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Presents several letters to the editor. Response to N.K. Chaudhry and colleagues on physicians' clinical experience versus the quality of their care; View that this journal has chosen to disparage older physicians with flimsy data at a time when malpractice and payment pressures are driving older, highly experienced physicians out of medicine early; View that the review by Chaudhry and colleagues showing a consistent negative relationship between experience and performance is controversial.

The need to investigate mineral precipitation in heterogeneous sedimentary rock with complex pore network and mineral composition arises with problems like pore clogging by barite precipitation during sulfate-rich water injection in geological reservoirs, the durability of long term storage of nuclear waste or the damage induced by crystallisation. At the LFCR (Laboratoire des Fluides Complexes et leurs Réservoirs, Anglet, France), we aim to reproduce geological objects in laboratory conditions. In this frame, we built a contra diffusive set up to precipitate a barite front in two sedimentary rock samples, a Lavoux oolitic limestone and a Vosges Sandstone with a fraction of clays. Two reservoirs filled respectively with BaCl 2 and Na 2 SO 4 dissolved in milli-Q water are in contact with a porous sample so that the ions diffuse through it. X-ray tomography shows that a barite front is precipitated in both samples at different positions depending on the diffusion of the different ions. SEM/EDS microanalysis on polish sections highlight both the barite front location and its connectivity. In the Lavoux limestone, a connected barite front is present. Fine barite aggregates preferentially precipitate in the smallest pores of the Lavoux sample, whilst the crystals precipitating in large macropores (>20 μ m) show a preferential orientation. We propose that the Gibbs free energy barrier for barite heterogeneous nucleation in the limestone is lower in contact with micrite in small pores than in contact with euhedral calcite in large pores. Finally, the Gibbs energy barrier for barite homogeneous nucleation in large pores is the highest. In the Vosges sandstone, the barite front is scattered with well-crystallized barite precipitating in large pores, and a more striking thin layer of barite is precipitated in the interfoliar space of chlorite-smectite complex. Consequently, we propose that smectite can concentrate barium by adsorption. Then because sulfate and sodium concentrations increase, ultimately barium is desorbed and barite precipitate. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the challenges of managing diabetes experienced by clients of a community-based social services organization via qualitative interviews; to develop recommendations for more effective diabetes education programming at the organization based on themes identified in the interviews. METHODS: Staff at Progreso Latino in Central Falls recruited clients with diabetes and prediabetes to participate in interviews during the summer of 2019. Each interview used a structured question set and was conducted in the participant's preferred language of Spanish or English. Investigators analyzed the interview transcripts and identified predominant themes. RESULTS: Analysis of fourteen interviews yielded four predominant themes: uncertainty about diagnosis and treatment, fear as part of the discussion with providers, language barriers, and cultural barriers. CONCLUSIONS: To strengthen diabetes education programming at a community-based organization, we recommend utilization of community health workers, development of culturally appropriate dietary recommendations, and creation of educational videos in clients' preferred languages. [ABSTRACT FROM AUTHOR]

Background: Although trauma centers represent an integral part of healthcare in the US, characterization of their financial vulnerability has not been reported. We sought to characterize the financial health and vulnerability among California trauma centers and identify factors associated with high and low vulnerability.Study Design: The RAND Hospital Data financial dataset was used to evaluate all American College of Surgeons (ACS)-verified trauma centers in California. Financial vulnerability of each center was calculated using 6 metrics to calculate a composite Financial Vulnerability Score (FVS). Tertiles of the FVS were generated to classify trauma centers as high, medium, or low financial vulnerability. Hospital characteristics were also analyzed and compared.Results: Forty-seven ACS trauma centers were identified. Nine were Level I, 27 were Level II, and 8 were Level III. Level I centers encompassed the greatest proportion of the high FVS tier (44%), whereas Level II and III centers were the most likely to be in the middle and lower tiers, respectively (44%; 63%). Lower FVS centers had greater asset:liability ratios, operating margins, and days cash on hand compared with the 2 higher tiers, whereas high FVS centers showed a greater proportion of uncompensated care, outpatient share rates, outpatient surgeries, and longer days in net accounts. Lower FVS centers were more likely to be teaching hospitals and members of a larger corporate entity.Conclusion: Many ACS trauma centers are at moderate/high risk for financial vulnerability and disparate impacts of stressor events, and the FVS may represent a novel metric that could be used at the local or statewide level. [ABSTRACT FROM AUTHOR]

This paper investigates an original method to efficiently trigger gas hydrate crystallization. This method consists of an in situ injection of a small amount of THF into an aqueous phase in contact with a gas-hydrate-former phase at pressure and temperature conditions inside the hydrate metastable zone. In the presence of a CO2-CH4 gas mixture, our results show that the THF injection induces immediate crystallization of a first hydrate containing THF. This triggers the formation of the CO2-CH4 binary hydrate as proven by the pressure and temperature reached at equilibrium. This experimental method, which "cancels out" the stochasticity of the hydrate crystallization, was used to evaluate the effect of the anionic surfactant SDS at different concentrations, on the formation kinetics of the CO2-CH4 hydrate. The results are discussed and compared with those published in a recent article (Ricaurte et al., 2013), where THF was not injected but present in the aqueous phase from the beginning and at much higher concentrations. [ABSTRACT FROM AUTHOR]

Background: Millions of people use the Internet as a source for health information yet little is understood about how the use of the Internet for health information is related to the doctor–patient relationship. Objective: We conducted the present study to understand the association between one’s interest in using the Internet for general and quality-oriented health information and attitudes about one’s communications with health care provider(s). Design: Cross-sectional survey. Setting: Four community-based primary care practices in Rhode Island. Measurements: A single self-administered survey included items to measure: interest in using the Internet to look for general and quality-oriented information and a patient’s perceptions of the degree to which their doctors over the previous year have: (1) given them information and (2) engaged them in the decision-making process. Results: A total of 300 patients completed the survey. Among patients without Internet access, interest in using the Internet for health related activities was less among patients who felt that their doctor gave less information: Odds ratio 0.83 (95% CI, 0.70–0.98) and greater among patients who felt that their doctor engaged them more in decision making: Odds ratio 1.3 (95% CI, 1.1–1.6). Among patients with Internet access, we found no relationship between interest in using the Internet for health related activities and measures of patient–physician communication or patient-physician decision making. Conclusions: Interest in using the Internet for health information is greater for those who (1) felt their doctors provided less information and (2) felt their doctors engaged them more in the decision-making process, but this is true only for those without access to the Internet. [Copyright &y& Elsevier]

Latinos have the highest uninsurance rates of any ethnic or racial group in the US despite recent health insurance expansion reform. In addition to immigration and language barriers, health literacy and attitudes may impact coverage disparities. Focus groups with Spanish-speaking community members and semi-structured interviews with health insurance navigators were conducted to explore knowledge, awareness, and attitudes towards healthcare reform among Latinos in Rhode Island. Sessions were audio recorded, transcribed, and analyzed employing standard qualitative methods. Thirty-two focus group participants and six navigators were enrolled in the study. Spanish-speaking participants demonstrated limited knowledge of the cost implications of the Medicaid Expansion and of the role of health insurance exchanges. Common misconceptions included that insurance costs would increase regardless of income, that enrollment would compromise green card and citizenship applications, that documented non-permanent residents would be ineligible for subsidies, and that reform benefits would apply to undocumented workers. Our findings suggest that local initiatives and providers should target Latinos in a culturally sensitive manner to increase literacy regarding insurance eligibility, affordability, points of access as well as to address misconceptions related to insurance eligibility for documented immigrants. [ABSTRACT FROM AUTHOR]

Background: Individuals with limited English proficiency (LEP) constitute an increasing share of the patient population in American healthcare settings. Few studies have described the patient's perspective on barriers to medical interpretation and experiences in the clinical setting. Methods: We conducted focus groups with 22 LEP Spanish-speaking adults. Focus groups were transcribed and analyzed in their original Spanish. Results: LEP patients face significant challenges when accessing health care services due to inadequate or insufficient access to professional interpreters. Predominant themes include: lack of interpreter availability, fear of disclosing limited English skills, and language discordant providers overestimating LEP patients' understanding of English. Many participants felt they had received poorer quality care. Conclusions: LEP patients face multiple barriers to accessing adequate interpretation leading to a perceived worsening in the quality of care. In order to improve health outcomes for LEP patients, routine provision of adequate interpretation is essential. [ABSTRACT FROM AUTHOR]

Despite generally lower socioeconomic status and worse access to healthcare, Latinos have better overall health outcomes and longer life expectancy than non-Latino Whites. This 'Latino Health Paradox' has been partially attributed to healthier cardiovascular (CV) behaviors among Latinos. However, as Latinos become more acculturated, differences in some CV behaviors disappear. This study aimed to explore how associations between acculturation and CV behaviors among Latinos vary by country of origin. Combined weighted data from the 2005 and 2007 California Health Interview Survey (CHIS) were used to investigate associations between acculturation level and CV behaviors among Latinos by country of origin. Among all Latinos, increased acculturation was associated with more smoking, increased leisure-time physical activity, and greater consumption of fast foods, but no change in fruit/vegetable and less soda intake. These trends varied, however, by Latino sub-groups from different countries of origin. Country of origin appears to impact associations between acculturation and CV behaviors among Latinos in complex ways. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated the incidence of Mycoplasma pneumoniae (Mp) infection and the presence of community-acquired respiratory distress syndrome toxin (CARDS Tx) in subjects with refractory asthma (RA). The researchers analyzed respiratory secretions and blood for the presence of CARDS Tx and P1 adhesin by polymerase chain reaction. It was found that 33 of 64 subjects tested positive for Mp.

Background and Objectives: Little is known about the differences in attitudes of medical students, Internal Medicine residents, and faculty Internists toward the physical examination. We sought to investigate these groups' self-confidence in and perceived utility of physical examination skills.Design and Participants: Cross-sectional survey of third- and fourth-year medical students, Internal Medicine residents, and faculty Internists at an academic teaching hospital.Measurements: Using a 5-point Likert-type scale, respondents indicated their self-confidence in overall physical examination skill, as well as their ability to perform 14 individual skills, and how useful they felt the overall physical examination, and each skill, to be for yielding clinically important information.Results: The response rate was 80% (302/376). The skills with overall mean self-confidence ratings less than "neutral" were interpreting a diastolic murmur (2.9), detecting a thyroid nodule (2.8), and the nondilated fundoscopic examination using an ophthalmoscope to assess retinal vasculature (2.5). No skills had a mean utility rating less than neutral. The skills with the greatest numerical differences between mean self-confidence and perceived utility were distinguishing between a mole and melanoma (1.5), detecting a thyroid nodule (1.4), and interpreting a diastolic murmur (1.3). Regarding overall self-confidence, third-year students' ratings (3.3) were similar to those of first-year residents (3.4; p = .95) but less than those of fourth-year students (3.8; p = .002), upper-level residents (3.7; p = .01), and faculty Internists (3.9; p < .001).Conclusions: Self-confidence in the physical exam does not necessarily increase at each stage of training. The differences found between self-confidence and perceived utility for a number of skills suggest important areas for educational interventions. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic disrupted chronic disease management in the United States and across the world. This study reports minimal effects of the initial COVID-19 surge on body mass index, blood pressure, cholesterol, and blood glucose control in ambulatory general internal medicine patients with Type 2 diabetes at a single academic center., Competing Interests: Declarations of Competing Interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Importance: Timely tests are warranted to assess the association between generative artificial intelligence (GenAI) use and physicians' work efforts., Objective: To investigate the association between GenAI-drafted replies for patient messages and physician time spent on answering messages and the length of replies., Design, Setting, and Participants: Randomized waiting list quality improvement (QI) study from June to August 2023 in an academic health system. Primary care physicians were randomized to an immediate activation group and a delayed activation group. Data were analyzed from August to November 2023., Exposure: Access to GenAI-drafted replies for patient messages., Main Outcomes and Measures: Time spent (1) reading messages, (2) replying to messages, (3) length of replies, and (4) physician likelihood to recommend GenAI drafts. The a priori hypothesis was that GenAI drafts would be associated with less physician time spent reading and replying to messages. A mixed-effects model was used., Results: Fifty-two physicians participated in this QI study, with 25 randomized to the immediate activation group and 27 randomized to the delayed activation group. A contemporary control group included 70 physicians. There were 18 female participants (72.0%) in the immediate group and 17 female participants (63.0%) in the delayed group; the median age range was 35-44 years in the immediate group and 45-54 years in the delayed group. The median (IQR) time spent reading messages in the immediate group was 26 (11-69) seconds at baseline, 31 (15-70) seconds 3 weeks after entry to the intervention, and 31 (14-70) seconds 6 weeks after entry. The delayed group's median (IQR) read time was 25 (10-67) seconds at baseline, 29 (11-77) seconds during the 3-week waiting period, and 32 (15-72) seconds 3 weeks after entry to the intervention. The contemporary control group's median (IQR) read times were 21 (9-54), 22 (9-63), and 23 (9-60) seconds in corresponding periods. The estimated association of GenAI was a 21.8% increase in read time (95% CI, 5.2% to 41.0%; P = .008), a -5.9% change in reply time (95% CI, -16.6% to 6.2%; P = .33), and a 17.9% increase in reply length (95% CI, 10.1% to 26.2%; P < .001). Participants recognized GenAI's value and suggested areas for improvement., Conclusions and Relevance: In this QI study, GenAI-drafted replies were associated with significantly increased read time, no change in reply time, significantly increased reply length, and some perceived benefits. Rigorous empirical tests are necessary to further examine GenAI's performance. Future studies should examine patient experience and compare multiple GenAIs, including those with medical training.

Although United States (US) medical institutions discuss the importance of diversity, equity, and inclusion, there is little guidance about the process by which these concepts can be attained programmatically within institutions. The Office of Belonging, Equity, Diversity, and Inclusion (OBEDI) at The Warren Alpert Medical School of Brown University intends to rise to the challenge and share knowledge and experience with other institutions. Program design models, and the alignment of inputs, outputs, and outcomes for the short-term and long-term are illustrated. OBEDI's unique model of how each of these concepts contribute towards health equity, from the individual to the community, is also explained. Finally, OBEDI shares promising practices and future directions.

Flexible rhinolaryngoscopy is an underused procedure that can provide allergists-immunologists and other physicians with several benefits over existing imaging techniques. In this article, we highlight the many benefits of flexible rhinolaryngoscopy and expand on its safety, cost-effectiveness, and convenience. This article also covers current procedure techniques and assesses the most common indications and relevant clinical findings for which flexible rhinolaryngoscopy can be used to evaluate the nasopharyngeal tract. Videos for the clinician showing some of the most common findings are included., (Copyright © 2022. Published by Elsevier Inc.)

Background: The relationship between surgical management of adhesive small bowel obstruction (ASBO) and hospital teaching status is not well known. We sought to elucidate the association between hospital teaching status and clinical metrics for ASBO., Methods: Using the 2007-2017 California Office of Statewide Health Planning and Development database, we identified adult ASBO patients hospitalized for surgical intervention. Hospital teaching status was categorized as major teaching (MajT), minor teaching (MinT), and non-teaching (NT). Cox proportional hazards modeling was used to evaluate risk of death and other adverse outcomes., Results: Of 25,047 admissions, 15.4% were at MajT, 32.0% at MinT, and 52.6% at NT; 2.9% died. Patients at MajT had longer overall hospital stays (HLOS) than those at MinT or NT (median days 9 vs. 8 vs. 8; p = 0.005), longer post-ASBO procedure HLOS (median days 7 vs. 6 vs. 6; p = 0.0001) and higher rates of small bowel resection (27.1% vs. 21.7% vs. 21.7%; p < 0.0001). Mean time to first surgery at MajT was 3.3 days compared with 2.6 days (p = 0.004) at MinT and NT. Compared with patients at NT, those at MajT were significantly less likely to die (HR 0.62, p < 0.0001), develop pneumonia (HR 0.57, p = 0.001), or experience adverse discharge disposition (HR 0.79, p < 0.0001)., Conclusion: Mortality and morbidity of ASBO surgery were reduced at MajT; however, time to surgery, HLOS, and rate of small bowel resection were greater. These findings may guide improvements in the management of ASBO patients., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Traumatic intracranial hemorrhage (ICH) is a highly morbid injury, particularly among elderly patients on preinjury anticoagulants (AC). Many trauma centers initiate full trauma team activation (FTTA) for these high-risk patients. We sought to determine if FTTA was superior compared with those who were evaluated as a trauma consultation (CON)., Methods: Patients aged ≥55 on preinjury AC who presented from January 2015 to December 2019 with blunt isolated head injury (non-head AIS ≤2) and confirmed ICH were identified. CON patients and FTTA patients were matched by age and head AIS. Cox proportional hazard model was used to assess patient and injury characteristics with mortality and survivor discharge disposition., Reasults: There were 45 CON patients and 45 FTTA patients. Mean age was 80 years in both groups. Fall was the most common mechanism (98% CON vs. 92% FTTA). Glasgow Coma Score (GCS) was lower in FTTA (14 vs. 15, p<0.01). CON had a significantly longer time from arrival to CT scan (1.3 vs. 0.4 hrs, p<0.01). Hospital days were similar (CON: 3.9 vs. FTTA: 3.7 days). However, CON had increased ventilator use (p=0.03). Lower admission GCS was the only factor associated with increased risk of death. Among survivors, only head AIS increased the risk of discharge to a level of care higher than that of preinjury (p=0.01)., Conclusion: There was no difference in mortality or adverse discharge disposition between FTTA and CON, although FTTA was associated with a more rapid evaluation and diagnosis. Any alteration in GCS was strongly associated with mortality and should prompt evaluation by FTTA., (Copyright © 2021. Published by Elsevier Inc.)

Background: Trauma care is associated with unplanned readmissions, which may occur at facilities other than the index treatment facility. This "fragmentation of care" may be associated with adverse outcomes. We evaluated a statewide database that includes readmissions to analyze the incidence and impact of FC., Methods: The California Office of Statewide Health Planning and Development patient discharge data set was evaluated for calendar years 2016 to 2018. Patients 15 years or older diagnosed with blunt abdominal solid organ injury during the index admission were identified. Readmissions were evaluated postdischarge at 1, 3, and 6 months. Patients readmitted within 6 months to a facility other than the index admission facility (fragmented care [FC]) were compared with those readmitted to their index admission facility (non-FC). Logistic regression modeling was used to evaluate risk of FC., Results: Of the total 1,580 patients, there were 752 FC (47.6%) and 828 (52.4%) non-FC. Readmissions representing FC at months 1, 3, and 6 were 40.3%, 49.3%, and 53.4%, respectively. At index admission, the groups were demographically and clinically similar, with similar rates of abdominal operations and complications. Non-FC patients had a higher rate of abdominal reoperation at readmission (5.8% non-FC vs. 2.9% FC, p = 0.006). In an adjusted model, multiple readmissions (odds ratio [OR] 1.11, p = 0.014), readmission >30 days after index facility discharge (OR, 1.98; p < 0.001), and discharge to a nonmedical facility (OR, 2.46; p < 0.0001) were associated with increased odds of FC. Operative intervention at index admission was associated with lower odds of FC (OR, 0.77; p = 0.039). However, FC was not independently associated with demographic or insurance characteristics., Conclusion: The rate of FC among patients with blunt abdominal injury is high. The risk of FC is mitigated when patients are managed operatively during the index admission. Trauma systems should implement measures to ensure that these patients are followed postdischarge., Level of Evidence: Prognostic and epidemiological, level III; Care management, level IV., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Methamphetamine (METH) is associated with an elevated risk of injury and the outcomes in the elderly remain unclear. We analyzed METH's impact in elderly trauma patients., Methods: Retrospective analysis (2009-2018) of trauma patients at a Level I trauma center. Elderly patients were defined as age ≥55. Substance use was identified by blood alcohol test and urine drug screen. Cox proportional hazard model was used to assess patient and injury characteristics with mortality., Results: Of 15,770 patient encounters with substance use testing, 5278 (34%) were elderly. Elderly METH use quadrupled over time (2%-8%; p < 0.01). Elderly METH + patients were more likely to require surgical intervention (35% vs. 17%), mechanical ventilation (15% vs. 7%), and a longer hospitalization (6.5 vs. 3.6 days) compared with elderly substance negative. Multivariate analysis showed increasing age, ventilator use, and injury severity were associated with mortality (ps < 0.01); METH was not related to mortality., Conclusion: Substance use in elderly trauma patients increased significantly. METH use in elderly trauma patients is a risk factor for significantly greater resource utilization., Competing Interests: Declaration of competing interest The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: We compared surgical device malfunction reports in the Food and Drug Administration (FDA) public Manufacturer and User Facility Device Experience (MAUDE) with those in the FDA nonpublic Alternative Summary Reporting (ASR)., Methods: General surgery device product code categories in MAUDE and ASR from 1999 to 2018 were identified. Changes in the rates of categories and adverse events were evaluated by Poisson regression., Results: There were 283,308 (72%) general surgical device malfunctions in MAUDE and 109,954 (28%) in ASR. Reports increased annually in ASR versus MAUDE, particularly for surgical staplers and clip devices (p < 0.05). ASR contained approximately 80% of these reports; MAUDE 20%. In MAUDE, 42.9% of surgical device malfunctions and 20.2% of stapler/clip malfunctions resulted in patient injury or death. ASR listed no injury or death information., Conclusions: ASR contained a significant portion of surgical device malfunctions hidden from public scrutiny. Access to such data is essential to safe surgical care., Competing Interests: Declaration of competing interest The authors have no financial or proprietary interest in the subject matter or materials discussed in the manuscript., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Organic clathrates formed by hydroquinone (HQ) and gases such as CO 2 and CH 4 are solid supramolecular host-guest compounds in which the gaseous guest molecules are encaged in a host framework of HQ molecules. Not only are these inclusion compounds fascinating scientific curiosities but they can also be used in practical applications such as gas separation. However, the development and future use of clathrate-based processes will largely depend on the effectiveness of the reactive materials used. These materials should enable fast and selective enclathration and have a large gas storage capacity. This article discusses the properties and performance of a new composite material able to form gas clathrates with hydroquinone (HQ) deposited on alumina particles. Apart from the general characterization of the HQ-alumina composite, one of the most remarkable observations is the unexpected formation of a guest-free clathrate structure with long-term stability (>2 years) inside the composite. Interestingly enough, in addition to a slight improvement in the enclathration kinetics of pure CO 2 compared to powdered HQ, preferential capture of CO 2 molecules is observed when the HQ-alumina composite is exposed to an equimolar CO 2 /CH 4 gas mixture. In terms of gas capture selectivity toward CO 2 , the performance of this new composite exceeds that of pure HQ and HQ-silica composites developed in a previous study, opening up new opportunities for the design and use of these novel materials for gas separation.

Purpose: Patients with advanced non-small cell lung cancer (NSCLC) whose tumors harbor anaplastic lymphoma kinase ( ALK) gene fusions benefit from treatment with ALK inhibitors (ALKi). Analysis of cell-free circulating tumor DNA (cfDNA) may provide a noninvasive way to identify ALK fusions and actionable resistance mechanisms without an invasive biopsy. Patients and Methods: The Guardant360 (G360; Guardant Health) deidentified database of NSCLC cases was queried to identify 88 consecutive patients with 96 plasma-detected ALK fusions. G360 is a clinical cfDNA next-generation sequencing (NGS) test that detects point mutations, select copy number gains, fusions, insertions, and deletions in plasma. Results: Identified fusion partners included EML4 (85.4%), STRN (6%), and KCNQ, KLC1, KIF5B, PPM1B , and TGF (totaling 8.3%). Forty-two ALK -positive patients had no history of targeted therapy (cohort 1), with tissue ALK molecular testing attempted in 21 (5 negative, 5 positive, and 11 tissue insufficient). Follow-up of 3 of the 5 tissue-negative patients showed responses to ALKi. Thirty-one patients were tested at known or presumed ALKi progression (cohort 2); 16 samples (53%) contained 1 to 3 ALK resistance mutations. In 13 patients, clinical status was unknown (cohort 3), and no resistance mutations or bypass pathways were identified. In 6 patients with known EGFR- activating mutations, an ALK fusion was identified on progression (cohort 4; 4 STRN , 1 EML4; one both STRN and EML4 ); five harbored EGFR T790M. Conclusions: In this cohort of cfDNA-detected ALK fusions, we demonstrate that comprehensive cfDNA NGS provides a noninvasive means of detecting targetable alterations and characterizing resistance mechanisms on progression. Clin Cancer Res; 24(12); 2758-70. ©2018 AACR ., (©2018 American Association for Cancer Research.)

Background: Omalizumab is approved for patients with poorly controlled asthma with serum IgE levels between 30 and 700 IU/mL and positive test results for perennial allergens. Its efficacy in patients with IgE levels greater than 700 IU/mL is unclear., Objective: To evaluate the response of asthmatic patients treated with omalizumab with IgE levels greater than 700 IU/mL., Methods: Asthmatic patients treated with omalizumab for 6 months or longer with elevated IgE levels were evaluated retrospectively. Emergency department (ED) visits, hospitalizations, change in forced expiratory volume in 1 second, corticosteroid bursts, and Asthma Control Test (ACT) scores were recorded for a period of 6 months before and after treatment., Results: Twenty-six patients with an IgE level greater than 700 IU/mL (group 1) were matched by age, sex, and severity of asthma to patients with an IgE of 30 to 700 IU/mL (group 2). The mean numbers of ED visits before and after treatment were 0.96 vs 0.23 (P = .008) in group 1 and 0.65 vs 015 (P = .02) in group 2. Both group 1 and group 2 had an improvement in asthma control based on the mean ACT score before and after treatment (15.6 vs 18.9 [P = .02] and 15.4 vs 19 [P = .006], respectively). There was also a significant reduction in the frequency of systemic corticosteroid use during the 6 months before and after treatment (2.58 vs 0.96 [P < .001] and 2.62 vs 1.23 [P < .001] systemic steroid treatments, respectively)., Conclusion: Omalizumab was as effective in reducing ED visits, controlling asthma symptoms, and reducing the need for systemic corticosteroids in patients with IgE levels greater than 700 IU/mL compared with patients with levels of 30 to 700 IU/mL., (Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Latina women are less likely to utilize cancer screening services than are non-Latina White women. The purpose of this study is to examine the relationship between preferred language (English vs. Spanish) and receipt of mammography and Pap-smear testing among US Latinas and non-Latinas. Cross-sectional analysis of the 2008 and 2010 Behavioral Risk Factor Surveillance System (BRFSS) surveys. While Latinas responding to the BRFSS in English or in Spanish had unadjusted lower odds of receiving mammography testing, in multivariable analysis Latinas responding-in-Spanish had 2.20 times the odds (OR = 2.20, 95 % CI, 1.90-2.55) of reporting mammography compared to non-Latinas. Similarly, Latinas responding-in- Spanish had lower unadjusted odds of receiving Pap-smear testing. However, Latinas responding-in-Spanish had 2.37 times the odds (OR = 2.37 CI, 2.04-2.75) of reporting having received Pap smear testing compared to non-Latinas in multivariate analysis. The results of this paper further confirm the "reversed associations" among Latinas and mammography and Pap smear testing described in previous studies and suggest that in addition to insurance status, preferred language may be a key variable contributing to the reversal phenomenon observed among Latinas.

Although colorectal cancer is the third leading cause of cancer-related deaths in the U.S., the burden of this disease could be dramatically reduced by increased utilization of screening. Evidence-based recommendations and guidelines from national societies recommend screening all average risk adults starting at age fifty. However, the myriad of screening options and slight differences in screening recommendations between guidelines may lead to confusion among patients and their primary care providers. This goal of this review is to briefly summarize the colorectal cancer screening guidelines issued by three major organizations, compare their recommendations, and address emerging issues in colorectal cancer screening.

This article describes the role of psychosocial support programs in American Red Cross-sponsored humanitarian assistance efforts in international disasters. The American Red Cross psychosocial support program consists of four specific components: participatory crisis assessment, dealing with survivors' root shock, community mobilization, and community development. The program is predicated on the assumption that after a disaster, survivors lose their sense of "place". Psychosocial community programs are based on outreach activities by local practitioners trained and supported by the American Red Cross. The approach sees psychological advantages to survivors of continuing to mobilize their own resources; familiarity, trust, and human capital build. The community members themselves decide the steps they are going to take to reestablish "place," thus becoming active participants in reducing the traumatic stress caused by the disaster. The article concludes with three actions that signal successful integration of psychosocial support programs into multisector responses to disasters: reestablishment of a sense of place, community mobilization, and taking actions that lead to a sense of physical and psychological well-being.

Objective: To determine the impact of interpretation method on outpatient visit length., Design: Time-motion study., Setting: Hospital-based outpatient teaching clinic., Participants: Patients presenting for scheduled outpatient visits., Measurements and Main Results: Over a 6-week study period, a research assistant recorded the following information for consecutive patient visits: patient age, gender and insurance type; type of interpreter used (none, hospital interpreter, telephone interpreter or patient-supplied interpreter); scheduled visit length; provider type (nurse practitioner; attending physician; resident in postgraduate year 1, 2 or 3, or medical student); provider gender; amount of time the patient spent in the examination room with the provider (provider time); and total time the patient spent in the clinic from check-in to checkout (clinic time). When compared to patients not requiring an interpreter, patients using some form of interpreter had longer mean provider times (32.4 minutes [min] vs 28.0 min, P <.001) and clinic times (93.6 min vs 82.4 min, P =.002). Compared to patients not requiring an interpreter, patients using a telephone interpreter had significantly longer mean provider times (36.3 min vs 28.0 min, P <.001) and clinic times (99.9 min vs 82.4 min, P =.02). Similarly, patients using a patient-supplied interpreter had longer mean provider times (34.4 min vs 28.0 min, P <.001) and mean clinic times (92.8 min vs 82.4 min, P =.027). In contrast, patients using a hospital interpreter did not have significantly different mean provider times (26.8 min vs 28.0 min, P =.51) or mean clinic times (91.0 min vs 82.4 min, P =.16) than patients not requiring an interpreter., Conclusion: In our setting, telephone and patient-supplied interpreters were associated with longer visit times, but full-time hospital interpreters were not.

Objectives: To determine the percentage of patients enrolled in a primary care practice who use the Internet for health information, to describe the types of information sought, to evaluate patients' perceptions of the quality of this information, and to determine if patients who use the Internet for health information discuss this with their doctors., Design: Self-administered mailed survey., Setting: Patients from a primary care internal medicine private practice., Participants: Randomly selected patients ( N=1,000) were mailed a confidential survey between December 1999 and March 2000. The response rate was 56.2%., Measurements and Main Results: Of the 512 patients who returned the survey, 53.5% (274) stated that they used the Internet for medical information. Those using the Internet for medical information were more educated ( P <.001) and had higher incomes ( P <.001). Respondents used the Internet for information on a broad range of medical topics. Sixty percent felt that the information on the Internet was the "same as" or "better than" information from their doctors. Of those using the Internet for health information, 59% did not discuss this information with their doctor. Neither gender, education level, nor age less than 60 years was associated with patients sharing their Web searches with their physicians. However, patients who discussed this information with their doctors rated the quality of information higher than those who did not share this information with their providers., Conclusions: Primary care providers should recognize that patients are using the World Wide Web as a source of medical and health information and should be prepared to offer suggestions for Web-based health resources and to assist patients in evaluating the quality of medical information available on the Internet.