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In the US, end-of-life health care (EOLHC) is often intensive and invasive, and at times may involve care that is inconsistent with patient values. US Muslims may not receive appropriate religious support, experience uncertainty around end-of-life decision-making, and under-utilize palliative and hospice care. As technological advancements and treatment options rise in EOLHC, Muslim American patients and their families need to understand more about the treatment options that are consistent with their beliefs. The objective of this study was to determine the efficacy of a pilot mosque-based educational workshop focused on increasing Muslim Americans' religious bioethics knowledge about end-of-life healthcare. Intervention sites were four mosques with racially and ethnically diverse members, two in the Chicago metropolitan area and two in the Washington, D.C. area. Eligible participants were self-reported Muslims, aged 18 years or older, who were proficient in English. The intervention included a pre and post-test survey and a workshop focused on the Islamic bioethical perspectives on EOLHC. Knowledge was measured with six true-false questions. Baseline and post-intervention scores were analyzed by McNemar's test and bivariate correlation. Overall, the analysis showed a significant improvement in post-intervention participant knowledge. There was increased knowledge of Islamic bioethical views on the moral status of seeking healthcare, brain death controversies, and religious perspectives on withholding or withdrawing life support near the end of life. Our pilot intervention successfully increased participant knowledge and underscores the need to improve the Muslim community's knowledge about the bioethical dimensions of EOLHC. [ABSTRACT FROM AUTHOR]

Introduction: Organ donation-related education is offered, and decisions are made at state Department of Motor Vehicles; however, little is known about Muslim Americans' attitudes toward these common practices. Research Questions: Are participants comfortable learning about deceased organ donation in the Department of Motor Vehicles setting? Are participants prepared to make deceased organ donation-related decisions at the Department of Motor Vehicles? Design: A survey of Muslim Americans attending an educational workshop at 4 mosques in two US cities. Primary study outcomes were self-reported (a) preparedness to make deceased donation-related decisions and (b) comfort with receiving organ donation education in the license renewal setting. We calculated Pearson product-moment correlations between these primary outcomes and participant characteristics including sociodemographic descriptors, religiosity and religious coping measures, and discrimination measures. Results: Most respondents indicated they were not prepared to make organ donation-related decisions at the Department of Motor Vehicles (79.6%). Preparedness did not vary by age, gender, country of origin or US residency duration, nor by religiosity, negative religious coping, or experiences of discrimination. However, higher scores on positive religious coping were associated with lower ratings of preparedness. A slight majority (58.9%) of respondents were comfortable receiving organ donation education. Conclusions: Muslim Americans are comfortable with learning about organ donation while at the Department of Motor Vehicles but are ill-prepared to make deceased donation-related decisions in the same setting. Further research is required to understand whether changes to the license renewal setting would improve decision-making outcomes in this population. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Renal replacement therapies (RRT) other than in‐centre haemodialyses are underutilised by African Americans with end‐stage renal disease (ESRD) even though they are associated with reduced costs, morbidity and mortality as well as improved quality of life for patients. Objectives: To understand African American patients' knowledge of RRT options and how patient, provider and system‐factors contribute to knowledge and preferences. Participants' interviews were conducted at the University of Chicago Medical Center with African American patients with chronic kidney disease (CKD). The final analysis included 28 interviews; 22 patients had CKD not yet on dialysis or having received a transplant, while 6 had reached ESRD and were receiving treatment for kidney failure. Approach Transcripts were uploaded into NVivo8 for coding. Thematic analysis was used for data interpretation. Results: Four themes were identified: (1) limited knowledge of home modalities and deceased donor options, (2) CKD patients gave little thought to choosing RRT options, (3) CKD patients relied on doctors for treatment decisions, and (4) while patients reported knowledge of living kidney donation transplants (LKDT), it did not translate to receiving an LKDT. Conclusion: African Americans face significant knowledge and access barriers when deciding on their RRT treatment. Even patients with advanced CKD were still in the early stages of RRT selection. Understanding the knowledge gaps and barriers patients face will inform our subsequent intervention to educate and motivate patients to increase CKD self‐care and improve communication between patients, their families and their providers about different RRT treatments. [ABSTRACT FROM AUTHOR]

Objective: Studies suggest that American Muslim women underutilize mammography. While religion has a strong influence upon Muslim health behaviors, scant research has examined how religion-related beliefs inform Muslim women's intention for mammography. Our study identifies and examines such beliefs.Methods: Muslim women aged 40 years and older sampled from mosques participated in focus groups and individual interviews. Drawing upon the theory of planned behavior, interviews elicited salient behavioral, normative, and control beliefs regarding mammography and the influence of Islam upon screening intention.Results: Fifty women participated in 6 focus groups and 19 in semistructured interviews, with near-equal numbers of African American, South Asian, and Arab Muslims. Forty-two percent of participants had not had a mammogram within the past 2 years. Across differences in race/ethnicity and mammography status, women voiced four religion-related salient beliefs that inform mammography intention: (1) the perceived duty to care for one's health, (2) religious practices as methods of disease prevention, (3) fatalistic notions about health, and (4) comfort with gender concordant health care.Conclusions: Religious beliefs influence decisions to pursue mammography across the ethnic/racial diversity of Muslim women. Notions about duty to God and the stewardship of one's body appear to enhance mammography intention. Theocentric notions of cure and illness and varied views regarding personal agency also inform decisional frames that impact mammography intention. Given the salience of religion among our participants, religiously tailored messages in interventions have the potential to enhance cancer screening. [ABSTRACT FROM AUTHOR]

Considerable research has focused on whether or not immigrants' health declines to match that of comparable native-born people. This immigrant health convergence is hypothesized to be driven by immigrants' acculturation to American society and habits. This is particularly problematic for a country such as the United States which combines a high number of immigrants, bad health habits among the native born, and an expensive health care system. Previous research in this literature uses the duration of an immigrant's current stay in the United States as the measure of exposure to acculturation. Using the duration of the immigrant's current stay in the United States implicitly assumes one long-term move. However, the largest immigrant group in the United States (Mexicans) is characterized by a pattern of repeated migration trips. This paper separates out the effects of migration duration and lifetime cumulative experience for Mexican immigrants to the United States. The empirical analysis is carried out using data from the Mexican Migration Project. The Mexican Migration Project has been collecting data on Mexican immigrants to the United States since the mid- 1980s. Empirical results find that while overall time spent in the United States supports the acculturation hypothesis, single-trip migration duration has the opposite effect. The positive impact of single-trip duration on health is likely caused by recovery time needed to compensate for difficult crossings into the United States which have an even harsher effect on health if the individual undertakes short, repeated migrations. We also find that having Latino friends improves health while Anglo friends cause faster convergence and worse long-term health impacts. Both support the acculturation hypothesis. Results suggest that researchers need to focus on the cumulative impact of time spent in the United States rather than relying on just the duration of the latest trip. This suggests a much larger negative effect of migration on health than studies relying solely on migration duration. In the case of repeated migration patterns, this imposes costs on both the health care systems of the destination (USA) and source (Mexico) countries. Repeated immigration to the United States can result in acculturation which causes bad health habits to be brought back to Mexico, along with the accompanying costs these incur. [ABSTRACT FROM AUTHOR]

Recognizing the gap between high-quality care and the care actually provided, health care providers across the country are under increasing institutional and payer pressures to move toward more high-quality care. This pressure is often leveraged through data feedback on provider performance; however, feedback has been shown to have only a variable effect on provider behavior. This study examines the cognitive behavioral factors that influence providers to participate in feedback interventions, and how feedback interventions should be implemented to encourage more provider engagement and participation. [ABSTRACT FROM AUTHOR]

Policies to deter illegal entry and reduce the number of undocumented immigrants have a complex impact on migration patterns, border crossings, and duration. However, studies generally assume the method of crossing into the United States is exogenous with respect to migration duration. Using data from the Mexican Migration Project, this paper finds that the migrant's decision to hire a coyote (smuggler) to cross the border is endogenous with respect to duration. Instrumental variable estimates provide evidence that migrants who incur the cost of hiring a coyote have longer migration durations as they need to work longer in the United States. The migrants most likely to hire coyotes have less education, little migration experience, and/or come from rural communities. Results suggest that continuing to increase guest worker programs could actually decrease the number of Mexican immigrants in the United States by eliminating the need for coyotes which would reduce migration durations. This would better utilize the immigrant population in the United States by encouraging immigrants to stay while employed and to migrate home when unemployed, with the knowledge they can later return. Reducing coyote use would also reduce income flowing to Mexican cartels which have profited from human smuggling. ( JEL O15, J61, J64) [ABSTRACT FROM AUTHOR]

The migration of Mexican immigrants to the U.S. is one of the largest bilateral migration flows in the world and remittances from these immigrants represent a crucial source of income for Mexican households. As the United States tightens controls on illegal migration, this may impact both migration durations and remittances. Tighter borders increase crossing costs, often because migrants need to pay smugglers (coyotes). Using data from the Mexican Migration Project, we find that higher crossing costs increase the probability of remitting, the remittance rate and the duration of stay as undocumented workers pay off the crossing debt. If immigrants did not incur these crossing debts then more of their earnings could be spent in the United States or by their households in Mexico on productive activities and durations in the U.S. might be lessened at the margin. This suggests some potential gain to both the U.S. and Mexican economies through expanding guest worker programs and consequently reducing the hiring of coyotes. [ABSTRACT FROM AUTHOR]

Scholars have noted that marriage frequently results in a sub-optimal job search. This literature suggests that the overeducation of wives is a result of household migration (tied-mover) or the result of an inability to migrate (tied-stayer). Others have found that overeducation may also be a cause of migration. This study examines overeducation as both a cause and effect of migration. Some evidence shows that families with an overeducated husband are found to be more likely to migrate. In turn, this migration leads to increased levels of overeducation among wives and decreased levels of overeducation among husbands. Household migration is also found to lower the full-time employment rates of wives by more than their male counterparts. [ABSTRACT FROM AUTHOR]

In the context of dramatically increasing U.S. health-care costs, this paper contributes to an ongoing debate discussing proposals to replace the government's current policy of matching state Medicaid spending with a block grant system. State-level panel data analysis provides evidence that, ceteris paribus, increasing the federal matching formula has a negative impact on prenatal care. This aggregate result masks significant differences between high- and low-spending states and appears to be driven by the high-spending states thus implying that a 2-track approach to Medicaid funding may be more appropriate than the current system. [ABSTRACT FROM AUTHOR]

In this article, the authors highlight the benefits and challenges of offering cross-border, interdisciplinary academic experiences for students and faculty. The enterprise of interdisciplinary environmental management is largely an act of transcending boundaries. In particular, the authors focus on lessons learned from an annual transboundary field course offered jointly to Canadian and U.S. students from Alberta and Montana. They offer reflections based on their experiences with the aim of promoting further collaboration and the development of similar initiatives.

The author has surveyed a quarter of the accredited undergraduate computer science programs in the United States. More than half of these programs offer a "social and ethical implications of computing" course taught by a computer science faculty member, and there appears to be a trend toward teaching ethics classes within computer science departments. Although the decision to create an "in house" computer ethics course may sometimes be a pragmatic response to pressure from the accreditation agency, this paper argues that teaching ethics within a computer science department can provide students and faculty members with numerous benefits. The paper lists topics that can be covered in a computer ethics course and offers some practical suggestions for making the course successful. [ABSTRACT FROM AUTHOR]

This paper constructs and tests a model that incorporates relative deprivation into the migration decision. Relatively deprived individuals view their situations as less than a community standard. Another innovation of this paper is the utilization of a cluster approach to wage differentials. This cluster method takes account of individual characteristics while avoiding the severe multicollinearity problems inherent in the standard wage equation approach. Using data from the Mexican Migration Project, relative deprivation is found to be a significant motivating factor in domestic migration decisions. The results also suggest that Mexico-US migration may be increasing relative deprivation in Mexican communities. For policymakers, the results indicate that policies attempting to slow domestic rural-to-urban migration must address both relative and absolute outcomes in communities. Investments in communities that raise aggregate incomes, but increase relative deprivation, could result in an increase in migration out of the community, not in a decrease as intended. [ABSTRACT FROM AUTHOR]

The article discusses alternatives for pricing electricity transmission in future regional transmission organizations (RTO) in the U.S. One alternative would be to charge the same rate system-wide across entire RTO and to roll in the costs of new electricity transmission investments. One undesirable implication of rolled-in postage-stamp pricing for new investments in electricity transmission is that it could underprice new investments by spreading some of those costs.

Focuses on the context of the directors' and officers' (D&O) liability insurance in the United States. Factors to consider in determining liabilities; Provisions of the D&O liability insurance; Identification of payable defense expenses.

Argues that early feature-length films in the U.S. were not simply a new production trend, they represented a series of developments in distribution and exhibition based on differentiation. Details on the redefinition of the early feature film; Background on feature film distribution and the Motion Picture Patents Company; Role of the Motion Picture Patents Company and the feature film; Conclusion.

Focuses on the United States (U.S.) Federal Energy Regulatory Commission's regulatory order which provides a call for performance-based regulation (PBR) in the electricity transmission industry. Components of PBR plans; Measurement of electricity transmission productivity; Parameters of the electricity price cap plans outside the U.S.

Studies the tectonic evolution of the western United States Cordillera during the Early Jurassic period. Analysis of data from the Black Rock Desert of northwest Nevada; Effect on Paleozoic and early Mesozoic magmatic arc rocks in the area by regional shortening deformation and metamorphism in the Early Jurassic; Variations of tectonic conditions along the Early Jurassic plate margin.

Presents mapping, structural and geochronologic data from Jackson Mountains of northwestern Nevada which led to a substantially different view of Mesozoic magmatic and structural evolution of the area. Occurrence of voluminous magmatism in the Early Jurassic; Other conclusions with implications for Mesozoic paleogeographic and tectonic reconstructions.

Objective: We evaluated the economic impact of group visits (GVs) in adults with uncontrolled diabetes in community health centers (CHCs) in the United States., Research Design and Methods: In this prospective controlled trial, we implemented 6 monthly GV sessions in 5 CHCs and compared intervention patients (n=49) to control patients (n=72) receiving usual care within the same CHCs. We conducted patient chart reviews to obtain health care utilization data for the prior 6 months at baseline, 6 months (during the GV implementation), and 12 months (after the implementation). We also collected monthly logs of CHC expenses and staff time spent on activities related to GVs. Per-patient total costs included CHCs' expenses and costs associated with staff time and patients' health care use. For group comparison, we used the Wilcoxon rank-sum test and the bootstrapping method that was to bootstrap generalized estimating equation models., Results: The GV group had fewer 6-month hospitalizations (mean: GV: 0.06 vs. control: 0.24, rate: 6.1% vs. 19.4%) ( P ≤ 0.04) and similar emergency department visits at 12 months than the control group. Implementing GV incurred $1770 per-patient. The intervention cost $1597 more than the control at 6 months ($3021 vs. $1424) but saved $1855 at 12 months ($857 vs. $2712) ( P =0.002)., Conclusions: The diabetes GV care model reduced hospitalizations and had cost savings at 12 months, while it improved patients' diabetes-related quality of life and glucose control. Future studies should assess its lifetime cost-effectiveness through a randomized controlled trial., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Although perfluorohexane sulfonate (PFHxS) is structurally similar to perfluorooctane sulfonate (PFOS) and also widely detected in humans and the environment, comparatively fewer toxicity data exists on this 6-chain perfluoroalkyl sulfonic acid. In this study, repeated oral doses of PFHxS were administered to deer mice (Peromyscus maniculatus) to evaluate subchronic toxicity and potential effects on reproduction and development. Maternal oral exposure to PFHxS caused increased stillbirths, which is relevant for ecological risk assessment, and resulted in a benchmark dose lower limit (BMDL) of 5.72 mg/kg-d PFHxS. Decreased plaque formation, which is relevant for human health risk assessment, occurred in both sexes of adult animals (BMDL = 8.79 mg/kg-d PFHxS). These data are the first to suggest a direct link between PFHxS and decreased functional immunity in an animal model. Additionally, female animals exhibited increased liver:body weight and animals of both sexes exhibited decreased serum thyroxine (T4) levels. Notably, since reproductive effects were used to support 2016 draft health advisories and immune effects were used in 2022 drinking water health advisories released by the United States Environmental Protection Agency for PFOS and perfluorooctanoic acid (PFOA), these novel data can potentially support advisories for PFHxS because relevant points of departure emerge at similar thresholds in a wild mammal and corroborate the general understanding of per- and polyfluoroalkyl substances (PFAS)., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Michael J. Quinn, Jr. reports financial support was provided by Strategic Environmental Research and Development Program., (Published by Elsevier Inc.)

Background: The donation of what might be termed expanded criteria kidneys has become an increasingly common practice. This study aimed to assign expanded criteria and non-expanded criteria donation status and examine early clinical and economic outcomes among expanded criteria and non-expanded criteria living kidney donor (LKD) hospitalizations in the US., Methods: Healthcare cost and Utilization Project-National (Nationwide) Inpatient Sample (HCUP-NIS) data (Jan 2008-Dec 2019, N = 12,020) were used. Expanded criteria LKDs were identified as admitted patients aged ≥ 60 years, or 50-59 years with any comorbidity that historically precluded donation. The Clavien-Dindo system was applied to classify surgical complications as grade I-IV/V., Results: The number of LKD admissions decreased by 31% over the study period, although this trend fluctuated over time. Compared to non-expanded criteria LKD admissions, expanded criteria LKD admissions had comparable surgical complication rates in Grade I (aOR 1.0, 0.8-1.3), but significantly higher surgical complication rates in Grade II (aOR 1.5, 1.1-2.2) and Grade III (aOR 1.4, 1.0-2.0). The two groups had comparable hospital length of stay and cost in the adjusted models. Notably, Grade II complications were significantly higher in private, for-profit hospitals (15%) compared to government hospitals (2.9%)., Conclusions: Expanded criteria LKDs had comparable early outcomes compared to non-expanded criteria LKDs, but the trends evident in LKDs over time and the variation in complication records warrant further research., (© 2022. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Biomedical and religious knowledge affects organ donation attitudes among Muslims. We tested the effectiveness of mosque-based, religiously tailored, ethically balanced education on organ donation among Muslim Americans. Our randomized, controlled, crossover trial took place at 4 mosques randomized to an early arm where organ donation education preceded a control educational workshop or a late arm with the order reversed. Primary outcomes were changes in biomedical (Rotterdam Renal Replacement Knowledge Test living donation subscale, R3KT) and religious (Islamic Knowledge of Living Organ Donation, IK-LOD) living kidney donation knowledge. Statistical analysis employed a 2 (Treatment Arm) X 3 (Time of Assessment) mixed-method analysis of variance. Of 158 participants, 59 were in the early arm and 99 in the late arm. A between group t test comparison at Period 1 (Time 1 - Time 2), demonstrated that the early arm had a significantly higher mean IK-LOD (7.11 v 5.19, P < .05) and R3KT scores (7.65 v 4.90, P < .05) when compared to the late arm. Late arm participants also had significant increases in mean IK-LOD (5.19 v 7.16, P < .05) and R3KT scores (4.90 v. 6.81, P < .05) postintervention (Time 2-Time 3). Our novel program thus yielded significant kidney donation-related knowledge gains among Muslim Americans (NCT04443114 Clinicaltrials.gov)., (© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Introduction: Studies around the world demonstrate that Muslim attitudes toward organ donation are closely tied to religion, but also that Muslim publics suffer from a lack of detailed knowledge about the Islamic perspectives on organ donation. Consequently, organ donation professionals and stakeholders are increasingly addressing knowledge gaps in the Muslim community through educational interventions. Yet, a measurement of Islamic knowledge of organ donation, and thereby the efficacy of such education, is not available., Research Question: To present the development and psychometric evaluation of the Islamic Knowledge of Living Organ Donation scale, designed to measure knowledge of the Islamic ethicolegal stances, and their underlying rationale, regarding living organ donation., Methods: Items were developed based on a review of Islamic juridical perspectives on organ donation, addressed knowledge gaps pervading Muslim communities, and pilot tested. The scale was statistically validated and psychometrically analyzed with a sample of 158 mosque-going Muslims in the United States., Results: The 9-item Islamic Knowledge of Living Organ Donation scale was found to be reliable (Cronbach α: 0.86), unidimensional, independent of religiosity, and predictive of social attitudes toward organ donation., Discussion: The survey can be used to validly assess Islamic knowledge of living organ donation among Muslim communities in research, educational, and clinical settings.

Objective: Expanding access to addiction screening and treatment in primary care, particularly in underserved communities, is a key part of the fight against the opioid epidemic. This study explored correlates of addiction treatment capacity in federally qualified health centers participating in the Midwest Clinicians' Network (MWCN)., Methods: Two surveys were fielded to 132 MWCN health centers: the Health Center Survey and the Behavioral Health and Diabetes Provider Survey. A total of 77 centers and 515 primary care clinicians, respectively, responded to the surveys. Data were combined with data from the 2016 Uniform Data System and information about receipt of targeted Health Resources and Services Administration (HRSA) grant funding for addiction treatment capacity. Multivariable models examined associations between Medicaid reimbursement for addiction services, HRSA targeted grant funding, and different types of on-site addiction treatment capacity: psychiatrist and certified addiction counselor staffing, addiction counseling services, and medication-assisted treatment (MAT) for opioid addiction., Results: Health centers that received Medicaid behavioral health reimbursement were five times as likely as those that did not to offer addiction counseling and to employ certified addiction counselors. Health centers that received targeted HRSA funding for addiction services were more than 20 times as likely as those that did not to provide MAT and more than three times as likely to employ psychiatrists. Training needs and privacy protections on data related to addiction treatment were cited as barriers to building addiction treatment capacity., Conclusions: Medicaid funding and targeted grant funding were associated with addiction treatment capacity in health centers.

To describe how patient characteristics influence physician decision-making about glycemic goals for Type 2 diabetes.2016 survey of 357 US physicians. The survey included two vignettes, representing a healthy patient and an unhealthy patient, adapted from a past survey of international experts and a factorial design vignette that varied age, heart disease history, and hypoglycemia history. Survey results were weighted to provide national estimates.Over half (57.6%) of physicians recommended a goal HbA1c <7.0% for most of their patients. For the healthy patient vignette, physicians recommended a goal similar to that of international experts (<6.66% (95% Confidence Interval (CI), 6.61-6.71%) vs <6.5% (Interquartile range (IQR), 6.5-6.8%)). For the unhealthy patient, physicians recommended a lower goal than international experts (<7.38% (CI, 7.30-7.46) vs <8.0% (IQR, 7.5-8.0%)). In the factorial vignette, physicians varied HbA1c goals by 0.35%, 0.06%, and 0.28% based on age, heart disease history, and hypoglycemia risk, respectively. The goal HbA1c range between the 55-year-old with no heart disease or hypoglycemic events and the 75-year-old with heart disease and hypoglycemic events was 0.65%.Despite guidelines that recommend HbA1c goals ranging from <6.5% to <8.5%, US physicians seem to be anchored on HbA1c goals around <7.0%.

Background To advance the literature on religiously-tailored interventions and on Muslim cancer screening disparity research, we report on a behavioral intervention that used religiously-tailored messages to address salient mammography-related barrier beliefs. Methods We crafted specific, religiously-tailored messages and designed a two-session, peer-led, mosque-based educational program to deploy them. t-tests assessed pre- and post-intervention changes in mammography knowledge, intention to obtain mammography, and levels of agreement with mammography-related barrier and facilitator beliefs, while ordered logistic regression models assessed predictors of change. Results 58 women participated, 29 who were South-Asian and 18 Arab. Mean mammography knowledge increased post-intervention. Participants' overall mean agreement with facilitator beliefs trended upward and there was a significant decrease in agreement with the belief "Breast Cancer Screening is not important because God decides who will get cancer," Discussion Religiously-tailored messages provide an opportunity for addressing barriers to preventive health in a theologically consonant way.

In 2014, the Affordable Care Act (ACA) provided funding for states to expand Medicaid coverage to include citizens who earned up to 138% of the federal poverty line. We sought to ascertain whether physicians practicing in Medicaid expansion states reported an increase in Medicaid or newly insured patients with type 2 diabetes in their panels, compared to physicians practicing in non-expansion states. We conducted a 55-question cross-sectional survey of 356 physicians providing outpatient care for adults with type 2 diabetes. We used adjusted multivariate logistic regression analyses to compare responses from physicians who practiced in expansion versus non-expansion states regarding whether they observed an increase since 2014 in (1) the number of Medicaid or newly insured patients with diabetes and (2) the number of additional newly or previously diagnosed patients who were newly receiving care, in their panels, adjusting for physician, practice, and patient-level characteristics, weighted for the U.S. physician population. 41% of eligible recipients responded. 64.2% of physicians who practice in an expansion state report an increase in Medicaid or newly insured patients with diabetes compared with 46.1% who practice in non-expansion states (p = 0.05; Table 2). Compared with physicians who practice in non-expansion states, physicians who practice in Medicaid expansion states are more likely to report an increase in the number of Medicaid or newly insured patients with diabetes in their practice since 2014. The increased access associated with the Medicaid expansion may improve long-term outcomes for patients with type 2 diabetes.

Objective: To describe the design of, and participant-level outcomes related to, a religiously tailored, peer-led group education program aimed at enhancing Muslim women's mammography intention., Method: Using a community-engaged approach and mixed methods, we identified and addressed barrier beliefs impeding mammography screening among Muslim American women. Our religiously tailored, mosque-based, peer-led intervention involved facilitated discussions and expert-led didactics conveying health-related religious teachings, and information about the benefits and process of mammography. Barrier beliefs were addressed through reframing, reprioritizing, or reforming such beliefs. Participant surveys were collected preintervention, postintervention, 6 months postintervention, and 1 year postintervention. These measured changes in mammography intention, likelihood, confidence, and resonance with barrier and facilitator beliefs., Results: A total of 58 Muslim women (mean age = 50 years) that had not had a mammogram in the past 2 years participated in the two-session program. Self-reported likelihood of obtaining a mammogram increased significantly ( p = .01) and coincided with a positive trend in confidence ( p = .08). Individuals with higher agreement with barrier beliefs preintervention had lower odds for positive change in likelihood (odds ratio = 0.80, p = .03), while those who were married had higher odds for positive change in likelihood (odds ratio = 37.69, p = .02). At 1-year follow-up, 22 participants had obtained a mammogram., Conclusion: Our pilot mosque-based intervention demonstrated efficacy in improving Muslim women's self-reported likelihood of obtaining mammograms, and increased their mammography utilization, with nearly 40% obtaining a mammogram within 12 months of the intervention., Impact: Our conceptual model for religiously tailoring messages, along with its implementation curriculum, proved effective in enhancing the likelihood and receipt of mammograms among Muslim American women. Accordingly, our work advances both the theory and practice of faith-based interventions and provides a model for addressing Muslim women's cancer screening disparities.

Improving outcomes in multiple myeloma will involve not only development of new therapies but also better use of existing treatments. We performed RNA sequencing on samples from newly diagnosed patients enrolled in the phase 2 PADIMAC (Bortezomib, Adriamycin, and Dexamethasone Therapy for Previously Untreated Patients with Multiple Myeloma: Impact of Minimal Residual Disease in Patients with Deferred ASCT) study. Using synthetic annealing and the large margin nearest neighbor algorithm, we developed and trained a 7-gene signature to predict treatment outcome. We tested the signature in independent cohorts treated with bortezomib- and lenalidomide-based therapies. The signature was capable of distinguishing which patients would respond better to which regimen. In the CoMMpass data set, patients who were treated correctly according to the signature had a better progression-free survival (median, 20.1 months vs not reached; hazard ratio [HR], 0.40; confidence interval [CI], 0.23-0.72; P = .0012) and overall survival (median, 30.7 months vs not reached; HR, 0.41; CI, 0.21-0.80; P = .0049) than those who were not. Indeed, the outcome for these correctly treated patients was noninferior to that for those treated with combined bortezomib, lenalidomide, and dexamethasone, arguably the standard of care in the United States but not widely available elsewhere. The small size of the signature will facilitate clinical translation, thus enabling more targeted drug regimens to be delivered in myeloma., (© 2018 by The American Society of Hematology.)

The health insurance coverage established by the Patient Protection and Affordable Care Act has created an opportunity to reduce racial/ethnic disparities in healthcare. It is expected that of the 24 million individuals projected to join, nearly one-half will be non-white and one-fourth will speak a language other than English at home. Asian Americans are one of the fastest growing racial/ethnic groups in the USA. The majority are foreign born and experience limited English proficiency. The role of navigators has been shown to increase enrollment rates of public insurance programs. They are trusted for their shared traditions and sense of community. By conducting culturally-targeted outreach, Cambodian, Chinese, Vietnamese, Korean, and Laotian community-based organizations were able to reach individuals for whom the percentage of uninsured is disproportionately high. They enrolled eligible Asians immigrants in coverage despite language barriers and limited health knowledge. Through a collaborative network, a community-level intervention was implemented that was associated with increases in first year marketplace enrollment and greater likelihood of obtaining a primary care physician. Preventable illnesses, lost productivity, and inadequate healthcare are major hardships in immigrant communities that bear similar burdens to society. Bringing primary care to the underserved helps to contain these costs., Competing Interests: Compliance with Ethical Standards Funding This study’s In-Person Counselor enrollment program was funded by the Illinois Department of Public Health, and the survey measurement and data collection components were funded by the Agency for Healthcare Research and Quality (grant #R24HS022063). Conflict of Interest All authors declare that they have no competing interests. Ethical Approval Procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments (or comparable ethical standards). Our research protocol was approved as ethical by the University of Chicago’s Institutional Review Board.

Objectives: Safety net health centers (SNHCs), which include federally qualified health centers (FQHCs) provide primary care for underserved, minority and low income patients. SNHCs across the country are in the process of adopting the patient centered medical home (PCMH) model, based on promising early implementation data from demonstration projects. However, previous demonstration projects have not focused on the safety net and we know little about PCMH transformation in SNHCs., Design: This qualitative study characterizes early PCMH adoption experiences at SNHCs., Setting and Participants: We interviewed 98 staff (administrators, providers, and clinical staff) at 20 of 65 SNHCs, from five states, who were participating in the first of a five-year PCMH collaborative, the Safety Net Medical Home Initiative., Main Measures: We conducted 30-45 minute, semi-structured telephone interviews. Interview questions addressed benefits anticipated, obstacles encountered, and lessons learned in transition to PCMH., Results: Anticipated benefits for participating in the PCMH included improved staff satisfaction and patient care and outcomes. Obstacles included staff resistance and lack of financial support for PCMH functions. Lessons learned included involving a range of staff, anticipating resistance, and using data as frequent feedback., Conclusions: SNHCs encounter unique challenges to PCMH implementation, including staff turnover and providing care for patients with complex needs. Staff resistance and turnover may be ameliorated through improved health care delivery strategies associated with the PCMH. Creating predictable and continuous funding streams may be more fundamental challenges to PCMH transformation.

Background: We sought to determine whether perceived patient-centered medical home (PCMH) characteristics are associated with staff morale, job satisfaction, and burnout in safety net clinics., Methods: Self-administered survey among 391 providers and 382 clinical staff across 65 safety net clinics in 5 states in 2010. The following 5 subscales measured respondents' perceptions of PCMH characteristics on a scale of 0 to 100 (0 indicates worst and 100 indicates best): access to care and communication with patients, communication with other providers, tracking data, care management, and quality improvement. The PCMH subscale scores were averaged to create a total PCMH score., Results: Six hundred three persons (78.0%) responded. In multivariate generalized estimating equation models, a 10% increase in the quality improvement subscale score was associated with higher morale (provider odds ratio [OR], 2.64; 95% CI, 1.47-4.75; staff OR, 3.62; 95% CI, 1.84-7.09), greater job satisfaction (provider OR, 2.45; 95% CI, 1.42-4.23; staff OR, 2.55; 95% CI 1.42-4.57), and freedom from burnout (staff OR, 2.32; 95% CI, 1.31-4.12). The total PCMH score was associated with higher staff morale (OR, 2.63; 95% CI, 1.47-4.71) and with lower provider freedom from burnout (OR, 0.48; 95% CI, 0.30-0.77). A separate work environment covariate correlated highly with the quality improvement subscale score and the total PCMH score, and PCMH characteristics had attenuated associations with morale and job satisfaction when included in models., Conclusions: Providers and staff who perceived more PCMH characteristics in their clinics were more likely to have higher morale, but the providers had less freedom from burnout. Among the PCMH subscales, the quality improvement subscale score particularly correlated with higher morale, greater job satisfaction, and freedom from burnout.