Faculty Bibliography

The lack of transparency in immigration detention in the United States has contributed to serious concerns about the fate of immigrants who are detained in the United States and require medical care. In particular, deficiencies in initial screening, chromic disease management (including referral to outside care), and pain management of detainees have been identified by numerous governmental and nongovernmental groups. We have identified a number of detainee deaths and poor medical outcomes that are related to substandard medical care and suggest system-wide problems in US Immigration and Customs Enforcement (ICE) health care. This article provides an overview of the current ICE health care system, presents four cases of detainee deaths and independent reporting of similar systemic problems, and recommends several specific changes to the ICE health care system.

We used adolescent simulated clients to evaluate whether HIV testing services in clinics participating in an adolescent-friendly initiative in Cape Town were superior to regular clinic services. We found improved accessibility to HIV testing, but no impact on adolescent's experience of negative attitudes from health workers and confidentiality breaches.

The opportunistic protozoan parasite Toxoplasma gondii is well known as a strong inducer of cell-mediated immunity, largely as a result of proinflammatory cytokine induction during in vivo infection. Yet, during intracellular infection the parasite suppresses signal transduction pathways leading to these proinflammatory responses. The opposing responses are likely to reflect the parasite's need to stimulate immunity allowing host survival and parasite persistence, and at the same time avoiding excessive responses that could result in parasite elimination and host immunopathology. This Review summarizes past and present investigations into the effects of Toxoplasma on host cell signal transduction. These studies reveal insight into the profound suppression of proinflammatory cytokine responses that occurs when the parasite infects macrophages and other cells of innate immunity.

Regular exercise, good dietary habits, knowledge of the disease and its warning signs as well as ability to perform CPR (cardiopulmonary resuscitation) are all important to prevent and combat Cardiovascular Disease (CVD) and Stroke. In 2005-2006, an AHA sponsored "Search Your Heart" cardiovascular disease intervention was conducted in 388 urban African-American/black and Latino/Hispanic faith based institutions, all churches of various denominations, to improve members' knowledge and preparedness about CVD and stroke. The intervention involved (a) distribution of a customized multi-component CVD and stroke related educational and skill development package to 388 "ambassadors" for all participating churches, (b) AHA staff coordinated educational sessions for the ambassadors and (c) 211 Ambassadors coordinating the conduct of at least one CVD educational activities in their churches. In May 2006, a written survey was distributed to 211 ambassadors affiliated with the Heritage affiliate of AHA, which covers New Jersey, Connecticut, Long Island and New York City, to: (a) assess the intervention's effect, and (b) plan and implement a targeted forward intervention approach based on findings. Survey questions addressed regular exercise, healthy eating, disease knowledge, and warning signs and ability to perform CPR.

PURPOSE: Optimal surgical approach for advanced pediatric appendicectomy remains controversial. We compare the open versus the laparoscopic approach. METHODS: Retrospective case notes review of children operated on for advanced appendicitis between January 2005 and July 2006 was undertaken for length of hospital stay, operating time, wound complications, need for further surgery, and hospital readmission. RESULTS: Forty children were included, 17 were treated with open approach and 23 with laparoscopic approach. There was no conversion from laparoscopic to open approach. Overall complication rate, length of hospital stay, and need for further surgery were similar in both groups. The mean operative time was longer in the laparoscopic group. Wound complications occurred more in the open group. Readmission for gastrointestinal obstruction was noted in the laparoscopic group. CONCLUSIONS: Laparoscopic approach is safe for advanced appendicitis in children. The outcomes are comparable in both study groups.

BACKGROUND: Nonadherence to asthma medications is associated with increased emergency department visits and hospitalizations. If adherence is to be improved, first-fill adherence is the first goal to meet after the physician and patient have decided to begin treatment. Little is known about first-fill adherence with asthma medications and the factors for no-fill. OBJECTIVE: The goal of the study was to examine the proportion of patients who fill a new prescription for an asthma medication and analyze characteristics associated with this first-fill. METHODS: This retrospective cohort study linked electronic health records with pharmacy claims. The cohort was comprised of 2023 patients aged 18 years or older who sought care from the Geisinger Clinic, had Geisinger Health Plan pharmacy benefits, and were prescribed an asthma medication for the first time between 2002 and 2006. The primary outcome of interest was first-time prescription filled by the patient within 30 days of the prescription order date. Covariates examined included factors related to the patient (ie, age, sex, and ethnicity), comorbidities and utilization (ie, Charlson comorbidity index, number of office visits, number of additional medications), asthma treatment (ie, delivery route, pharmacologic class), and pharmacy copay amount. A logistic-regression model was used to determine covariates associated with first-fill. RESULTS: The overall first-fill rate for new asthma medications was 78%. First-fill rate was lower for patients with a copay above the mean of $12 (odds ratio = 0.76; 95% confidence interval, 0.58-0.99) and higher for patients prescribed oral plus inhaled medications (versus inhaled only, odds ratio = 3.91; 95% confidence interval, 2.15-7.11). CONCLUSIONS: SEVERAL FACTORS ASSOCIATED WITH FAILING TO FILL AN INITIAL PRESCRIPTION FOR ASTHMA CAN BE ADDRESSED THROUGH SIMPLE INTERVENTIONS: screening for difficulties a patient may have in filling prescriptions, avoiding nonformulary medications, and recognizing the barrier that high copays present. In addition, for employers and policymakers, decreasing copay may improve adherence and, therefore, asthma control.

The new Ru(II) chloroquine complexes [Ru(eta(6)-arene)(CQ)Cl2] (CQ = chloroquine; arene = p-cymene 1, benzene 2), [Ru(eta(6)-p-cymene)(CQ)(H2O)2][BF4]2 (3), [Ru(eta(6)-p-cymene)(CQ)(en)][PF6]2 (en = ethylenediamine) (4), and [Ru(eta(6)-p-cymene)(eta(6)-CQDP)][BF4]2 (5, CQDP = chloroquine diphosphate) have been synthesized and characterized by use of a combination of NMR and FTIR spectroscopy with DFT calculations. Each complex is formed as a single coordination isomer: In 1-4, chloroquine binds to ruthenium in the eta(1)-N mode through the quinoline nitrogen atom, whereas in 5 an unprecedented eta(6) bonding through the carbocyclic ring is observed. 1, 2, 3, and 5 are active against CQ-resistant (Dd2, K1, and W2) and CQ-sensitive (FcB1, PFB, F32, and 3D7) malaria parasites (Plasmodium falciparum); importantly, the potency of these complexes against resistant parasites is consistently higher than that of the standard drug chloroquine diphosphate. 1 and 5 also inhibit the growth of colon cancer cells, independently of the p53 status and of liposarcoma tumor cell lines with the latter showing increased sensitivity, especially to 1 (IC50 8 microM); this is significant because this type of tumor does not respond to currently employed chemotherapies.

CONTEXT: Little is known about the influence of the primary care workplace on patient care. Assessing physician opinion through focus groups can elucidate factors related to safety and error in this setting. METHOD: During phase 1 of the Minimizing Error, Maximizing Outcome (MEMO) Study, 9 focus groups were conducted with 32 family physicians and general internists from 5 areas in the upper Midwest and New York City. RESULTS: The physicians described challenging settings with rapidly changing conditions. Patients are medically and psychosocially complex and often underinsured. Communication is complicated by multiple languages, time pressure, and inadequate information systems. Complex processes of care have missing elements including medication lists and test results. Physicians are pressed to be more productive, and key administrative decisions are made without their input. Targeted areas to improve safety and reduce error included teamwork, aligned leadership values, diversity, collegiality, and respect. CONCLUSIONS: Primary care physicians clearly described positive and negative workplace factors related to safety and error. The themes suggest that systems of care and their dynamic nature warrant attention. Enhancing positive and ameliorating negative cultures and processes of care could bring real benefits to patients, physicians, and ambulatory office settings.