African American Adults’ Experiences with the Health Care System: In Their Own Words

African Americans suffer a disproportionate burden of death and illness from a number of different chronic diseases. Inequalities in health care practices and poor patient and provider communication between African American patients and health care professionals contribute to these disparities. We describe findings from focus groups with 79 urban African Americans in which the participants discussed their interactions with the healthcare system as well as beliefs and opinions of the healthcare system and professionals. Analysis revealed five major themes: (1) historical and contextual foundations; (2) interpersonal experiences with physicians and other health care workers; (3) discrimination; (4) trust, opinions and attitudes, and (5) improving health care experiences. These findings indicate that perceptions of discrimination and racism were prevalent among African Americans in this study, and that the expectation of a negative interaction is a barrier to seeking care. Authors discuss prevention and public health implications of these findings and make recommendations for health care practitioners

Kaposi sarcoma in a HIV uninfected man who has sex with men

Kaposi's sarcoma (KS) is a rare angioproliferative tumor associated with human herpesvirus 8 (HHV-8) infection. Four clinical variants of KS have been described: classic, endemic, iatrogenic and HIV-associated. We describe a 53-year-old men who had sex with men with a rapidly growing nodule on his left foot. Histologically KS was confirmed. Our patient did not match the clinical subgroups as HIV infection or other immune disorders could be ruled out. KS in HIV-negative MSM has only been reported sporadically. It was shown that KS in these patients clinically resembles classic KS but occurs at a younger age, is limited to the skin, and is associated with a good prognosis

Primary merkel cell carcinoma clinically presenting as deep oedematous mass of the groin

Merkel cell carcinoma (MCC) is a relatively rare, polyomavirus associated, primary neuroendocrine carcinoma of the skin which is usually arising from dermal skin layers. However, the origin of MCC in the subcutaneous tissue is debatable. We report a 58-yearold female patient with an oedematous mass on her left groin that was firm in consistency and had no discoloration or other visible abnormality of the overlying skin. On histology and immunohistology the tumour was consistent with the diagnosis of MCC showing a predominant subcutanous growth pattern. Pelvic magnetic resonance tomography revealed a tumour conglomerate reaching from the subcutis of the left groin to the left paraaortal and parailiacal region indicating widespread lymphogenic metastisation. Despite complete medical work-up no other MCC primary could be detected. In conclusion, predominant subcutaneous growth pattern as well as tumour localization in the groin are uncommon features of MCC. MCC showing the aforementioned features may be associated with significant delay of diagnosis and therefore represents an unfavourable prognostic factor

Coupling a single atomic quantum bit to a high finesse optical cavity

The quadrupole S$_{1/2}$ -- D$_{5/2}$ optical transition of a single trapped Ca$^+$ ion, well suited for encoding a quantum bit of information, is coherently coupled to the standing wave field of a high finesse cavity. The coupling is verified by observing the ion's response to both spatial and temporal variations of the intracavity field. We also achieve deterministic coupling of the cavity mode to the ion's vibrational state by selectively exciting vibrational state-changing transitions and by controlling the position of the ion in the standing wave field with nanometer-precision

Differing severities of acute exacerbations of idiopathic pulmonary fibrosis (IPF): Insights from the INPULSIS\uae trials

Background: Given the broad definition of an acute exacerbation of IPF, it is likely that acute exacerbations are heterogeneous in their aetiology, severity and clinical course. We used pooled data from the INPULSIS\uae trials of nintedanib versus placebo to investigate whether acute exacerbations reported as serious adverse events were associated with higher mortality than those reported as non-serious adverse events and to assess the effect of nintedanib on these types of events. Methods: Adverse events considered by an investigator to be an acute exacerbation were adjudicated as a confirmed acute exacerbation, suspected acute exacerbation, or not an acute exacerbation. Time to first investigator-reported acute exacerbation or confirmed/suspected acute exacerbation reported as a serious adverse event or non-serious adverse event over the 52-week treatment period was assessed post-hoc. Deaths were assessed based on data collected over the 52-week treatment period. Results: Of 63 patients who had 651 investigator-reported acute exacerbation, 48 (76.2%) had a first acute exacerbation reported as a serious adverse event. Thirty-six (3.4%) patients had 651 confirmed/suspected acute exacerbation, of whom 31 had a first event reported as a serious adverse event. Investigator-reported acute exacerbations reported as serious adverse events occurred in 23 patients in the nintedanib group and 26 in the placebo group. Confirmed/suspected acute exacerbations reported as serious adverse events occurred in 10 and 21 patients in these groups, respectively. Nintedanib significantly reduced the risk of a first acute exacerbation reported as a serious adverse event (HR 0.57 [95% CI: 0.32, 0.99]; p = 0.0476) and the risk of a first confirmed/suspected acute exacerbation reported as a serious adverse event (HR 0.30 [95% CI: 0.14, 0.64]; p = 0.0019) versus placebo. A higher proportion of patients with investigator-reported acute exacerbations reported as serious adverse events died than patients with acute exacerbations reported as non-serious adverse events (61.2% versus 7.1%). Conclusion: Different severities of acute exacerbation of IPF may exist. Acute exacerbations reported as serious adverse events in the INPULSIS\uae trials were associated with high mortality. Nintedanib significantly reduced the risk of acute exacerbations reported as serious adverse events. Trial registration: ClinicalTrials.gov NCT01335464 and NCT01335477