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Speciated particulate matter (PM)2.5 data collected as part of the Interagency Monitoring of Protected Visual Environments (IMPROVE) program in Phoenix, AZ, from April 2001 through October 2003 were analyzed using the multivariate receptor model, positive matrix factorization (PMF). Over 250 samples and 24 species were used, including the organic carbon and elemental carbon analytical temperature fractions from the thermal optical reflectance method. A two-step approach was used. First, the species excluding the carbon fractions were used, and initially eight factors were identified; non-soil potassium was calculated and included to better refine the burning factor. Next, the mass associated with the burning factor was removed, and the data set rerun with the carbon fractions. Results were very similar (i.e., within a few percent), but this step enabled a separation of the mobile factor into gasoline and diesel vehicle emissions. The identified factors were burning (on average 2% of the mass), secondary transport (7%), regional power generation (13%), dust (25%), nitrate (9%), industrial As/Pb/Se (2%), Cu/Ni/V (7%), diesel (9%), and general mobile (26%). The overall contribution from mobile sources also increased, as some mass (OC and nitrate) from the nitrate and regional power generation factors were apportioned with the mobile factors. This approach allowed better apportionment of carbon as well as total mass. Additionally, the use of multiple supporting analyses, including air mass trajectories, activity trends, and emission inventory information, helped increase confidence in factor identification. [ABSTRACT FROM AUTHOR]

The article presents a profile of a continuing medical education (CME) initiative discussed at Arizona Academy of Family Physicians (AzAFP) Clinical Education conferences. The course developed emphasized evidence-based medicine and avoided potential bias by minimizing sponsorship funding from the pharmaceutical and medical device industries. Participants of the conference highly rated the evidence-based format and indicated willingness to pay for sponsorship-free CME costs.

Background: Many physicians dispense drug samples in their offices, but this practice may not benefit patients. We analyzed the novelty and usefulness of the medications most commonly found in sample closets in primary care practices., Methods: In this cross-sectional study, we inventoried 10 sample closets from internal medicine and family practice offices in the Phoenix metropolitan area. We analyzed 23 medications found in 7 or more closets. To assess novelty, we determined whether the sample medication had a new mechanism of action, a generic version with the same mechanism of action on the market, and a generic medication for the same indication on the market. To assess usefulness, we determined whether the sample medication improved patient-oriented outcomes, safety, and tolerability. We noted the cost of a 1-month supply for a typical starting dose., Results: Ninety-six percent (n = 22) of sample closet medications had a generic medication for the same indication and 74% (n = 17) had a generic medication with the same mechanism available on the market. Only 3 medications (13%) had evidence of superior patient-oriented outcomes when compared with other medications for the same indication. Six medications (26%) demonstrated superior safety or tolerability. Only one medication (4%) was recommended as a first-line therapy in an evidence-based guideline. The mean cost for a 1-month supply of a typical starting dose was $178., Conclusions: Sample closet medications have limited novelty and usefulness and are often expensive. The widespread use of sample medications should be reexamined.

Background and Objectives: The Indian Health Service (IHS) is an educational rotation site for numerous medical students and residents. These IHS rotations may be an important factor in recruitment and retention of physicians to the IHS. We describe the combined number of student/resident rotations in the Southwest IHS and their influence on recruitment and retention. We also analyze factors related to choice of rural practice in the IHS., Methods: We conducted a survey of clinical directors and IHS physicians in Arizona and New Mexico., Results: Twenty (87%) clinical director surveys and 289 (66%) physician surveys were returned. More than 400 students/residents participate in rotations annually in the IHS in Arizona and New Mexico. Eighty-four percent of clinical directors feel that educational programs are important to recruitment. Forty-five percent of current IHS physicians participated in IHS rotations as students or residents, and 87% feel that rotating influenced their decision to join the IHS. Eighty percent of IHS physicians who teach feel that working with students and residents improves their job satisfaction. Seventy-five percent of respondents practice in rural areas. Rural medical student and resident rotations are associated with subsequent rural practice., Conclusions: Many medical students and residents rotate in the Southwest IHS. Clinical directors state that these rotations are helpful to recruitment, and IHS physicians who rotated feel it was important in their decision to join the IHS. IHS clinicians feel that teaching improves job satisfaction.