Set Of Nets Research Articles

Timeliness of Lung Cancer Care From the Point of Suspicious Image at an Urban Safety Net Hospital

BackgroundTimeliness of care is an important metric for lung cancer patients, and care delays in the safety-net setting have been described. Timeliness from the point of the suspicious image is not well-studied. Herein, we evaluate time intervals in the workup of lung cancer at an urban, safety net hospital and assess for disparities by demographic and clinical factors. Patients and MethodsWe performed a retrospective analysis of lung cancer patients receiving some portion of their care at Boston Medical Center between 2015 and 2020. A total of 687 patients were included in the final analysis. Median times from suspicious image to first treatment (SIT), suspicious image to diagnosis (SID), and diagnosis to treatment (DT) were calculated. Nonparametric tests were applied to assess for intergroup differences in time intervals. ResultsSIT, SID, and DT for the entire cohort was 78, 34, and 32 days, respectively. SIT intervals were 87 days for females and 72 days for males (p < .01). SIT intervals were 106, 110, 81, and 41 days for stages I, II, III, and IV, respectively (p < .01). SID intervals differed between black (40.5) and Hispanic (45) patients compared to white (28) and Asian (23) patients (p < .05). ConclusionAdvanced stage at presentation and male gender were associated with more timely treatment from the point of suspicious imaging while white and Asian were associated with more timely lung cancer diagnosis. Future analyses should seek to elucidate drivers of timeliness differences and assess for the impact of timeliness disparities on patient outcomes in the safety net setting.

PRIMARY CARE PROVIDER PERSPECTIVES ON LANGUAGE AND COMMUNICATION BARRIERS IN DEMENTIA DIAGNOSIS AND CARE

Abstract Dementia diagnosis and care relies on extensive communication between a doctor, patient, and oftentimes a family caregiver. Communication is important for recognizing when there is a cognitive concern, gaining an understanding of the patient’s history of cognitive decline, engaging in cognitive testing, and providing quality care post-diagnosis. We conducted a qualitative study of 35 primary care clinicians and primary care nurse practitioners working in safety net settings in California to understand facilitators and barriers to dementia diagnosis and care. Using thematic analysis, we identified similar themes to those that have been explored extensively related to language and communication in doctor-patient relationship. Topics ranging from challenges that emerge when there is language discordance, difficulties finding and using interpreters, and challenges related to communicating medical topics in a patient’s native language. Specifically related to dementia, we found that language challenges emerge due to inadequate translation or availability of cognitive testing and post-diagnostic resources in multiple languages. However, we also identified unique challenges related to communication, including hearing loss, communicating about trauma during the diagnostic history interview, navigating the logistics of care, including communicating with specialists, building trust and rapport when there is language discordance, and cultural miscommunication even when the spoken language is the same. These issues affect historically marginalized individuals and communities, especially when dementia and cognitive impairment are present. We suggest new approaches and policies to enhance communication and better ways of working with patients who are hard of hearing.

Quantum operations on conformal nets

On a conformal net [Formula: see text], one can consider collections of unital completely positive maps on each local algebra [Formula: see text], subject to natural compatibility, vacuum preserving and conformal covariance conditions. We call quantum operations on [Formula: see text] the subset of extreme such maps. The usual automorphisms of [Formula: see text] (the vacuum preserving invertible unital *-algebra morphisms) are examples of quantum operations, and we show that the fixed point subnet of [Formula: see text] under all quantum operations is the Virasoro net generated by the stress-energy tensor of [Formula: see text]. Furthermore, we show that every irreducible conformal subnet [Formula: see text] is the fixed points under a subset of quantum operations. When [Formula: see text] is discrete (or with finite Jones index), we show that the set of quantum operations on [Formula: see text] that leave [Formula: see text] elementwise fixed has naturally the structure of a compact (or finite) hypergroup, thus extending some results of [M. Bischoff, Generalized orbifold construction for conformal nets, Rev. Math. Phys. 29 (2017) 1750002]. Under the same assumptions, we provide a Galois correspondence between intermediate conformal nets and closed subhypergroups. In particular, we show that intermediate conformal nets are in one-to-one correspondence with intermediate subfactors, extending a result of Longo in the finite index/completely rational conformal net setting [R. Longo, Conformal subnets and intermediate subfactors, Comm. Math. Phys. 237 (2003) 7–30].

Symbolic Verification of Current-State Opacity of Discrete Event Systems Using Petri Nets

Given a discrete event system, it is said to be opaque if an intruder who can partially observe system behavior cannot infer that the system is necessarily in a predefined secret. A discrete event system is current-state opaque if an intruder is never able to verify whether the current state of the system is within the secret states. This article addresses the verification of current-state opacity of a discrete event system modeled with Petri nets, where the secret is defined as a set of states. The existing methods cannot deal with large-sized systems due to the curse of dimensionality. Multi-valued decision diagrams (MDDs) are widely accepted as an efficient and compact data structure for representing the extremely large reachability sets of Petri nets. We show that MDDs can be used in Petri nets with partial observable transitions and propose an approach for the verification of current-state opacity for bounded Petri nets. It is shown by experimental studies that the symbolic approach is practically more efficient than traditional techniques such as basis reachability graphs (BRGs).

Sand control effect of HDPE sandbreak nets with different porosity structure

Straw checkerboard sand barriers with a porous structure that consists of a pervious upper portion and a dense lower portion are widely used to achieve great sand control effect. Considering this, and resolving the serious earth surface undercutting problem after HDPE sandbreak net checkboard barriers setting, the authors used HDPE (high-density polyethylene) materials to prepare new sandbreak materials with a similar porous structure. Through wind tunnel simulations and field sand control monitoring, we compared the sand control effect of three HDPE sandbreak nets with different porosity structure. Compared to the sandbreak net with uniform porosity structure, the three types of HDPE sandbreak nets with different porosity structure had poorer effect on reducing sand transport rates, but had longer effective protection distance before sandbreak nets at low wind velocity conditions (<12 m/s), longer effective protection distance at high wind velocity (>14 m/s) and longer effective protection distance between sandbreak nets at all experimental wind velocity conditions. Wind and sand control effect characteristics of HDPE sandbreak nets with different porosity structure provide an ideal material on semi-buried checkerboard sand barriers for sand stabilization. By contrast, uniform-type sandbreak nets are used as materials on high upright sand fences for sand blocking. These HDPE sandbreak nets can be used to replace traditional sandbreak materials and have a very high potential for widespread and popular application in aeolian sand disaster control.

СТРУКТУРНI ПОКАЗНИКИ ПОПУЛЯЦІЇ КАРАСЯ СРІБЛЯСТОГО (CARASSIUS GIBELIO B.) КРЕМЕНЧУЦЬКОГО ВОДОСХОВИЩА

Ukraine ranks first in Europe in the number of natural water bodies. These abundant water resources are the source of significant fish resources, which are effectively exploited by the fishing industry. Rationalization and equal distribution of the commercial load, the reduction of the commercial pressure on the main fish species has always been an urgent issue. This can be achieved by shifting the focus of fishing to other types of fish, which will allow rational use of the entire complex of commercial species. The Prussian carp Carassius gibelio (Bloch, 1782) is among such promising objects of fishing - a massive, small-particle species, which in certain water bodies of Ukraine has displaced other minor commercial fish species and formed stable numerical populations. &#x0D; A decisive role in the age structure formation of the Prussian carp population was played by the increase in the specific number of middle and older age groups, which is associated with an insufficient level of commercial load. Thus, the variation series of this species in the commercial catches of 2021, unlike other species, had the form of a double-peaked curve, which was formed due to the loss of size classes of 25-28 cm. According to the Fishing Rules and the Regime of Fishery Operation of the Dnipro Reservoirs in force today, nets with a step are allowed hole a=38-49 mm and 70 mm and more. This distribution of commercial load selectivity reduces pressure on bream and bream populations. However, it also causes a significant increase in the stock of Prussian carp. And this alien species has formed abundant populations in the Kremenchuk Reservoir. Thus, its average annual catch in the period 2000-2020 increased from 44.6 to 462.4 tons or 10 times in 20 years. &#x0D; We should note that Prussian carp occupied an insignificant segment of the catch - no more than 0.1% by weight in the traditional commercial set of gill nets (a=75-90 mm) at the Kremenchuk Reservoir, while, in the 50-60 mm mesh size nets this species is dominant with a share in catches of up to 60% by weight. Thus, the main indicators that characterize the fisheries and environmental protection components of gill net fishing are a mesh size that deals with part of the main target fishing objects, size and weight indices, and bycatch of immature commercially valuable species. The gill nets with 50-60 mm generally meet the requirements for the current legislation and might be used for targeted harvest of the species in the littoral zones. Considering the need to intensify fishing for Prussian carp and its high actual specific mass in catches of nets with a mesh size of 50-60 mm, the implementation of specialized fishing for this species in the Dnieper reservoirs can be considered as a means of optimizing the use of the formed bioresource for the commercial fishery. In order to minimize the negative impact of this fishing on the structural and functional indicators of the bream population, specialized fishing should be focused on the areas of accumulation of Prussian carp, i.e. it is a specialized fishery with a share of Prussian at least 50%. The necessity of the meliorative capture introduction aimed to downgrade the reproductive core of the population of this alien species to prevent its uncontrolled population growth.

Abstract 11069: Evaluation for Ischemic Cardiomyopathy After Heart Failure Diagnosis is Associated With Reduced Mortality in a Safety-Net Setting

Introduction: Ischemic cardiomyopathy is a common cause of heart failure (HF). Many commercially insured HF patients are not evaluated for ischemia, but rates of testing in a safety net setting have not been investigated, and the effect of testing on mortality is not clear. Methods: We developed an EHR cohort of individuals with HF by ICD9 or 10 code in San Francisco’s municipal health system during 2001-2019. Invasive coronary angiography, nuclear stress, and coronary CT angiography were considered as ischemic testing. Proportions tested and adjusted relative risks [ARR] for testing were adjusted for age, sex, diabetes, hypertension, and tobacco use. To estimate the effect of testing on mortality, we created a “target trial” of patients with incident HF without known CAD using propensity score models. Results: Out of 15,558 individuals with HF, 4,215 (27.1%) ever underwent ischemic testing, without increase over time (p=0.33). Excluding those with prior testing, 2,483/13,821 (18.0%) had testing at a median 25 days after HF diagnosis (IQR 0-417). Groups less likely to receive testing included women (ARR 0.89, 95%CI 0.82-0.96; p=0.003), unstably housed individuals (ARR 0.45, 95%CI 0.37 to 0.54, p&lt;0.0001), people with HIV (ARR 0.67, 95%CI 0.57-0.79, p&lt;0.0001), and methamphetamine users (ARR 0.77, 95%CI 0.69-0.86; p&lt;0.0001). Those hospitalized for HF were more likely to be tested (ARR 2.21, 95% CI 2.05-2.39; p&lt;0.0001). Testing within 30 days was associated with a 4% absolute reduction in mortality (95%CI -6.5 to -1.6%; p&lt;0.001) independent of hospitalization. Testing within 30 days and ever were associated with 22% and 27% lower mortality hazard, respectively (Figure). Conclusions: In a municipal health system in San Francisco, women, people with HIV, without stable housing, and methamphetamine users were less likely to receive ischemic testing. Ischemic testing was associated with improved survival. Ischemic testing should be considered for everyone with HF.

Optimal settings and advantages of drones as a tool for canopy arthropod collection

The growing field of aeroecology is limited by difficulties associated with sampling in the air column. Aerial insects are particularly hard to sample, despite being the main prey in the air column, with some recent studies attempting to use drones as a collection method. We conducted a study to determine the optimal drone settings for collecting insects above the canopy, where drones are seldom used. By attaching a net to the body of a small, commercial drone, we tested yield from different height, speed, and net settings in wetlands, as well as compared insect diversity across different habitat canopies. Height was the most important setting; grazing the canopy yielded significantly more insects than flying one meter above it. Speed, drone type, and net size did not influence the number of insects caught per trial. Wetland canopies had higher abundance, diversity, and species richness in its arthropod populations compared to forest canopies or lakes. Compared to the yield of Lindgren funnels—a traditional sampling method in entomology—drones captured higher diversity and abundance of insects in a fraction of the time. This study confirms that drones are an efficient and accurate way to collect canopy arthropods.

Population Dynamics of American Bullfrog (Lithobates catesbeianus) and Implications for Control.

Simple SummaryLithobates catesbeianus (American bullfrog) was introduced to South Korea and caused various damage in the Korean natural environment for the past 25 years. Although several management strategies were implemented, the effectiveness of past control decisions is largely unknown. We built a population dynamics model for L. catesbeianus in the Onseok reservoir, South Korea, in order to assist managerial decisions. Control scenarios with varying intensities were simulated to evaluate their effectiveness. The population of the American bullfrog in the reservoir was reduced to a manageable level under intensive control of the tadpole stage, using three sets of double fyke nets and 80% direct removal of juvenile and adult stages. According to our results, integrated, intensive, and continuous control is essential for managing the invasive American bullfrog population.Lithobates catesbeianus (American bullfrog), known to be one of the notorious invasive species, was introduced to South Korea and has proliferated in the Korean natural environment for the past 25 years. The ecological impact caused by the species is well known, and several management decisions have been implemented to cull its population. However, the effectiveness of past control decisions is largely unknown. We built a population dynamics model for L. catesbeianus in the Onseok reservoir, South Korea, using STELLA architect software. The population model was based on the demographics and ecological process of the species developing through several life stages, with respective parameters for survivorship and carrying capacity. Control scenarios with varying intensities were simulated to evaluate their effectiveness. The limitations of isolated control methods and the importance of integrated management are shown in our results. The population of the American bullfrog in the reservoir was reduced to a manageable level under intensive control of the tadpole stage, using three sets of double fyke nets and 80% direct removal of juvenile and adult stages. According to our results, integrated, intensive, and continuous control is essential for managing the invasive American bullfrog population. Finally, our modeling approach can assist in determining the control intensity to improve the efficiency of measures against L. catesbeianus.

Business process recommendation method based on cost constraints

ABSTRACT Business process recommendation can be used to simplify the working procedures of enterprises, avoid unnecessary expenses, and promote the development of enterprises. In the process of process recommendation, there are a lot of activities that are similar in structure and difficult to choose. Here, a process recommendation method based on cost constraints is proposed to solve the problem of difficult to distinguish similar processes. First, the business process is transformed into a labelled Petri net, and the execution probability of each transition is calculated according to the business process log. Then, the matrix used to represent Petri nets is constructed according to the adjacent relationship between transitions, and the matrix is made into the same dimension, and the similarity between matrices is calculated by biggest–smallest approach degree, and the set of Petri nets with similar structure is established. Finally, a cost constraint-based process recommendation method is proposed to find lower service cost items in similar process sets. In the experimental part, the feasibility of the method is compared and verified.

Evaluating the Teaching Health Center Graduate Medical Education Model at 10 Years: Practice-Based Outcomes and Opportunities.

Since 2011, the Teaching Health Center Graduate Medical Education (THC GME) program has sought to expand access to care by training residents in safety net settings. To examine impact on physician scope, location, and patient population served using a unique data set. Using 2017-2020 data from the American Board of Family Medicine National Graduate Survey, we compared demographics, practice location, populations served, and scope of practice between graduates of THC GME programs and graduates of other family medicine programs. Our sample comprised 8608 (out of 13 465) eligible family medicine graduates 3 years after completion of residency training, for a response rate of 63.9%. THC graduates were significantly more likely than other graduates to practice in a rural location (17.9% to 11.8%), within 5 miles of their residency program (18.9% to 12.9%), and to care for medically underserved populations (35.2% to 18.6%). Their scope of practice was wider than other graduates and more likely to comprise services like buprenorphine prescribing, behavioral health care, and outpatient gynecological procedures. Regression results suggest that THC training is independently correlated with a broader scope of practice. Graduates of THC programs were significantly more likely than graduates of other programs to practice close to their training sites and in rural areas, and to care for underserved patients while maintaining a broader scope of practice than other graduates.

English

To investigate the ecological, yield, physiological, and biochemical index of cultivated pinellia under different shade conditions and to analyze the influence of light intensity on Pinellia ternata’s ecological and physiological characteristics, our experiment employed four varieties of pinellia, Changde pinellia, Yuanling pinellia, Ziyang pinellia, and Bijie pinellia, as experiment materials, planted them under equivalent growing conditions, and placed them under different shade conditions (shade net settings of 0%, 25%, 50%, and 75% shade). The present study sought to determine the index changes of pinellia, including their morphology, photosynthesis, antioxidant enzyme activity, and yield, over a 100-day growth period. The results under 25% shade, compared with full light, revealed the following: pinellia plants reached heights of up to 20.04 cm, an increase of 43.35%; the maximum leaf area was 16.15 cm2, an increase of 34.78%; and the fresh weight of pinellia tubers decreased to varying degrees. Under shade treatment, the content of chlorophyll in pinellia leaves increased, the content of soluble protein and malondialdehyde decreased, and the activities of three antioxidant enzymes increased; these changes were overall consistent with the typical characteristics of shade plants, and the adaptability of pinellia to different shade conditions varied considerably. Moderate shade (25%–50% shade) could improve the physiological and ecological indicators of pinellia and reduce the threat of intense light exposure, but it would also reduce the tuber yield to varying extents

The performance of the Khorana score in women with gynecologic cancer in a diverse, safety net hospital setting (452)

The performance of the Khorana score in women with gynecologic cancer in a diverse, safety net hospital setting (452)

Opportunistic gillnet depredation by common bottlenose dolphins in the southwestern Gulf of Mexico: Testing the relationship with ecological, trophic, and nutritional characteristics of their prey

Competition between fisheries and bottlenose dolphins is a globally relevant conflict given its socioeconomic and ecological implications. Understanding the factors driving the interactions between dolphins and fishery activities is key to the development of appropriate mitigation strategies. Our study aimed to assess whether these interactions are related to the ecological, trophic, and nutritional characteristics of the catch. We used 117 gillnet sets from 48 fishing trips during 2009 – 2010 and 2015 – 2019, which were classified based on the presence or absence of dolphin interactions. These interactions occurred year-round and were documented in 46.1% of the sets, with 14.5% of those showing signs of depredation. The passive acoustic predatory hypothesis, which states that fish species that generate sound are subject to a higher predation intensity by dolphins, was not supported by our data. Also, with the exception of species diversity, ecological parameters such as richness, biomass and CPUE were slightly higher, although not significant in sets with dolphin interaction. Furthermore, during 2015 – 2016, we sampled 123 organisms of 25 representative fish species in the catches and determined the whole fish isotopic composition (δ13C and δ15N), and estimated the nutritional value (i.e., lipid, protein, and energy content) of each species. Isotopic values showed no differences between net settings (with and without interaction), fish habitat, or prey type (potential prey,n= 11 species,vs. non-potential prey,n= 14). However, a preference towards fish from a certain range of thropic levels was evident. All the fish (N= 123) showed significantly higher protein values during the Rainy period, which may be attributed to their reproductive cycles and higher primary productivity. Interestingly, energy contents of the dolphins’ potential prey were also significantly higher during this period. Unexpectedly, protein and energy contents were significantly higher in the fishes caught in the sets without dolphin interaction, but only during the Dry and Windy periods, respectively. Opportunistic feeding habits are well known for bottlenose dolphins, and our results showed that “easy access” to prey will likely prompt interaction with gillnets, regardless of the species composition, biomass, seasonality, preferred habitat, sound production capacity, or nutritional value of the captured fish.

Identifying the Needs of Primary Care Providers Caring for Breast and Colon Cancer Survivors in the Safety-Net: a Qualitative Study

As the number of cancer survivors continues to increase and given the shortage of oncology clinicians in safety net health care settings, primary care providers (PCPs) in these settings will increasingly provide cancer survivorship care. In order to ensure equitable care for low-income and underserved breast and colon cancer survivors, it is essential to understand the safety-net PCPs’ perspective. We conducted semi-structured, in-depth qualitative interviews with 11 PCPs working in a safety-net health care system to identify their needs in caring for cancer survivors. Interviews were audio-recorded and professionally transcribed. Two coders independently coded the interviews and conducted regular meetings until we reached consensus on the results. Analysis was based in grounded theory and performed using the constant comparative method. Thematic analysis identified six themes as follows: (1) Cancer survivorship care can be integrated with the whole person and chronic disease care management that occurs in primary care; (2) PCPs’ perceptions regarding patients’ survivorship care needs and their confidence in meeting those needs; (3) preference for a shared care model; (4) coordination of care; (5) PCPs’ need for survivorship care education and training; and (6) unique issues involved in the care of older cancer survivors. PCPs in the safety-net believe that providing comprehensive survivorship care requires coordination of care through the cancer continuum. Tools like checklists, electronic health records-based communication, and convenient electronic consultations with cancer specialists would enhance the quality of survivorship care. Respondents advocate the inclusion of survivorship care education in medical education. The continuity of care with PCPs means that they play a particularly important role in the care of older cancer survivors.

Hardware-Trojan Detection Based on the Structural Features of Trojan Circuits Using Random Forests

Recently, with the spread of Internet of Things (IoT) devices, embedded hardware devices have been used in a variety of everyday electrical items. Due to the increased demand for embedded hardware devices, some of the IC design and manufacturing steps have been outsourced to third-party vendors. Since malicious third-party vendors may insert malicious circuits, called hardware Trojans, into their products, developing an effective hardware-Trojan detection method is strongly required. In this paper, we propose 25 hardware-Trojan features focusing on the structure of trigger circuits for machine-learning-based hardware-Trojan detection. Combining the proposed features into 11 existing hardware-Trojan features, we totally utilize 36 hardware-Trojan features for classification. Then we classify the nets in an unknown netlist into a set of normal nets and Trojan nets based on a random-forest classifier. The experimental results demonstrate that the average true positive rate (TPR) becomes 64.2% and the average true negative rate (TNR) becomes 100.0%. They improve the average TPR by 14.8 points while keeping the average TNR compared to existing state-of-the-art methods. In particular, the proposed method successfully finds out Trojan nets in several benchmark circuits, which are not found by the existing method.

Gill Net Selectivity for Fifteen Fish Species of the Upper San Francisco Estuary

Gill-net size selectivity for fifteen fish species occurring in the upper San Francisco Estuary was estimated from a data set compiled from multiple studies which together contained 7,096 individual fish observations from 882 gill net sets. The gill nets considered in this study closely resembled the American Fisheries Society’s recommended standardized experimental gill nets for sampling inland waters. Relationships between gill-net mesh sizes and the sizes for each fish species retained in them were estimated indirectly using generalized linear modeling and maximum likelihood. Selectivity curves are provided for each species to inform researchers about population characteristics of fishes sampled with similar gill nets.

Implementation of a “genetic testing station” in a safety net hospital to optimize access and increase equity.

e18565 Background: Diagnosis of hereditary cancers by genetic testing (GT) has significant implications for treatment decisions for individuals and risk reduction among family members. Recent guidelines have expanded the eligibility criteria for GT. However, significant disparities in GT completion persist based on race, ethnicity, insurance status, and English proficiency. Thus, novel interventions are needed to provide diverse populations equitable access to GT. Methods: From March to October 2021, we conducted a single arm study of a genetic testing station (GTS) intervention in a safety net hospital. The GTS intervention included (1) screening of clinic schedules for eligible patients; (2) video-based GT education in English, Spanish, and Cantonese; (3) consent for GT and collection of a blood or saliva sample by a genetic counseling assistant; (4) telehealth-based post-test counseling with a genetic counselor (GC). Bilingual, culturally concordant staff developed the educational videos and study materials. Patients who met the NCCN criteria for GT were eligible. We compared this group to a historical cohort who initiated GT in the preceding nine months. The historical cohort underwent GT in a traditional model: (1) oncologist-initiated referral, (2) pretest counseling with a GC, (3) GT if appropriate, and (4) post-test counseling to review and discuss results. Our primary outcomes were accessibility and feasibility assessed by tracking the implementation process. Secondary outcomes included completion rates of GT and post-test GC visit, and time from enrollment to GT result disclosure. We evaluated all associations with Chi-square tests for categorical variables and Pearson’s Chi-square test of medians for time to post-test visit. Results: We approached 92 patients for GTS; 3 declined, 89 patients underwent the GTS intervention. Of 155 patients (GTS: n = 89, historical cohort: n = 66), 15% were Black, 28% Asian, 17% White, 31% Hispanic/Latinx, 2% Native Hawaiian/Pacific Islander, and 7% multiethnic/other; 51% spoke English, 27% Spanish, 17% Cantonese, and 5% other. In the GTS cohort, 85 (96%) of participants completed GT and 80 (90%) completed the post-test GC visit, compared to 46 (70%, p &lt; 0.001) and 42 (64%, p &lt; 0.001) respectively in the historical cohort. The median time to result disclosure was 30.5 days (IQR 23.8 - 38.8) for the GTS cohort and 80.5 days (IQR 37.5 - 137.5, p = 0.001) for the historical cohort. Conclusions: Implementation of GTS was feasible and acceptable in a safety net setting. GTS resulted in more patients completing GT and post-test counseling and significantly reduced the time to result disclosure, which has the potential to impact treatment decisions and outcomes. As GT eligibility criteria broaden, innovative interventions, workflows, and tailored educational resources for diverse populations are needed to ensure equitable access to GT.

Consideration of racism experiences in the implementation of trauma-focused therapy in primary care.

To understand providers' perceptions of how a patient's experience of racism may impact the successful implementation of a brief posttraumatic stress disorder (PTSD) treatment in the safety net integrated primary care setting. To conduct a developmental formative evaluation prior to a hybrid type I effectiveness-implementation trial. From October 2020 to January 2021, in-depth qualitative interviews were conducted with integrated primary care stakeholders (N=27) at the largest safety net hospital in New England, where 82% of patients identify as racial or ethnic minorities. Interviews with clinical stakeholders were used to (a) contextualize current patient and provider experiences and responses to racism, (b) consider how racism may impact PTSD treatment implementation, (c) gather recommendations for potential augmentation to the proposed PTSD treatment (e.g., culturally responsive delivery, cultural adaptation), and (d) gather recommendations for how to shift the integrated primary care practice to an antiracist framework. Interview data were gathered using remote data collection methods (video conferencing). Participants were hospital employees, including psychologists, social workers, primary care physicians, community health workers, administrators, and operations managers. We used conventional content analysis. Clinical stakeholders acknowledged the impact of racism, including racial stress and trauma, on patient engagement and noted the potential need to adapt PTSD treatments to enhance engagement. Clinical stakeholders also characterized the harms of racism on patients and providers and provided recommendations such as changes to staff training and hiring practices, examination of racist policies, and increases in support for providers of color. This study contextualizes providers' perceptions of racism in the integrated primary care practice and provides some suggestions for shifting to an antiracist framework. Our findings also highlight how racism in health care may be aPTSD treatment implementation barrier.

"It closes the gap when the ball is dropped": patient perspectives of a novel smartphone app for regional care coordination after hospital encounters.

Despite the broad adoption of electronic health records (EHRs) for inpatient and outpatient care, and wide availability of EHR-linked portals, these tools are not always effective in informing primary care teams about patients' emergency department (ED) visits or inpatient admissions, leading to persistent gaps in care coordination. The objective of this study was to understand how patients with limited patient portal use in a safety net setting engaged with a smartphone app that used location tracking to detect and notify care teams about patients' hospital use in order to stimulate care coordination and follow-up care. We recruited English- and Spanish-speaking adults at high risk of hospital use from a Federally Qualified Health Center (FQHC). The app detected when patients visited the hospital and asked them to confirm a hospital visit. When confirmed, the app notified the primary care team about the visit, and the care team followed up with patients according to the FQHC protocols for care coordination. We collected qualitative data on app experience from participants who used the app for four months and used a general inductive approach to identify recurring themes. Participants generally reported a positive app experience, as it helped solve the problem of poor follow-up care. "I liked the goal of the app…Ultimate goal of it was comforting", recounted one participant when describing her app experience. Participants thought the app push notifications could be refined and the app itself could be modernized. Participants also suggested improvements to the push notifications they received from the app and the visit information they entered into the app for care teams to receive. Some participants also suggested improvements to the FQHC's care coordination workflows facilitated by the app, like an immediate connection to the patient's primary care team. The app was well received by low-income patients at high risk of ED/inpatient visits. Future research is needed to determine feasibility of implementation in other settings.