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The severe acute respiratory syndrome (SARS)-CoV-2 pandemic continues to produce a large number of patients with chronic respiratory failure and ventilator dependence. As such, surgeons will be called upon to perform tracheotomy for a subset of these chronically intubated patients. As seen during the SARS and the SARS-CoV-2 outbreaks, aerosol-generating procedures (AGP) have been associated with higher rates of infection of medical personnel and potential acceleration of viral dissemination throughout the medical center. Therefore, a thoughtful approach to tracheotomy (and other AGPs) is imperative and maintaining traditional management norms may be unsuitable or even potentially harmful. We sought to review the existing evidence informing best practices and then develop straightforward guidelines for tracheotomy during the SARS-CoV-2 pandemic. This communication is the product of those efforts and is based on national and international experience with the current SARS-CoV-2 pandemic and the SARS epidemic of 2002/2003., (© 2020 Wiley Periodicals, Inc.)

Objective: To compare commonly used dietary screeners for fat intake and fruit and vegetable intake with 24 h dietary recalls among low-income, overweight and obese African-American women., Design: Three telephone interviews were completed; measures included two 24 h dietary recalls (a weekday and weekend day) using the Nutrition Data System for Research software, the Behavioral Risk Factor Surveillance System's (BRFSS) Fruit and Vegetable Consumption Module and the National Cancer Institute's (NCI) Percentage Energy from Fat Screener., Setting: Participants were recruited from three federally qualified health centres in south-west Georgia, USA., Subjects: Participants (n 260) were African-American women ranging in age from 35 to 65 years. About half were unemployed (49.6%) and 58.7% had a high-school education or less. Most were obese (88.5%), with 39.6% reporting a BMI ≥ 40.0 kg/m(2)., Results: Mean fruit and vegetable intake reported from the 24 h dietary recall was 2.66 servings/d compared with 2.79 servings/d with the BRFSS measure. The deattenuated Pearson correlation was 0.22, with notable variation by weight status, education level and age. Mean percentage of energy from fat was 35.5% as reported from the 24 h dietary recall, compared with 33.0% as measured by the NCI fat screener. The deattenuated Pearson correlation was 0.38, also with notable variation by weight status, education level and age., Conclusions: Validity of brief dietary intake measures may vary by demographic characteristics of the sample. Additional measurement work may be needed to accurately measure dietary intake in obese African-American women.

In the United States, discussing end-of-life wishes and preferences has been taboo ever since death and dying moved from a stage of life to a medical condition. This article describes the transformative nature of a Minnesota health care initiative, Honoring Choices Minnesota (HCM). As the world's largest nongovernmental, voluntary community-centered initiative, HCM is changing the culture around speaking of death and dying, one conversation at a time.

This article discusses the use and abuse of religious beliefs and their role in divide-and-conquer strategies. Divide-and-conquer strategies are engaged to disrupt potential coalitions between and among marginalized group members, specifically sexual minority groups and people of color. Tensions between these groups have been exacerbated by the debate on same-sex marriage and comparisons between the discriminatory treatment of each group. A component of this discussion includes a brief exploration of one of the historical abuses of religious doctrine used to legitimize the marginalization of people of color and sexual minorities in the United States. For African Americans, one form of marginalization was reflected in criminalizing interracial marriage, and for members of sexual minority groups, a form of marginalization is denying group members the right to marry. The author also explores culturally competent and respectful disciplinary and clinical responses to religiously derived prejudice against sexual minority group members and people of color and discusses the implications for multicultural discourse., (Copyright 2009 by the American Psychological Association)

Crossing the Quality Chasm, the Institute of Medicine's recently issued report on the quality of health care in America, is a call to arms for the urgent redesign of the U.S. health care system. The big question confronting health care organizations is how to mount new strategies that will enhance organizational effectiveness and reduce system failures as well as individual errors. Redesign implies organizational restructuring and engineering as well as serious steps in organizational development, with the emphasis on leadership enhancement strategies focused on performance excellence. This article addresses the state of the leadership literature and concludes that massive new investments will have to be made to tackle the issues of leadership training and accountability.