Effects of a severe storm on seagrass meadows.

Extreme environmental events can strongly affect coastal marine ecosystems but are typically unpredictable. Reliable data on benthic community conditions before such events are rarely available, making it difficult to measure their effects. At the end of October 2018, a severe storm hit the Ligurian coast (NW Mediterranean) producing damages to coastal infrastructures. Thanks to recent data collected just before the event on two Posidonia oceanica seagrass meadows hit by the storm, it has been possible to assess the impact of the event on one of the most valuable habitats of the Mediterranean Sea. By means of seagrass cover and depth data gathered along four depth transects positioned within the two meadows in areas differently exposed to the storm waves, and by using models (WW3® + SWAN + XBeach 1D) to evaluate wave height and bed shear stress, we showed that meadows experienced erosion and burial phenomena according to exposure. Paradoxically, meadows in good conditions suffered more damage as compared to those already suffering from previous local anthropogenic impacts. Besides the direct effect of waves in terms of plant uprooting, a major loss of P. oceanica was due to sediment burial in the deepest parts of the meadows. Overall, the loss of living P. oceanica cover amounted to about 50%. Considering that previous research showed that the loss of the original surface of P. oceanica meadows in 160 years due to anthropogenic pressures was similarly around 50%, the present study documented that an extreme environmental event can generate in a single day a loss of natural capital equal to that produced gradually by more than a century of human impact.

Do we practice what we preach? Comparing the patients of faculty and residents.

BACKGROUND AND OBJECTIVES: In academic family practice centers, the distribution of patients between faculty and residents influences the educational milieu. The medical literature has rarely addressed the differential case mix within the ambulatory medical educational setting. The goal of this study was to compare the characteristics of patient visits to resident and faculty physicians in seven community-based, university-affiliated family practice programs. METHODS: Using the National Ambulatory Care Survey instrument and protocol, 98 faculty and resident physicians recorded their ambulatory patient visits for one randomly selected week between July 1991 and June 1992 (n = 1,498). RESULTS: Patients of resident physicians were younger, more likely to be nonwhite (21.7% vs 9.8%, P < .001), and more likely to be reimbursed by Medicaid (34.2% vs 14.3%, P < .001) than patients of faculty physicians. Despite these patient differences, the spectrum of clinical problems was similar. There were minimal differences in the delivery of diagnostic services and therapeutic services. CONCLUSIONS: The patients seen by residents and faculty differ in important demographic characteristics. These differences could adversely affect the education of resident physicians. Academic family practice centers should actively monitor the age/gender/payment profile of resident and faculty patient panels and assign patients to achieve a desirable case mix for resident education. The differential racial distribution of faculty and resident visits suggests an unidentified systematic bias in patient assignment that warrants further investigation.

Economic analysis of family practice residency programs: a report from the Northeastern Ohio Network.

BACKGROUND: The financial impact of a family practice residency program on a sponsoring institution is poorly understood. This study intended to describe as fully as possible all the expenses and revenues from five community-based family practice residency programs in northeastern Ohio. METHODS: Direct and indirect expenses, revenues, and demographics were evaluated for 1992. Similarities and differences among the participating programs were examined. RESULTS: Overall expenses per resident were similar in all five programs, with a range from $162,000 to $203,000. Revenues reflected the number of residents in the program, although collection ratios varied. Inpatient collections ranged from 53%-76% and outpatient collections ranged from 60%-76%. An average of 30% of graduates from the past 10 years were on the active medical staff of their sponsoring institution, with a range of 21%-36%. CONCLUSION: Based on the expenses, revenues collected, and reasonable assumptions made about cost of care in the hospital setting, the family practice residencies are probably a break-even operation, excluding the benefit of providing primary care physicians to the community.

Does family practice at residency teaching sites reflect community practice?

BACKGROUND: Family medicine has aspired to train residents and conduct research in settings that closely resemble community practice. The purpose of this study was to compare the patient characteristics of the ambulatory teaching centers of a consortium of seven community-based university-affiliated family practice residency programs in northeast Ohio with the National Ambulatory Medical Care Survey (NAMCS) results for family physicians (FPs) and general practitioners (GPs). METHODS: Ninety-eight faculty and resident physicians at the residency training site of the Northeastern Ohio Universities College of Medicine collected data on all ambulatory patient visits (N = 1498) for one randomly chosen week between July 1, 1991, and June 30, 1992. We compared these data with patient visits reported in the 1990 NAMCS for FPs and GPs. RESULTS: The residency training sites saw slightly more children, women, blacks, and Medicare and Medicaid patients. The most common reason for an office visit in both populations was an undifferentiated symptom. Fifteen of the top 20 "reason for visit" codes were identical, as were 14 of the top 20 diagnoses. More preventive and therapeutic services were offered or performed at our residency training sites but fewer diagnostic services were performed. There were fewer consultations requested at our residency training sites but similar hospitalization rates for patients. The mean duration of visit differed by only 1 minute. CONCLUSIONS: The residency training sites of the Northeastern Ohio Universities College of Medicine provide patient care opportunities similar to those found in a national survey of family and general practitioners.