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Background. Flea-borne typhus (FBT), an uncommon illness in the United States, typically presents as a high continuous fever with commonly associated symptoms including headache, myalgias, and rashes on the trunk and extremities. Patients infected with FBT may also present with atypical symptoms. As such, the combination of its relatively low incidence in the United States coupled with its variability in associated symptoms poses a diagnostic challenge for clinicians; early empiric treatment with doxycycline is warranted prior to a definitive diagnosis to reduce the risk of damage to vital organs. Case Report. This case describes a 54-year-old male who presented to an emergency room in Houston, Texas, with one week of constant right upper quadrant abdominal pain and fevers up to 40°C. The patient was initially diagnosed with Grade III severe acute cholangitis after abdominal ultrasound revealed gallbladder sludge and wall thickening without ductal dilatation, but a subsequent endoscopic retrograde cholangiopancreatography was unremarkable. Following intermittent fevers and worsening anemia, the patient was started on oral doxycycline for atypical infection, and an infectious disease workup subsequently returned a positive titer for Rickettsia typhi. He experienced rapid symptomatic and clinical improvement, and the patient was discharged home with a final diagnosis of flea-borne typhus. Conclusion. Albeit uncommon, the presentation of this patient's symptoms and final diagnosis of flea-borne typhus demonstrates the importance of (1) keeping atypical infections such as FBT in the differential diagnosis and (2) beginning empiric treatment to prevent damage to vital organs if suspicion of FBT is high. [ABSTRACT FROM AUTHOR]

Despite the great body of work examining the cultural content of the international and local ELT textbooks, the cultural content and elements of the ELT textbooks in the inner, outer, and expanding circle countries have seldom been reported. That said, the purpose of this study was twofold: first, it was aimed to investigate the cultural content of the ELT textbooks of the inner, outer, and expanding circle countries; and, second, to examine the cultural elements of these ELT textbooks. To that end, three ELT textbook series from inner, outer, and expanding circle countries were selected and analyzed. The results of this study showed that there were differences among the ELT textbooks of different concentric circles. While the ELT textbooks of the inner circle contained more L1 and L2 cultural content, the ELT textbooks of the expanding circle contained more L1 and international cultural content. Moreover, the ELT textbooks of the outer circle showed tendency to contain L1, L2, and international cultural content. With respect to the cultural elements, the inner and outer circle contained more L2 esthetic cultural elements, whereas the expanding circle ELT textbooks tended to represent their cultural elements through L1 esthetic and sociolinguistic cultural senses.

OBJECTIVES: To describe the uptake and out-of-pocket (OOP) costs of Basaglar, the first long-acting insulin biosimilar, in a commercially insured population in the United States. STUDY DESIGN: Retrospective analysis of commercial pharmacy claims and pharmacy co-payment offsets. METHODS: We assessed Basaglar uptake by examining trends in the composition of the long-acting insulin market in the United States from 2014 to 2018. As patient demographics and plan type may be important determinants of biosimilar uptake, we also assessed characteristics of all long-acting insulin users by drug. We examined Basaglar OOP costs by assessing mean OOP costs per claim for users of Basaglar and other long-acting insulins, overall and by plan type, and the number and source of co-payment offsets for Basaglar and other insulin glargine products from Basaglar market entry through 2018. We used multivariate linear models to examine the relationship between Basaglar OOP expenditures and insurer-negotiated amounts, overall and by plan type. RESULTS: Basaglar experienced a rapid uptake. However, there was no evidence that Basaglar users had lower OOP costs than reference product (Lantus) users. CONCLUSIONS: Given our results and the approval of the first interchangeable biosimilar, we recommend the empirical evaluation of biosimilar cost savings to patients and insurers prior to promoting their automatic substitution. [ABSTRACT FROM AUTHOR]

Background: Relatively little is known about the use patterns of potential pharmacologic treatments of COVID-19 in the United States.Objective: To use the National COVID Cohort Collaborative (N3C), a large, multicenter, longitudinal cohort, to characterize the use of hydroxychloroquine, remdesivir, and dexamethasone, overall as well as across individuals, health systems, and time.Design: Retrospective cohort study.Setting: 43 health systems in the United States.Participants: 137 870 adults hospitalized with COVID-19 between 1 February 2020 and 28 February 2021.Measurements: Inpatient use of hydroxychloroquine, remdesivir, or dexamethasone.Results: Among 137 870 persons hospitalized with confirmed or suspected COVID-19, 8754 (6.3%) received hydroxychloroquine, 29 272 (21.2%) remdesivir, and 53 909 (39.1%) dexamethasone during the study period. Since the release of results from the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial in mid-June, approximately 78% to 84% of people who have had invasive mechanical ventilation have received dexamethasone or other glucocorticoids. The use of hydroxychloroquine increased during March 2020, peaking at 42%, and started declining by April 2020. By contrast, remdesivir and dexamethasone use gradually increased over the study period. Dexamethasone and remdesivir use varied substantially across health centers (intraclass correlation coefficient, 14.2% for dexamethasone and 84.6% for remdesivir).Limitation: Because most N3C data contributors are academic medical centers, findings may not reflect the experience of community hospitals.Conclusion: Dexamethasone, an evidence-based treatment of COVID-19, may be underused among persons who are mechanically ventilated. The use of remdesivir and dexamethasone varied across health systems, suggesting variation in patient case mix, drug access, treatment protocols, and quality of care.Primary Funding Source: National Center for Advancing Translational Sciences; National Heart, Lung, and Blood Institute; and National Institute on Aging. [ABSTRACT FROM AUTHOR]

Background: Hypercoagulability may be a key mechanism of death in patients with coronavirus disease 2019 (COVID-19).Objective: To evaluate the incidence of venous thromboembolism (VTE) and major bleeding in critically ill patients with COVID-19 and examine the observational effect of early therapeutic anticoagulation on survival.Design: In a multicenter cohort study of 3239 critically ill adults with COVID-19, the incidence of VTE and major bleeding within 14 days after intensive care unit (ICU) admission was evaluated. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done to examine the observational effect of early therapeutic anticoagulation on survival. A Cox model with inverse probability weighting to adjust for confounding was used.Setting: 67 hospitals in the United States.Participants: Adults with COVID-19 admitted to a participating ICU.Measurements: Time to death, censored at hospital discharge, or date of last follow-up.Results: Among the 3239 patients included, the median age was 61 years (interquartile range, 53 to 71 years), and 2088 (64.5%) were men. A total of 204 patients (6.3%) developed VTE, and 90 patients (2.8%) developed a major bleeding event. Independent predictors of VTE were male sex and higher D-dimer level on ICU admission. Among the 2809 patients included in the target trial emulation, 384 (11.9%) received early therapeutic anticoagulation. In the primary analysis, during a median follow-up of 27 days, patients who received early therapeutic anticoagulation had a similar risk for death as those who did not (hazard ratio, 1.12 [95% CI, 0.92 to 1.35]).Limitation: Observational design.Conclusion: Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in the target trial emulation.Primary Funding Source: None. [ABSTRACT FROM AUTHOR]

Potato psyllid (Bactericera cockerelli Sulc)-transmitted "Candidatus Liberibacter solanacearum" (Lso) has been negatively impacting the potato industry in the United States as well as other potato-producing countries. Lso has been linked to a condition known as zebra chip (ZC) that affects yield and quality of potato tubers. Efforts to find sources of resistance to ZC have primarily focused on greenhouse evaluations based on a single inoculation time prior to harvest. Plant response to infection, however, could be influenced by the developmental stage of the host plant, and ZC may continue to develop after harvest. The objectives of this study were to quantify Lso inoculation success, Lso titer, ZC severity and Lso development during storage in eight potato genotypes. These evaluations were conducted on plants infested with Lso-positive psyllids at 77, 12, and 4 days before vine removal (DBVR). The evaluated genotypes were categorized according to their relative resistance to Lso and tolerance to ZC symptoms. Lso inoculation success in the genotype family A07781, derived from Solanum chacoense, was lower than that of the susceptible control ('Russet Burbank'). A07781-4LB and A07781-3LB genotypes were characterized relatively resistant to the pathogen and highly tolerant to ZC symptoms, while A07781-10LB was categorized as susceptible to Lso but relatively tolerant to symptom expression. In stored potatoes, increase in Lso concentrations was observed for all infestation times. However, significantly higher Lso titer was detected in tubers infested 12 DBVR and the effect was similar across genotypes. Overall, the A07781 family can be considered as a promising source of resistance or tolerance to ZC. [ABSTRACT FROM AUTHOR]

Background Breast cancer brain metastases (BCBM) are the final frontier in neuro-oncology for which more efficacious therapies are required. In this work, we explore clinical trials in BCBM, and determine the shortcomings in the development of new BCBM therapies to shed light on potential areas for enhancement. Methods On July 9, 2018, we searched ClinicalTrials.gov for all interventional and therapeutic clinical trials involving BCBM, without limiting for date or location. Information on trial characteristics, including phase, status, start and end dates, study design, primary endpoints, selection criteria, sample size, experimental interventions, results, and publications were collected and analyzed. Results Fifty-three trials fulfilled the selection criteria. Median trial duration across phases ranged between 3 and 6 years. More than half of the trials were conducted in the United States. Although 94% of the trials were in early phases (I-II), 20% of patients were in phase III trials. Two phase III trials were anteceded by phase II trials that were non-randomized; one reported positive results. Approximately one-third of the trials were completed, whereas 23% of trials were terminated early; mostly due to inadequate enrollment. Only 13% of all trials and 22% of completed trials had published results directly linked to their primary outcomes. Conclusions The low number of trials and accrual numbers, the lack of diversity, and the scarcity of published results represent the main troubles in clinical BCBM research. Optimization of BCBM trials is necessary to achieve effective therapies. [ABSTRACT FROM AUTHOR]

A method was developed and tested to estimate challenge load due to disease outbreaks and other challenges in sows using reproduction records. The method was based on reproduction records from a farm with known disease outbreaks. It was assumed that the reduction in weekly reproductive output within a farm is proportional to the magnitude of the challenge. As the challenge increases beyond certain threshold, it is manifested as an outbreak. The reproduction records were divided into 3 dataseis. The first dataset called the Training dataset consisted of 57,135 reproduction records from 10,901 sows from 1 farm in Canada with several outbreaks of porcine reproductive and respiratory syndrome (PRRS). The known disease status of sows was regressed on the traits number bom alive, number of losses as a combination of still birth and mummified piglets, and number of weaned piglets. The regression coefficients from this analysis were then used as weighting factors for derivation of an index measure called challenge load indicator. These weighting factors were derived with i) a two-step approach using residuals or year-week solutions estimated from a previous step, and ii) a single-step approach using the trait values directly. Two types of models were used for each approach: a logistic regression model and a general additive model. The estimates of challenge load indicator were then compared based on their ability to detect PRRS outbreaks in a Test dataset consisting of records from 65,826 sows from 15 farms in the Netherlands. These farms differed from the Canadian farm with respect to PRRS virus strains, severity and frequency of outbreaks. The singlestep approach using a general additive model was best and detected 14 out of the 15 outbreaks. This approach was then further validated using the third dataset consisting of reproduction records of831,855 sows in 431 farms located in different countries in Europe and America. A total of 41 out of 48 outbreaks detected using data analysis were confirmed based on diagnostic information received from the farms. Among these, 30 outbreaks were due to PRRS while 11 were due to other diseases and challenging conditions. The results suggest that proposed method could be useful for estimation of challenge load and detection of challenge phases such as disease outbreaks. [ABSTRACT FROM AUTHOR]

Early death (ED) occurs in 10–30% of patients with acute promyelocytic leukemia (APL). Is all- trans retinoic acid (ATRA) promptly given and does it decrease overall early mortality? ATRA was administered within 24 h of morphological suspicion in only 44% of the 120 consecutive patients treated in the four collaborating centers. Absence of disseminated intravascular coagulation ( p = 0.012) and admission to a non-university-affiliated hospital ( p = 0.032) were independent predictors of ATRA delay. ED occurred in 17% of patients, and was independently correlated only with ICU admission ( p = 0.002). Our results do not demonstrate that prompt (versus delayed) ATRA administration decreases overall early death. [ABSTRACT FROM AUTHOR]

This paper is intended to show how a single reality, that is the continuation of war in Iraq by the American troops, is presented and viewed by the two major American political parties' (Republican and Democratic) candidates of the US presidential primaries of 2008. In this study, van Dijk's (2004) framework adopted from Politics, ideology and discourse is used to detect discursive structures within the transcripts of the candidates' speeches and discover the ideologies underlying them. The macro strategies of 'positive self-representation' and 'negative other- representation' (which are intimately tied up with 'Polarization' of in group vs. out group ideologies or US-THEM) plus the other 25 more subtle strategies have turned out to be very accurate criteria for the evaluation of attitudes, and opinions. The findings of this study can be conducive to expanding readers' critical thinking abilities in comprehension and production of language. [ABSTRACT FROM AUTHOR]

Discusses several Islamic beliefs and worldviews in order to reduce potential care conflict of Asian-Islamic women in U.S. hospitals. Brief background on the origing of Islam; Details on the Islamic belief system and some of the critical concepts; Relevance of Islamic concepts in health care practice; Information on professional training interventions.

Explores religious and socio-cultural issues relevant to breast cancer screening practices among older immigrant Asian-Islamic women in the United States. Islamic tenets which help and hinder breast cancer screening; Socio-cultural barriers to cancer screening; Recommendations to increase knowledge and practice of breast cancer screening.

The article offers information concerning Chronic Kidney Disease (CKD) based on the National Health and Nutrition Examination Survey. Result reveals that patients with CKD are at high risk for adverse drug reactions and drug-drug interactions which affect glomerular blood flow and filtration, tubular secretion and reabsorption, and renal inactivation and metabolism. It suggests to change the physician prescribing habits and to use eGFR as an indicator of kidney function and not on creatinine.

Competing Interests: Declaration of competing interest G. Sadigh receives an honorarium from the Journal of the American College of Radiology in her role as Associate Editor. G Sadigh receives research support from NIH/NCI. A. Rashidi serves as a paid consultant to Covera Health. R. Kao and R. Echeverria have nothing to disclose.

The use of opioids and/or benzodiazepines in older adults (65 y+) who received an allogeneic hematopoietic cell transplant (HCT) is not known. In March 2016, the CDC released its strongest guidelines against prescription of opioids and co-prescription of opioids + benzodiazepines. We evaluated the use of opioids and/or benzodiazepines in older (65 y + , n = 114) vs. younger (40-64 y, n = 240) allogeneic-HCT recipients before and after the CDC guidelines. The proportion of patients with >10-days of use of opioids and/or benzodiazepines peri-HCT (day-14 to +28) was compared. Opioids: the older (65 + y) group had similar odds of receiving opioids as the younger group (40-64 y) [O.R. 0.7 (95%CI:0.4-1.2)]. Those transplanted after the CDC guideline had 0.4 (95%CI:0.2-0.7) times the odds of receiving opioids. Benzodiazepines: The older (65 + y) group was 0.6 times (95%CI:0.3-0.9) as likely to receive benzodiazepines. There was no significant change in benzodiazepines use after the CDC guideline. Opioids + Benzodiazepines: The older group (65 + y) was 0.5 (95%CI:0.3-0.9) times as likely to receive both opioids+benzodiazepines. There was no significant change in opioids+benzodiazepines use after the CDC guideline. Though we observed a significant decrease in use of opioids after the CDC guideline, the use of benzodiazepines and combined opioids+benzodiazepines remained constant. Older recipients (65 + y) received less opioids, benzodiazepines, and combined opioids+benzodiazepines., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Regimen-related toxicities with high-dose therapy followed by hematopoietic cell rescue leads to considerable patient distress, morbidity, and high readmission rates. Palifermin is a recombinant keratinocyte growth factor that is Food and Drug Administration-approved to decrease severe oral mucositis (OM) associated with autologous hematopoietic cell transplantation (ASCT) for hematologic malignancies. We added palifermin as a supportive care measure for patients with lymphoma undergoing ASCT with BEAM conditioning. We compared patients receiving palifermin (n = 35) with historical controls (n = 38) for toxicity and readmission outcomes. The cumulative incidence of OM of any grade was 23% in the palifermin-treated patients and 42% in the control group. Patients receiving palifermin were less likely to be readmitted (57% versus 82%; P = .04), had fewer hospital readmission days (median, 4 days versus 7 days; P < .01), and had fewer total days in the hospital through day +30 after ASCT (median, 12 days versus 15 days; P = .05). Fewer patients in the palifermin group had >20 days in the hospital through day +30 (9% in the palifermin group versus 23% of controls). Adverse events associated with palifermin were mild and transient. The addition of palifermin limits severe regimen-related toxicities and decreases readmissions and duration of hospital stay. This and other measures are needed to identify comprehensive and cost-effective approaches, possibly including palifermin, to prevent severe regimen-related toxicities and decrease health care resource utilization., (Copyright © 2020 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

Rationale & Objective: Underlying kidney disease is an emerging risk factor for more severe coronavirus disease 2019 (COVID-19) illness. We examined the clinical courses of critically ill COVID-19 patients with and without pre-existing chronic kidney disease (CKD) and investigated the association between the degree of underlying kidney disease and in-hospital outcomes., Study Design: Retrospective cohort study., Settings & Participants: 4,264 critically ill patients with COVID-19 (143 patients with pre-existing kidney failure receiving maintenance dialysis; 521 patients with pre-existing non-dialysis-dependent CKD; and 3,600 patients without pre-existing CKD) admitted to intensive care units (ICUs) at 68 hospitals across the United States., Predictor(s): Presence (vs absence) of pre-existing kidney disease., Outcome(s): In-hospital mortality (primary); respiratory failure, shock, ventricular arrhythmia/cardiac arrest, thromboembolic events, major bleeds, and acute liver injury (secondary)., Analytical Approach: We used standardized differences to compare patient characteristics (values>0.10 indicate a meaningful difference between groups) and multivariable-adjusted Fine and Gray survival models to examine outcome associations., Results: Dialysis patients had a shorter time from symptom onset to ICU admission compared to other groups (median of 4 [IQR, 2-9] days for maintenance dialysis patients; 7 [IQR, 3-10] days for non-dialysis-dependent CKD patients; and 7 [IQR, 4-10] days for patients without pre-existing CKD). More dialysis patients (25%) reported altered mental status than those with non-dialysis-dependent CKD (20%; standardized difference=0.12) and those without pre-existing CKD (12%; standardized difference=0.36). Half of dialysis and non-dialysis-dependent CKD patients died within 28 days of ICU admission versus 35% of patients without pre-existing CKD. Compared to patients without pre-existing CKD, dialysis patients had higher risk for 28-day in-hospital death (adjusted HR, 1.41 [95% CI, 1.09-1.81]), while patients with non-dialysis-dependent CKD had an intermediate risk (adjusted HR, 1.25 [95% CI, 1.08-1.44])., Limitations: Potential residual confounding., Conclusions: Findings highlight the high mortality of individuals with underlying kidney disease and severe COVID-19, underscoring the importance of identifying safe and effective COVID-19 therapies in this vulnerable population., (Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT)., Methods: We conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. We used multivariable logistic regression to identify patient-and hospital-level risk factors for AKI-RRT and to examine risk factors for 28-day mortality among such patients., Results: A total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Patient-level risk factors for AKI-RRT included CKD, men, non-White race, hypertension, diabetes mellitus, higher body mass index, higher d-dimer, and greater severity of hypoxemia on ICU admission. Predictors of 28-day mortality in patients with AKI-RRT were older age, severe oliguria, and admission to a hospital with fewer ICU beds or one with greater regional density of COVID-19. At the end of a median follow-up of 17 days (range, 1-123 days), 403 of the 637 patients (63.3%) with AKI-RRT had died, 216 (33.9%) were discharged, and 18 (2.8%) remained hospitalized. Of the 216 patients discharged, 73 (33.8%) remained RRT dependent at discharge, and 39 (18.1%) remained RRT dependent 60 days after ICU admission., Conclusions: AKI-RRT is common among critically ill patients with COVID-19 and is associated with a hospital mortality rate of >60%. Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission., (Copyright © 2021 by the American Society of Nephrology.)

Exposure to high concentrations of airborne ultrafine particles in construction jobsites may play an important role in the adverse health effects among construction workers, therefore adequate respiratory protection is required. The performance of particulate respirators has never been evaluated in field conditions against ultrafine particles on construction jobsites. In this study, respiratory protection levels against ultrafine particles of different size ranges were assessed during three common construction related jobs using a manikin-based set-up at 85 L/min air flow rate. Two NanoScan SMPS nanoparticle counters were utilized for measuring ultrafine particles in two sampling lines of the test filtering facepiece respirator-one from inside the respirator and one from outside the respirator. Particle size distributions were characterized using the NanoScan data collected from outside of the respirator. Two models of N95 respirators were tested-foldable and pleated. Collected data indicate that penetration of all categories of ultrafine particles can exceed 5% and smaller ultrafine particles of <36.5 nm size generally penetrated least. Foldable N95 filtering facepiece respirators were found to be less efficient than pleated N95 respirators in filtering nanoparticles mostly at the soil moving site and the wooden building frameworks construction site. Upon charge neutralization by isopropanol treatment, the ultrafine particles of larger sizes penetrated more compared to particles of smaller sizes. Our findings, therefore, indicate that N95 filtering facepiece respirators may not provide desirable 95% protection for most categories of ultrafine particles and generally, 95% protection is achievable for smaller particles of 11.5 to 20.5 nm sizes. We also conclude that foldable N95 respirators are less efficient than pleated N95 respirators in filtering ultrafine particles, mostly in the soil moving site and the wooden building framework construction site.

Background and Objectives: Cardiovascular disease is the most common cause of death in CKD. This study evaluated whether electrocardiogram (ECG) abnormalities are predictors of cardiovascular death in CKD., Design, Setting, Participants, & Measurements: The Cardiovascular Health Study limited database (1989-2005) was used to identify a cohort with CKD at baseline (estimated GFR < 60 mL/min per 1.73 m(2)). The patients were categorized as having major, minor, or no ECG abnormalities. Rates of adjudicated cardiovascular events and mortality were compared among the groups using proportional hazards regression models., Results: A total of 1192 participants had CKD at baseline; mean age ± SD was 74.7±6.2 years. Of these patients, 452 (38.8%) had major, 346 (29.7%) had minor, and 367 (31.5%) had no ECG abnormalities. Participants with estimated GFR < 60 mL/min per 1.73 m(2) were more likely to have ECG abnormalities at baseline (adjusted prevalence odds ratio, 1.23 [95% confidence interval (CI), 1.06-1.43]) than those with GFR ≥ 60 mL/min per 1.73 m(2). During mean follow-up of 10.3±3.8 years, 814 (68.3%) participants died. Compared with participants without ECG abnormalities, participants with major abnormalities had the highest risk for cardiovascular events and death; adjusted hazard ratios were 2.15 (95% CI, 1.56-2.98) and 2.27 (95% CI, 1.56-3.30), respectively. For minor ECG abnormalities, hazard ratios were 1.24 (95% CI, 0.91-1.70) and 1.48 (95% CI, 1.00-2.18), respectively., Conclusions: In patients with CKD, major ECG abnormalities are frequently present and predict a significantly higher risk for death and adverse cardiovascular outcomes.

Psychotherapists' knowledge and understanding of Muslim women's culture is essential for them to effectively treat patients. Muslim women's culture is based on Islam, which permeates their thinking patterns, their interaction with themselves and others, and all activities of their daily lives. Western psychotherapy ineffectively treats Muslim women because its individualistic and fragmented method is contrary to the Muslim population's holistic spiritual approach to life. This article provides a theoretical integration of Eastern and Western therapeutic concepts for Muslim women, to promote a more effective therapeutic approach for this population residing in the United States.

The Muslim immigrant population is increasing in the United States. To provide appropriate psychotherapy for this group, especially Islamic women, treatment professionals must have a deeper understanding of the culture of Eastern Islamic women. Islam is the lifestyle of this population and it influences their thinking, the relationships among themselves and with others, and all other activities of daily life. The holistic approach of the Eastern Islamic population is incompatible with the individualistic approach of Western psychotherapy in treating Islamic women. We explore a theoretical model of psychotherapy for Eastern Asian-Islamic women suffering from mental illness (MI) to develop an effective and appropriate therapy. Health care providers, specifically those dealing with MI patients, will gain insights from the suggested psychotherapeutic model and its relevance to Islamic concepts and practices.

Muslims constitute a growing proportion of the African-American population. This paper explores the health practices, health behaviors, and code of ethics as informed by the Islamic religion within the context of African-American Muslim women's lives. An overview of the history of Islam in the world, and in the U.S., the main Islamic tenets, and the socio-cultural context of African-American Muslim women provides the broad framework for this paper. This information will be helpful in meeting the health needs of African-American Islamic women, within an outreach/community health promotion setting, within a clinical/hospital setting, or within a home care setting.

This exploratory, descriptive research study examined the knowledge and frequency of breast self-examination (BSE) among Middle Eastern Asian Islamic immigrant women residing in a major metropolitan U.S. city. The purposive sample consisted of 39 Middle Eastern Asian Islamic immigrant women ranging in age from 20 to 48 years (mean, 33; SD, 8.29). The sample was recruited from women who attended a local mosque. Data was collected by asking a list of seven questions based on Champion's BSE tool that assessed knowledge and frequency of BSE. Sociodemographic information also was collected. The results indicated that 33 women (85%) had heard of breast self-examination, and 29 women (74%) had not examined their breasts for lumps. None of the participants had examined her breasts monthly for lumps during the past year. Most of the women had not learned about BSE from a health professional, nor had they undergone a clinical breast examination (CBE). The results of this research show that Middle Eastern Asian immigrant women may be a population overlooked by health care professionals in the education of BSE. Suggestions to improve breast cancer screening practices among this population are provided.