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Background Mailed stool testing programs increase colorectal cancer (CRC) screening in diverse settings, but whether uptake differs by key demographic characteristics is not well-studied and has health equity implications. Objective To examine the uptake and equity of the first cycle of a mailed stool test program implemented over a 3-year period in a Central Texas Federally Qualified Health Center (FQHC) system. Design Retrospective cohort study within a single-arm intervention. Participants Patients in an FQHC aged 50–75 at average CRC risk identified through electronic health records (EHR) as not being up to date with screening. Interventions Mailed outreach in English/Spanish included an introductory letter, free-of-charge fecal immunochemical test (FIT), and lab requisition with postage-paid mailer, simple instructions, and a medical records update postcard. Patients were asked to complete the FIT or postcard reporting recent screening. One text and one letter reminded non-responders. A bilingual patient navigator guided those with positive FIT toward colonoscopy. Main Measures Proportions of patients completing mailed FIT in response to initial cycle of outreach and proportion of those with positive FIT completing colonoscopy; comparison of whether proportions varied by demographics and insurance status obtained from the EHR. Key Results Over 3 years, 33,606 patients received an initial cycle of outreach. Overall, 19.9% ( n = 6672) completed at least one mailed FIT, 5.6% ( n = 374) tested positive during that initial cycle, and 72.5% ( n = 271 of 374) of those with positive FIT completed a colonoscopy. Hispanic/Latinx, Spanish-speaking, and uninsured patients were more likely to complete mailed FIT compared with white, English-speaking, and commercially insured patients. Spanish-speaking patients were more likely to complete colonoscopy after positive FIT compared with English-speaking patients. Conclusions Mailed FIT outreach with patient navigation implemented in an FQHC system was effective in equitably reaching patients not up to date for CRC screening.

Nascent medical students’ first view into medical school orients them toward what is considered important in medicine. Based on ethnography conducted over 18 months at a New England medical school, this article explores themes which emerged during a first-year student orientation and examines how these scripts resurface across a four-year curriculum, revealing dynamics of enculturation into an institution and the broader profession. We analyze orientation activities as discursive and embodied fields which serve “practical” purposes of making new social geographies familiar, but which also frame institutional values surrounding “soft” aspects of medicine: professionalism; dynamics of hierarchy and vulnerability; and social difference. By examining orientation and connecting these insights to later, discerning educational moments, we argue that orientation reveals tensions between the overt and hidden curricula within medical education, including what being a good doctor means. Our findings are based on data from semi-structured interviews, focus groups, and participant-observation in didactic and clinical settings. This article answers calls within medical anthropology and medical education literature to recognize implicit values at play in producing physicians, unearthing ethnographically how these values are learned longitudinally via persisting gaps between formal and hidden curricula. Assumptions hidden in plain sight call for ongoing medical education reform.

BACKGROUNDSurgical site infections (SSIs) following colorectal surgery (CRS) are among the most common healthcare-associated infections (HAIs). Reduction in colorectal SSI rates is an important goal for surgical quality improvement.OBJECTIVETo examine rates of SSI in patients with and without cancer and to identify potential predictors of SSI risk following CRSDESIGNAmerican College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data files for 2011-2013 from a sample of 12 National Comprehensive Cancer Network (NCCN) member institutions were combined. Pooled SSI rates for colorectal procedures were calculated and risk was evaluated. The independent importance of potential risk factors was assessed using logistic regression.SETTINGMulticenter studyPARTICIPANTSOf 22 invited NCCN centers, 11 participated (50%). Colorectal procedures were selected by principal procedure current procedural technology (CPT) code. Cancer was defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes.MAIN OUTCOMEThe primary outcome of interest was 30-day SSI rate.RESULTSA total of 652 SSIs (11.06%) were reported among 5,893 CRSs. Risk of SSI was similar for patients with and without cancer. Among CRS patients with underlying cancer, disseminated cancer (SSI rate, 17.5%; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.23-2.26; P=.001), ASA score ≥3 (OR, 1.41; 95% CI, 1.09-1.83; P=.001), chronic obstructive pulmonary disease (COPD; OR, 1.6; 95% CI, 1.06-2.53; P=.02), and longer duration of procedure were associated with development of SSI.CONCLUSIONSPatients with disseminated cancer are at a higher risk for developing SSI. ASA score >3, COPD, and longer duration of surgery predict SSI risk. Disseminated cancer should be further evaluated by the Centers for Disease Control and Prevention (CDC) in generating risk-adjusted outcomes.Infect Control Hosp Epidemiol 2018;39:555-562.

Parents and families of youth who are chronically ill are felt to have increased distress during the transition from youth into adulthood (Rapanaro, Bartu, & Lee, 2008). While parents historically have expressed some satisfaction with the transition services being provided, the research has only looked at individuals with severe intellectual disabilities and not at youth who are also medically fragile (Neece, Kraemer, & Blacher, 2009). Additionally, both the school and the medical field are shown to have needs to connect with the community; however, neither the school nor the medical community has been shown in the literature to work together with the parents to ensure a smooth and complete transition from school to adulthood. The present study expands on the current literature in two important ways: (a) by examining the youth who are medically fragile and severely intellectually delayed (MFSID) and (b) by including interviews with the medical personnel and parents in the analysis. Twelve interviews were conducted to examine the needs and perspectives of parents regarding the transitioning process. A purposeful sampling with inclusion factors was utilized in the selection of participants. Questions were created and prepared based on my own experience, gaps within the literature, and the goal of gathering information regarding the perception of transition for each of the participants. Interviews were semi-structured, with questions addressing participants’ experiences in transitioning youth who are medically fragile and severely intellectually delayed. Several themes emerged and aligned closely with the research questions regarding participants, communication, roles, perceived views of transition success, and additional resources that are needed in the transition process. Participants felt frustration, happiness, worry, and—at times—isolation. Overall, the youth who are MFSID are themselves dynamic entities that move in and out of different environments, similar to Bronfenbrenner’s (1979) theory. Each environment affects the youth and their support systems. Transition success depends on one of two scenarios: (1) Parents, medical staff, and school staff need to increase their communication with one another so that there is appropriate coverage of needed information, or (2) a case manager at the state level should be assigned to help organize and provide a link across many of the systems, focused on a continuation of services throughout the different environments and life course. A website is a possible solution to connect many of these systems to allow both the parents of youth who are MFSID and the youth themselves to feel successful.

This essay considers the aesthetic and ethical workings of a keyword in James: \"form.\" While The Golden Bowl is considered the apotheosis of Jamesian Form and \"late\" semantic playfulness, with seventy instances of the word in its many applications, Roderick Hudson, James's \"first\" novel, surprisingly displays a programmatic interest in \"form\" (sculpture, objets d'art, beauty, good conduct). The most interesting struggles in James–those over ethics, aesthetics, etiquette, and economics–are often enacted in a single word. Only by scrutiny of overused, self-masking words can the insidious confusion of the beautiful, the valuable, and the good be exposed.

Falling between ‘Daisy Miller’ (1878) andThe Europeans(1878), on one side, andWashington Square(1880) andThe Portrait of a Lady(1880-81), on the other,Confidence(1879) belongs to the early, Austenian phase of James; coruscating, ironic, compact—it goes about its business transparently and unswervingly. Or does it? Already in James, even in 1879, there are the stirrings of his inveterate tendency towards “merciful indirection” (The Art of the Novel306), the kind of indirection that manifests itself in style more than in syntax: in innuendo, euphemism, allusiveness, and the irony that reveals even as it pretends to

[...]this is despite (or perhaps because of) advances in digital collation tools.9 The fact that lists of variants can now be generated electronically arguably complicates (rather than simplifies) an editor's work, in that increasing the quantity of data available makes problems of evaluation-of deciding which of those minor variants \"matter\"-less rather than more manageable. [...]a reader may come away from Bristow's edition with a sense that Stoddart, far from exercising a censoring hand over an important aspect of Wilde's style (as Frankel implies), did a thorough and necessary job of \"clearing\" the typescript of errors and inconsistencies prior to typesetting.24 These two approaches to the treatment of punctuation variants in The Picture of Dorian Gray provide subtly different views of Wilde's creativity: [...]a greatly increased range of textual features has been brought to the attention of the literary critic, but without any mechanism being provided (in the absence of an argument about authorial control) for determining their relative significance for literary-critical appreciation. [...]this tends to be true about debates over interpretation in literary studies in general; so even reader-response theories (whether by Wolfgang Iser, Hans Robert Jauss or Stanley Fish, or those informed by Richard Rortÿs concept of intersubjective communities) are apt to work with hypothetical or implied readers. 33.

As an American author who chose to live in Europe, Henry James frequently wrote about cultural differences between the Old and New World. The plight of bewildered Americans adrift on a sea of European sophistication became a regular theme in his fiction. This collection of twenty-four papers from some of the world’s leading James scholars offers a comprehensive picture of the author’s cross-cultural aesthetics. It provides detailed analyses of James’s perception of Europe—of its people and places, its history and culture, its artists and thinkers, its aesthetics and its ethics—which ultimately lead to a profound reevaluation of his writing.