This is likely to be one of the most well-cited pictures o

This is likely to be one of the most well-cited pictures of Earth
called “Blue
Marble”. It was taken on December 7, 1972, by the crew of the
Apollo 17
spacecraft. It has a distinct color of blue, because the Earth
uniquely carries
an atmosphere and 70% of the Earth’s surface is covered by the
ocean.
Atmosphere from Space
We can see our atmosphere even from space. In this figure, the
bright layer is
the atmosphere between space and Earth; both are shown here in
black.
Please note how thin the atmospheric layer is relative to Earth’s
diameter!
Another view
of the
Atmosphere
from Space

This is a zoomed-in image of the atmosphere. You will notice
that there is a
gradual color change ranging from a brownish color closer to
the Earth’s
surface that transitions to a pale blue and eventually fades into
space. The
atmosphere extends about 10,000km into space. There is no
exact top to the
atmosphere. Due to the Earth’s gravity, the number of
molecules, which
individually each carry mass, gradually decreases outward into
space. Most of
the gas molecules are within the lower atmosphere. 90% of the
atmosphere’s
mass is in its lower 10km and 99.9997% is within the lower
100km. You will
also notice that there are little blobs in the brownish colored
layer close to the
surface. This layer is called the troposphere, the lowest layer of
the
atmosphere ranging from 6-10km above sea level. This is where
we live,
clouds are formed, daily weather is observed, and the majority
of the
molecules exist. The blobs you see are seemingly giant
cumulonimbus – dense
towering clouds – often associated with thunderstorms.
Composition of the Atmosphere including
variable components (by volume)

The three elements that make up over 99.9% of the atmosphere
– nitrogen,
oxygen, and argon. These elements are abundant in the
atmosphere and have
many uses.
Pure nitrogen (N2) is used in its very cold, liquid state as it
boils at -195.8 C (or
-320F). Ted Williams, a baseball player who played for the
Boston Red Sox for
22 years, and deceased in 2002, is preserved in liquid nitrogen
since his family
members chose to have his remains frozen.
Pure oxygen (O2) is used to achieve higher temperatures, to
increase the
efficiency of waste incinerators. It is also used as an oxidizing
agent, and in
medical applications to assist and sustain a person’s respiratory
functions.
Argon (Ar) is a colorless, odorless, nontoxic, and nonreactive
gas. It creates
inert environments for growing crystals, often used in
semiconductors. It
protects materials against corrosion. It also fills the air space in
double-pane
insulating windows.
Earth’s climate system
and interactions of its
components

Two key ideas for this course, especially for the first half is:
1st: Climate is regulated by complex interactions amongst
components of
the Earth’s system.
2nd: Understanding climate change can be reduced to
understanding
how “the control knobs” function
Climate change
The knobs that control earth’s climate:
• Atmospheric composition (greenhouse effect)
• Amount of solar radiation (luminosity)
• What parts of Earth get radiation (orbit)
• Atmospheric and ocean circulation
• Earth’s albedo (fraction of solar energy reflected off earth’s
surface)
• Volcanoes
• Plate tectonics
Greenhouse Effect
We are here.
First, a bit about radiation . . .

How the control knobs work
Amount of energy reaching earth determines the climate.
Dominant source
of energy is sunlight, which when reaching Earth can heat the
land, ocean,
and atmosphere.
If a chunk of matter oscillates and interacts with light at all
possible
frequencies, it is called blackbody. And the light (energy) that
is emitted by
a blackbody is called blackbody radiation. In this manner,
although
“blackbody” is originally named for an ideal object, we
consider the Earth
as a blackbody. In fact, many objects that radiate energy back
when they
are heated are considered as a blackbody.
The Greenhouse Effect
Greenhouse gases don’t “trap”
heat; they absorb heat and re-
radiate it out to space and back
to Earth.
So, some of that sunlight is reflected back to space by the
Earth’s surface,
clouds, or ice. But much of the sunlight that reaches Earth is

absorbed and
warms the planet. When Earth emits the same amount of energy
that it
absorbs, its energy budget is in balance, and its average
temperature
remains stable.
The discrepancy between incoming solar energy and outgoing
radiation
energy is the greenhouse effect. Earth’s atmosphere contains
greenhouse
gases (e.g. CO2, CH4, etc.) that absorb 95% of the longwave
(we will learn
more about this later) back radiation emitted from the surface.
Earth’s radiation budget
Here is a breakdown of the numbers…
Solar radia)on arriving at the top of Earth’s atmosphere
averages 342 W/m2,
indicated here as 100% (upper leB). About 30% of the incoming
radia)on is
reflected and scaHered back into space, and the other 240 W/m2
(70%) enters
the climate system. Some of this entering radia=on warms
Earth’s surface
and causes it to radiate heat upward (right). The greenhouse
effect (lower

right) retains 96% of the heat radiated back from Earth’s heated
surface and
warms Earth by 31 C
̊ .
410
http://berkeleyearth.org/2018-
temperatures/
(Upper figure) Mean global air temperature variation from 1850
to 2018
In 2018, 9 of the 10 warmest years have occurred since 1990.
(Lower figure) Atmospheric CO2 variation during the same
interval
From 1960 to present: the atmospheric CO2 concentration has
been
measured in Mauna Loa, Hawaii. Before 1960, the CO2
concentration is a
reconstructed value based upon CO2 preserved in ice cores.
Ice core records
Temp.
CO2
Dust
Annually

laminated
bands
within ice
core
Thousands of years ago
Why do we use ice core records instead of observed data (which
seems to
be the more direct and reliable approach)?
This is because, unfortunately, we only have a limited number
of observed
records for us to understand the natural cycle of the Earth’s
climate – most
of the data are available only for the past 50 years of which a
few extend
past a couple hundred years. This means, for instance, if we
would like to
discuss our climate system in relation to the El Nino cycle,
which likely
occurs every 3-5 years on average, we can only refer to a few of
those
events. For this reason, we need a longer record than the
observational
record.
By using ice core records, as shown in this figure, we can study
and argue
climate/environmental variability of the past 400,000 years. If
the ice core
preserves annual layers (like tree rings), the record you are

looking at is
basically a sub-seasonal resolution of climate variability.
Climate Change in New England
Weider and Boutt, 2010
What is happening in New England?
This figure shows 12 month moving averages of temperature
data
measured at 43 observational sites across New England between
1920 and 2009. Please note that this data is an average of 12
months, and any seasonal variability is expressed much less
obvious.
There maybe a warming trend? This may be correct. However,
importantly, local temperature variability can be quite different
from
global temperature variability – it maybe even cooling in some
areas.
Receding mountain glacier due to recent warming.

0
1000
2000
3000
4000
5000
6000
7000
1000 1200 1400 1600 1800 2000
P
op
ul
at
io
n
(M
ill
io
ns
)

Time (Years)
World Population
(http://www.census.gov/ipc/www/idb/worldpopinfo.html)
1967
1920
1850
Today 7 billion
Is this temperature trend related to population growth?
Popula'on growth
If so, what will the future population be?
Check today’s population:
https://www.census.gov/popclock/
MMD-A1B 2080-2099 vs 1980-1999 IPCC 2007
Effects on Agriculture and the Ocean?
Also figures from the IPCC (Intergovernmental Panel on
Climate Change)
showing the discrepancy between simulated climate model
results 2080-2099

and observational data 1980-1999. Precipitation, soil moisture,
runoff, and
evaporation. Some areas experience drier conditions.
Source: IPCC 2007
Black line: observed temperatures
Blue: expected changes due to natural factors
Pink: expected changes due to natural factors plus greenhouse
gases
Comparison of observed continental- and global-scale changes
in surface
temperature with results simulated by climate models using
either natural or both
natural and anthropogenic forcings. Averages of observations
are shown for the
period 1906-2005 (black line) plotted against the center of the
decade and relative
to the corresponding average for 1901-1950. Lines are dashed
where spatial
coverage is less than 50%. Blue shaded bands show the 5 to
95% range for 19
simulations from five climate models using only natural
forcings due to solar
activity and volcanoes. Red shaded bands show the 5 to 95%
range for 58
simulations from 14 climate models using both natural and
anthropogenic forcings
(like CO2)

Change in Snow Depth CRCM-A2 2070
Results from another climate model showing changes in snow
depth in
North America.
An example of a positive feedback
Warming reduces the cover of snow and sea ice in the Arctic
from 2005
(right) to 2007 (left), increases the amount of heat absorbed by
exposed
water, reduces albedo, and thereby further warms the climate.
This is called
a positive feedback process.
We will learn more about “albedo” and “feedback process” later
this
semester.
November Arctic Ocean Ice Extent
Source: NSIDC
Monthly November ice
extent for 1979 to 2014
shows a decline of 4.7%
per decade relative to the
1981 to 2010 average.

Source: Steffen et al., 2008
Area of Melting on the Greenland Ice Sheet: increasing
Greenland ice sheet is also increasingly melting from 1979 to
2008.
Maps of maximum annual surface melt on the Greenland Ice
Sheet
derived from monthly ice surface temperature product of
Greenland
(2000-2016). Greenland ice sheet is also increasingly melBng!
A Multilayer Surface Temperature, Surface Albedo, and Water
Vapor Product of
Greenland from MODIS, April 2018, Remote Sensing
10(4):555,
DOI: 10.3390/rs10040555
This figure shows the amount of ice sheet lost in Greenland and
Antarctica
between 2002 and 2009.
Velicogna (2009), Geophysical Research Letters, v.36. L19503,
DOI: 10.1029GL040222
https://www.antarcticglaciers.org/2020/01/what-is-the-ice-
volume-of-thwaites-glacier/

Ice streams of Antarctica
Recent observations show that
incursions of warm ocean water cause
melting of the undersides of floating ice
shelves in West Antarctica. This could
cause a rapid and irreversible rise in sea
level.
Reference: Hillenbrand, CD., Smith, J., Hodell, D. et
al. West Antarctic Ice Sheet retreat driven by
Holocene warm water incursions. Nature 547, 43–
48 (2017). https://doi.org/10.1038/nature22995
Our own UMass faculty, Prof. DeConto
published in Nature journal in 2021 a
suggestion that if emissions continue at
their current pace, by approximately
2060, the Antarctic Ice Sheet will have
crossed a critical threshold that will
cause irreversible global sea level rise
within a human timescale.
Reference: DeConto, R.M., Pollard, D., Alley, R.B. et
al. The Paris Climate Agreement and future sea-
level rise from Antarctica. Nature 593, 83–89
(2021). https://doi-
org.silk.library.umass.edu/10.1038/s41586-021-
03427-0
https://www.antarcticglaciers.org/2020/01/what-is-the-ice-
volume-of-thwaites-glacier/
https://doi-org.silk.library.umass.edu/10.1038/s41586-021-
03427-0
Future Sea Level?

If we lose all ice in the world – what will happen to the sea
level?
Bamber et al., 2009
A simula)on model result shows what happens to the sea level,
if all sea
ice/con)nental ice (ice sheet) fully collapsed. Most of the
northern
hemisphere experiences an increase in sea level of over 1 m.
What happens
with 1 m sea
level rise?
Here are links that include recent research outcome about ice
loss from
Earth’s ice sheets. Check out the amazing and disturbing videos
in this NASA
briefing….
Snow over Antarctica Buffered Sea Level Rise during Last
Century
https://go.nasa.gov/2GeaWZb

Carbon Brief.org
http://www.carbonbrief.org/blog/2015/08/new-nasa-videos-
show-stark-ice-
loss-from-earths-ice-sheets/
Annual Arctic sea ice minimum 1979-2018 with area graph
https://climate.nasa.gov/climate_resources/155/video-annual-
arctic-sea-
ice-minimum-1979-2018-with-area-graph/
Antarctic ice loss: 2002-2016
https://climate.nasa.gov/climate_resources/154/video-antarctic-
ice-loss-
2002-2016/
https://t.co/9metgs5qRp
http://www.carbonbrief.org/blog/2015/08/new-nasa-videos-
show-stark-ice-loss-from-earths-ice-sheets/
https://climate.nasa.gov/climate_resources/155/video-annual-
arctic-sea-ice-minimum-1979-2018-with-area-graph/
https://climate.nasa.gov/climate_resources/154/video-antarctic-
ice-loss-2002-2016/
Changes in Medical Education
Scenario
Imagine you are a medical apprentice in the 1800s. Envision
your medical training during this era under the apprenticeship
model. Jump to the 1960s and envision your training under the
academic model. Finally, think of what your medical school
training might look like today.

Of particular interest for today’s training are the many
technology innovations for learning in medical schools,
including augmented reality (AR), virtual reality (VR), robotic-
assisted surgery, and minimally or noninvasive procedure
technologies. Today’s training features remote patient
monitoring (RPM) and telemedicine through a virtual model of
care (VMC), as well as learning to use the human genome for
more accurate diagnosing and patient-specific treatments.
Instructions
Write a 3–4 page paper to analyze the scope of change in
medical education from the 1800s to today, the apprenticeship
and academic models, and the importance of understanding the
history in order to help improve medical education in the future.
Do the following:
1. The textbook is suggested as the most efficient resource for
this assessment, or use other resources from those provided with
this assessment. You may also use resources you find on your
own from the History of Health Care Research tab in the Health
Care Administration Undergraduate Library Research Guide to
research the history of medical education from the 1800s,
1960s, early 2000s, and today.
. You will need to include four references in your paper, one of
which can be your textbook.
. Use the course resources provided for the remaining
references, or locate your own resources.
· Write an introduction to your paper using the Changes in
Medical Education Template [DOCX].
. Include a brief explanation of the purpose of the paper and its
main ideas.
. Refer to the Writing Support page on Campus for resources to
help you as you write and revise your paper.
· In The Changing Scope of Medical Education section of the
assessment template, analyze the scope of the changes in
medical education from the 1800s to today.
. How widespread are the newer technologies impacting medical
training?

. Have there been mandated changes or have there been cultural
changes that have impacted medical education?
· In the Apprenticeship Model vs. Academic Model section of
the assessment template, compare and contrast the
apprenticeship and academic models of medical education in the
1800s, 1960s, 2000s, and today.
. Describe the apprenticeship model and the academic model.
. Compare and contrast the similarities and differences in their
features.
. Analyze how the models have evolved over time and the
impact the evolution of these models has had on the quality of
patient care.
· In the Importance of Understanding History of
Medicine section of the assessment template, explain the
importance of understanding the history of medical education in
order to help improve medical education in the future.
· Write a conclusion to your paper in which you summarize the
main themes you addressed.
· Cite all the resources you used in your paper in APA 7TH
Edition format.
Additional Requirements
· Your paper should be 3–4 pages, in addition to the title page
and references page.
· Double space and use Times New Roman, 12-point font, as is
provided in the template.
· Use a minimum of four resources; you may include the
textbook and other course resources.
· Respond to all parts of the template, using the headings
provided.
· Support all points with credible evidence, in the form of APA
citations.
· Include a references page in APA format with appropriate
citations.
Competencies Measured
By successfully completing this assessment, you will
demonstrate your proficiency in the following course

competencies and scoring guide criteria:
· Competency 3: Analyze the development of medical education
in the United States.
. Analyze the scope of change in medical education from the
1800s to today.
. Compare and contrast the apprenticeship model and the
academic model of medical education.
. Analyze the impact of the evolution of the models on patient
care.
. Analyze why it is important to understand the history of
medicine in order to improve medical education.
· Competency 4: Communicate in a manner that is scholarly,
professional, and respectful of the diversity, dignity, and
integrity of others.
. Articulates meaning relevant to the main topic, scope, and
purpose of the prompt.
. Applies APA formatting to in-text citations and references.
2
3
Your Full Name (no credentials)
Capella University
BHA-FPX4002: History of the United States Health Care
System

Instructor’s Name
Date
Write your introduction here. Include a brief explanation of the
purpose of the paper and its main ideas.The Changing Scope of
Medical Education
Analyze the scope of change in medical education from the
1800s to today. How widespread are the newer technologies
impacting medical training? Have there been mandated changes
or have there been cultural changes that have impacted medical
education?
Apprenticeship Model vs. Academic Model
Description and Comparison of Both Models
Describe both the apprenticeship and academic models of
medical education in the 1800s, 1960s, early 2000s, and today.
Compare and contrast the features of both models.
Analysis of Evolution and Impact
Analyze how the two models have evolved over time and
the impact the evolution of these models has had on the quality
of patient care.
Importance of Understanding History of Medicine
Explain why it is important to understa nd the history of medical
education in order to help improve medical education in the
future. Be sure to provide examples that illustrate your point.
Conclusion
Summarize the main themes of your paper.
References
(Include a minimum of four resources, all of which must be
cited in the body of your paper.)
Young, K. M., & Kroth, P. J. (2018). Sultz & Young's health
care USA: Understanding its organization and delivery (9th
ed.). Jones & Bartlett Learning.

Historical Health Care Trend Analysis
In this assessment, you will review the private and public health
legislation, regulatory agencies, and quality initiatives that have
catapulted the United States into the quality revolution that we
are experiencing today. As this quality revolution continues,
health care professionals can expect to see more innovations
contributing to individual patient and population health quality
initiatives, with many more regulations to come.
Scenario
You are a health care educator for a large integrated
accountable care organization (ACO). You are tasked to work
with a group of hospital executives to identify milestone events
for three eras, the 1800s, 1900s, and 2000s, and identify trends
from those events that impacted the health care industry. The
trend analysis will consist of three critical measures: access,
quality, and costs. Milestone events and trends identified for
these three measures over time should include legislation,
regulatory agencies, and quality initiatives in the various time
periods. The final paper will be used in an annual strategic
planning session attended by the ACO and hospital executives
to demonstrate how the quality movement has evolved into a
quality revolution.Instructions
Write a 2–3-page paper in which you explain and analyze health
care regulations and medical practice evolutionary changes for
access, quality, and cost, including the significant milestone
events from different time periods.
Complete the following:
1. References and citations:
. You are required to reference a total of three scholarly
sources in your paper.
. Be sure to cite these references within the body of your paper
correctly using APA style citations. Refer to Evidence and

APA in the Capella Writing Center for help with using APA
style.
· Complete the Trend Analysis Table: Evolution of Access,
Quality, and Cost in Health Care in the appendix for the
assessment template.
. For each time period, select 2 milestone events or regulations
. There should be a total of 18 milestone events or regulations
in the completed table.
. Include bullet points with notes that describe each event or
regulation and how it impacted access, quality, or cost.
· Write an introduction for the paper using the Historical Health
Care Trend Analysis Template [DOCX].
. Provide a brief explanation of the purpose of this historical
trend analysis and how it might be used in your work as a health
administrator (1 paragraph).
· Use the Trend Analysis Table: Evolution of Access, Quality,
and Cost in Health Care table to write the body of your paper.
. Complete the Trends and Regulations section in the assessment
template.
. Provide a brief description of the key measures of health care
services, which are access, quality, and cost (1–2 paragraphs).
. In the Health Care Access subsection, explain the significant
trends and regulatory milestones associated with access to
health care over the recent eras (1–2 paragraphs).
. What U.S. legislation, regulatory agencies, and quality
initiatives from the 1800s, 1900s, and 2000s have influenced
access to health care services in the United States?
. What does your milestone trend analysis reveal for access to
care?
. Include citations and references to specific regulations, events,
or agencies.
· In the Health Care Quality subsection, explain the significant
trends and regulatory milestones associated with health
care quality over the recent eras (1–2 paragraphs).
initiatives from the 1800s, 1900s, and 2000s have influenced

care quality in health care services in the United States?
. What does your trend analysis reveal for care quality?
or agencies.
· In the Health Care Cost subsection, explain the significant
trends and regulatory milestones associated with access to
health care costs over the recent eras (1–2 paragraphs).
initiatives from the 1800s, 1900s, and 2000s have affected
health care costs for medical services?
. What does your trend analysis reveal for medical service
costs?
or agencies.
· Complete the Trend Analysis section of the assessment
template (1–2 paragraphs).
· Analyze the trends and regulations in health care access,
quality, and cost to draw conclusions about the evolution of
health care regulations and practice throughout the recent eras.
· Describe professional experiences or examples to illustrate the
trends.
·
· Write the conclusion for the paper (1 paragraph).
· Briefly restate the trends revealed for health care access,
quality, and cost.
· Draw a conclusion about how the milestones, regulations, and
changes have improved, been neutral, or inhibited progress of
the U.S. health care system.
· Summarize clear and concise conclusions of your trend
analysis. Additional Requirements
· Your paper should be 2–3 pages, in addition to the title page,
appendix, and references page.
· Double space your paper, and use Times New Roman, 12-point
font, as indicated in the assessment template.
· Use a minimum of three resources. This may include your
textbook and other course resources.

· Complete all parts of the assessment template, using the
headings provided in the template.
citations.
citations.
· Complete the Trend Analysis Table: Evolution of Access,
Quality, and Cost in Health Care in the appendix of the
assessment template.Competencies Measured
· Competency 1: Analyze trends in the U.S. health care system
from a historical perspective.
. Identify health care legislative, regulatory agency, and quality
initiative events in a trend analysis table of different eras.
· Competency 2: Explain the development of health regulation
and the evolution of medical practice.
. Explain the significant trends and regulatory milestones
associated with access to health care over the recent eras.
associated with health care quality over the recent eras.
associated with health care costs over the recent eras.
. Analyze the trends and regulations in health care access,
health care regulations and practice throughout the recent eras.

Comparative Analysis: Physician Practice Evolution
EXAMPLE PAPER
Learner’s Name
School of Business, Technology, and Health Care
Administration, Capella University
BHA4002/BHA-FPX4002: History of the United States Health
Care System
Capella Instructor’s Name
Date
Note: This is an example paper written on the evolution of
physician practices. The actual assessment is a comparative
analysis of the evolution of hospitals.
2
Example-only Comparative Analysis Paper
© Capella University, Not for Distribution
Comparative Analysis: Physician Practice Evolution

In this comparative analysis report, the evolution of physician
practice is reviewed from the 1800’s
through the 2000s. The purpose of this report is to show the
progress of how physician practices, their
staff and payment systems have changed over the last three
centuries. The irony is that they have
changed, and they have also gone full circle as explained below.
In the 1800 and 1900 centuries, the relationship with the
physician was very personal and patient-
centered. The physician knew everything about their patient,
and the patient knew everything about their
hometown physician. As medicine evolved, physicians became
more specialized, and focused on specific
diseases. This often removed that personal relationship between
physician specialist and patient. The
irony is that the 2019 COVID pandemic put a spotlight once
again on the primary care physician-patient
relationship, but in a much broader context. The pandemic
showed us the importance of the primary and
community healthcare (P&CHC) systems focus (Lauriola, et al.,
2021). The pandemic revealed a
weakness in P&CHC worldwide, i.e., it put a focus on hospital
and intensive care beds and not on
community and primary care. In Lauriola et al. (2021), the

authors propose that the pandemic has shown
us that P&CHC is where the focus needs to be though local
community problem-solving to safeguard
communities, which brings us back to the primary care
physician and infrastructure at the community
level, but in a context of global world health (Lauriola et al.,
2021).
Comparative Grid and Analysis
In Appendix A, the table entitled The Physician Practice
Evolution and Changes shows how the
physician practice has progressed. There are several major
milestones that stand out in the table which
includes the evolution of the physicians’ offices, the training of
their staff, and how they were paid
compared to payment systems today.
The Physician Practice
In the 1800s, physicians would often go to see the patient at
their home (Nespor, 2009).
Physicians were solo practitioners around the turn of the 19th
century. By the mid-1900s physicians were
more likely to be in a group practice of two or more providers
(Kroth & Young, 2018). In the early 1990s,
healthcare markets began to consolidate nationwide due to

rising healthcare costs and reduced
reimbursement. By the 1990s group practices began to integrate
horizontally into Independent Practice
3
Associations (IPAs) (Kroth & Young, 2018). The IPAs then
vertically integrated with hospitals and formed
Physician-Hospital Organizations (PHOs). The PHOs were
established to retain and gain market share
through managed care contracting and used shared purchasing
groups to achieve cost-savings (Kroth &
Young, 2018; Williams & Cuneo,1997).
Physician Staff
In the 1800s, the physician most often worked as a solo
practitioner without an assistant. If they
had an assistant, it was someone that they personally trained
(Nespor, 2015). By the 1960s, due to
population growth and the demand for health services,
physicians time became a scarce commodity, and

the nurse practitioner movement began (Kroth & Young, 2018).
This movement persists today because of
population demand and the projected physician shortages
(AAMC, 2021).
Payment Systems
From the 1800s to the early 1900s, physicians were paid in
small amounts of cash, or in food
and services from their patients (Allen, 2016). As healthcare
costs rose between 1960-2000, physicians’
fees declined. The physicians’ reimbursement changed from fee-
for-service to discounted fee-for-service
and capitation (Kroth & Young, 2018). Capitation is a flat
prepaid fee to providers per member per month
(PMPM) from the managed care organizations (MCOs) (Kroth &
Young, 2018).
Comparative Analysis Summary
In the 1800s, the physician’s office was often their home. By
the 1960s offices were centrally
located and often group practices with two or more physicians.
In the 1800, physicians extenders did not
exist. In the 1960s and still today the educational programs for
NP and PA are well established and the
physician extender, working under the supervision of the
physician, is common.

One of the biggest changes in the physician practice has been
in the reimbursement for their
services. In the 1800s, physicians received payment in cash or
food and services. Blue Cross (BC) was
established in 1929, Medicare and Medicaid in 1965 as fee for
service payers. However, by the early
1990s markets consolidated and managed care organizations
were on the rise promoting care quality and
cost containment.
4
Conclusion
In conclusion, the evolution of the physicians practice has been
progressively positive, and the
improvements have established higher quality of care in medical
practices today. The changes in the
physician’s medical practice have been and will continue to be

dynamic and persistent. However, the
medical industry is unable to ignore what the 2019 COVID
pandemic has revealed, i.e., the importance of
the primary and community healthcare (P&CHC) systems focus.
Although, the primary care and specialty
care physicians will continue to manage patient care and
prevention at the community level they will need
to do so within a broader world-health context.
5
References
Allen, E. (2016, April 28). Paying the doctor in 18th-century
Philadelphia. Library of Congress.
https://blogs.loc.gov/loc/2016/04/paying-the-doctor-in-18th-
century-philadelphia/
Association of American Medical Colleges. (2021, June 11).
AAMC report reinforces mounting physician
shortage. https://www.aamc.org/news-insights/press-

releases/aamc-report-reinforces-mounting-
physician-shortage
Berenson, R. A., & Rich, E. C. (2010). US approaches to
physician payment: The deconstruction of
primary care. Journal of General Internal Medicine, 25(6), 613–
618.
https://doi.org/10.1007/s11606-010-1295-z
Kroth, P. J., & Young, K. M. (2018). Sultz & Young's health
care USA: Understanding its organization and
delivery (9th ed.). Jones & Bartlett.
Lauriola, P., Martín-Olmedo, P., Leonardi, G. S., Bouland, C.,
Verheij, R., Dückers, M., van Tongeren, M.,
Laghi, F., van den Hazel, P., Gokdemir, O., Segredo, E., Etzel,
R. A., Abelsohn, A., Bianchi, F.,
Romizi, R., Miserotti, G., Romizi, F., Bortolotti, P., Vinci, E.,
Giustetto, G., … Zeka, A. (2021). On
the importance of primary and community healthcare in relation
to global health and
environmental threats: lessons from the COVID-19 crisis. BMJ
Global Health, 6(3), e004111.
https://doi.org/10.1136/bmjgh-2020-004111
Nespor, C. (2009, March 11). 19th century doctors in the U.S.
Melnick Medical (History) Museum.

https://melnickmedicalmuseum.com/2009/03/11/19th-century-
doctors-in-the-us/
Nespor, C. (2015, October 28). Doctors’ offices. Melnick
Medical (History) Museum.
https://melnickmedicalmuseum.com/tag/doctors-offices/
Williams, W. C., III, & Cuneo, K. F. (1997). Physician-hospital
organizations and PHO executives. What
lies ahead for the PHO? Physician Executive, 23(2), 13–15.
http://web.b.ebscohost.com.library.capella.edu/ehost/
6
Appendix A
The Physician Practice Evolution and Changes
Theme 1800s 1960s 2000s
The
Physician’s
Office
• Often the

providers home
• Often the patients
home (Nespor,
2009).
• Single Physician
Office (Nespor,
2009).
• Small group
Practice of 2-4
physicians (Kroth
& Young, 2018).
• Independent Physician
Associations (IPAs).
• Consolidation of market
with larger physician
groups contracted with
Hospitals, i.e., Physician
Hospital organizations
(PHOs). (Kroth & Young,
2018).
The
Physician
Assistant
• None with formal
training.
• Trained by the
physician to assist
them (Nespor,

2015).
• Office staff, may
include RN, LPN,
or MA
• Often trained by
the physician to
assist them
(Kroth & Young,
2018).
• Specialization, Physician
extenders, Nurse
practitioners (NP) and
Physician Assistants
(PA)
• Lab Technicians,
Radiology Technologists
(Kroth & Young, 2018).
The
Physician
Payment
Systems
• Small cash
payments
• Goods, such as
coffee, tea, wine,
and beer; and
services such as
carpentry, painting
and so on were

offered as
payment (Allen,
2016).
• Fee-for-Service:
Private pay.
• Early insurance
payments form
BCBS (1929),
• 1965 and
beyond,
Medicare and
Medicaid (Kroth
& Young, 2018).
• Medicare Physicians Fee
Schedule (PFS),
Resource-Based
Relative Value Scale
(RBRVS),
• Capitation, one fee per
member per month
(PMPM) (Kroth & Young,
2018).

Historical Trend Analysis
Capella University
System
Instructor’s Name
1
2
Date
Historical Trend Analysis
Write your introduction here. Provide a brief explanation of the
purpose of this historical trend analysis and how it might be
used in your work as a health administrator (1 paragraph).
Where appropriate, reference significant health care milestones,
regulations, and measures for access, quality, and cost.
Trends and Regulations
Provide a brief description of the key measures of health care
services, which are access, quality, and cost (1–2 paragraphs).
Health Care Access
Explain why access to health care is important and what it
means. What U.S. legislation, regulatory agencies, and quality
initiatives for the 1800s, 1900s and 2000s have influenced
access to health care services in the United States. What does
your milestone trend analysis reveal for access to care? (1–2
paragraphs)
Health Care Quality
Explain what quality health care is and why it is important.
What U.S. legislation, regulatory agencies, and quality
initiatives for the 1800s, 1900s and 2000s have influenced care

quality in health care services in the United States. What does
your trend analysis reveal for care quality? (1–2 paragraphs)
Health Care Cost
Explain what health care cost is and why it is important.
What U.S. legislation, regulatory agencies, and quality
initiatives for the 1800s, 1900s and 2000s have affected health
care costs for medical services. What does your trend analysis
reveal for medical service costs? (1–2 paragraphs)
Trend Analysis
Analyze the trends and regulations in health care access,
health care regulations and practice throughout the recent eras
(1–2 paragraphs). Describe professional experiences or
examples to illustrate the trends. Include citations and
references to specific regulations, events, or agencies.
Conclusion
Summarize clear and concise conclusions of your trend analysis
(1 paragraph). What are the trends revealed for health care
access, quality, and cost? Draw a conclusion about how the
changes have improved, been neutral, or inhibited progress of
the U.S. health care system.
References
Kroth, P. J., & Young, K. M. (2018). Sultz & Young's health
care USA: Understanding its organization and delivery (9th
ed.). Jones & Bartlett.
Appendix
Trend Analysis Table: Evolution of Access, Quality, and Cost in
Health Care
Milestones
Health Care Access
Health Care Quality
Health Care Costs

1800s
Regulatory Legislation, Agencies, or Quality Initiatives
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note
1900s
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note

Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note
2000s
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note
Year, Milestone
· Note
· Note

Evolution of the Hospital Industry: A Comparative Analysis
Capella University
System
Instructor’s Name
Date
2
2
Write your introduction here. Include a brief explanation of the
purpose of the paper and main ideas. Reference significant
trends that you noticed as appropriate (1 paragraph).
Hospital Care Evolution
Provide a brief overview of the evolution of hospital care from
the 1800s to the 1960s to today (1 short paragraph).
Hospital Environment
Describe your findings about hospital environme nts from the
1800s, 1960s, and 2000s
(1 paragraph).
Staff Education
Describe your findings about hospital environments from the
1800s, 1960s, and 2000s
(1 paragraph).
Level of Care
1800s, 1960s, and 2000s
(1 paragraph).
Paying for Your Care

1800s, 1960s, and 2000s
(1 paragraph).
Comparative Analysis
Write a brief summary of your comparisons and analysis about
the significance of the key changes from the different time
periods. Draw conclusions about how the hospital industry has
evolved from the 1800s, to the 1960s, to today, and about the
significance of the key milestones from the different time
periods. Give specific examples of the impact on the quality of
patient care during these time frames (1–2 paragraphs).
Conclusion
Summarize clear and concise conclusions drawn from your
comparisons and analysis about the different time periods and
the hospital environment, staff education, level of care, and
payment for care topics. Explain why it is important to study
the history of hospital care for your profession (1 paragraph).
References
(Include a minimum of three resources, all of which must be
cited in the body of your paper.)
Young, K. M., & Kroth, P. J. (2018). Health care USA:
Understanding its Organization and delivery (9th ed.). Jones &
Bartlett Learning.
Appendix
Comparative Analysis Table: Hospital Care Evolution
Instructions: Fill in the chart with bullet points that describe the
key milestones (events, regulations, laws, etc.) and the
supporting details to explain the topics in each cell. Use your
textbook and at least two other resources from the course
resources for this assessment or your own research, and
document where you found the information using accurate APA
citations.

Subject/Topic
1800s
1960s
2000s
Hospital Environment
(Describe the overall hospital environment.)
Medical Staff Education Level
(Describe the care providers and their education levels.)
Level of Care
(Describe the quality of care for each century and if it
improved.)
Paying for Care
(Describe how care was paid for.)
Instructions
Write a 2–3 page paper about the similarities and differences in
hospital care from the different time periods (1800s, 1960s, and

today), as well as the conclusions you drew from your analysis.
Include a research table in the appendix of your paper.
Complete the following:
1. Research how the hospital industry has evolved in terms of
hospital environment, medical staff education, level of care in
hospitals, and payment systems.
. You will need to reference a total of three scholarly sources in
your paper.
. Be sure to cite these references within the body of your paper
correctly using APA 7th Edition style citations.
· Complete the Comparative Analysis Table: Hospital Care
Evolution, located in the appendix of the Comparative Analysis
Template [DOCX].
. Provide two descriptive changes for each time period under
each of the headings.
. Add bullet points to each cell in the table to document the
descriptive changes that you have found for each topic.
. Document the source where you found the information for
each cell in the table, using APA-style citations.
· Write an introduction to the paper using the Comparative
Analysis Template [DOCX].
. Include a brief explanation of the purpose of the paper and
main ideas.
. Reference significant trends that you noticed as appropriate.
. Refer to the Writing Support page on Campus for resources to
help you as you write and revise your paper.
· Write the body of the paper.
. Write the Hospital Care Evolution section in the assessment
template, using the information from the Comparative Analysis
Table you completed.
. Describe your findings about each topic in the different time
periods under each subtopic heading.
. Explain the trends in hospital environment, medical staff
education, level of care in hospitals, and the payment systems in
a short paragraph (3–4 sentences) for each topic, using the
subheadings provided in the assessment template.

. Cite all references used within the body of your paper using
APA-style citations.
· Write the Comparative Analysis section (1–2 paragraphs) in
the assessment template.
. Write a brief summary of your comparisons and analysis about
the significance of the key changes from the different time
periods.
. Draw conclusions about how the hospital industry has evolved
from the 1800s to the 1960s to today and about the significance
of the key milestones from the different time periods.
. Give specific examples of the impact on the quality of patient
care during these time frames.
· Write a conclusion paragraph where you summarize the main
ideas included in the paper.
· Explain why it is important to study the history of hospital
care for your profession.
Additional Requirements
· Your paper should be 2–3 pages, in addition to the title page,
appendix, and reference page.
· Double space your paper, and use Times New Roman, 12-point
font, as indicated in the assessment template.
· Use a minimum of three resources.
· Complete all parts of the assessment template, using the
headings provided in the template.
citations.
citations.
· Complete the Comparative Analysis Table: Hospital Care
Evolution table in the appendix of the assessment template.
Competencies Measured

· Competency 1: Analyze trends in the U.S. health care system
from a historical perspective.
. Compare and contrast the hospital environments of the 1800s,
1960s, and today.
. Compare and contrast the level of care provided in hospitals of
the 1800s, 1960s, and today.
. Compare and contrast the payment systems in the hospitals of
. Draw conclusions about how the hospital industry has evolved
from the 1800s, to the 1960s, to today.
· Competency 3: Analyze the development of medical education
in the United States.
. Compare and contrast the staff education level in hospitals of
· Competency 4: Communicate in a manner that is scholarly,
professional, and respectful of the diversity, dignity, and
integrity of others.
. Appropriately addresses all components of the assessment
prompt, using the assessment description to structure text.
. Apply APA 7th Edition formatting to in-text citations and
references.
Arctic Climate Change
The difference during summer
is increasing as the sea ice
extension is decreasing in
relation to the recent past.
http://nsidc.org/arcticseaicenews/

In lecture 1, we learned about the seasonal migration of Arctic
sea ice extension. In this figure, it is very clear that 2012 was
exceptional because the Arctic sea ice during that summer was
at the greatest minimum ever observed, dropping far below the
mean of the long term trend. Let’s take a look what happened
after, particularly in 2016.
(National Snow and Ice Data Center)
This figure is based on a report of sea ice extension in
November
2016. At the end of summer in 2016, the minimum sea ice
extension was the second lowest after the 2012 extension (left
red arrow). As the season migrates and turns colder, the sea ice
did not grow back as fast as it should have relative to all
previously measured patterns (right red arrow). By November,
the
sea ice extension was the lowest ever recorded in November.
What was happening in 2016?
Daily mean temperatures for the Arctic area north of the
80th northern parallel. (Danish Meteorological Institute)
Arctic temperatures are about 20 degrees Celsius higher than
normal
above 80 degrees North Latitude! (Nov 2016).

This figure shows daily temperature measurements in the Arctic
at 80 degrees north in
2016 (red line) along with a computer simulation of temperature
patterns based on long-
term temperature measurements of the Arctic region (green
line). The blue line is the
point of freezing (0 degree Celsius). Please note that Y-axis
identifies temperature shown
in units Kelvin (K). Kelvin is a commonly used unit of
measurement in science for
temperature. Please see the following slide for more detail. The
X-axis identifies the
number of days in 2016. For example, the day 1 indicates
January 1st, and the day 365
equates to December 31st.
As you can see, there is seasonal variation. You will also notice
that, most of the year, the
temperature remains below the freezing level (blue line),
although it will slightly exceed
freezing for a short period of time during summer. In November
of 2016, the temperature
north of 80 degrees latitude was around -5 degrees C. This is
below freezing (not by
much), but is anomalous to the normal temperature of around -
25 degrees C (see vertical
blue dashed line). The temperature difference between the long
term mean (green line)
and the observed temperature (red line) was as great as 20
degrees!!
(continue)

(continued)
Why was this happening? Why did it happen in the Arctic? This
phenomenon is
known as polar amplification and it is important that we learn
about this
concept to understand how and why changes in our climate
system affect
different parts of the world unequally. For now, maintain an
awareness of polar
amplification as we will learn more about this concept in the
following weeks.
In the meantime, please take a moment to think about whether
such daily
temperature changes north of 80 degrees latitude are considered
“climate” or
“weather”?
Further, please check the latest news from Arctic Sea Ice News
and Analysis for
additional information: https://nsidc.org/arcticseaicenews/
A recent science study reports that
rapid warming in the Arctic is a likely
driver of the recent extreme winter
weather in the US.
https://www.science.org/doi/10.11
26/science.abi9167?utm_campaign
=SciMag&utm_source=Social&utm_
medium=Twitter
https://nsidc.org/arcticseaicenews/
https://www.science.org/doi/10.1126/science.abi9167?utm_cam
paign=SciMag&utm_source=Social&utm_medium=Twitter

Fahrenheit is a temperature scale based on one proposed in 1724
by the
German physicist Daniel Gabriel Fahrenheit. 0 F was the lowest
temperature
Dr. Fahrenheit could measure, 100 F is the average human core
body
temperature. In scientific measurement, Kelvin is more common
because by
definition 0 Kelvin is called absolute zero. Absolute zero is
theoretically the
lowest possible temperature where all molecules seize their
motion (almost no
heat is emitted by the molecule). In this slide, temperatures in
Fahrenheit,
Kelvin, and Celsius are compared in the same scale.
Weather Forecasting
• Weather affects nearly everyone, every day.
• Weather forecasts are issued:
o To save lives
o Reduce property damage
o Reduce crop damage
o To let the general public know what to expect
• Forecasts are often utilized to make many important decisions
on
a daily basis

• So how is it done, and how is it done correctly?
National Weather Service Mission:
• The NWS provides weather, hydrologic, and climate
forecasts and warnings for the US, its territories,
adjacent waters, and ocean areas for the protection
of life and property and the enhancement of the
national economy.
Tools available to a forecaster…
• Weather Observations
(including surface data, satellite data, and radar data)
• Commercial aircraft data
• Wind profilers
• Numerical Model Output
…There are a lot of sources for data!
Forecasting technique - Persistence
13Image from WW2010 Online Guide
The most primitive method of forecasting is to observe and

estimate that
there will be no changes to the present. Today is sunny,
therefore, tomorrow
will also be sunny. This may work relatively well in a dry and
arid region, but
does it work in the New England region? Probably not.
The Trend Technique
15Image from Meteorology Today by C. Donald Ahrens
Another method of forecasting that has been used in the more
recent past is to
understand trends. As we all know, however, weather systems
migrate from west
to east in the mid latitude, where we live, due to prevailing
wind called the
westerly (we will cover this in the following weeks). The
atmospheric pressure
system, in general, crosses over North America in 3 to 5 days.
With this, the
system travels approximately 800 miles per day. With this
understanding, we can
broadly predict when a storm will approach a specified region.
Can this be used
to make an accurate prediction? Although this maybe not be a
desirable way to
forecast for a long-term period, it may work for a shorter and
current time
interval.

The Analogue Technique
17
The analogue technique is a combination of climate and
weather. Based on long-
term observations, you might be able to identify a clear pattern
in the
atmospheric system. For instance, you may notice that,
statistically, when a dry
and cold weather pattern is observed in the northwest (high
pressure system),
there is a tendency for stormy weather in the northeast (low
pressure system).
This method could be useful and may produce relatively reliable
results for
slightly longer time periods (few days to a week).
Accuracy and skill in forecasting
After you learn about forecasting techniques, you may be asking
yourself
– what is an ”accurate” forecast?
• What is an accurate forecast?
o Your forecast for tonight’s minimum temp is 0F
If the actual minimum was 1F, is it inaccurate??
If the actual minimum was 10F, is it inaccurate??
o Accuracy (in forecasting) is arbitrary and relative – it is not

clearly or objectively defined.
19
Modern weather forecasts are based on model
forecasts
– Numerical Weather Prediction
In order to increase accuracy, we heavily rely on numerical
weather prediction.
• Predict the state of the atmosphere (e.g., pressure,
temperature, precip, winds, etc) in time
• Use mathematical equations – initialized with observational
data
…Why are models often wrong?
20
Problems with numerical modeling
21
• Models represent a “simplified” atmosphere – not every real
process in atmosphere can be resolved in models.
• Many are not global in coverage
• The initial atmospheric state is not well-known

• The data may also have errors in it
• The model equations compute quantities at grid points (30-
50km).
• The atmosphere is fundamentally chaotic!
So, the atmosphere is fundamentally chaotic and this is why
weather
forecasting, although state of the art, is still not perfect.
Therefore, in order
to understand the climate system, scientists focus on key
phenomena and/or
relationships that effectively control or alter the climate system
of the Earth.
Here, we call them the “climate knobs” and let’s talk more
about it in the
next lecture.
Here is a news from weather forecast development:
Artificial Intelligence May Be Key to
Better Weather Forecasts
Recent advances in machine learning
hold great potential for converting a
deluge of data into weather forecasts
that are fast, accurate, and detailed.
By Sid-Ahmed Boukabara, Vladimir
Krasnopolsky, Jebb Q. Stewart, Stephen
G. Penny, Ross N. Hoffman, and Eric
Maddy, 1 August 2019
https://eos.org/opinions/artificial-intelligence-may-be-key-to-
better-weather-forecasts

mailto:[email protected]
https://eos.org/opinions/artificial-intelligence-may-be-key-to-
better-weather-forecasts
https://www.ncdc.noaa.gov/billions/overview
“In 2021, there were 20 weather/climate disaster events with
losses exceeding $1 billion each
to affect the United States.” “Overall, these events resulted in
the deaths of 688 people and
had significant economic effects on the areas impacted.”
https://www.ncdc.noaa.gov/billions/overview
https://www.noaa.gov/news/2021-was-worlds-6th-
warmest-year-on-record
2021 was world’s 6th-warmest year says NOAA
https://medialibrary.climatecentral.org/resources/2020-in-
review-global-temperature-rankings
– Could we have predicted that 2021
would become the 6nd warmest year on
record or predict what 2022
temperatures will look like when the
report becomes available? The answer
is no. However, you can look into the
long-term trend and anticipate what
likely will happen in the future!
(weather vs climate)
https://www.noaa.gov/news/2021-was-worlds-6th-warmest-year-

on-record
https://medialibrary.climatecentral.org/resources/2020-in-
review-global-temperature-rankings
Please take a moment to read the article published in March
2017 about our
perceptions of climate change. This was before the catastrophes
caused by Hurricane
Harvey and Hurricane Irma in 2017.
How Americans Think About
Climate Change, in Six Maps
By NADJA POPOVICH, JOHN SCHWARTZ
and TATIANA SCHLOSSBERG
MARCH 21, 2017
https://www.nytimes.com/interactive/201
7/03/21/climate/how-americans-think-
about-climate-change-in-six-maps.html
https://www.nytimes.com/interactive/2017/03/21/climate/how -
americans-think-about-climate-change-in-six-maps.html
Example Test 1 question:
Climate differs from weather in that
A. climate is a broad composite of temperature
conditions, while weather addresses temperature
as well as precipitation, snow and ice cover, and
wind conditions.
B. climate change occurs over longer durations than
do weather changes.

C. climate change is exclusively global, whereas
weather is exclusively regional.
D. climate and weather do not differ, they are
interchangeable terms.
At last, here is an example questions in preparation for the test.
The
questions in test 1 will be similar in format to this question, but
not
necessarily the same question.
The answer is B.

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