US Grade Research Articles

A Critical Analysis of the Information Available Online for Ménière's Disease.

Patients increasingly rely on online resources for medical information; however, the Internet is unregulated and prone to misinformation. This study analyzes the reliability, quality, and readability of websites for Ménière's disease. A Google search was performed using keywords Ménière's disease. The first 5 pages (50 results) were reviewed. Websites were sorted into 5 categories: academic institutions, government agencies, professional organizations, medical information websites, and miscellaneous. The reliability, quality, and readability of each website were evaluated using the DISCERN instrument and Flesch-Kincaid Grade Level (FKGL). DISCERN assesses reliability and quality by scoring 15 questions on a scale from 1 (low) to 3 (high). The reliability score emphasizes clear objectives and sources, as well as lack of bias, whereas the quality score emphasizes information on treatment options. The FKGL of each website was calculated using a formula to determine the equivalent US grade reading level. Ambulatory. None. Forty-two websites were analyzed. Academic institutions were the most common (n = 13, 31%) but scored the lowest using DISCERN at 1.75 ± 0.13. Medical information websites scored highest at 2.24 ± 0.09 (P = .024 compared to academic institutions). The average FKGL of all websites was 10.12 ± 0.57 with medical information websites being the easiest to read at 8.84 ± 0.83. Only 5 (13%) of websites scored below the eighth-grade reading level. Most top online search results for Ménière's disease are deficient in quality and readability. Medical information websites are generally the most reliable and easy to read.

Role of transthoracic ultrasonography in evaluation of pleural thickening observed during medical thoracoscopy

Background and objective Ultrasound can evaluate pleural thickening; however, medical thoracoscopy permits direct inspection of the pleura, and biopsies are taken under direct vision. This study evaluated the degree of pleural thickening observed during medical thoracoscopy and compared it with the pleural thickness grades assessed and measured using transthoracic ultrasonography (TUS). Patients and methods A total of 118 cases with undiagnosed exudative pleural effusion were included. They were subjected to history taking, clinical examination, routine laboratory investigations, computed tomography chest, TUS to assess degree of parietal pleural thickening, and medical thoracoscopy to evaluate the observed degree of pleural thickening. Results There was a significant positive correlation between pleural thickening measured by US with thoracoscopic grades of thickness and significant positive correlation between pleural thickening grades measured by US and thoracoscopic grades of pleural thickness. Performance of thoracoscopy using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for assessment of pleural thickening in comparison with US as a standard tool for measurement was 36, 77, 52, 77, and 66%, respectively, whereas in assessing the shape of visceral pleura, this performance increased up to 89, 89, 85, 85, and 88%, respectively. Conclusion This study showed the superiority of TUS in assessment of parietal pleura thickening and chest wall invasion. In addition, TUS has other advantages as being noninvasive, less expensive, and no exposure to radiation. However, medical thoracoscopy can detect the visceral pleural shape better owing to the advantage of direct visualization of the lung surface.

Factor Investing in Corporate Bond Markets: Enhancing Efficacy Through Diversification and Purification!

We show that factors from value, quality, low-risk, and momentum styles play an important role in explaining the cross-section of corporate bond expected returns for the US and Euro Investment Grade and US BB-B Nonfinancial High Yield universes. We demonstrate the importance of purifying factor data by neutralizing a number of risk biases that are present in the factors: controlling for sectors, option-adjusted spread, duration, and size biases significantly increase the predictive power of style factors. We propose a new simple approach for efficiently neutralizing the biases from multiple risk variables and demonstrate its superiority relative to stratified sampling and optimization as alternative control methods. We also measure the added value from diversifying the number of factors in each style. Finally, we show that the results are robust in relation to transaction costs and can be used to design strategies that aim at outperforming traditional benchmark indexes. TOPICS:Analysis of individual factors/risk premia, factor-based models, style investing Key Findings • Factors from value, quality, low-risk, and momentum styles play an important role in explaining the cross-section of corporate bond expected returns for the US and Euro Investment Grade and US BB-B Nonfinancial High Yield universes. • The forecasting efficacy of style factors increases significantly if biases such as sectors, option-adjusted spread, duration, and size in the factor data are neutralized. Diversifying the number of factors in each style also significantly improves the forecasting efficacy. • We propose a new simple approach for increasing the forecasting efficacy of style factors by efficiently neutralizing the biases from multiple risk variables. We demonstrate the superiority of this approach over stratified sampling and optimization.

Potential recovery and long term follow up of heart block following surgical repair of congenital heart disease

Purpose: Pacemaker implantation in pediatric patients is commonly needed after surgical heart block as well as post-operative high grade sinus node dysfunction. The purpose of our study was to examine in detail the risk factors for heart block prior to and following cardiac surgery. Additionally we aimed to study the evolution of pacing needs, recovery of conduction and pacemaker properties over time as there is extremely limited data regarding the same. Methods: We performed a retrospective cohort study by …

Methodology development for cutting force components determination for aerospace materials milling

The purpose of this paper is to develop a method to determine cutting force components for milling tough materials in different cutting conditions: VT23 titanium grade, 40HN2MA (4340 US Grade) and V95 of high tough aluminium grade. The basis of the method is calculation of the exponential function based on determination of instantaneous values of chip thickness depending on the angle position of the cutting edge. Several tests are used for determination of experimental cutting force for the milling process with tungsten carbide inserts of various geometry in different cutting conditions using industrial equipment, instruments and tooling. The method shows a good convergence with experimental data. It provides an accurate description of cutting force which is enough to determine some phenomenon of cutting force dynamics for these materials. Phenomena of Fx cutting force delay for milling of titanium grade are presented as an example. The nature of the cutting force component delay during the run-off from the single cut may be a case of future study.

Considering Low Health Literacy: How Do the Pelvic Floor Distress Inventory-Short Form 20 and Pelvic Floor Impact Questionnaire-Short Form 7 Measure Up?

The objective of this study was to evaluate the readability and understandability of 2 commonly used pelvic floor disorder questionnaires, Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7), in a low health literacy patient population. Flesh-Kincaid, SMOG, Fry, and FORCAST readability assessment tools were used to assign US grade levels to each questionnaire (PFDI-20, PFIQ-7). Two health literacy experts used PEMAT and ELF-Q tools to determine understandability, organization, content, and quality of each form. A focus group of women with low health literacy used Stop Light Coding and a facilitator-prompted discussion to further evaluate understandability and critique the forms. The PFIQ-7 required higher reading ability compared with PFDI-20 (ninth to 11th vs sixth to eighth mean grade level equivalents). Expert and focus group reviews identified concerns regarding purpose, formatting, and word choice in both forms. Focus group participants recommended assistance with questionnaire completion from clinical staff and gave mean overall ratings of 5.4 (0-10/worst to best) for PFDI-20 and 8.0 for PFIQ-7. Knowledge of potential barriers to understanding and completion may improve utilization of and accuracy of patient responses to PFDI-20 and PFIQ-7 in women with low health literacy.

The History of Urology at the Minneapolis Veterans Affairs Health Care System

ObjectiveThe Section of Urology at the Minneapolis Veteran's Affairs (VA) Medical Center has a long history of contributions to Urology including the Gleason Score, Fuhrman Grading system, testicular tumor marker development and the birth of Endourology. The objective of this manuscript is to compile and present the Urologic history of the Minneapolis VA. MethodsThe Urologic literature and institutional records originating from the Minneapolis VA Medical Center from 1946-2017 were reviewed and presented herein. ResultsThe Minneapolis VA Health Care System originated in 1921 and currently employs 5 Urologist who serve over 16,000 veterans per year. Historic achievements from the Minneapolis VA Section of Urology include the development of the Veteran's Affairs Cooperative Research Group (VACURG) which was instrumental to development of the Gleason grading system for prostate cancer in 1965. Additional urologic oncology achievements originating from the Minneapolis VA Section of Urology included the development of the diagnostic utility of tumor markers in testis cancer in 1976 and The Fuhrman Grading System in 1982. Perhaps the greatest contribution to the field of Urology was the birth of Endourology at the Minneapolis VA in the late 1970s under the direction of Dr. Paul Lange. Currently the Minneapolis VA is a premier center for Evidence Based Urology by housing Cochrane Urology and the U.S. Grading of Recommendations Assessment, Development and Evaluation network (US GRADE). ConclusionSince 1946, the section of Urology at the Minneapolis VA has contributed basic science, clinical technique and evidence based medicine to the field of Urology while providing care to the nation's veterans.

Dietary assessment of the ‘sweet enough program’ for primary school students in Chiang Mai, Thailand

Background: Since 2007, Chiang Mai Public Health Office has conducted a campaign called “Chiang Mai On Wan” to decrease sugar consumption. The aim of this study was to evaluate the dietary patterns of students in schools participating in the program.Methods: The cross-sectional data were obtained from primary school children during November 2010 to February 2011. A total of 240 children were selected from Prathom 5 students (US Grade 5) in 12 schools. Sweet Enough Program (SEP) schools are those which implement public nutrition policies and supportive environments according to the Ottawa Charter, including no candy, no high-risk decay food or drink, and campaigns to reduce sugar consumption. Dietary patterns were collected using 7-day meal books in which each student recorded individual consumption.Results: Students in the SEP were found to have a much lower sugar intake than those in non-SEP schools. All students consumed candy, jelly and sweet snacks but the percentages of candy, jelly, and sweet snacks for SEP students were 1.7%, 3.4%, and 11.8%, respectively, while non-SEP students’ percentages were 26.4%, 11.6%, and 37.2%, respectively. There were significant differences between program school students and non-program school students with regards to candy (p<0.001), jelly (p=0.043), sweet crackers (p<0.001), biscuit (p<0.001), and chips (p<0.001).Conclusions: The success of this program is highlighted by the nutritional changes among the students. This was achieved by creating public health policies and supportive environments, as set out in the Ottawa Charter strategy.

Perceived family relationship quality and use of poly-tobacco products during early and late adolescence

BackgroundThe role of family relationship in adolescent use of emerging tobacco products, which have become increasingly popular, is unknown. We examined the associations of perceived family relationship quality with current use of poly-tobacco products including cigarettes, electronic cigarettes (e-cigarettes), waterpipe and smokeless tobacco in adolescents. MethodsData from a representative sample of 42,250 US grade 7–12 equivalent students (mean ± SD age 14.6 ± 1.9 years; 51.3% boys) from 75 randomly selected secondary schools in Hong Kong (2012−13) were analysed. Logistic regressions yielded adjusted odds ratios (AORs) for current (past 30-day) use of cigarettes, e-cigarettes, waterpipe, smokeless tobacco and poly-tobacco (≥2 products) in relation to perceived family relationship quality, adjusted for age, sex, perceived family affluence, parental education, family structure, parental and sibling smoking and secondhand smoke exposure at home. Subgroup analyses were conducted to compare the associations in early (aged ≤14 years) versus late (>14) adolescents. ResultsThe odds of current use increased with worse perceived family relationship quality with AORs (95% confidence interval) of up to 2.92 (2.32–3.68) for cigarettes, 7.28 (4.71–11.2) for e-cigarettes, 5.04 (3.44–7.40) for waterpipe, 8.09 (4.87–13.4) for smokeless tobacco and 5.25 (3.45–8.01) for poly-tobacco products use (all P for trend <.001). The associations for all tobacco use outcomes were stronger in early than late adolescents (all P for interaction <.001). ConclusionsDose-response relationships were found between negatively perceived family relationship quality and current poly- and individual tobacco product use by Hong Kong Chinese secondary students. The associations were stronger for alternative tobacco products and in early adolescents.

Longitudinal measurement invariance and explanatory IRT models for adolescents\u2019 oral health-related quality of life

BackgroundLongitudinal invariance is a perquisite for a valid comparison of oral health-related quality of life (OHRQoL) scores over time. Item response theory (IRT) models can assess measurement invariance and allow better estimation of the associations between predictors and latent construct. By extending IRT models, this study aimed to investigate the longitudinal invariance of the two 8-item short forms of the Child Perception Questionnaire (CPQ11–14) regression short form (RSF:8) and item-impact short form (ISF:8) and identify factors associated with adolescents’ OHRQoL and its change.MethodsAll students from S1 and S2 (equivalent to US grades 6 and 7) who were born in April 1997 and May 1997 (at age 12) from 45 randomly selected secondary schools were invited to participate in this study and followed up after 3 years. Data on the CPQ11–14 RSF:8 and CPQ11–14 ISF:8, demographics, oral health behavior and status were collected. Explanatory graded response models were fitted to both short forms of the CPQ11–14 data for assessing longitudinal invariance and factors associated with OHRQoL. The Bayesian estimation method – Monte Carlo Markov Chain (MCMC) with Gibbs sampling was adopted for parameter estimation and the credible intervals were used for inference.ResultsData from 649 children at age 12 at baseline and 415 children at age 15 at follow up were analyzed. For the 12 years old children, healthier oral health behavior, better gum status, families with both parents employed and parents’ education level were found to be associated with better OHRQoL. Four items among the 2 short forms lacked longitudinal invariance. With statistical adjustment of longitudinal invariance, OHRQoL were found improved in general over the 3 years but no predictor was associated with OHRQoL in follow-up. For those with decreased family income, their OHRQoL had worsened over 3 years.ConclusionsIRT explanatory analysis enables a more valid identification of the factors associated with OHRQoL and its changes over time. It provides important information to oral healthcare researchers and policymakers.

Websites on Bladder Cancer: an Appropriate Source of Patient Information?

A growing number of patients search for health information online. An early investigation of websites about bladder cancer (BCa) revealed mostly incomplete and particularly inaccurate information. We analyzed the quality, readability, and popularity of the most frequented websites on BCa. An Internet search on www.google.com was performed for the term "bladder cancer." After selecting the most frequented websites for patient information, HONcode quality certification, Alexa popularity rank, and readability scores (according to US grade levels) were investigated. A 36-point checklist was used to assess the content according to the EAU guidelines on BCa, which was categorized into seven topics. The popularity of the 49 websites analyzed was average, with a median Alexa popularity rank of 41,698 (interquartile range [IQR] 7-4,671,246). The readability was rated difficult with 11years of school education needed to understand the information. Thirteen (27%) websites were HONcode certified. Out of 343 topics (seven EAU guideline topics each on 49 websites), 79% were mentioned on the websites. Of these, 10% contained incorrect information, mostly outdated or biased, and 34% contained incomplete information. Publically provided websites mentioned more topics per website (median [IQR] 7 [5.5-7] vs. 5.5 [3.3-7]; p = 0.022) and showed less incorrect information (median [IQR] 0 [0-1] vs. 1 [0-1]; p = 0.039) than physician-provided websites. Our study revealed mostly correct but partially incomplete information on BCa websites for patients. Physicians and public organizations should strive to keep their website information up-to-date and unbiased to optimize patients' health literacy.

Advancing Guideline Development in the United States: A Call to Action by the US GRADE Network.

Advancing Guideline Development in the United States: A Call to Action by the US GRADE Network.

Dominant achievement goals and academic outcomes across tracks in high school

The self-reported grades Dutch, English and Math of 13,970 students in the third grade of Dutch secondary education (US grade 9) were investigated with regard to educational track-level and dominant achievement goal (DAG). The performance approach goal group scored significantly higher on all three subjects than the performance avoidance group, the mastery approach group, the mastery avoidance group and the group without a DAG. In addition, the differences between the performance approach group and the other groups with regard to the three school subjects were of the same size, suggesting that the DAG is associated with the same processes across various school subjects. The magnitude of the differences between the other DAG groups, however, decreased with decreasing track level, suggesting that the DAGs’ adaptive value varies systematically with ability level.

Secondhand Smoke From Multiple Sources, Thirdhand Smoke and Respiratory Symptoms in Hong Kong Adolescents.

Reports on involuntary tobacco smoke exposure in children have focused mostly on secondhand smoke (SHS) from smoking inside the home. We studied the separate and combined prevalence of SHS exposure from multiple sources and thirdhand smoke (THS) and the associations with respiratory symptoms in Hong Kong adolescents. In 2010-2011, 61 810 Secondary 1 (US Grade 7) to seven students reported their smoking status, respiratory symptoms, and exposure to four sources of tobacco smoke in the past 7 days. Weighted prevalence of exposure was calculated. Associations with respiratory symptoms were analyzed in 50 762 never smokers using logistic regression. Tobacco smoke exposure at home was 23.2% considering SHS exposure from inside the home, but increased to 33.2% including SHS from neighbors and 36.2% further including THS. Including SHS outside home (55.3%), 63.3% of adolescents were exposed to SHS anywhere or THS at home. In never smokers, SHS from each source and THS at home were linearly associated with respiratory symptoms. Exposure to more sources yielded stronger associations with respiratory symptoms (p for trend<.001). The adjusted odds ratios (95% CI) were 1.04 (0.97-1.11), 1.12 (1.03-1.22), 1.40 (1.26-1.56) and 1.99 (1.74-2.28) for 1, 2, 3, and 4 sources, respectively. Although Hong Kong's smoking prevalence is among the lowest in the developed world, over 60% of its adolescents were involuntarily exposed to tobacco smoke from one or more sources with a linear association with respiratory symptoms in never smokers. More stringent policies are needed to protect adolescents from tobacco smoke. In a high-density urban setting, involuntary exposure to tobacco smoke in adolescents can be much higher than the smoking prevalence of the general population, especially if SHS exposure from multiple sources and THS are also considered. Such exposures have important health implications as demonstrated by their linear associations with respiratory symptoms. Tobacco control measures effective in reducing smoking prevalence may have little effect in reducing adolescent exposure to tobacco smoke, especially in the private home, in which other public health strategies are urgently needed.

Conversion and reliability of two urological grading systems in infants: the Society for Fetal Urology and the urinary tract dilatation classifications system.

The urinary tract dilation (UTD) classification system was proposed in 2014. To evaluate the correspondence and reliability of two US grading systems for postnatal urinary tract dilatation in infants: the Society for Fetal Urology (SFU) and the UTD systems. We assessed 180 kidneys in infants younger than 1year. Four radiologists assessed the kidneys twice using both the SFU system (grades 0 to 4) and the UTD system (grades normal, P1, P2, P3). The SFU system was re-categorized into SFU-A (grades 0, 1-2, 3, 4) and into SFU-B (grades 0-1, 2, 3, 4). The Cohen kappa statistic was used for estimating agreement of both UTD-SFU-A and UTD-SFU-B. The Cohen kappa was significantly higher between UTD and SFU-B as compared to the UTD and SFU-A (0.75 vs. 0.50, P < 0.001). Intra-observer agreement was similar for the two grading systems (SFU 0.64-0.88 vs. UTD 0.48-0.92, P = 0.050-0.885). SFU grades 2 and 3 showed fair to moderate inter-observer agreement and corresponding UTD grades P1 and P2 showed moderate to substantial agreement. The overall inter-observer agreement was significantly higher for the UTD system than for the SFU system during the first assessment (95% confidence interval [CI]: right kidney, -0.069 to -0.062; left kidney, -0.048 to -0.043). Correspondence between the systems was poor using a recommended re-categorization (SFU-A). An alternative re-categorization (SFU-B) was found to be more appropriate for establishing correspondence between the systems. Both systems were reliable, with good intra- and inter-observer agreement for the assessment of infant kidneys, but the UTD system had better inter-observer agreement.

The relationship of waterpipe use with cigarette smoking susceptibility and nicotine dependence: A cross-sectional study among Hong Kong adolescents

IntroductionWaterpipe smoking has become increasingly popular in adolescents. We examined the association of waterpipe smoking with cigarette smoking susceptibility and nicotine dependence among adolescents in Hong Kong. MethodsWe analyzed the data of School-based Survey on Smoking among Students 2012/13 from a representative sample of 45,857 secondary school students (US grades 7–12) in Hong Kong. Among never cigarette smokers (n=37,740), we conducted chi-square test to compare cigarette smoking susceptibility by current (past 30-day) waterpipe smoking status, and used multivariate logistic regression to examine the association between current waterpipe smoking and cigarette smoking susceptibility controlling for age, sex, peer cigarette smoking, and living with a cigarette smoker. Then we conducted chi-square test and multivariate logistic regression among current cigarette smokers (n=1694) to examine the relationship of current waterpipe smoking with two nicotine dependence outcomes, including heavier smoking (≥5 cigarettes/day) and first cigarette within 30min of waking, controlling for demographics and the number of smoking days in the past 30days. ResultsAmong never cigarette smokers, current waterpipe use was associated with cigarette smoking susceptibility (adjusted odds ratio [AOR]=3.58, 95% confidence interval [CI]: 1.61–7.97). Of current cigarette smokers, waterpipe use was associated with heavier smoking (AOR=1.56, 95% CI: 1.00–2.43) and first cigarette within 30min of waking (AOR=2.08, 95% CI: 1.35–3.19). ConclusionsSurveillance, prevention, and intervention programs should address waterpipe use in addition to cigarette smoking. Educational programs need to inform youth about the harmful and addictive effects of waterpipe smoking. Public health campaigns deglamourizing waterpipe use may help reduce waterpipe smoking among youth.

Evaluation of the Readability of Dermatological Postoperative Patient Information Leaflets Across England.

Postoperative patient information leaflets (PILs) provide important guidance to patients after skin surgery. Readability is a method of evaluating information for text comprehension. The recommended level for PIL readability is US grade ≤6. To evaluate the readability of public English dermatological postoperative PILs. All dermatology departments in England were requested to provide their postoperative PILs. Patient information leaflets were evaluated using Readability Studio (Oleander Software, Vandalia, OH). Two preselected parameters were also noted: whether the PIL was doctor or nurse-written, and whether the PIL was Information Standard hallmarked. Eighty-five of one hundred thirty (65.4%) of PILs were evaluated. Only 29.4% of the PILs were grade level ≤6 with Flesch-Kincaid. The mean readability levels were 7.8 for Flesch-Kincaid, 67 for Flesch reading ease, 10.5 for Simple Measure of Gobbledygook (SMOG), 9.4 for Gunning-Fog, 8 for Fry, and 9.8 for FORCAST. No instruments demonstrated a significant difference between doctor (6) and nurse-written (7) PILs. Two instruments found that the 3 Information Standard hallmarked PILs had a higher (harder) readability than ordinary PILs (n = 82) (Gunning-Fog, p = .029*; SMOG p = .049*). Most English postoperative dermatological PILs' readability levels exceed recommendations (US grade ≤6). Departmental PILs should be reviewed to ensure that they are comprehensible to their patients.

What Conceptions have US Grade 4-6 Students' Generalized for Formal and Informal Common Representations of Unknown Addends?

This article reports findings from a study of grade 4-6 students' conception(s) for various representations of unknown addends [variables] commonly found in US elementary mathematics textbooks. Specifically, thirty-six US grade 4-6 students participated in two semi-structured task based interviews designed to explore their conception(s) of formal and informal representations of unknown addends as revealed by the types of numbers substituted across core mathematical tasks and task types.

Reported alcohol drinking and mental health problems in Hong Kong Chinese adolescents

ObjectiveTo investigate the association between reported alcohol drinking and mental health problems in Hong Kong adolescents. MethodsIn a school-based questionnaire survey in 2012-13 on 4620 Secondary one (US Grade seven) to six students (mean age 14.5, SD 1.6 years; 53.4% boys), alcohol drinking was classified as never drinking (reference), experimental, former, less-than-weekly and weekly drinking. Binge drinking was defined as drinking at least five drinks on one occasion. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ) with five subscales (emotional symptoms, conduct problems, hyperactivity, peer relationship problems and prosocial activity) and the total difficulties score (sum of the first four subscales). Multilevel regression was used to analyse the associations of mental health problems with drinking frequency and binge drinking, adjusting for potential confounders. ResultsCompared with never drinking, higher total difficulties scores were associated with less-than-weekly drinking (adjusted odds ratio AOR 1.39, 95% CI 1.01–1.91), weekly drinking (AOR 3.21, 95% CI 2.18–4.70), and binge drinking (AOR 2.18, 95% CI 1.42–3.32). Weekly drinking was most strongly associated with hyperactivity (AOR 6.27, 95% CI 1.42–3.32) among all subscales. Girls were more likely than boys to report emotional problems (AOR 3.36 vs 1.47) and hyperactivity (AOR 19.2 vs 2.31) related to weekly alcohol drinking (both P for interaction <0.05). ConclusionsIn Hong Kong adolescents, less-than-weekly, weekly, and binge drinking are associated with higher risks of mental health problems based on self-reported data. Prospective studies are warranted to explore the causality between alcohol drinking and mental health problems.

Quality of consumer-targeted internet guidance on home firearm and ammunition storage.

Four storage practices protect against unintentional and/or self-inflicted firearm injury among children and adolescents: keeping guns locked (1) and unloaded (2) and keeping ammunition locked up (3) and in a separate location from the guns (4). Our aim was to mimic common Google search strategies on firearm/ammunition storage and assess whether the resulting web pages provided recommendations consistent with those supported by the literature. We identified 87 web pages by Google search of the 10 most commonly used search terms in the USA related to firearm/ammunition storage. Two non-blinded independent reviewers analysed web page technical quality according to a 17-item checklist derived from previous studies. A single reviewer analysed readability by US grade level assigned by Flesch-Kincaid Grade Level Index. Two separate, blinded, independent reviewers analysed deidentified web page content for accuracy and completeness describing the four accepted storage practices. Reviewers resolved disagreements by consensus. The web pages described, on average, less than one of four accepted storage practices (mean 0.2 (95% CL 0.1 to 0.4)). Only two web pages (2%) identified all four practices. Two web pages (2%) made assertions inconsistent with recommendations; both implied that loaded firearms could be stored safely. Flesch-Kincaid Grade Level Index averaged 8.0 (95% CL 7.3 to 8.7). The average technical quality score was 7.1 (95% CL 6.8 to 7.4) out of an available score of 17. There was a high degree of agreement between reviewers regarding completeness (weighted κ 0.78 (95% CL 0.61 to 0.97)). The internet currently provides incomplete information about safe firearm storage. Understanding existing deficiencies may inform future strategies for improvement.