Medicaid Coverage of Guidelines-Based Asthma Care Across 50 States, the District of Columbia, and Puerto Rico, 2021-2022.

INTRODUCTION: Asthma affects more than 25 million Americans, including 4.2 million children. The burden of asthma disproportionately affects people enrolled in Medicaid, among other disparate groups. Improved availability and accessibility of guidelines-based treatments and services may ensure positive health outcomes for people with asthma. In this article, we provide an update to the American Lung Association's Asthma Guidelines-Based Care Coverage Project (the Project) to determine the extent of asthma care coverage and associated barriers in Medicaid programs for all 50 states, the District of Columbia, and Puerto Rico, and examine improvements in coverage since 2017. METHODS: Findings from the Project, representing coverage from 2016-2017, were first published in Preventing Chronic Disease in 2018. The Project was updated in 2021 to reflect the National Asthma Education and Prevention Program guidelines 2020 Expert Panel Report-3 updates, which were finalized in December 2020. It now tracks coverage for 8 areas of guidelines-based care and 7 barriers to care in Medicaid programs by reviewing publicly available plan documents and engaging with Medicaid programs to review and confirm findings. RESULTS: Results from the Project, which reflect coverage in 2021-2022, show an increase in comprehensive coverage in Medicaid programs over the last 5 years. However, coverage remains inconsistent across programs, and barriers to accessing asthma care still exist. CONCLUSION: Although substantial improvement has been made to coverage, certain gaps and barriers to care must be addressed for patients to fully benefit from guidelines-based care to manage their asthma and improve health outcomes.

Completion lymph node dissection in patients with melanoma and positive sentinel lymph node biopsy.

Melanoma is a highly aggressive cancer that represents a significant disease burden, making diagnosis and appropriate control of disease vital for improving morbidity and mortality. The most recent guidelines for melanoma treatment advise performing a sentinel lymph node biopsy for intermediate thickness melanomas, with subsequent completion lymph node dissection (CLND) if sentinel nodes are positive. This guideline is controversial due to the limited availability of data on this topic. CLND is an extensive surgery with known risks and complications and a small survival benefit. However, in patients without significant comorbidities and at low risk for surgery, the survival benefit outweighs the procedural risk. This article reviews CLND and the current recommendations.

The congruency sequence effect emerges when the distracter precedes the target.

The congruency effect in distracter interference tasks is typically smaller when the previous trial was incongruent as compared to congruent, suggesting the operation of a control process that minimizes the influence of irrelevant stimuli on behavior. However, both the conditions under which this congruency sequence effect (CSE) can be most easily observed without the typical learning and memory confounds, and the control process underlying it, remain controversial. We therefore tested a recent hypothesis that the CSE is most easily observed without the typical confounds when the distracter is processed before the target. In line with this "distracter head start" hypothesis, in Experiments 1 and 2 the CSE was larger when the distracter appeared before, relative to with, the target. Further, in Experiment 3, we observed a negative congruency effect after incongruent trials when a long interval separated the distracter from the target, consistent with a modulation of the response engendered by the distracter but not with a shift of attention toward the target. These findings reveal an important determinant of CSE magnitude when the typical learning and memory confounds are absent and new insights into the nature of control processes that contribute to this phenomenon.