The impact of changing guidelines on prostate cancer screening in a population-based setting, 2000-2014

Introduction: This study evaluates the potential impact of the publication of conflicting prostate cancer (PCa) screening trial results in 2009 and changes to the US Preventive Services Task Force (USPSTF) guidelines to recommend against screening in 2012 on temporal trends in PSA testing at two participating sites in the NCI-funded Cancer Research Network. Methods: Study participants were men aged 40-80 without a history of PCa who sought care at Fallon Health (Worcester, MA) or Henry Ford Health System (Detroit, MI) between 2000-2014. We used health claims and electronic health record data to identify men who underwent PSA testing per calendar year. We also examined trends in PSA testing among high-risk men (African-American, family history of PCa). Testing rates were compared between 2000-2008, 2009-2012, and 2013-2014. Results: From a population of 279,350 eligible men, 133,038 (48%) had at least one PSA test during the study period. Mean age at PSA test was 57 years, which increased over time at both sites. Overall, PSA testing rates rose between 2000-2008 (27-32% of eligible men per year), but declined between 2009-2012 (25% of eligible men). Testing rates declined further in 2013-2014 (23% of eligible men). We observed similar rates of decline in testing for men aged 55-69 and those aged ≥70. High-risk men were less likely to be screened across all time periods, although data was limited. Conclusions: This analysis of two population-based electronic health datasets provides evidence of a recent decrease in PSA testing, following an increase in the early 2000s. Although we are unable to determine causality, it is plausible that results of recent screening trials and/or changes to the USPSTF guidelines have impacted PSA testing practices over the past 14 years

Mortality and Access to Care among Adults after State Medicaid Expansions

Background: Several states have expanded Medicaid eligibility for adults in the past decade, and the Affordable Care Act allows states to expand Medicaid dramatically in 2014. Yet the effect of such changes on adults’ health remains unclear. We examined whether Medicaid expansions were associated with changes in mortality and other health related measures.Methods:We compared three states that substantially expanded adult Medicaid eligibility since 2000 (New York, Maine, and Arizona) with neighboring states without expansions. The sample consisted of adults between the ages of 20 and 64 years who were observed 5 years before and after the expansions, from 1997 through 2007. The primary outcome was all-cause county-level mortality among 68,012 year- and countyspecific observations in the Compressed Mortality File of the Centers for Disease Control and Prevention. Secondary outcomes were rates of insurance coverage, delayed care because of costs, and self-reported health among 169,124 persons in the Current Population Survey and 192,148 persons in the Behavioral Risk Factor Surveillance System.Results Medicaid expansions were associated with a significant reduction in adjusted allcause mortality (by 19.6 deaths per 100,000 adults, for a relative reduction of 6.1%;P=0.001). Mortality reductions were greatest among older adults, nonwhites, and residents of poorer counties. Expansions increased Medicaid coverage (by 2.2 percentage points, for a relative increase of 24.7%; P=0.01), decreased rates of uninsurance (by 3.2 percentage points, for a relative reduction of 14.7%; P<0.001), decreased rates of delayed care because of costs (by 2.9 percentage points, for a relative reduction of 21.3%; P=0.002), and increased rates of self-reported healthstatus of “excellent” or “very good” (by 2.2 percentage points, for a relative increase of 3.4%; P=0.04). Conclusions State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and selfreported health

Validating a virtual human and automated feedback system for training doctor-patient communication skills

Effective communication between a clinician and their patient is critical for delivering healthcare maximizing outcomes. Unfortunately, traditional communication training approaches that use human standardized patients and expert coaches are difficult to scale. Here, we present the development and validation of a scalable, easily accessible, digital tool known as the Standardized Online Patient for Health Interaction Education (SOPHIE) for practicing and receiving feedback on doctor-patient communication skills. SOPHIE was validated by conducting an experiment with 30 participants. We found that participants who underwent SOPHIE performed significantly better than the control in overall communication, aggregate scores, empowering the patient, and showing empathy ($p < 0.05$ in all cases). One day, we hope that SOPHIE will help make communication training resources more accessible by providing a scalable option to supplement existing resources.Comment: 10 pages, 5 figures, 2 table

Sesame eliciting and safe doses in a large sesame allergic population

Background: Sesame is a significant food allergen causing severe and even fatal reactions. Given its increasing prevalence in western diet, sesame is listed as an allergenic food requiring labeling in the United States and EU. However, data on the population reaction doses to sesame are limited. Methods: All sesame oral food challenges (OFCs), performed either for diagnosis or for threshold identification before the beginning of sesame oral immunotherapy (OIT) between November 2011 and July 2021 in Shamir medical center were analyzed for reaction threshold distribution. Safe-dose challenges with 90–120 min intervals were also analyzed. Results: Two hundred and fifty patients underwent 338 positive OFCs, and additional 158 safe-dose OFCs were performed. The discrete and cumulative protein amounts estimated to elicit an objective reaction in 1% (ED01) of the entire cohort (n = 250) were 0.8 mg (range 0.3–6.3) and 0.7 mg (range 0.1–7.1), respectively, and those for 5% of the population (ED05) were 3.4 mg (range 1.2–20.6) and 4.5 mg (range 1.2–28.8), respectively. Safe-dose OFCs showed similar values of ED01 (0.8, 0.4–7.5 mg) and ED05 (3.4, 1.2–22.9 mg). While doses of ≤1 mg sesame protein elicited oral pruritus in 11.6% of the patients, no objective reaction was documented to this amount in any of the challenges, including safe-dose OFCs. Conclusions: This study provides data on sesame reaction threshold distribution in the largest population of allergic patients studied, with no right or left censored data, and with validation using a safe-dose OFC. It further supports the current methods for ED determination as appropriate for establishing safety precautions for the food industry

Brokered Graph State Quantum Computing

We describe a procedure for graph state quantum computing that is tailored to fully exploit the physics of optically active multi-level systems. Leveraging ideas from the literature on distributed computation together with the recent work on probabilistic cluster state synthesis, our model assigns to each physical system two logical qubits: the broker and the client. Groups of brokers negotiate new graph state fragments via a probabilistic optical protocol. Completed fragments are mapped from broker to clients via a simple state transition and measurement. The clients, whose role is to store the nascent graph state long term, remain entirely insulated from failures during the brokerage. We describe an implementation in terms of NV-centres in diamond, where brokers and clients are very naturally embodied as electron and nuclear spins.Comment: 5 pages, 3 figure