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Acupuncture is an evidence-based treatment for acute and chronic pain in outpatient settings, but has not yet been fully established in emergency department (ED) settings. To adapt acupuncture for the ED in a pragmatic randomized controlled trial of ED acupuncture for acute musculoskeletal pain management, we collected qualitative interview feedback from ED patients on their experiences and recommendations to iteratively improve the intervention, balancing feasible ED delivery with patient acceptability and treatment satisfaction. Between May 2020 and May 2021, 28 patients who received ED acupuncture were interviewed 1-3 months after their ED visit. We performed semi-structured interviews using an idiographic approach and performed inductive content analysis. Participants' median age was 44 years (min 20, max 79), 13 were female, and 6 had previously received acupuncture. Most participants reported joining the study for pain relief. Additional facilitators to participation included the convenience of receiving acupuncture while in the ED, reduced wait times for treatment in the ED, the curiosity of being a clinical study participant, and hoping to contribute to knowledge generation that may improve future clinical care. Another important factor was the favorable interactions with acupuncturists and study personnel, who were described as compassionate, knowledgeable, and explained things well. While most participants found the ED environment acceptable as a setting to receive acupuncture, others commented that the noise and frequent disruptions negatively impacted their experience. Study procedure updates improved these issues. Participant feedback yields important perspectives that can improve patient study engagement and experience. This project is included as part of the Duke School of Medicine Opioid Collaboratory which is administered through the Duke Department of Population Health Sciences and supported by grant funding from the Duke Endowment. The Collaboratory's mission is to save lives and reduce the harmful impact of opioids in North Carolina through the development, implementation, and/or evaluation of system-level interventions.

Objectives/HypothesisThere is currently no single histological or genotypic marker that reliably predicts the biological behavior of head and neck squamous cell carcinoma (HNSCC). While multiple genetic mutations have been investigated, no single genotypic alteration has consistently correlated with tumor aggressiveness. Phenotypic markers may prove more predictive, because they can represent many different genetic alterations. We investigated the frequency of centrosome hyperamplification in HNSCC and examined its usefulness as a marker for tumor recurrence.

Several letters to the editor are presented in response to articles in previous issues including "The War on Drugstores" in the May/June 1997 issue, "Timeless Paris" in the July/August 1997 issue, and "Son Shines on Chicago Landmarks" in the May/June 1997.

Glanzmann Thrombasthenia is a rare bleeding disorder causing life-threatening bleeding at menarche in the adolescent female. Bleeding often necessitates admission and multiple blood transfusions. Due to the rarity of the disease, management of acute bleeding in new-onset menarche poses a particular challenge. A 12-year-old menarchial female had persistent vaginal bleeding despite multiple treatment modalities including aminocaproic acid, recombinant factor VIIa, intravenous estrogen, and gonadotropin receptor hormone agonists. Although the standard treatment of bleeding in patients with GT is primarily rFVIIa, new-onset menstrual bleeding in conjunction with an immature hypothalamic-pituitary-ovarian axis often requires expanding treatment to include multiple drug modalities. In our case, a two-step approach was necessary. The first is targeting the cessation of the first menses. The second is optimizing ongoing management of long-term control of heavy menstrual bleeding to achieve amenorrhea, prevent further hospital admissions, and avoid recurrent transfusions.

Describes how the author undertook the project of documenting the lives of women who served as United States ambassadors between 1933 and 1983, which resulted in the publication of the book `Her Excellency: An Oral History of American Women Ambassadors.' Interviews; Shift in emphasis; Finance.