In the United States, we need to push the envelope in our attempts to understand new developments in primary care delivery and its relationship to the overall healthcare system. While we typically consider ourselves a developed country, as we all know, there are wide sections of the United States that are developing; the current economic crisis is only increasing this trend. This same disparity also occurs in other parts of the world. Countries throughout the Americas have many of the same disparities, and experts in ambulatory care management from these regions are piloting new approaches to many of the same challenges we face. This issue of the journal under the expert guidance of Professor James Macinko, PhD, highlights some of the innovations currently underway and in a testing phase. Similar to other efforts we have undertaken to understand developments in other parts of the world, I am certain that these articles will be of interest to all ambulatory care practitioners. I am also hopeful that this issue will continue to stimulate submissions to the journal not only from the United States but, as has already occurred, from other parts of the world also.

We continue with our special features From the Republic of Texas and our regular Ambulatory Care Challenge column, this month focused on "You're Starting an IV and The Catheter Breaks off in the Vein".

Norbert Goldfield, MD

Editor