Nurse Practitioner and Physician's Assistant Clinics in Rural California: Part I: Issues

The primary health care needs of at least 26 rural California communities are being served by nurse practitioners (NP''s) or physician''s assistants (PA''s). All of these have physician supervision and support. NP''s and PA''s have proved to be acceptable and effective. With 230 rural areas in California identified as having unmet health care needs, this type of service is likely to increase and should be supported.NP/PA clinics serve total populations or concentrate on Indians, Chicanos or the poor. Many barriers have been overcome, especially over the past four years, to allow these clinics to flourish and increase in number. The availability of nurse practitioners and physician''s assistants has increased due to support to schools and to school policies. Clinic funding has greatly improved; federal funds for general rural clinics, Indians, migrants, family planning and maternalchild health have been greatly supplemented by California state funds. Beginning in 1978, rural NP and PA services can be reimbursed by Medicare and Medi-Cal (California''s Medicaid program).Since 1975 state laws have defined PA and NP roles broadly, and these roles are more precisely defined at the local level. Although nurse practitioners and physician''s assistants generally cannot prescribe or dispense drugs (a major problem in many clinics), demonstration legislation allows special pilot projects to do both. As remaining funding and legal problems are corrected, NP''s and PA''s will serve an even greater role in rural areas.     

The Chilliwack Respiratory Survey, 1963: Part II. Aerometric Study

A study of the quality of the ambient air at Chilliwack, British Columbia, was conducted from May 1963 to April 1964. Measurements of dustfall, soiling, sulfation, hydrogen sulfide, oxidants and total hydrocarbons were made by a network of five sampling stations. The results of this survey indicated that Chilliwack was relatively free from any air pollution and would therefore be a suitable control for a study of the relationship between community air pollution and respiratory disease.     

Restoration and Science: A Practitioner/Scientist's View from Rare Habitat Restoration at a Southern California Preserve

Researchers reexamining the relationship between restoration science and practice report a continuing scientist‐practitioner gap. As a land manager with scientific training, I offer my perspective of the chasm and describe a restoration practice infused with as much science as the realities of limited budget and time allow. The coastal sage scrub (CSS) restoration project at Starr Ranch, a 1,585 ha Audubon preserve in southern California, combines non‐chemical invasive species control, restoration, and applied research. Our practices evolve from modified scientific approaches and the scientific literature. Results from experiments with non‐optimum replication (on effects of seed rates, soil tamping, and timing of planting) nonetheless had value for management decisions. A critical practice came from academic research that encouraged cost‐effective passive restoration. Our passive restoration monitoring data showed 28–100% total native cover after 3–5 years. Another published study found that restoration success in semiarid regions is dependent on rainfall, a finding vital for understanding active restoration monitoring results that showed a range of 0–88% total native cover at the end of the first season. Work progresses through a combination of applied research, a watchful eye on the scientific literature, and “ecological intuition” informed by the scientific literature and our own findings. I suggest that it is less critical for academic scientists to address the basic questions on technique that are helpful to land managers but rather advocate practitioner training in methods to test alternative strategies and long‐term monitoring.     

A Survey of Newborn Intensive Care Centers in California

Newborn intensive care has come of age in California. Twenty-one newborn intensive care centers and 11 community level units are now approved by Crippled Children Services in California. In 1973 there were more than 6,863 patients admitted to the 20 centers surveyed, over half requiring transport from referring hospitals. This paper provides information on the distribution, admission and occupancy rates, length of stay, costs and admission diagnoses for these high risk infants.     

Self-Reported Serious Illnesses in Rural Cambodia: A Cross-Sectional Survey

Background

There is substantial evidence that ill-health is a major cause of impoverishment in developing countries. Major illnesses can have a serious economic impact on poor households through treatment costs and income loss. However, available methods for measuring the impact of ill-health on household welfare display several shortcomings and new methods are thus needed. To understand the potential complex impact of major illnesses on household livelihoods, a study on poverty and illness was conducted in rural Cambodia, as part of an international comparative research project. A cross-sectional survey was performed to identify households affected by major illness for further in-depth interviews.

Methodology and Principal Findings

5,975 households in three rural health districts were randomly selected through a two-stage cluster sampling and interviewed. 27% of the households reported at least one member with a serious illness in the year preceding the survey and 15% of the household members reported suffering from at least one serious illness. The most reported conditions include common tropical infectious diseases, chronic diseases (notably hypertension and heart diseases) and road traffic accidents. Such conditions were particularly concentrated among the poor, children under five, women, and the elderly. Poor women often reported complications related to pregnancy and delivery as serious illnesses.

Conclusions and Significance

Despite some methodological limitations, this study provides new information on the frequency of self-reported serious illnesses among the rural Cambodia''s population, which serves as a basis for further in-depth investigation on ‘major illnesses’ and their economic consequences on poor households. This can in turn help policy makers to formulate appropriate interventions to protect the poor from the financial burden associated with ill-health. Our findings suggest that every year a considerable proportion of rural population in Cambodia, especially the poor and vulnerable, are affected by serious illnesses, both communicable and non-communicable diseases.     

A Phytosociological Survey of the Chionophilous Communities of Western North America. Part II: Boreal Associations

To continue our study on the chionophilous communities of western North America, this report presents a phytosociological survey of communities growing in a boreal macroclimate. Combining the Braun-Blanquet approach with numerical analysis, 378 relevés were ordered and classified by tabular and average linkage cluster analyses, revealing 11 associations in the classes Salicetea herbaceae, Loiseleurio–Vaccinietea, and Carici rupestris–Kobresietea bellardii. The following new syntaxa are described and typified: Carici podocarpae–Anemonetalia parviflorae, Solidagini arcticae–Dryadion alaskensis, Taraxaco alaskani–Salicion rotundifoliae, Vaccinio mini–Betuletalia exilis, Polygono plumosi–Cassiopion tetragonae, Arnico lessingii–Cassiopetum tetragonae, and Carici podocarpae–Betuletum exilis.     

Winter Bird Assemblages in Rural and Urban Environments: A National Survey

Urban development has a marked effect on the ecological and behavioural traits of many living organisms, including birds. In this paper, we analysed differences in the numbers of wintering birds between rural and urban areas in Poland. We also analysed species richness and abundance in relation to longitude, latitude, human population size, and landscape structure. All these parameters were analysed using modern statistical techniques incorporating species detectability. We counted birds in 156 squares (0.25 km2 each) in December 2012 and again in January 2013 in locations in and around 26 urban areas across Poland (in each urban area we surveyed 3 squares and 3 squares in nearby rural areas). The influence of twelve potential environmental variables on species abundance and richness was assessed with Generalized Linear Mixed Models, Principal Components and Detrended Correspondence Analyses. Totals of 72 bird species and 89,710 individual birds were recorded in this study. On average (±SE) 13.3 ± 0.3 species and 288 ± 14 individuals were recorded in each square in each survey. A formal comparison of rural and urban areas revealed that 27 species had a significant preference; 17 to rural areas and 10 to urban areas. Moreover, overall abundance in urban areas was more than double that of rural areas. There was almost a complete separation of rural and urban bird communities. Significantly more birds and more bird species were recorded in January compared to December. We conclude that differences between rural and urban areas in terms of winter conditions and the availability of resources are reflected in different bird communities in the two environments.     

Approaches for Quantifying the Metabolism of Physical Economies: A Comparative Survey: Part II: Review of Individual Approaches

This article is the second of a two-part series that describes and compares the essential features of nine "physical economy" approaches for mapping and quantifying the material demands of the human economy upon the natural environ-ment. These approaches are critical tools in the design and implementation of industrial ecology strategies for greater eco-efficiency and reduced environmental impacts of human economic activity. Part I of the series provided an overview, meth-odological classification, and comparison of a selected set of major materials flow analysis (MFA) and related techniques. This sequel includes a convenient reference and overview of the major metabolism measurement approaches in the form of a more detailed summary of the key specific analytical and other features of the approaches introduced in part I. The surveyed physical economy related environmental analysis ap-proaches include total material requirement and output mod-els, bulk MFA (IFF (Department of Social Ecology, Institute for Interdiscplinary Studies of Austrian Universities) material flow balance model variant), physical input-output tables, substance flow analysis, ecological footprint analysis, environmental space, material intensity per unit service, life-cycle assessment (LCA), the sustainable process index, and company-level MFA.