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There are persistent disparities in the delivery of cancer treatment, with Black patients receiving fewer of the recommended cancer treatment cycles than their White counterparts on average. To enhance racial equity in cancer care, innovative methods that apply antiracist principles to health promotion interventions are needed. The parent study for the current analysis, the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) intervention, was a system-change intervention that successfully eliminated the Black–White disparity in cancer treatment completion among patients with early-stage breast and lung cancer. The intervention included specially trained nurse navigators who leveraged real-time data to follow-up with patients during their treatment journeys. Community and academic research partners conducted thematic analysis on all clinical notes (n = 3,251) written by ACCURE navigators after each contact with patients in the specialized navigation arm (n = 162). Analysis was informed by transparency and accountability, principles adapted from the antiracist resource Undoing Racism and determined as barriers to treatment completion through prior research that informed ACCURE. We identified six themes in the navigator notes that demonstrated enhanced accountability of the care system to patient needs. Underlying these themes was a process of enhanced data transparency that allowed navigators to provide tailored patient support. Themes include (1) patient-centered advocacy, (2) addressing system barriers to care, (3) connection to resources, (4) re-engaging patients after lapsed treatment, (5) addressing symptoms and side effects, and (6) emotional support. Future interventions should incorporate transparency and accountability mechanisms and examine the impact on racial equity in cancer care.

IntroductionMultiple symptoms occur in people with kidney failure receiving haemodialysis (HD) and these symptoms have a negative impact on health-related quality of life (HRQoL). Fatigue, the most common symptom, is debilitating and difficult to manage. Educational interventions involving energy conservation strategies are helpful in reducing fatigue, however the effectiveness of energy conservation has not been previously studied in those receiving HD. The aim of this study is to evaluate the effectiveness of an energy conservation education intervention for people with end-stage kidney disease receiving HD (EVEREST trial).Methods and analysisA pragmatic cluster randomised control trial with repeated measure will be used. One hundred and twenty-six participants from tertiary level dialysis centre will be cluster randomised to the intervention and control group according to HD treatment day. The intervention group will receive usual care along with a structured energy conservation education programme over 12 weeks comprising three individual face-to-face educational intervention sessions, one booster session and a booklet. The control group will receive usual care from their healthcare providers and a booklet at the end of the study. The primary outcome is fatigue, and the secondary outcomes are other Chronic Kidney Disease (CKD) symptoms, occupational performance and HRQoL. Intention-to-treat analysis will occur and will include a change in primary and secondary outcomes.Ethics and disseminationEthical approval has been obtained from the Human Research Committee of the Griffith University and Nepal Health Research Council. The results of this research will be published and presented in a variety of forums.Trial registration numberNCT04360408.

Utilizing the metaphors of family and the migrant family road trip, this essay offers an appreciative challenge to Vondey’s contribution of constructive theological narrative of the fivefold gospel. By suggesting the importance of the inclusion of a relational and familial model, it raises the issue of what is missed by the lack of inclusion of the voices of testifying members of the Pentecostal family, particularly those of sisters and mothers. Further, the journey motif, it is suggested, better fits the epic spirituality of the Pentecostal movement.

In this chapter, we will discuss how we use REBT to treat couples—whether they be in love but experiencing conflict, have drifted apart and wish to rekindle their connection, or are at a crisis point where the survival of the relationship is at stake.

Albert Ellis began practicing group therapy with deviant adolescents utilizing a psychoanalytic approach in the early year of 1949 at the New Jersey State Diagnostic Center. For many of the same reasons he criticized individual therapy using psychoanalysis, he had similar views about conducting group therapy with psychoanalysis.

The phenomenon known as the heavenly choir was a common feature of early Pentecostal worship and revival, rivaled only by speaking in tongues. Participation in the heavenly choir was transformative of both singer and hearer, producing a desire for a fuller experience of God. The experience of participation in the communion of singers transformed the marginalized into prophetic leaders, their earthy meeting places became sanctuaries of ‘heaven below’. This transformation was subversive in that dominant cultural constructs based on race, gender, class, ethnicity, and age were weakened if not toppled. Interpretation of this phenomenon by participants involved an approach to Scripture more dynamic than the later biblicism, interpreters finding resonance with the worship scenes in the book of Revelation rather than dependence upon a one-to-one correspondence of events in the Acts narrative or discourse by Paul, subverting later doctrinal construction beholden to Evangelical schemes.

Objectives To describe rates of first significant infection of rheumatoid arthritis patients who switch between anti-tumor necrosis factor (aTNF) drugs. Methods Subjects with rheumatoid arthritis who received only aTNF drugs were observed in an insurance claims database from January 2001 to December 2007. Nonswitchers (NS) remained on one aTNF throughout the study period (date of the first aTNF claim was the index date); switchers (S) received at least one other aTNF (claim date for the 2nd agent was the index date). Significant infections included those that required intravenous antibiotics or hospitalization. Two attributable risk periods were used: (1) an infection occurring ≤90 days following a claim for an aTNF (90-day) and (2) an infection occurring after the index date (ever-treated). Follow-up was censored at the first occurrence of a significant infection event, end of eligibility, or end of study period. Data were analyzed using Cox regression. Results In 13,752 NS and 2293 S patients, time-stratified rates declined 2- to 3-fold between the first year versus ≥2 years. Risk of significant infection was not different for either attribution model [90-day hazard ratio (HR) = 0.93, 95CI: 0.74 to 1.17, P = 0.55; ever treated HR=0.94, 95CI: 0.78 to 1.15, P = 0.57]. First and second year rates were similar. Predictors included age ≥50 years; history of significant or opportunistic infection, diabetes, respiratory disease; Charlson score ≥2; or prior hospitalizations. Conclusions The risk of a significant infection was not different between NS and S patients. Regardless of switching status, the rate of infection was greater in the first year. This study was limited by the lack of clinical data to determine the reason for switching.

This essay maintains that women within the Pentecostal tradition are being socialized to languish rather than flourish. Through an examination of the parallel stories of Mary, the mother of Jesus, and Catherine Booth, founder of the Salvation Army, the study explores the “call narrative” of the Pentecostal female minister and the accompanying need for affirmation from the community. The essay explores this narrative within the context of the ecclesial community and its failure to create an environment where women may flourish. This failure on the Church’s part has contributed to its own languishing.

The objectives of this study were to determine the duration of fecal Salmonella shedding among dairy cattle in the northeastern United States following laboratory-confirmed clinical disease and to evaluate whether age group or serotype was associated with either shedding period or mortality. Study farms included 22 dairy herds that had at least two previous salmonellosis cases confirmed by fecal culture. Veterinarians continued to submit culture samples from clinical suspects following herd enrollment, and fecal samples from positive cattle were collected monthly until three sequential negative results were obtained or until loss to follow-up. There were 357 culture-positive clinical cases that each involved a single serotype during the shedding period. The Kaplan-Meier median duration of fecal Salmonella shedding was 50 days, and the maximum was 391 days. S. Newport was the predominant serotype, accounting for 51% of the cases. Age group and serotype were not significant predictors of Salmonella shedding duration in a Cox proportional hazards model, when stratifying by herd. However, the proportion of adult cows shedding for at least two consecutive monthly samples was significantly greater than the proportion of female calves shedding for this duration (Fisher’s exact test p-value < 0.01). Age group was also associated with mortality in this study; calves with salmonellosis were more likely to die than cows as estimated by a logistic regression model which controlled for herd as a random effect (p-value = 0.04).

Objective—To determine the duration of fecal shedding of and serologic response to Salmonella spp after natural infection in dairy calves and characterize Salmonella organisms recovered from these herds. Design—Longitudinal study. Animals—Calves from 2 dairy herds (A and B) in the northeast United States that were identified at the beginning of a Salmonella outbreak. Procedures—Fecal samples were collected twice per week (herd A) or once per week (herd B); blood samples were collected for serologic testing once per week in both herds. Bacteriologic culture of fecal samples was performed, and Salmonella isolates were characterized by serotype, pulsed-field gel electrophoresis (PFGE) pattern, and antimicrobial resistance profile. Results—All Salmonella isolates from herd A were serovar Typhimurium var Copenhagen, had the same PFGE pattern, and were resistant to at least 9 antimicrobials. All isolates from herd B were Salmonella Typhimurium, represented 2 PFGE patterns, and were susceptible to all antimicrobials evaluated. The estimated duration of fecal shedding was 14 days in herd A and 9 days in herd B. Few calves were seropositive for antibody against Salmonella lipopolysaccharide within the first week after birth (0 of 20 in herd A and 13 of 79 in herd B) or seroconverted (6 in herd A and 4 in herd B). Fecal shedding was more common in calves that seroconverted, but overall, there was not a strong association between seropositivity and fecal shedding of Salmonella organisms. Conclusions and Clinical Relevance—Although the herds differed in serologic response and Salmonella subtype, the duration of fecal shedding among calves was similar between herds.

The objectives of this study were to estimate the incidence of salmonellosis among a large sample of dairy herds in the northeastern United States (both at the animal level and the herd level), to describe the serotypes and antimicrobial resistance profiles of the positive samples, and to determine whether various herd-level factors were important predictors of incidence. Participating veterinarians enrolled 831 dairy herds and submitted fecal samples from 2,565 female dairy cattle for Salmonella culture because of suspicion of clinical disease. Estimates of animal-level incidence rates were calculated for each age group as the number of cases per animal time at risk, and an estimate of herd-level incidence rate was calculated as the number of positive herds per herd time at risk. Descriptive analysis of serotype data and level of antimicrobial resistance was performed, and Poisson regression analysis was used to study associations between the within-herd incidence of salmonellosis and certain predictor variables (herd size, housing type, vaccination status, and prior history of Salmonella infection). Salmonella was isolated from 576 (22.5%) samples representing 93 herds. The animal-level incidence rates for preweaned female calves, heifers, and adult cows were 8.1, 0.04, and 1.8 cases per 1,000 animal-years, respectively. The herd-level incidence rate was 8.6 positive herds per 100 herd-years. Salmonella Newport was the predominant serotype, accounting for 41% of the cases, followed by Salmonella Typhimurium. Over 68% of all isolates were resistant to 5 or more antimicrobial agents. Herd size was the only significant predictor of the incidence of salmonellosis in a multivariable model; herds with at least 400 female dairy cattle had a higher incidence rate than smaller herds. Our results shed light on the impact of salmonellosis on the dairy industry in the northeastern United States, and they help clarify the role of dairy cattle as a source of Salmonella serotypes that are also important human pathogens.

This article surveys early Pentecostal discussions of the doctrine of the Trinity and water baptism and focuses specifically on baptismal mode and formula. In tracing the discussion from 1906 to the period just after the 1916 General Council of the Assemblies of God, literature from various streams of the tradition is examined. By surveying the periodical literature as well as official documents produced by these various denominations and groups, not only will doctrinal discussions be seen but also the practices associated with water baptism. It is the author's conclusion that there was some degree of flexibility with regard to both formula and mode of baptism before the emergence of the New Issue (1914). However, the research reveals that there was a well thought out doctrine of the Trinity prior to the rise of Oneness theology thereby establishing that Pentecostal theology was Trinitarian in its inception.

Objective To estimate rates of all-cause mortality, fatal infection, and fatal malignancy in rheumatoid arthritis (RA) patients treated with anti-tumor necrosis factor-α (anti-TNF) biologics. Methods A retrospective cohort study of RA patients initiating therapy with adalimumab, etanercept, or infliximab from January 2000 to December 2008 was conducted using an administrative database of a large health care insurer. Patients were followed for the occurrence of fatal events, which were identified using the National Death Index database. Overall and anti-TNF biologic-stratified incidence rates per 1000 person-years were calculated. Primary analyses were time-on-drug based on current anti-TNF biologic exposure on the outcome date for fatal infection and intent-to-treat based on the anti-TNF biologic initiated at cohort entry for fatal malignancy. Results Seven thousand seven hundred thirty-four patients initiated an anti-TNF biologic with 13,296 person-years of observation. Seventy-one deaths were identified, including 12 fatal infections and 21 fatal malignancies. The all-cause mortality rate was 5.34 per 1000 person-years. Incidence rates for fatal infection were similar among anti-TNF biologic current exposure groups (0.78 to 0.88 per 1000 person-years). Incidence rates for fatal malignancy were similar among anti-TNF biologic initiator groups (1.24 to 1.84 per 1000 person-years). Conclusions The all-cause mortality rate in RA patients treated with anti-TNF biologics was lower than in previous studies in similar non-US populations, but comparable to mortality rates in the US general population. Fatal infection and fatal malignancy rates were similar across anti-TNF biologic groups. Further studies, designed to detect risk differences associated with anti-TNF biologic use and baseline risk factors, would provide additional information.

Increased frequency of antimicrobial resistant Salmonella isolated from humans over the last quarter century in the United States has led to concern about the contribution animal production systems have played in the emergence and spread of antimicrobial resistant Salmonella. In order to better understand the potential role of dairy cattle as a reservoir for antimicrobial resistant Salmonella, it is important to understand methods currently used to measure the prevalence of antimicrobial resistance among Salmonella from human and animal populations. This review describes the biology of Salmonella and antimicrobial resistance, methods used to monitor antimicrobial resistance, and studies that have measured the prevalence of antimicrobial resistant Salmonella among human and dairy cattle populations in the U.S. Although the prevalence of antimicrobial resistance among Salmonella from healthy dairy cattle is low, similar trends in the prevalence of resistance among Salmonella from clinically ill human and dairy cattle populations were observed in the literature.

Mecklenburg Emergency Medical Services Agency, better known as Medic, provides emergency and nonemergency paramedic level medical services to the citizens of Mecklenburg County. Medic is part of a unique partnership between Mecklenburg County, Carolinas HealthCare System, and Presbyterian Health Care/Novant Health. Since fiscal year 1997, Medic has reduced ambulance response times, implemented higher clinical standards, and reduced the taxpayer subsidy per call by half The agency will answer more than 85,000 calls for medical help this year. Medic also conducts frequent community education programs on health, safety, injury prevention, and emergency-related issues.