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Background Incorporation of patient religious and spiritual beliefs in medical care has been shown to improve the efficacy of medical interventions and health outcomes. While previous study has highlighted differences in patient desire for spiritual assessment based on patient religiosity, little is known about patient desire for spiritual assessment based on community type, particularly in urban compared to rural communities. We hypothesized that, given demographic trends which show a higher degree of religiosity in rural areas, patients in rural communities will be more likely to desire spiritual assessment. Methods In this cross-sectional study of 141 adult primary care patients in rural and urban Colorado at non-religiously affiliated clinics, we surveyed patient demographic information, measures of religiosity, patient desire for spiritual assessment, and frequency of spiritual assessment in practice. Univariate logistic regression analyses were used to compare the two populations. Results In both Denver County (urban) and Lincoln County (rural) over 90% of patients identified as religious, spiritual, or a combination of the two. Thirty eight percent (38.3%) of patients in Denver County and 49.1% of patients in Lincoln desired spiritual assessment. Over 97% of patients in both areas reported rarely or never being asked about their R/S within the past year. For patients who have had five or more clinic visits in the past year, more than 91% in both areas stated they have never or rarely been asked about their beliefs. Conclusions While the majority of patients in this study identify as religious or spiritual and many patients desire spiritual assessment, the majority of patients have never or rarely been asked about their spirituality within the past year. This demonstrates a significant gap between patient preference and provider practice of spiritual assessment in the primary care setting, which was similar in both rural and urban settings. This highlights the need for interdisciplinary focus on spiritual assessment and incorporation of patient R/S beliefs in medical care to provide holistic patient care and improve health outcomes.

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This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/jgs.17069 Luisa, the daughter of an 80-year-old patient in your clinic, calls to ask if you, as his doctor can help her obtain the COVID-19 vaccine for him. Her family has been praying for months for him to receive a vaccine. She tells you her father recently received an email from his health system that included the words "COVID-19," but he could not understand the rest due to his limited English proficiency (LEP). Some of his friends have called the health system to obtain information about scheduling their vaccination appointments, but he is too scared to make the call in English. Luisa, who cares for her children and father while also working full-time since her husband was laid off because of the pandemic, was recently able to log in to the health system patient portal. Her father's link to schedule a COVID-19 vaccination appointment had expired, so she is turning to you for help. The impact of the COVID-19 pandemicover 24 million cases and 400,00 deaths in the United States as of mid-January 2021 1does not affect all groups equally. There are large socioeconomic disparities in outcomes for persons in racial/ethnic minority groups, including Hispanic, African American, and American Indian communities. 2,3,4 Further, older adults face far worse outcomes related to COVID-19, with over 80% of COVID-19 deaths in the United States attributed to patients age 65 or older. 5 One particular population that requires special attention is older adults with Limited English Proficiency (LEP), who often experience the intersections of geriatric syndromes, racial or ethnic minority background, lower socioeconomic status, multiple chronic conditions, need for family caregiver involvement, and cultural, neighborhood, or legal influences that affect access to healthcare. As of 2019, approximately 8.2% of the total United States population and 8.7% of the population age 65 or older have LEP, defined as individuals who identify as speaking English less than "very well." 6 Importantly, persons with LEP have lower rates of health literacy and

Synovial sarcoma is a soft tissue sarcoma accounting for approximately 1,000 cases per year in the United States. Currently, standard treatment of advanced and metastatic synovial sarcoma is anthracycline-based chemotherapy. While advanced synovial sarcoma is more responsive to chemotherapy compared to other soft tissue sarcomas, survival rates are poor, with a median survival time of less than 18 months. Enhanced understanding of tumor antigen expression and molecular mechanisms behind synovial sarcoma provide potential targets for treatment. Adoptive Cell Transfer using engineered T-cell receptors is in clinical trials for treatment of synovial sarcoma, specifically targeting New York esophageal squamous cell carcinoma-1 (NY-ESO-1), preferentially expressed antigen in melanoma (PRAME), and melanoma antigen-A4 (MAGE-A4). In this review, we explore the opportunities and challenges of these treatments. We also describe artificial adjuvant vector cells (aAVCs) and BRD9 inhibitors, two additional potential targets for treatment of advanced synovial sarcoma. This review demonstrates the progress that has been made in treatment of synovial sarcoma and highlights the future study and qualification needed to implement these technologies as standard of care.