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Congenital pseudarthrosis of the clavicle is a rare phenomenon with multiple proposed causes. Surgical management is typically indicated either because of the cosmetic appearance of the irregularity or, less commonly, for pain, particularly in adolescent patients. Multiple surgical methods have previously described in the literature, which have raised concern owing to the persistently high rate of nonunion postoperatively. This article describes management of congenital pseudarthrosis of the clavicle with open reduction and internal fixation using a T-shaped iliac crest autograft.

Thermal power cycles using sCO2 as a working fluid place extreme demands on their turbomachinery components and their electric motors/generators. In this paper, new system topologies for sCO2 turbomachinery are proposed which take advantage of “bearingless” electric machine technology to improve performance. Bearingless motors/generators are a new type of electric machine which integrate the functionality of active magnetic bearings into the existing hardware of an electric motor/generator. The existing electromagnetic surfaces and materials are reused to enable controllable production of radial forces on the machine shaft. This is envisioned to improve hermetic direct-drive turbomachinery systems by either augmenting existing bearings (i.e., bearing assist) or replacing existing bearings (i.e., bearing removal). The state-of-the-art technologies for several bearing types (gas foil bearings, externally pressurized porous (EPP) gas bearings, and active magnetic bearings) and electric machines are reviewed to motivate the introduction of bearingless technology. Two system designs using bearingless machines are proposed and compared against existing commercial solutions in terms of maximum shaft weight, number of passthroughs into the hermetic environment, cost, and complexity. A case-study bearingless motor/generator is assessed via simulations and a hardware prototype to investigate practical considerations for using bearingless technology in sCO2 turbomachinery. The proposed bearingless solutions have potential to enable a new generation of sCO2 turbomachinery with improved reliability, reduced complexity, and lower cost. This paper shows that by transforming the motor/generator already present in turbomachinery into a bearingless motor/generator, the technical challenges involved with sCO2 can be overcome without adding significant cost.

Background: Additive manufacturing has recently gained popularity and is widely adopted in the orthopaedic industry. However, there is a paucity of literature on the radiographic and clinical outcomes of these relatively novel components. The aim of this study was to assess the 2-year clinical and radiographic outcomes of a specific additive-manufactured acetabular component in primary total hip arthroplasty. Methods: We performed a retrospective review of 60 patients who underwent primary total hip arthroplasty with the use of the Stryker’s TRIDENT II acetabular component. Evaluation of radiographs was performed at 6 weeks, 1 year, and 2 years postoperatively. Radiographs were evaluated for radiolucencies in Charnley and DeLee zones, signs of biologic fixation, and acetabular inclination and anteversion measurements. Patient-reported outcomes and complications were also obtained. Results: There were no cases of component loosening or changes in component position during follow-up, with an average follow-up time of 1.7 years. A radiolucent line was identified in one patient in zone 1 at 6 weeks; this was absent at 1 year. Radiographic signs of cup biologic fixation were present in 85% of cases by final follow-up. The average inclination was 45.1 (SD = 4.0), and the average anteversion was 26.9 (SD = 5.2). Patient-Reported Outcomes Measurement Information System scores significantly increased at the final follow-up, and there were no complications in this cohort. Conclusions: This study demonstrated excellent radiographic and clinical outcomes with this novel additive-manufactured acetabular component at early follow-up. Although longer-term follow-up is warranted, this additively manufactured highly porous titanium acetabular component demonstrated excellent biologic fixation and reliable fixation at mid-term follow-up.

A common solution to mitigate the complexity of power system studies is time aggregation. This is to replace the actual data set for all time intervals with representative time periods. Previous research confirms that when energy storage systems are involved in the study, preserving the overall shape of the original data is crucial. This paper proposes a new time aggregation framework to incorporate a shape-based distance to jointly extract representative periods of wind and demand data. The duration curve of the net demand is used as a data-based validation index to compare the performance of the proposed method against other techniques. Also, a 3-bus case study that includes a wind resource, an energy storage system, and two conventional generators is designed. Four model-based validation indices are defined and applied for performance measurement, including the annual operation cost of the system, the annual wind curtailment in the system, the energy throughput of the storage facility, and the daily average of the state of the charge of the energy storage for each 365 days of the year.

The Hippo signaling pathway is a vital regulator of pancreatic development and homeostasis, directing cell fate decisions, morphogenesis, and adult pancreatic cellular plasticity. Through loss-of-function research, Hippo signaling has been found to play key roles in maintaining the proper balance between progenitor cell renewal, proliferation, and differentiation in pancreatic organogenesis. Other studies suggest that overactivation of YAP, a downstream effector of the pathway, promotes ductal cell development and suppresses endocrine cell fate specification via repression of Ngn3. After birth, disruptions in Hippo signaling have been found to lead to de-differentiation of acinar cells and pancreatitis-like phenotype. Further, Hippo signaling directs pancreatic morphogenesis by ensuring proper cell polarization and branching. Despite these findings, the mechanisms through which Hippo governs cell differentiation and pancreatic architecture are yet to be fully understood. Here, we review recent studies of Hippo functions in pancreatic development, including its crosstalk with NOTCH, WNT/β-catenin, and PI3K/Akt/mTOR signaling pathways.

This paper examines the relationships that developed over a 10+ year span at a comprehensive college in upstate New York. When the library was reorganized into a generalist model of library support, the faculty members felt unsupported. The paper explains the origin of the department-wide collaboration and then uses reflections to analyze ways in which the relationship with a liaison librarian support the faculty members work. Specific themes include overcoming library anxiety, online teaching support, and scholarship support with suggestions for librarian practice.

This paper analyses the impact of petrol price movements on inflation outcomes in South Africa since the mid-1970s. The results show that, over time, the direct contribution of petrol inflation to headline inflation has not only increased, but has also exceeded its weight in the consumer price index. In addition, Granger causality tests and the autoregressive distributed lag approach to co-integration testing reveal that petrol prices have an important bearing on the prices of other (non-petrol) commodities in the economy. The results essentially show that petrol price increases had an important bearing on inflation outcomes in South Africa. This implies that petrol price movements warrant special attention in policy formulation and implementation in South Africa if inflation outcomes were to be kept in check. Keywords: commodity prices, energy prices, inflation, core inflation

Objective: To examine the impact of workplace smoking bans on smoking behavior of employees.Participants: A total of 1469 current or former smokers (intervention group) employed in smoke-free hospitals and 920 current or former smokers (comparison group) employed in non-smoke-free workplaces were surveyed to determine smoking behavior.Design: This cross-sectional study is part of a larger, ongoing prospective study. The study design was quasi-experimental. We randomly selected sites consisting of a hospital and a corresponding community. Furthermore, we randomly selected subjects from hospitals and their corresponding communities.Main Outcome Measures: Postban quit ratio and progression along the stages-of-change continuum.Methods: The Cox proportional hazards model was used to compare the postban quit ratio between the intervention and comparison groups. The Cochran-Mantel-Haenszel analysis of variance statistic was used to compare groups on the stages-of-change variables.Results: Beginning with the smoking ban and continuing for 5 years after implementation, statistically significant differences in the postban quit ratio were observed between employees of smoke-free hospitals who were smokers and counterparts in the community (P<.001). Despite preban differences in smoking intensity, the overall difference in postban quit ratios remained significant even after multivariate adjustment for socioeconomic, demographic, and smoking intensity variables. For those sites that were 5 years postban, the quit ratio was 0.506 in smoke-free workplaces compared with 0.377 in workplaces where smoking was permitted. In all but 1 category, the intervention group was further along the stages-of-change continuum toward quitting smoking than the comparison group (P<.001).Conclusion: American hospitals' experiences with smoking bans, which directly affect more than 5 million workers, should be examined by other industries as a method of improving employee health. Workplace smoking bans could also be effective in saving lives, reducing health care costs, addressing safety concerns, and decreasing operating and maintenance expenses of employers. [ABSTRACT FROM AUTHOR]

In this paper, clustering for the circuit placement problem is examined from the perspective of wire length contribution from groups of nets. First, the final wire length data of groups of nets with different degrees are extracted and studied. It is illustrated that nets with high-degree contribute a high percentage to the total wire length. To remedy this problem, a clustering algorithm for placement is proposed that focuses on clustering nets with high-degree. This new clustering algorithm is implemented as a preprocessing step in the placement stage. ICCAD04 benchmark circuits abstracted from IBM are used to validate the placement quality by using four academic placers with and without the proposed preprocessing step. Experiments show that the overall placement results can be improved by up to 5%.

CONTEXT AND OBJECTIVE: Changes in metabolism have been reported in the majority of patients undergoing cancer treatment, and these are usually characterized by progressive change in body composition. The effects of aerobic exercise programs to combat the cancer and cancer treatment-related side effects, which include the negative changes in body composition, have been extensively reported in the literature. However, few resistance exercise intervention studies have hypothesized that breast cancer patients might benefit from this type of exercise. The purpose of this study was to determine whether exercise protocols that emphasize resistance training would change body composition and strength in breast cancer patients undergoing treatment. DESIGN AND SETTING: Randomized controlled trial, at the Campus Recreation Center and Rocky Mountain Cancer Rehabilitation Institute of the University of Northern Colorado, and the North Colorado Medical Center. METHODS: Twenty inactive breast cancer patients were randomly assigned to a 21-week exercise group (n = 10) or a control group (n = 10). The exercise group trained at low to moderate intensity for 60 minutes on two days/week. The primary outcome measurements included body composition (skinfold method) and muscle strength (one repetition maximum). RESULTS: Significant differences in lean body mass, body fat and strength (p = 0.004, p = 0.004, p = 0.025, respectively) were observed between the groups at the end of the study. CONCLUSION: The results suggest that exercise emphasizing resistance training promotes positive changes in body composition and strength in breast cancer patients undergoing treatment.

Can art and visual images meant for public consumption (museums, galleries, social media platforms) serve as a critical form of health communication for breast cancer patients? For their clinicians? For the population at large? Art history research methods are applied to a range of breast cancer images in western art in order to understand what the images communicate to us about patient experience, agency, and inequity in health care at the time of their construction. The following is a selective look at western art as it reflects and informs our understanding of breast cancer over time.

This chapter introduces the importance and some of the multidisciplinary diversity in Donald A.B. Lindberg M.D.'s home library. The latter collection minimally suggests his varied interests, which often inspired a multidisciplinary approach to tackling problems and managing the U.S. National Library of Medicine (NLM). Dr. Lindberg converted the ideas he picked up from reading into administering projects as well as to set aspirational goals for NLM and for himself. The chapter suggests Dr. Lindberg's home library was an enduring reservoir of knowledge, judgment, planning, and creativity. The chapter also discusses two of Dr. Lindberg's leadership traits: the cultivation of discovery and project development in educational administration and the need for leaders to determine and act in the greater public interest. The chapter suggests the latter two traits defined Dr. Lindberg's NLM leadership., (© 2022 – The authors. Published by IOS Press.)

Section four provides additional insights into Donald A.B. Lindberg M.D.'s life, character, interests, and passions. It includes 20 memoirs, a few of his photographs, a Resource Guide, and an essay about the influence of his home library and leadership traits. Section four's 20 memoirs are brief, more colloquial, and sometimes personal. The memoirs discuss Dr. Lindberg's interactions with family, lifelong friends, biomedical informatics colleagues, and U.S. National Library of Medicine (NLM) peers. The Resource Guide, photos, and essay yield other insights and assist readers who wish to learn more about Dr. Lindberg.

Donald A.B. Lindberg M.D. was an enthusiastic photographer. This chapter presents five photographs that had special meaning to him. They are accompanied by five pictures taken of him by other photographers. The captions explain a little about each image.

Lamar Dodd was a 20 th century American artist, the long-term director of the Lamar Dodd School of Art at the University of Georgia, and an arts advocate raised in LaGrange, Georgia. In the late 1970s after serving as a cultural emissary to the U.S. Department of State and as an artist for the National Aeronautics and Space Administration (NASA), Dodd explored the complexities and mysteries of cardiac surgery. The result of this artistic inquiry was The Heart Series , a profound collection of more than 50 works of art that explore the medical sciences and cardiothoracic surgery. This article reviews Dodd's artistic career and explores the ability of the visual arts to communicate scientific content and capture the transcendent elements of medical intervention. Special attention is paid to the unique relationship Dodd shared with his hometown community in LaGrange, the Wellstar West Georgia Medical Center, Robert Copeland (founder and long-term director of the Copeland Heart and Vascular Center at the Wellstar West Georgia Medical Center), and local philanthropist, Fuller E. Callaway, Jr.

The term "duty' has occurred frequently in discussions about the role of healthcare professionals in the current pandemic. Duty can take multiple forms in the professional and private worlds of those working to save the lives of others. At times, different forms of duty create confliciting demands, necessitating some kind of sacrifice. This dilemma is not new; it was a central theme of Virgil's Aeneid , the best known epic poem of ancient Rome. Statues and paintings of a scene from this poem, in which a man carries his father on his shoulders to safety from a burning city, became the most common representation of duty in Rome after the first century BCE and were frequently copied in later ages. Examining how Virgil's poem and these images communicate the rewards, complexity, ambiguity, and costs of duty can contribute to our understanding of the experiences of those who work to heal others in this lethal pandemic. Like Aeneas, the mythical Roman, healthcare workers have been called heroes of duty as they are asked to carry their entire communities on their shoulders.

Masks, now recommended and worn by a growing proportion of the world's population, have reflected various perceived meaning across time. This paper provides a brief history of the socio-cultural perceptions attached to wearing a mask by surveying how masks were perceived in ancient Greece and Rome, the origins of medical masks, and the ascribed socio-cultural meaning of masks during the COVID-19 pandemic. The use of a mask has historically diverse perceived meanings; currently, wearing a mask communicates a bipolar socio-cultural meaning and a nuanced, divisive symbology. To some, masks communicate a belief in medical science and a desire to protect one's neighbor from contagion. To others, a mask communicates oppression, government overreach, and a skepticism toward established scientific principles. It is the mask's ability to signal a deception, or extrapolated more broadly, a value system, that is highly relevant to current public health guidelines encouraging mask use to decrease the transmission of SARS-CoV-2, the novel coronavirus responsible for the COVID-19 pandemic. Public health officials and providers should utilize evidence-based health communication strategies when findings warrant a reversed recommendation of a symbol (such as masks) with a legacy of socio-cultural underpinnings that are deep-seated, complex, and emotional.

Competing Interests: Conflict-of-Interest Disclosures: Wilma Alvarado-Little has no relevant financial or non-financial relationships to disclose. She contributed to this article based on her experience in the field of health literacy and cultural competency and the opinions and conclusions of the article do not represent the official position of the New York State Department of Health. Cherylee Sherry discloses that she works for the Minnesota Department of Health in the Office of Statewide Health Improvement Initiatives which oversees the Statewide Health Improvement Partnership Program funded by the State of Minnesota.

Section one addresses health literacy's capacity to foster progress in clinical care and public health. Section one (and this summary) are divided into five subsections: an introduction; health literacy interventions/activities and clinical practice; health literacy interventions/activities and public health; international health literacy activities; and a concluding discussion of health literacy's three current platforms and health literacy's distinctive impact on health.

The chapters in section three of the book address health literacy's capacity to foster progress in: multidisciplinary research and practice; clinical care; public health; institutional accountability; and social progress. Unlike sections one and two, section three contains only chapters and it focuses on research or multidisciplinary health literacy practice opportunities. In contrast to the other sections, section three's emphasis is on research and the section is written more for current and future researchers in diverse areas where there is potential to integrate more health literacy (HL) research.

Background: Quality control of indoor residual spraying (IRS) is necessary to ensure that spray operators (SOs) deposit the correct concentration of insecticide on sprayed structures, while also confirming that spray records are not being falsified., Methods: Using high-performance liquid chromatography (HPLC), this study conducted quality control of the organophosphate insecticide pirimiphos-methyl (Actellic 300CS), during the 2018 IRS round on Bioko Island, Equatorial Guinea. Approximately 60 SOs sprayed a total of 67,721 structures in 16,653 houses during the round. Houses that were reportedly sprayed were randomly selected for quality control testing. The SOs were monitored twice in 2018, an initial screening in March followed by sharing of results with the IRS management team and identification of SOs to be re-trained, and a second screening in June to monitor the effectiveness of training. Insecticide samples were adhesive-lifted from wooden and cement structures and analysed using HPLC., Results: The study suggests that with adequate quality control measures and refresher training, suboptimal spraying was curtailed, with a significant increased concentration delivered to the bedroom (difference = 0.36, P < 0.001) and wooden surfaces (difference 0.41, P = 0.001). Additionally, an increase in effective coverage by SOs was observed, improving from 80.7% in March to 94.7% in June after re-training (McNemar's test; P = 0.03)., Conclusions: The ability to randomly select, locate, and test houses reportedly sprayed within a week via HPLC has led to improvements in the performance of SOs on Bioko Island, enabling the project to better evaluate its own performance.

The colors reflected from the skin are important indicators of dermatologic and systemic disorders. Incident light is subject to absorption by chromophores in the skin and scattering. Chromophores associated with yellow light reflection include the carotenoids and bilirubin. Various pathophysiologic mechanisms associated with these and other chromophores manifest with a yellow hue on examination. This review describes these mechanisms and the clinical features of yellow skin disorders by morphology. A brief summary of the differential diagnosis, laboratory investigations, and treatments are presented. Yellow skin disorders are a heterogenous group composed of abnormalities in keratin, elastic and connective tissue, lipid metabolism, and other states of metabolic, inflammatory, or organ dysfunction. Patients will present through different routes, and skin disease may precede or follow systemic disease. Dermatologists have an essential role in identifying those with malignant or systemic associations to ensure early diagnosis and treatment., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)

Historically, study and implementation of health literacy mostly focused on text-based information with frequent attention to medical and health related content within an increasingly complex healthcare system. This chapter introduces visual literacy, particularly as it relates to the visual arts, as a potentially understudied and underutilized component of health literacy that might offer benefit to both patients and healthcare workers. Literacy is both content and context specific. We posit that interaction with the arts improves the ability to appreciate the context inherent within communication across cultures and belief systems.

This chapter compares the conceptual foundations of health literacy and health disparities. It details some of the conceptual differences between health literacy and health disparities and explains some similarities that suggest the need for increased research collaboration. The chapter is among the first to address the structural and social determinants of health together and explain that future research needs to assess their interactions. Overall, the chapter creates a conceptual foundation as well as challenges future scholars/practitioners to take more multidimensional approaches to assess health's determinants. The chapter also attempts to demonstrate there is nothing more practical than good theory, or clear conceptual foundations. The chapter is divided into four sections that address the following topics: three conceptual frameworks about the determinants of health; opportunities in health disparities and health literacy research; seeking an expanded, multidimensional conceptual approach to health literacy and health disparities research; as well as a conclusion. The chapter suggests there are vacuums in current research knowledge that need future attention - especially regarding the integration of health literacy and health disparities research.

Background: Snake venoms contain many proteinaceous toxins that can cause severe pathology and mortality in snakebite victims. Interestingly, mRNA encoding such toxins can be recovered directly from venom, although yields are low and quality is unknown. It also remains unclear whether such RNA contains information about toxin isoforms and whether it is representative of mRNA recovered from conventional sources, such as the venom gland. Answering these questions will address the feasibility of using venom-derived RNA for future research relevant to biomedical and antivenom applications., Methodology/principal Findings: Venom was extracted from several species of snake, including both members of the Viperidae and Elapidae, and either lyophilized or immediately added to TRIzol reagent. TRIzol-treated venom was incubated at a range of temperatures (4-37°C) for a range of durations (0-48 hours), followed by subsequent RNA isolation and assessments of RNA quantity and quality. Subsequently, full-length toxin transcripts were targeted for PCR amplification and Sanger sequencing. TRIzol-treated venom yielded total RNA of greater quantity and quality than lyophilized venom, and with quality comparable to venom gland-derived RNA. Full-length sequences from multiple Viperidae and Elapidae toxin families were successfully PCR amplified from TRIzol-treated venom RNA. We demonstrated that venom can be stored in TRIzol for 48 hours at 4-19°C, and 8 hours at 37°C, at minimal cost to RNA quality, and found that venom RNA encoded multiple toxin isoforms that seemed homologous (98-99% identity) to those found in the venom gland., Conclusions/significance: The non-invasive experimental modifications we propose will facilitate the future investigation of venom composition by using venom as an alternative source to venom gland tissue for RNA-based studies, thus obviating the undesirable need to sacrifice snakes for such research purposes. In addition, they expand research horizons to rare, endangered or protected snake species and provide more flexibility to performing fieldwork on venomous snakes in tropical conditions.

This article introduces the Journal of Health Communication's special section, Evaluating Health Communication Programs. This special section is based on a public lecture series supported by the National Library of Medicine titled "Better Health: Evaluating Health Communication Programs" designed to share best practices for using evaluation research to develop, implement, refine, and institutionalize the best health communication programs for promoting public health. This introduction provides an overview to the series, summarizes the major presentations in the series, and describe implications from the series for translational health communication research, interventions, and programs that can enhance health outcomes.

Background: Skin cancer prevention emphasizes early adoption and practice of sun protection behaviors. Adolescence represents a high-risk period for ultraviolet radiation exposure, presenting an opportunity for intervention. The ubiquity of mobile phones among teens offers an engaging medium through which to communicate prevention messages., Purpose: To evaluate a skin cancer prevention intervention using short messaging service (SMS, or text messages) to impact sun-related knowledge, beliefs, and behaviors among adolescents., Methods: The intervention was conducted in middle school youth (N=113) recruited in April or October 2012. Participants were English speakers, 11-14 years old, routinely carried a mobile phone, and completed a 55-minute sun safety education program. Participants were sent three sun safety-themed SMS messages each week for 12 weeks. Skin and sun protective knowledge, beliefs, behaviors, and post-intervention program satisfaction were collected and analyzed at baseline and end of intervention (April/June 2012; October 2012/January 2013). Paired responses were tested for equality using Wilcoxon signed-rank tests., Results: Ninety-six students (85%) completed the study. At 12 weeks, significant positive changes were reported for sun avoidance during peak ultraviolet radiation, sunscreen application, wearing hats and sunglasses, and knowledge about skin cancer risk. Participants expressed moderately high satisfaction with the program, and 15% shared messages with family or friends., Conclusions: A brief, SMS-based intervention affected youth skin cancer prevention behaviors and knowledge. Future research will determine whether program effects were sustained at 24 weeks and explore how sun safety parenting practices inform these effects., (Copyright © 2014 American Journal of Preventive Medicine. All rights reserved.)

We present two cases of a rare clinical condition presenting as a delayed and transient pruritus of the trunk following sun exposure. These cases differ from previously reported conditions such as brachioradial pruritus because of the transient nature and anatomical location of the itching. These two cases extend the clinical spectrum of sun-induced pruritus. The patients' initial response to rigorous sun protection is good, but the specific treatment and natural history of the condition have yet to be determined., (© 2014 British Association of Dermatologists.)

Background: The internet can provide evidence-based patient education to overcome time constraints of busy ambulatory practices. Health information prescriptions (HIPs) can be effectively integrated into clinic workflow, but compliance to visit health information sites such as MedlinePlus is limited., Objective: Compare the efficacy of paper (pHIP) and email (eHIP) links to deliver HIPs; evaluate patient satisfaction with the HIP process and MedlinePlus information; assess reasons for noncompliance to HIPs., Method: Of 948 patients approached at two internal medicine clinics affiliated with an academic medical centre, 592 gave informed consent after meeting the inclusion criteria. In this randomised controlled trial, subjects were randomised to receive pHIP or eHIP for accessing an intermediate website that provided up to five MedlinePlus links for physician-selected HIP conditions. Patients accessing the intermediate website were surveyed by email to assess satisfaction with the health information. Survey non-responders were contacted by telephone to determine the reasons for no response., Results: One hundred and eighty-one patients accessed the website, with significantly more 'filling' eHIP than pHIP (38% vs 23%; P < 0.001). Most (82%) survey respondents found the website information useful, with 77% favouring email for future HIPs delivery. Lack of time, forgot, lost instructions or changed mind were reasons given for not accessing the websites., Conclusions: Delivery of MedlinePlus-based HIPs in clinic is more effective using email prescriptions than paper. Satisfaction with the HIP information was high, but overall response was low and deserves further investigation to improve compliance and related outcomes.

Objectives: The objectives of this study were to assess the reactions of adult patients and parents of children with metabolic conditions to receipt of an "information prescription" (IP) to visit Genetics Home Reference (GHR), a National Institutes of Health/National Library of Medicine online resource, and evaluate the perceived utility of information found on the site., Methods: Patients seen at the University of Utah Metabolic Service Clinic were invited to participate in the study and asked to complete an initial survey to gather demographic data and an online survey six weeks later to obtain information about user experience., Results: Fifty-three of 82 individuals completed both surveys, for an overall response rate of 64.6%. Most respondents (88.7%) agreed that receiving the IP was a "good idea," and nearly all used the IP to visit GHR. More than three-quarters (79.6%) agreed that information on GHR supplemented a physician's advice; 60.4% reported an improved understanding of a health condition; and 41.5% either looked for or would consider looking for additional information. Eighty-six percent of respondents were satisfied with the information found on GHR, and 80% would recommend the site., Conclusions: Use of an IP to direct patients to GHR was well received, and retrieved information was perceived as useful in key areas. The high level of satisfaction with GHR argues for expanded use of the IP approach in this patient population.

Background In 2006 a U.K. government White Paper recommended making NHS care in England more accessible by shifting services from secondary care into community settings. There is a shortage of contemporary activity data for U.K. dermatology units to allow benchmarking for service development. This study will not only provide useful comparative data for the future in Wales, but will also serve to highlight the impact of changes made in England. Objective To provide an overview of 1 week's dermatology outpatient activity for the whole of Wales. Methods All dermatology units in Wales collected data for 1 week in early 2007. The case mix, appropriateness of referral, requirement for surgery or second-line therapies and follow-up requirements were all determined. Results A total of 2142 patients were seen. Of new patients, 21% had skin cancer. Seventeen per cent of skin cancers had no diagnosis suggested by the general practitioner (GP) and 10% of basal cell carcinomas, 33% of squamous cell carcinomas and 17% of malignant melanomas were inappropriately diagnosed. In all, 26% of new patients had benign lesions, and this group caused the greatest diagnostic difficulty for GPs. Seventy-one per cent of these patients were diagnosed, reassured and discharged at their first visit without the need for biopsy or surgery. Thirty-seven per cent of new patients required surgery, of which 21% required complex intervention. Twenty-six per cent of follow-up patients were receiving second-line therapies. The new to follow-up ratio varied considerably according to diagnosis, the mean ratio being 1 : 0.21 for benign lesions through to 1 : 5.53 for psoriasis. This highlights the inappropriate nature of a 'one fits all' ratio. The majority of follow-up patients in secondary care required this level of input for monitoring of cancer, complex second-line therapies or surgery. Conclusions This study provides evidence to support logical planning of dermatological services and to assess the impact of proposed changes on different healthcare systems in the U.K.

Purpose: This study explores how diverse attitudes about health literacy are assessed by medical librarians and other health care professionals., Procedures: An online survey of thirty-six items was conducted using Q methodology in two phases in spring 2005 and winter 2006. Respondents (n = 51) were nonrandomly self-selected from a convenience sample of members of the Medical Library Association and a group of environmental health consultants to the National Library of Medicine., Findings: Three factors were identified. Factor 1 is optimistic and supportive of health literacy's transformative sociocultural and professional potential, if clinical settings become a launching point for health literacy activities. Factor 2 is less optimistic about health literacy's potential to improve clinical or patient outcomes and prefers to focus health literacy initiatives on classroom education settings. Factor 3 supports improving the nation's health literacy but tends to support health literacy initiatives when people privately interact with health information materials., Conclusions: Each factor's attitudes about the appropriate educational venue to initiate health literacy activities are different and somewhat mutually exclusive. This suggests that health literacy is seen through different perceptual frameworks that represent a possible source of professional disagreement.

This paper presents an idealized conceptual framework for consumer health informatics research drawing from complementary disciplines: information science and health campaign research. This synthesis is designed to provide researchers with a flexible model to evaluate current research and inform future studies. Following a description of the major components, we describe a recent evaluation of consumer perceptions of a health information system, Genetics Health Reference. This study illustrates how the framework may be applied to provide some direction and insights into ongoing consumer health informatics research. While this model represents a work in progress, we present it in support of efforts to understand the multidimensional impacts of the public's access to health information. We also discuss challenges that remain to develop a better conceptual understanding of how consumers converge on health informatics services.

This paper reports selected results from two comprehensive evaluation studies of the Information Prescription (or "Information Rx") Program implementation conducted from 2002-05 by the American College of Physicians Foundation (ACPF) and the U.S. National Library of Medicine (NLM). In this Program physicians are provided with Information Prescription pads, analogous to pads used to prescribe medications, that are used to direct patients to the MedlinePlus web site and its contents that are applicable to a patient's health condition. The results describe the Program's potential to enhance patient education and interpersonal communication from physician and patient perspectives. The findings suggest once physicians adopt the use of an information prescription, they perceive they are providing an additional clinical service that enhances patient education and interpersonal communication. For physicians, participation in information prescription may improve patient communication, encourage information seeking, and lessen the number of poor quality Internet searches that patients frequently self-perform and bring to a doctor's office. Similarly, once patients receive a recommendation from a physician to seek health information on the web, patients may be more comfortable with health seeking on the Internet and discussing their findings with their doctor. The conclusions of the two evaluation studies imply an Information Prescription fosters a dialogue between providers and patients, helps patients use the Internet more effectively and seems to favorably impact patient education. As the medical community and patient advocacy groups continue to emphasize the importance of evidence-based information as the gold standard for accepted care, it can be expected that informatics tools such as Information Rx will come to play an increasingly important role as a vehicle to help identify and access high quality health information on the Internet.

Objectives: This paper provides the most complete accounting of the National Library of Medicine's (NLM's) Native outreach since 1995, when there were only a few scattered projects., Method: The descriptive overview is based on a review of project reports, inventories, and databases and input from the NLM Specialized Information Services Division, National Network Office of the Library Operations Division, National Network of Libraries of Medicine, and Office of Health Information Programs Development of the Office of the NLM Director. The overview focuses on NLM-supported or sponsored outreach initiatives involving Native peoples: American Indians, Alaska Natives, and Native Hawaiians., Results: The review of NLM's relevant activities resulted in a portfolio of projects that clustered naturally into the following areas: major multisite projects: Tribal Connections and related, Native American Information Internship Project: Sacred Root, tribal college outreach and tribal librarianship projects, collaboration with inter-tribal and national organizations, participation in Native American Powwows, Native American Listening Circle Project, Native American Health Information, and other Native American outreach projects., Implications: NLM's Native American Outreach reached programmatic status as of late 2004. The companion paper identifies several areas of possible new or enhanced Native outreach activities. Both papers highlight the importance of solid reporting and evaluation to optimize project results and programmatic balance and priorities.