Prescribing by Physician Associates and Nurse Practitioners in Older Adults Is Outpacing Traditional Prescribers: Implications for Practice in American Medicine.

Prescribing is a significant activity undertaken by physicians, physician associates/assistants (PAs), and nurse practitioners (NPs). We analyzed prescribing data to understand better the growing presence of PAs and NPs in older adults. A trend in frequently prescribed medications was compared with other physicians. All prescriptions in Medicare Part D were grouped into broad categories of drugs and linked to each type of provider. The analysis spanned 9 years (2013-2021). The results revealed that all five providers similarly prescribed the top three main drug classes (antacids, antihypertensives, and statins). In addition, there was a decline in the number of unique prescribers and prescriptions for all three types of physicians (family medicine, internal medicine, and general practice physicians). Concurrently, the number and share of prescriptions for NPs and PAs increased yearly. The findings are consistent with data that PAs and NPs are backfilling physician shortages in treating older adults.

The role of terrestrial productivity and hydrology in regulating aquatic dissolved organic carbon concentrations in boreal catchments.

The past decades have witnessed an increase in dissolved organic carbon (DOC) concentrations in the catchments of the Northern Hemisphere. Increasing terrestrial productivity and changing hydrology may be reasons for the increases in DOC concentration. The aim of this study is to investigate the impacts of increased terrestrial productivity and changed hydrology following climate change on DOC concentrations. We tested and quantified the effects of gross primary production (GPP), ecosystem respiration (RE) and discharge on DOC concentrations in boreal catchments over 3 years. As catchment characteristics can regulate the extent of rising DOC concentrations caused by the regional or global environmental changes, we selected four catchments with different sizes (small, medium and large) and landscapes (forest, mire and forest-mire mixed). We applied multiple models: Wavelet coherence analysis detected the delay-effects of terrestrial productivity and discharge on aquatic DOC variations of boreal catchments; thereafter, the distributed-lag linear models quantified the contributions of each factor on DOC variations. Our results showed that the combined impacts of terrestrial productivity and discharge explained 62% of aquatic DOC variations on average across all sites, whereas discharge, gross primary production (GPP) and RE accounted for 26%, 22% and 3%, respectively. The impact of GPP and discharge on DOC changes was directly related to catchment size: GPP dominated DOC fluctuations in small catchments (<1 km2 ), whereas discharge controlled DOC variations in big catchments (>1 km2 ). The direction of the relation between GPP and discharge on DOC varied. Increasing RE always made a positive contribution to DOC concentration. This study reveals that climate change-induced terrestrial greening and shifting hydrology change the DOC export from terrestrial to aquatic ecosystems. The work improves our mechanistic understanding of surface water DOC regulation in boreal catchments and confirms the importance of DOC fluxes in regulating ecosystem C budgets.

Retention and change in PAs' first years of employment.

OBJECTIVE: Employment analyses demonstrate that physician assistants (PAs) exhibit role flexibility in US medicine. The next step in understanding this labor-shifting observation is to know at what career stage it first occurs. METHODS: Using matriculate data linked to the American Academy of PAs (AAPA) census survey data, a longitudinal analysis of seven graduate cohorts revealed that one-third of PAs changed specialty roles at least once during their first decade of employment. RESULTS: From this series, it appears that new PAs spend about 3.4 years in their first job, on average, before they decide to move to another medical or surgical field. In examining PAs who changed their clinical role during this time period, 28% shifted from primary care to another medical or specialty role. Overall, the PA career movement to nonprimary care specialties increased substantially. CONCLUSIONS: These findings support observations that PAs provide an adaptive role in a dynamic and changing medical workforce.