Film Review: The Business of America

[Excerpt] In the Business of America, the filmakers-at California Newsreel have once again demonstrated their ability to produce lively and substantive documentary on economic issues. In the late 1970s, they produced Controlling Interest, perhaps the most incisive film analysis of multinational corporations ever made. The Business of America turns out to be a worthy sequel

Towards Addressing the Misalignment of Object Proposal Evaluation for Vision-Language Tasks via Semantic Grounding

Object proposal generation serves as a standard pre-processing step in Vision-Language (VL) tasks (image captioning, visual question answering, etc.). The performance of object proposals generated for VL tasks is currently evaluated across all available annotations, a protocol that we show is misaligned - higher scores do not necessarily correspond to improved performance on downstream VL tasks. Our work serves as a study of this phenomenon and explores the effectiveness of semantic grounding to mitigate its effects. To this end, we propose evaluating object proposals against only a subset of available annotations, selected by thresholding an annotation importance score. Importance of object annotations to VL tasks is quantified by extracting relevant semantic information from text describing the image. We show that our method is consistent and demonstrates greatly improved alignment with annotations selected by image captioning metrics and human annotation when compared against existing techniques. Lastly, we compare current detectors used in the Scene Graph Generation (SGG) benchmark as a use case, which serves as an example of when traditional object proposal evaluation techniques are misaligned.Comment: Accepted to WACV 2024 (Round 1

Risk-Utility Analysis in the Failure to Warn Context

Elsewhere in this Symposium issue, Professor Mark Geistfeld presents an argument favoring the application of risk-utility analysis to the duty to warn doctrine encompassed by the Restatement (Third) of Torts. In addition, the comments and the reporters\u27 notes to the Restatement (Third) suggest altering the traditional duty to warn if the warning would cause information overload, if the danger is open and obvious, or if the danger applies to only a small percentage of potential customers. In response to Geistfeld and the Restatement (Third) comments and notes, Rheingold and Feinglass assert that applying a risk-utility analysis or altering the duty to warn in certain cases undermines the doctrine and does not reflect the application of the doctrine by the courts. Instead, Rheingold and Feinglass argue that the traditional duty to warn doctrine should remain the focus of the Restatement (Third). The authors point to the text of the Restatement (Third); the potential difficulties in determining the utility of a warning or the social cost of information overload ; the minimal cost of providing a warning even in marginal cases; and the competency of juries to apply the traditional doctrine

Are we providing patient-centered care? Preferences about paracentesis and thoracentesis procedures

Procedures performed at the bedside are as safe and less expensive than Interventional Radiology (IR) procedures. Patient preferences regarding location are rarely taken into account. Therefore, in this study we compared patient satisfaction with bedside and IR paracentesis and thoracentesis procedures, and identified reasons for patient location preferences. We performed a cross-sectional survey of medical inpatients undergoing paracentesis or thoracentesis procedures at a tertiary care academic medical center. The survey had eight domains: overall experience, pain control, expertise, courtesy, bedside manner of the physician, time required, explanation of risks/benefits, comfort and privacy. Patients were also asked about their preference for procedure location. Two hundred and twenty surveys (162 paracentesis and 58 thoracentesis) were completed on 152 patients. Patient satisfaction was similar for bedside and IR procedures across all domains. A location preference was expressed in 151 surveys (68.6%). Thirty-five of 108 responses (32.4%) from patients with a paracentesis expressed a preference for bedside procedures while 73/108 (67.6%) responses expressed a preference for IR. Twenty-eight of 43 responses (65.1%) from patients with a thoracentesis expressed a preference for bedside procedures while 15/43 (34.9%) responses expressed a preference for IR. Comfort was listed as the most common reason for preferring the bedside while specialized equipment and safety were the most common reasons for preferring IR. Patients are equally and highly satisfied with bedside and IR paracentesis and thoracentesis procedures. Because both approaches are safe and effective, clinicians should pursue informed discussions with patients when a choice is available

Association of Childhood Psychosocial Environment With 30-Year Cardiovascular Disease Incidence and Mortality in Middle Age

Background Childhood adversity and trauma have been shown to be associated with poorer cardiovascular disease (CVD) outcomes in adulthood. However, longitudinal studies of this association are rare. Methods and Results Our study used the CARDIA (Coronary Artery Risk Development in Young Adults) Study, a longitudinal cohort that has followed participants from recruitment in 1985-1986 through 2018, to determine how childhood psychosocial environment relates to CVD incidence and all-cause mortality in middle age. Participants (n=3646) completed the Childhood Family Environment (CFE) questionnaire at the year 15 (2000-2001) CARDIA examination and were grouped by high, moderate, or low relative CFE adversity scores. We used sequential multivariable regression models to estimate hazard ratios of incident (CVD) and all-cause mortality. Participants were 25.1+/-3.6 years old, 47% black, and 56% female at baseline and 198 participants developed CVD (17.9 per 10 000 person-years) during follow-up. CVD incidence was \u3e 50% higher for those in the high CFE adversity group compared with those in the low CFE adversity group. In fully adjusted models, CVD hazard ratios (95% CI) for participants who reported high and moderate CFE adversity versus those reporting low CFE adversity were 1.40 (0.98-2.11) and 1.25 (0.89-1.75), respectively. The adjusted hazard ratios for all-cause mortality was 1.68 (1.17-2.41) for those with high CFE adversity scores and 1.55 (1.11-2.17) for those with moderate CFE adversity scores. Conclusions Adverse CFE was associated with CVD incidence and all-cause mortality later in life, even after controlling for CVD risk factors in young adulthood

‘We all have the same right to have health services’: a case study of Namati’s legal empowerment program in Mozambique

Background Legal empowerment and social accountability are two strategies that are increasingly used to address gaps in healthcare in low- and middle-income countries, including failure to provide services that should be available and poor clinical and interpersonal quality of care. This paper is an explanatory case study of a legal empowerment effort that employs community paralegals and trains Village Health Committees (VHCs) in Mozambique. The research objective was to explore how community paralegals solved cases, the impact paralegals had on health services, and how their work affected the relationship between the community and the health sector at the local level. Methods The case study had two components: (1) a retrospective review of 24 cases of patient/community grievances about the health system, and (2) qualitative investigation of the program and program context. The case reviews were accomplished by conducting structured in-depth interviews (IDIs) with those directly involved in the case. The qualitative investigation entailed semi-structured Key Informant Interviews (KIIs) with district, provincial, and national health managers and Namati staff. In addition, focus group discussions (FGDs) were held with Health Advocates and VHC members. Results Case resolution conferred a sense of empowerment to clients, brought immediate, concrete improvements in health service quality at the health facilities concerned, and seemingly instigated a virtuous circle of rights-claiming. The program also engendered incipient improvements in relations between clients and the health system. We identified three key mechanisms underlying case resolution, including: bolstered administrative capacity within the health sector, reduced transaction and political costs for health providers, and provider fear of administrative sanction. Conclusions This study contributes to the limited literature regarding the mechanisms of legal empowerment case resolution in health systems and the impact of hybrid legal empowerment and social accountability approaches. Future research might assess the sustainability of case resolution; how governance at central, provincial, and district level is affected by similar programs; and to what extent the mix of different cases addressed by legal empowerment influences the success of the program

Patterns of analgesic use, pain and self-efficacy: a cross-sectional study of patients attending a hospital rheumatology clinic

Background: Many people attending rheumatology clinics use analgesics and non-steroidal anti-inflammatories for persistent musculoskeletal pain. Guidelines for pain management recommend regular and pre-emptive use of analgesics to reduce the impact of pain. Clinical experience indicates that analgesics are often not used in this way. Studies exploring use of analgesics in arthritis have historically measured adherence to such medication. Here we examine patterns of analgesic use and their relationships to pain, self-efficacy and demographic factors. Methods: Consecutive patients were approached in a hospital rheumatology out-patient clinic. Pattern of analgesic use was assessed by response to statements such as 'I always take my tablets every day.' Pain and self-efficacy (SE) were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Arthritis Self-Efficacy Scale (ASES). Influence of factors on pain level and regularity of analgesic use were investigated using linear regression. Differences in pain between those agreeing and disagreeing with statements regarding analgesic use were assessed using t-tests. Results: 218 patients (85% of attendees) completed the study. Six (2.8%) patients reported no current pain, 26 (12.3%) slight, 100 (47.4%) moderate, 62 (29.4%) severe and 17 (8.1%) extreme pain. In multiple linear regression self efficacy and regularity of analgesic use were significant (p < 0.01) with lower self efficacy and more regular use of analgesics associated with more pain. Low SE was associated with greater pain: 40 (41.7%) people with low SE reported severe pain versus 22 (18.3%) people with high SE, p < 0.001. Patients in greater pain were significantly more likely to take analgesics regularly; 13 (77%) of those in extreme pain reported always taking their analgesics every day, versus 9 (35%) in slight pain. Many patients, including 46% of those in severe pain, adjusted analgesic use to current pain level. In simple linear regression, pain was the only variable significantly associated with regularity of analgesic use: higher levels of pain corresponded to more regular analgesic use (p = 0.003). Conclusion: Our study confirms that there is a strong inverse relationship between self-efficacy and pain severity. Analgesics are often used irregularly by people with arthritis, including some reporting severe pain

Legal Empowerment and Social Accountability: Complementary Strategies Toward Rights-based Development in Health?

Citizen-based accountability strategies to improve the lives of the poor and marginalized groups are increasingly being used in efforts to improve basic public services. The latest thinking suggests that broader, multi-pronged, multi-level, strategic approaches that may overcome the limitations of narrow, localized successes, hold more promise. This paper examines the challenges and opportunities, in theory and practice, posed by the integration of two such citizen-based accountability strategies—social accountability and legal empowerment. It traces the foundations of each of these approaches to highlight the potential benefits of integration. Consequently it examines whether these benefits have been realized in practice, by drawing upon five cases of organizations pursuing integration of social accountability and legal empowerment for health accountability in Macedonia, Guatemala, Uganda, and India. The cases highlight that while integration offers some promise in advancing the cause of social change, it also poses challenges for organizations in terms of strategies they pursue