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IntroductionEffective, equity-promoting interventions implemented by health care systems are needed to address health care disparities and population-level health disparities. We evaluated the impact of a clinical decision support tool to improve evidence-based thiazide diuretic prescribing among Black patients to address racial disparities in hypertension control.MethodsWe employed an interrupted time series design and qualitative interviews to evaluate the implementation of the tool. Our primary outcome measure was the monthly rate of thiazide use among eligible patients before and after implementation of the tool (January 2013-December 2016). We modeled month-to-month changes in thiazide use for Black and White patients, overall, and by sex and medical center racial composition. We conducted key informant interviews to identify modifiable facilitators and barriers to implementation of the tool across medical centers.ResultsOf the 318,720 patients, 15.5% were Black. We observed no change in thiazide use or blood pressure control following the implementation of the tool in either racial subgroup. There was a slight but statistically significant reduction (2.32 percentage points, p < 0.01) in thiazide use among Black patients following the removal the tool that was not observed among White patients. Factors affecting the tool's implementation included physician and pharmacist resistance to thiazide use and a lack of ongoing promotion of the tool.DiscussionThe clinical decision support tool was insufficient to change prescribing practices and improve blood pressure control among Black patients.ConclusionsFuture interventions should consider physician attitudes about thiazide prescribing and the importance of multilevel approaches to address hypertension disparities.

This is a review of the book Harry Potter and the Other; Race, Justice and Difference in the Wizarding World edited by Sarah Park Dahlen and Ebony Elizabeth Thomas. of MacDonald's more unorthodox beliefs and how they actually fit into traditional interpretations of Christianity rather than being outlandish or sui generis, as is sometimes said about MacDonald's ideas. Moreover, this work demonstrates how MacDonald was both a visionary and also a man of his times, a voice of hope in a world that had gone dark, a reassuring presence in a world that seemed destined for chaos. --James Hamby, Harry Potter and the Other; Race, Justice and Difference in the Wizarding World, edited by Sarah Park Dahlen and Ebony Elizabeth Thomas, and Open at the Close: Literary Essays on [...]

An emerging body of opinion cites the Daenerys subplot in George R. R. Martin's A Song of Ice and Fire (1996-) as a white savior narrative. This article argues against this. Martin presents his emblematic medievalist Occident as equally barbaric as his Orient, disabling the Manichean colonialist allegory some scholars perceive in his work. Although Daenerys certainly thinks like a colonialist savior, such discourse makes most sense as Bakhtinian image of a language, exhibited by Martin in concert with depictions of the intractable problems her actions cause, to mount a polemic authorial critique of colonialist literature. Support for this reading can be found elsewhere in Martin's work, in which he frequently critiques uncritical espousals of literary tropes, and in his careful moral variegation of the peoples Daenerys conquers., In Medievalism in A Song of Ice and Fire and Game of Thrones, Shiloh Carroll takes issue with George R. R. Martin's portrayal of Daenerys Targaryen's adventures in Essos, the [...]

Primary nonadherence, a form of prescription nonadherence, is defined as failure to fill and pick up a prescription medication. Little is known about the relationship between distance to pharmacy and primary nonadherence in dermatology. In this study, we investigated the association between primary nonadherence and distance between a patient’s home and pharmacy. We focused on a low-income patient population within the dermatology clinic of a large, urban county hospital system in which patients were enrolled in a pharmacy benefit within a closed-system. Among 678 patients who were prescribed a total of 1156 prescription medications for dermatologic conditions, 11.7% did not pick up any of their prescriptions. After adjusting for patient demographics of race/ethnicity, sex, age, language, and relationship status, there was no association between primary nonadherence and distance traveled between a patient’s home and pharmacy. Results of this study are consistent with other studies in non-dermatologic patients and suggtableest that distance from a pharmacy may not be strongly associated with primary nonadherence for dermatologic medications.

Why do foreign militaries attack some insurgencies and not others? Although foreign involvement in civil conflicts is on the rise, many insurgencies are not targeted militarily by external powers. Current research suggests organizations that are lethal or that attack democracies should be targeted more often. We argue that organizations that have vital markers of capabilities, such as alliances with other violent non-state actors (VNSAs) and territorial control, and the ability to attack members of a powerful country, in this case, U.S. citizens at home or abroad, are more likely to be targeted. Our empirical analysis supports this contention: we use a logistic regression model and, in post-estimation, predicted probabilities and a Classification and Regression Tree (CART) model to understand the effect of potential factors on international military interventions. [ABSTRACT FROM AUTHOR]