable isotopic composition of soil (13)CO(2) flux is important for monitoring soil biological and physical processes. While several methods exist to measure the isotopic composition of soil flux, we do not know how effective each method is at achieving this goal. To provide clear evidence of the accuracy of current measurement techniques we created a column filled with quartz sand through which a gas of known isotopic composition (-34.

Age-related trends in red spruce foliar plasticity in relation to declining productivity.

Phenotypic plasticity in needle morphology with increasing tree size and age was investigated by comparing four age classes of red spruce (Picea rubens Sarg.) ranging from juvenile (3-12 years old) to mature (over 100 years old). With increase in tree age there were significant increases in leaf mass per unit area (LMA), mesophyll and vascular bundle area as a percentage of total needle cross-sectional area, and stomatal density.

Biophysical constraints on leaf expansion in a tall conifer.

The physiological mechanisms responsible for reduced extension growth as trees increase in height remain elusive. We evaluated biophysical constraints on leaf expansion in old-growth Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) trees.

Using nocturnal cold air drainage flow to monitor ecosystem processes in complex terrain.

This paper presents initial investigations of a new approach to monitor ecosystem processes in complex terrain on large scales. Metabolic processes in mountainous ecosystems are poorly represented in current ecosystem monitoring campaigns because the methods used for monitoring metabolism at the ecosystem scale (e.g.

Developmental decline in height growth in Douglas-fir.

The characteristic decline in height growth that occurs over a tree's lifespan is often called "age-related decline." But is the reduction in height growth in aging trees a function of age or of size? We grafted shoot tips across different ages and sizes of Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) trees to determine whether the decline in height growth is mediated by tree size or by the age of the apical meristem.

Contributions of evaporation, isotopic non-steady state transpiration and atmospheric mixing on the delta18O of water vapour in Pacific Northwest coniferous forests.

Changes in the 2H and 18O of atmospheric water vapour provide information for integrating aspects of gas exchange within forest canopies. In this study, we show that diurnal fluctuations in the oxygen isotope ratio (delta 18O) as high as 4% per hundred were observed for water vapour (delta (18)Ovp) above and within an old-growth coniferous forest in the Pacific Northwest region of the United States. Values of delta 18Ovp decreased in the morning, reached a minimum at midday, and recovered to early-morning values in the late afternoon, creating a nearly symmetrical diurnal pattern for two consecutive summer days.

The hydraulic limitation hypothesis revisited.

We proposed the hydraulic limitation hypothesis (HLH) as a mechanism to explain universal patterns in tree height, and tree and stand biomass growth: height growth slows down as trees grow taller, maximum height is lower for trees of the same species on resource-poor sites and annual wood production declines after canopy closure for even-aged forests. Our review of 51 studies that measured one or more of the components necessary for testing the hypothesis showed that taller trees differ physiologically from shorter, younger trees. Stomatal conductance to water vapour (g(s)), photosynthesis (A) and leaf-specific hydraulic conductance (K L) are often, but not always, lower in taller trees.

Use of the Conners-wells adolescent self-report scale (short form) with children.

The short form of the Conners-Wells Adolescent Self-Report Scale (CASS:Short) is administered to 319 children and 844 adolescents to investigate whether the instrument can be used with respondents under the age of 12. Mothers of all respondents are asked to rate each child using a measure designed to assess a parallel set of problem behaviors. The factor structure of the CASS:Short is tested in both samples and is found to have good fit to the data.

Environmental sensitivity of gas exchange in different-sized trees.

The carbon isotope signature (delta13C) of foliar cellulose from sunlit tops of trees typically becomes enriched as trees of the same species in similar environments grow taller, indicative of size-related changes in leaf gas exchange. However, direct measurements of gas exchange in common environmental conditions do not always reveal size-related differences, even when there is a distinct size-related trend in delta13C of the very foliage used for the gas exchange measurements. Since delta13C of foliage predominately reflects gas exchange during spring when carbon is incorporated into leaf cellulose, this implies that gas exchange differences in different-sized trees are most likely to occur in favorable environmental conditions during spring.

Alexithymia in young adulthood: a risk factor for pathological gambling.

Background: Pathological gambling is more prevalent among postsecondary students than among the general adult population. While the prevalence of pathological gambling in this group has risen over the past decade, factors underlying the development of problem gambling among university students remain largely unexplored. One early study found alexithymia to be associated with pathological gambling.

Structural and compositional controls on transpiration in 40- and 450-year-old riparian forests in western Oregon, USA.

Large areas of forests in the Pacific Northwest are being transformed to younger forests, yet little is known about the impact this may have on hydrological cycles. Previous work suggests that old trees use less water per unit leaf area or sapwood area than young mature trees of the same species in similar environments. Do old forests, therefore, use less water than young mature forests in similar environments, or are there other structural or compositional components in the forests that compensate for tree-level differences? We investigated the impacts of tree age, species composition and sapwood basal area on stand-level transpiration in adjacent watersheds at the H.

Evidence that hydraulic conductance limits photosynthesis in old Pinus ponderosa trees.

We tested the hypotheses that hydraulic conductance is lower in old (about 250 years old and 30 m tall) compared to young (about 40 years old and 10 m tall) Pinus ponderosa Dougl. ex Laws. trees and that lower hydraulic conductance of old trees limits their photosynthesis.

A micro-power precision amplifier for converting the output of light sensors to a voltage readable by miniature data loggers.

To record photosynthetically active radiation (PAR) simultaneously at a number of points throughout a forest canopy, we developed a simple, inexpensive (< $10 US) current-to-voltage converter that processes the current generated by a photodiode radiation sensor to a voltage range that is recordable with a miniature data logger. The converter, which weighs less than 75 g and has a volume of only 100 cm(3), is built around an ultra-low power OP-90 precision operational amplifier, which consumes less than 0.5 mA at 9 V when converting the output of a Li-Cor LI-190SA quantum sensor exposed to photosynthetically active radiation (PAR) of 2500 &mgr;mol m(-2) s(-1) or only 5 &mgr;A in low light.

Stomatal behavior of four woody species in relation to leaf-specific hydraulic conductance and threshold water potential.

Midday stomatal closure is mediated by the availability of water in the soil, leaf and atmosphere, but the response to these environmental and internal variables is highly species specific. We tested the hypothesis that species differences in stomatal response to humidity and soil water availability can be explained by two parameters: leaf-specific hydraulic conductance (K(L)) and a threshold leaf water potential (Psi(threshold)). We used a combination of original and published data to estimate characteristic values of K(L) and Psi(threshold) for four common tree species that have distinctly different stomatal behaviors: black cottonwood (Populus trichocarpa Torr.

An investigation of hydraulic limitation and compensation in large, old Douglas-fir trees.

The hydraulic limitation hypothesis (Ryan and Yoder 1997) proposes that leaf-specific hydraulic conductance (kl) and stomatal conductance (gs) decline as trees grow taller, resulting in decreased carbon assimilation. We tested the hydraulic limitation hypothesis by comparison of canopy-dominant Douglas-fir (Pseudotsuga menziesii var. menziesii (Mirb.