Motor–manual, mechanical, and herbicide release affect early successional vegetation in northwestern Ontario

Cover and height of vegetation before and one growing season after: 1) motor-manual cutting, 2) mechanical brush cutting (Silvana Selective/Ford Versatile), 3) aerial application of Release® (a.i. triclopyr) herbicide, 4) aerial application of Vision® (a.i. glyphosate) herbicide, and 5) control (no treatment) were quantified. Multivariate analysis permitted the study of vegetation response as a whole, while accounting for correlations that exist among the individual vegetation groups. Univariate analysis were used to study the responses of individual vegetation groups. Although no pre-treatment differences in percent cover were observed (P = 0.128), deciduous tree, shrub, forb, grass, and sedge groups responded differently to the treatments after one growing season (P < 0.018). Post-treatment cover of deciduous tree and shrub groups was lower in herbicide treated plots than in cut plots. Forb, grass and sedge covers varied greatly among treatments. Brush saw and Silvana Selective treatments decreased cover of deciduous trees. Release® decreased cover of deciduous trees and shrubs. Vision® decreased cover of deciduous trees, shrubs and ferns. Cover of all vegetation groups increased on the untreated control. Among the conifer release treatments examined, Vision® reduced woody and herbaceous vegetation most. Key words: clearing saw, conifer release, Falingsnow Ecosystem Project, glyphosate, herbicides, Release®, Silvana Selective, spruce, triclopyr, vegetation management, Vision®.

Download Full-text

Indirect effects of conifer release alternatives on songbird populations in northwestern Ontario

The Forestry Chronicle ◽

10.5558/tfc73107-1 ◽

1997 ◽

Vol 73 (1) ◽

pp. 107-112 ◽

Cited By ~ 15

Author(s):

John Woodcock ◽

John P. Ryder ◽

R. A. Lautenschlager ◽

F. Wayne Bell

Keyword(s):

Bird Species ◽

Growing Season ◽

Common Species ◽

Post Treatment ◽

Breeding Bird ◽

Northwestern Ontario ◽

Dendroica Pensylvanica ◽

Treatment Data ◽

Major Treatment ◽

Pre Treatment

The effects of conifer-release alternatives on songbird densities (determined by territory mapping, mist netting, and banding) in four young (four to seven year old) spruce plantations were examined. Twenty to 38 (block dependent) species bred on each treatment block. Post-treatment data revealed no major treatment-related changes in breeding bird species composition. The mean density of all birds decreased from 6.9 pairs ha−1 pre-treatment, to 6.3 pairs ha−1 in the first post-treatment growing season (P > 0.05). Mean densities of the 11 most common species increased by 0.35 ha−1 on the control plots during the first post-treatment growing season, but decreased on treated plots by 1.1 ha−1 (brush saw), 1.6 ha−1 (Silvana Selective), 0.14 ha−1 (Release®) and 0.72 ha−1 (Vision®). Following the conifer-release treatments, Chestnut-sided Warbler (Dendroica pensylvanica) had lower (P < 0.05) mean densities on the brush saw- and Silvana Selective-treated plots than on the control plots and fewer (P < 0.05) female birds were captured in the first post-treatment year. Key words: brush saw, Chestnut-sided Warbler, conifer-release, Fallingsnow Ecosystem Project, glyphosate, mist netting, Silvana Selective, songbirds, territory mapping, triclopyr

Download Full-text

Effect of individual- versus collective-based nutritional-lifestyle intervention on the atherogenic index of plasma in children with obesity: a randomized trial

Nutrition & Metabolism ◽

10.1186/s12986-020-00537-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Elvira Verduci ◽

Giuseppe Banderali ◽

Elisabetta Di Profio ◽

Sara Vizzuso ◽

Gianvincenzo Zuccotti ◽

...

Keyword(s):

Body Mass Index ◽

Lifestyle Intervention ◽

Body Mass ◽

Univariate Analysis ◽

Atherogenic Index ◽

Z Score ◽

Blood Profile ◽

Atherogenic Index Of Plasma ◽

Paediatric Obesity ◽

The Individual

Abstract Background The Atherogenic Index of Plasma is a predictive biomarker of atherosclerosis in adults but there is a lack of studies in paediatric population aimed at evaluating the longitudinal changes of the AIP and of the cardiometabolic blood profile related to nutritional interventions. The aim of this study was to compare the effect of individual- versus collective-based nutritional-lifestyle intervention on the Atherogenic Index of Plasma in schoolchildren with obesity. Methods One-hundred sixty-four children aged 6–12 years with Body Mass Index z-score > 2 referred to the Paediatric Obesity Clinic, San Paolo Hospital, Milan, Italy, were consecutively enrolled and randomized to undergo to either an individual- (n = 82) or a collective- (n = 82) based intervention promoting a balanced normo-caloric diet and physical activity. In addition, the individual intervention included a tailored personalized nutritional advice and education based on the revised Coventry, Aberdeen, and London-Refined taxonomy. Both at baseline and after 12 months of intervention, dietary habits and anthropometric measures were assessed, a fasting blood sample were taken for biochemistry analysis. Results The participation rate at 12 months was 93.3% (n = 153 patients), 76 children in the individual-intervention and 77 children in the collective intervention. At univariate analysis, mean longitudinal change in Atherogenic Index of Plasma was greater in the individual than collective intervention (− 0.12 vs. − 0.05), as well as change in triglyceride-glucose index (− 0.22 vs. − 0.08) and Body Mass Index z-score (− 0.59 vs. − 0.37). At multiple analysis, only change in Body Mass Index z-score remained independently associated with intervention (odds ratio 3.37). Conclusion In children with obesity, an individual-based nutritional and lifestyle intervention, including techniques from the CALO-RE taxonomy, could have an additional beneficial effect over a collective-based intervention, although the actual size of the effect remains to be clarified. Trial Registration Clinical Trials NCT03728621

Download Full-text

The Australian National Windbreaks Program: overview and summary of results

Australian Journal of Experimental Agriculture ◽

10.1071/ea02003 ◽

2002 ◽

Vol 42 (6) ◽

pp. 649 ◽

Cited By ~ 35

Author(s):

H. A. Cleugh ◽

R. Prinsley ◽

P. R. Bird ◽

S. J. Brooks ◽

P. S. Carberry ◽

...

Keyword(s):

Growing Season ◽

Climate Data ◽

Financial Gain ◽

Temperature And Humidity ◽

Wind Climate ◽

Wind Events ◽

Differing Effect ◽

Economic Analyses ◽

The Individual ◽

Variable Wind

This overview paper presents a description of the National Windbreaks Program (NWP) — its objectives, the main methods used to achieve these objectives and a summary of the key results. It draws these from the individual papers appearing in this special issue, which provide detailed descriptions and discussion about the specific research sites and research methods used, in addition to interpreting and discussing the results. The key findings were the following: (i) Two broad areas of crop and pasture response can be identified downwind of a porous windbreak: a zone of reduced yield associated with competition with the windbreak trees that extended from 1 H to 3 H, where H is the windbreak height, and a zone of unchanged or slightly increased yield stretching downwind to 10 H or 20 H. (ii) Averaged over the paddock, yield gains due to the effect of shelter on microclimate were smaller than expected — especially for cereals. Yield simulations conducted using the APSIM model and 20 years of historical climate data confirmed this result for longer periods and for other crop growing regions in Australia. Larger yield gains were simulated at locations where the latter part of the growing season was characterised by high atmospheric demand and a depleted soil water store. (iii) Economic analyses that account for the costs of establishing windbreaks, losses due to competition and yield gains as a result of shelter found that windbreaks will either lead to a small financial gain or be cost neutral. (iv) Part of the reason for the relatively small changes in yield measured at the field sites was the variable wind climate which meant that the crop was only sheltered for a small proportion of the growing season. In much of southern Australia, where the day-to-day and seasonal variability in wind direction is large, additional windbreaks planted around the paddock perimeter or as closely-spaced rows within the paddock will be needed to provide more consistent levels of shelter. (v) Protection from infrequent, high magnitude wind events that cause plant damage and soil erosion was observed to lead to the largest yield gains. The main forms of direct damage were sandblasting, which either buries or removes seedlings from the soil or damages the leaves and stems, and direct leaf tearing and stripping. (vi) A corollary to these findings is the differing effect that porous windbreaks have on the air temperature and humidity compared to wind. While winds are reduced in strength in a zone that extends from 5 H upwind to at least 25 H downwind of the windbreak, the effects of shelter on temperature and humidity are smaller and restricted mainly to the quiet zone. This means that fewer windbreaks are required to achieve reductions in wind damage than for altering the microclimate. (vii) The wind tunnel experiments illustrate the important aspects of windbreak structure that determine the airflow downwind, and subsequent microclimate changes, in winds oriented both perpendicular and obliquely to porous windbreaks. These results enable a series of guidelines to be forwarded for designing windbreaks for Australian agricultural systems.

Download Full-text

Early growth of lodgepole pine after establishment of alsike clover–Rhizobium nitrogen-fixing symbiosis

Canadian Journal of Forest Research ◽

10.1139/x92-144 ◽

1992 ◽

Vol 22 (8) ◽

pp. 1089-1093 ◽

Cited By ~ 2

Author(s):

R. Trowbridge ◽

F.B. Holl

Keyword(s):

Forest Floor ◽

Lodgepole Pine ◽

Nitrogen Concentration ◽

Growing Season ◽

Early Growth ◽

Percent Cover ◽

Foliar Nitrogen ◽

Growing Seasons ◽

Pine Seedlings ◽

Needle Mass

An overdense lodgepole pine (Pinuscontorta Dougl. ex Loud.) stand was knocked down and the site was prepared by broadcast burn, windrow burn, or mechanical forest floor removal. Inoculated alsike clover (Trifoliumhybridum L.) was seeded at 0, 10, 20, and 30 kg/ha for the three different site preparation treatments to determine the effects of (i) site preparation on infection and effectiveness of the clover–Rhizobium symbiosis and clover percent cover and (ii) the clover–Rhizobium N2-fixing symbiosis on survival, early growth, and foliar nitrogen concentration of lodgepole pine seedlings. The N2-fixing symbiosis established well in all treatments. Clover percent cover increased with increasing rate of seeding, although by relatively few percent in the clover seeded plots. Broadcast burning, windrow burning, and mechanical forest floor removal did not affect the establishment of the N2-fixing symbiosis or clover percent cover. Lodgepole pine survival was not affected by the seeding treatments in any year, nor were height measurements during the first three growing seasons. Seedling height was slightly less in clover-seeded plots compared with controls in the fourth growing season. Lodgepole pine seedlings on clover-seeded plots had decreased diameter growth compared with controls during the first three growing seasons, but incremental diameter growth no longer showed this effect by the fourth growing season. Needle mass (g/100 needles) was less in clover-seeded plots at the end of the second growing season, but this effect was reversed by the fourth growing season, when both needle mass and foliar nitrogen concentration in lodgepole pine foliage were greater in clover-seeded plots.

Download Full-text

Treatment Outcomes of Early-Stage Natural-Killer/T-Cell Lymphomas Treated with Chemoradiotherapy: Data from 3 Tertiary Cancer Centres in Singapore

Blood ◽

10.1182/blood-2019-125085 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5274-5274

Author(s):

Ya Hwee Tan ◽

Siqin Zhou ◽

Liu Xin ◽

Soon Thye Lim ◽

Miriam Tao ◽

...

Keyword(s):

Treatment Outcomes ◽

Chemotherapy Regimen ◽

Early Stage ◽

Univariate Analysis ◽

Stage I ◽

Survival Outcomes ◽

Natural Killer T Cell ◽

End Of Treatment ◽

Pre Treatment ◽

Killer T Cell

Background: Extranodal natural killer/T cell lymphoma (ENKL) is an aggressive Epstein-Barr virus (EBV) associated lymphoma with a strong geographical predilection for Asia and South America. While treatment outcomes of advanced stage (AS) disease (i.e., stage III and IV) are uniformly poor, early stage (ES) disease treated with concomitant or sequential chemotherapy (ChT) and radiotherapy (RT) can yield good long-term outcomes. Currently there is no standard therapy for ES ENKL. We describe our experience treating patients with ES ENKL in 3 tertiary cancer centres in Singapore. Method: We performed a retrospective analysis using data from Singapore Lymphoma Study Group database which captures patients from 3 largest tertiary cancer centres in Singapore: National Cancer Centre Singapore (NCCS), Singapore General Hospital (SGH) and National University Cancer Institute, Singapore (NCIS). We included patients with stage I or II ENKL that were treated with ChT and RT from 1996 to March 2019. Patients who did not receive treatment or received radiotherapy alone were excluded. We recorded data on patient demographics, chemotherapy regimen, radiotherapy dosage, sequencing of treatment, response and survival outcomes. End of treatment overall response rates (ORR) included those who achieved complete response (CR) and a partial response (PR). Progression free survival (PFS) was defined as date of diagnosis to date of progression, relapse or death. Overall survival (OS) was defined as date of diagnosis to date of death from all causes. Survival distributions were estimated by the Kaplan-Meier method. Assuming cox proportional hazards models, univariate analysis for OS was performed and Wald tests were used to evaluate the statistical significance. All the statistical analysis was performed using R. Results: There were 56 patients who fulfilled the inclusion criteria. Forty (71%) were male, 47 (84%) were Chinese and the median age of this cohort was 50 (range 18-80). Thirty-one (55%) patients had stage I disease and all had nasal involvement. All patients had ECOG performance status of 0 or 1 and most had low or low-intermediate international prognostic index (IPI) score. Ten patients (18%) had B-symptoms and LDH was elevated in 22 (39%). Pre-treatment positron emission tomography-computed tomography (PET/CT) was performed in 36 (64%) patients. Pre-treatment EBV titres were tested in only 23 patients and they were detected in 17 (74%) of patients. Twenty-five patients (45%) had sandwich (ChT, RT then ChT), 25 (45%) had ChT followed by RT, while 6 had RT followed by ChT. None had concurrent ChT/RT. The most commonly used ChT regimen was ICE (ifosfamide, carboplatin, etoposide) in 19 patients and SMILE (steroids, methotrexate, ifosfamide, L-asparaginase, etoposide) was used in 9 patients. Most patients (75%) did not receive L-asparaginase containing regimens. The median RT dose was 50Gy. The ORR for this cohort was 87.5% and 7 patients (12.5%) progressed at the end of treatment. Our median duration of follow up is 3.5 years (range: 0.25 - 21.6 years). The 5-year OS for stage I and II disease were 78.5% (95% CI, 64.2%-96.0%) and 65.6% (95% CI 47.5% to 90.5%) respectively. The 5-year PFS for stage I and II disease was 78.5% (95% CI 64.2%-96.0%) and 58.8% (95% CI 40.9% to 84.5%) respectively. On univariate analysis, only the sequence of therapy i.e., the sandwich ChT-RT-ChT approach when compared to sequential treatment with ChT followed by RT, was associated with better OS with a hazard ratio (HR) of 0.18 (95% CI 0.04 to 0.84 , p = 0.03). When L-asparaginase containing regimens were compared against those without, no statistical significant difference was observed in OS in ES ENKL, with HR of 3.38 (95%CI 0.44-26.15, p=0.243) Conclusion: Survival outcomes for ES ENKL especially that of stage I ENKL, are good with chemoradiotherapy. This contrasts against the treatment outcomes of AS ENKL. It is likely that many patients in this study were under-staged since PET scans were only performed in 64% of patients. Within the limits of this retrospective analysis and the small numbers, the ICE chemotherapy regimen appears to be an effective treatment when "sandwich"-sequenced with radiotherapy. Disclosures Lim: National Cancer Centre Singapore: Employment.

Download Full-text

240 Discovery of biomarkers of resistance to immune checkpoint blockade in non-small-cell lung cancer (NSCLC) using high-plex digital spatial profiling

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2021-sitc2021.240 ◽

2021 ◽

Vol 9 (Suppl 3) ◽

pp. A258-A258

Author(s):

Myrto Moutafi ◽

Sandra Martinez-Morilla ◽

Prajan Divakar ◽

Ioannis Vathiotis ◽

Niki Gavrielatou ◽

...

Keyword(s):

Lung Cancer ◽

Immune Checkpoint ◽

Biomarker Discovery ◽

Univariate Analysis ◽

Predictive Biomarkers ◽

Protein Detection ◽

Statistical Testing ◽

Multiple Testing Correction ◽

Stromal Compartment ◽

Pre Treatment

BackgroundDespite the clinical effectiveness of Immune Checkpoint Inhibitors (ICI) in lung cancer, only around 20% remain disease free at 5 years. Predictive biomarkers for ICIs are neither sensitive nor specific. Here, we used the GeoMx Digital Spatial Profiler (DSP) (NanoString, Inc.) to analyze high-plex protein in a quantitative and spatially resolved manner from single formalin-fixed paraffin embedded tissue sections toward the goal of identification of new biomarkers with better predictive value.MethodsPre-treatment samples from 56 patients with NSCLC treated with ICI were collected, represented in Yale tissue microarray 471 (YTMA471), and analyzed. A panel of 71 photocleavable oligonucleotide-labeled primary antibodies (NanoString Human IO panel) was used for protein detection. Protein expression was measured in 4 molecularly defined tissue compartments, defined by fluorescence co-localization (tumor [panCK+], leukocytes [CD45+/CD68-], macrophages [CD68+] and an aggregate stromal immune cell compartment, defined as the sum of leukocyte and macrophage expression [panCK-/CD45+/CD68+]) generating 284 variables representing potential predictive biomarkers. Promising candidates were orthogonally validated with Quantitative Immunofluorescence (QIF). Pre-treatment samples from 40 patients with NSCLC (YTMA404) that received ICI, and 174 non-ICI treated operable NSCLC patients (YTMA423) were analyzed to provide independent cohort validation. All statistical testing was performed using a two-sided significance level of α=0.05 and multiple testing correction (Benjamini-Hochberg method, FDR < 0.1).ResultsInitial biomarker discovery on 284 protein variables were generated by univariate analysis using continuous log-scaled data. High PD-L1 expression in tumor cells predicted longer survival (PFS; HR 0.67, p=0.017) and validated the training cohort. We found 4 markers associated with PFS, and 3 with OS in the stromal compartment. Of these, expression of CD66b in stromal immune cells predicted significantly shorter OS (HR 1.31, p=0.016) and shorter PFS (HR 1.24, p = 0.04). Tertile analysis using QIF on all three tissue cohorts for CD66b expression, assessed by QIF, showed that CD66b was indicative but not prognostic for survival [discovery cohort, YTMA471 (OS; HR 3.02, p=0.013, PFS; HR 2.38, p=0.023), validation cohort; YTMA404 (OS; HR 2.97, p=0.018, PFS; HR 1.85, p=0.1), non-ICI treated cohort YTMA423 (OS; HR 1.02, p>0.9, PFS; HR 0.72, p=0.4)].ConclusionsUsing the DSP technique, we have discovered that CD66b expressed in the stromal immune [panCK-/CD45+/CD68+] molecular compartment is associated with resistance to ICI therapy in NSCLC. This observation was validated by an orthogonal approach in an independent ICI treated NSCLC cohort. Since CD66b identifies neutrophils, further studies are warranted to characterize the role of neutrophils in ICI resistance.AcknowledgementsDr Moutafi is supported by a scholarship from the Hellenic Society of Medical Oncologists (HESMO)Ethics ApprovalAll tissue samples were collected and used under the approval from the Yale Human Investigation Committee protocol #9505008219 with an assurance filed with and approved by the U.S. Department of Health and Human Services

Download Full-text

Using Canopy Measurements to Predict Soybean Seed Yield

Remote Sensing ◽

10.3390/rs13163260 ◽

2021 ◽

Vol 13 (16) ◽

pp. 3260

Author(s):

Peder K. Schmitz ◽

Hans J. Kandel

Keyword(s):

Seed Yield ◽

Prediction Models ◽

Plant Density ◽

Soybean Seed ◽

Canopy Cover ◽

Growing Season ◽

Practical Method ◽

Coefficient Of Determination ◽

Planting Dates ◽

The Individual

Predicting soybean [Glycine max (L.) Merr.] seed yield is of interest for crop producers to make important agronomic and economic decisions. Evaluating the soybean canopy across a range of common agronomic practices, using canopy measurements, provides a large inference for soybean producers. The individual and synergistic relationships between fractional green canopy cover (FGCC), photosynthetically active radiation (PAR) interception, and a normalized difference vegetative index (NDVI) measurements taken throughout the growing season to predict soybean seed yield in North Dakota, USA, were investigated in 12 environments. Canopy measurements were evaluated across early and late planting dates, 407,000 and 457,000 seeds ha−1 seeding rates, 0.5 and 0.8 relative maturities, and 30.5 and 61 cm row spacings. The single best yield predictor was an NDVI measurement at R5 (beginning of seed development) with a coefficient of determination of 0.65 followed by an FGCC measurement at R5 (R2 = 0.52). Stepwise and Lasso multiple regression methods were used to select the best prediction models using the canopy measurements explaining 69% and 67% of the variation in yield, respectively. Including plant density, which can be easily measured by a producer, with an individual canopy measurement did not improve the explanation in yield. Using FGCC to estimate yield across the growing season explained a range of 49% to 56% of yield variation, and a single FGCC measurement at R5 (R2 = 0.52) being the most efficient and practical method for a soybean producer to estimate yield.

Download Full-text

Five Years of Vegetation Succession Following Vegetation Management Treatments in a Jack Pine Ecosystem

Northern Journal of Applied Forestry ◽

10.1093/njaf/17.3.100 ◽

2000 ◽

Vol 17 (3) ◽

pp. 100-109 ◽

Cited By ~ 8

Author(s):

D.G. Pitt ◽

Andrée E. Morneault ◽

Philip Bunce ◽

F.Wayne Bell

Keyword(s):

Pinus Banksiana ◽

Jack Pine ◽

Height Growth ◽

Volume Index ◽

Deciduous Tree ◽

Stem Volume ◽

Deciduous Trees ◽

Growing Seasons ◽

Fern Species ◽

Crown Closure

Abstract Five years of data on vegetation dynamics and succession are provided for six operational release treatments applied to three 2- to 4-yr-old jack pine (Pinus banksiana Lamb.) plantations in central Ontario. Treatments included 3 yr of annual noncrop vegetation removal, conventional aerial spray with glyphosate (1.42 kg ae/ha), ground application of glyphosate with a mist blower, basal-bark application of triclopyr, motor-manual cutting (brush saw), and no treatment. Conventional aerial spraying and annual removal resulted in the greatest jack pine crop growth, with trees exceeding 90% crown closure, 7 cm in groundline diameter, and 3 m in height (stem volume index = 5.1 dm³) after 5 growing seasons. The cover of herbaceous plants was highest (30–50%) in the aerial spray plots during the observation period. Deciduous tree, shrub, and fern species remained well represented on these plots, although total cover and height were low (≤ 35% and 1 m, respectively). Mist-blower and brush-saw plots contained mid-sized pine (3.5 dm³) with 69% crown closure. In contrast, untreated and basal-bark plots contained the smallest pine (2.3 dm3 and 31% crown closure), likely caused by heavy competition and herbicide damage, respectively. On mist-blower and basal-bark plots, good height growth was observed on untreated deciduous trees; low-shrub and fern cover remained high (46 and 30%, respectively); and herbaceous cover increased gradually to 22%. On brush-saw plots, recovery of woody cover was rapid, but height growth was relatively slow. Deciduous trees and tall shrubs dominated untreated sites (> 70% cover) by the end of the fifth growing season. Successional trends suggest that aerial spray and annual removal treatments will produce pure jack pine stands at maturity; mist blower, basal bark, and brush-saw treatments may produce mixedwood stands; and untreated plots will likely be dominated by hardwoods. North. J. Appl. For. 17(3):100–109.

Download Full-text

PAHs associated with the leaves of three deciduous tree species. II: uptake during a growing season

Chemosphere ◽

10.1016/s0045-6535(00)00268-x ◽

2001 ◽

Vol 44 (2) ◽

pp. 155-164 ◽

Cited By ~ 44

Author(s):

Mike Howsam ◽

Kevin C Jones ◽

Philip Ineson

Keyword(s):

Tree Species ◽

Growing Season ◽

Deciduous Tree

Download Full-text

Specialty Physician Designation in Referrals from a Vertically Integrated PCMH

Health Services Research and Managerial Epidemiology ◽

10.1177/2333392819850389 ◽

2019 ◽

Vol 6 ◽

pp. 233339281985038

Author(s):

Andrew D. Schreiner ◽

Keri T. Holmes-Maybank ◽

Jingwen Zhang ◽

Justin Marsden ◽

Patrick D. Mauldin ◽

...

Keyword(s):

Medical Home ◽

Univariate Analysis ◽

Cross Sectional Study ◽

Individual Characteristics ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Cross Sectional ◽

Medical Specialties ◽

The Individual

Introduction: Primary care referrals to specialty physicians once relied upon the medical skill of the specialist, the quality of past communication, and previous consultative experiences. As health systems vertically integrate, patterns of specialty physician referral designation are not known. Methods: This cross-sectional study from a patient-centered medical home (PCMH) evaluated the proportion of referrals with named specialists. All outpatient specialty referrals from the PCMH between July and December of 2014 were eligible for inclusion, and 410 patients were randomly selected for chart review. The outcome of interest was specialty physician designation. Other variables of interest included PCMH provider experience, the reason for referral, and time to specialty visit. Univariate analysis was performed with Fisher exact tests. Results: Of 410 specialty referrals, 43.7% were made to medical specialties, 41.7% to surgical specialties, and 14.6% to ancillary specialties. Resident physicians placed 224 referrals (54.6%), faculty physicians ordered 155 (37.8%), and advanced practice providers ordered 31 (7.6%). Only 11.2% of the specialty referral orders designated a specific physician. No differences appeared in the reason for referral, the referral destination, the proportion of visits scheduled and attended, or the time to schedule between those referrals with and without specialty physician designation. Faculty physicians identified a specific specialist in 21.4% of referrals compared to residents doing so in 4.9% ( P < .0001). Conclusion: Patient-centered medical home referrals named a specific specialty physician infrequently, suggesting a shift from the historical reliance on the individual characteristics of the specialist in the referral process.

Download Full-text