A Public Health Framework for Screening Mammography: Evidence-Based Versus Politically Mandated Care

This Viewpoint highlights the societal risks of politically motivated mandates relating to public health guidelines. Although the Affordable Care Act mandated insurance coverage for U.S. Preventive Services Task Force (USPSTF)-recommended preventive services, it went further for mammography screening. Instead of relying on the most recent USPSTF guidelines, Congress amended the ACA to require the Department of Health and Human Services (DHHS) to use its 2002 guidelines, which recommended screening every 1-2 years starting at age 40. The FY 2016 Consolidated Appropriations Act instructs DHHS to interpret any reference to “current” USPSTF breast cancer screening recommendations to mean those issued “before 2009” — in other words, its 2002 recommendations. Essentially, Congress is requiring health insurers to ignore modern scientific assessments, and instead use 14-year-old guidance. The ACA improved the public’s health by guaranteeing that insurers provide uniform, cost-free access to preventive services based on modern evidence of effectiveness. The public’s health is best served when women’s personal decisions about screening are informed by evidence rather than political considerations. The Congress’s paternalistic response to USPSTF mammography-screening recommendations vividly illuminate the social costs of politically mandated care. Rather than benefiting women, political interference with science can discourage shared decision-making, increase harms from screening, and sow public doubt about the value and integrity of science

Semantic bottleneck for computer vision tasks

This paper introduces a novel method for the representation of images that is semantic by nature, addressing the question of computation intelligibility in computer vision tasks. More specifically, our proposition is to introduce what we call a semantic bottleneck in the processing pipeline, which is a crossing point in which the representation of the image is entirely expressed with natural language , while retaining the efficiency of numerical representations. We show that our approach is able to generate semantic representations that give state-of-the-art results on semantic content-based image retrieval and also perform very well on image classification tasks. Intelligibility is evaluated through user centered experiments for failure detection

Multiplicity, average transverse momentum and azimuthal anisotropy in U+U collisions at sNN\sqrt{s_{NN}} = 200 GeV using AMPT model

Using a multi-phase transport (AMPT) model that includes the implementation of deformed Uranium nuclei, we have studied the centrality dependence of the charged particle multiplicity, , eccentricity (e2), triangularity (e3), their fluctuations, elliptic flow (v2) and triangular flow (v3) for different configurations of U+U collisions at midrapidity for \sqrt(s_NN)=200 GeV. The results are compared to the corresponding observations from Au+Au collisions. We find that for the U+U collisions the dNch/d\eta at midrapidity is enhanced by about 15-40% depending on the collision and model configuration chosen, compared to Au+Au collisions. The tip-to-tip collisions leads to the largest values of Nch,transverse energy (ET) and . The and its fluctuation shows a rich centrality dependence, whereas not much variations are observed for and its fluctuations. The U+U side-on-side collision configuration provides maximum values of and minimum values of eccentricity fluctuations, whereas for peripheral collisions and mid-central collisions minimum values of and maximum value of eccentricity fluctuations are observed for body-to-body configuration and the tip-to-tip configuration has minimum value of and maximum value of eccentricity fluctuations for central collisions. The calculated v2 closely correlates with the eccentricity in the model. It is smallest for the body-to-body configuration in peripheral and mid-central collisions while it is minimum for tip-to-tip configuration in central collisions. For peripheral collisions the v2 in U+U can be about 40% larger than in Au+Au whereas for central collisions it can be a factor 2 higher depending on the collision configuration. It is also observed that the v3(pT) is higher for tip-to-tip and body-to-body configurations compared to other systems for the collision centrality studied.Comment: 10 pages and 29 figures. Accepted for publication in Physical Review

A Case Report of Tragaxofusp Causing Severe Tumor Lysis Syndrome In A Patient With Blastic Plasmacytoid Dendritic Cell Neoplasm

The patient was an 83-year-old male without significant past medical hsitory who presented to his primary care physician with several days of generalized malais

The Effect of the Surgery Rotation Sequence on Surgery and Emergency Medicine NBME Scores

Purpose: Within a school, the formerly fourth year emergency medicine clerkship was added to the third year curriculum in a sequence with general surgery and surgical subspecialty clerkships. Together, a student can be placed in any permutation of the three clerkships, but a student will take the Surgery and EM NBME exam after the completion of the respective clerkship regardless of the order of clerkships. The purpose of this project was to look to see if there was a significance difference in NBME scores between four different sequences of clerkships and to see if sequence of a third year student’s clerkship affects NBME scores. Methods: The study cohort consisted of medical students graduating in 2021 (n = 125). The primary measure of interest and data collected was the sequence of three clerkships (emergency medicine, general surgery, and surgical subspecialty), Surgery NBME subject exam score, and Emergency Medicine NBME subject exam score. We reported the descriptive statistics and conducted a one-way ANOVA analysis to answer the research question. Results and Conclusions: Completion of emergency medicine, general surgery, and surgery subspecialties clerkships in the four possible sequences offered at this school had no significant difference in the means of Surgery NBME and Emergency Medicine NBME subject exam scores. The order in which students complete the three clinical clerkships were not associated with any difference in NBME subject exam scores for Surgery and Emergency Medicine. The findings may be taken into consideration for curriculum re-design at other medical schools

A Case Report of Hemophagocytic Lymphohistiocytosis Secondary to Disseminated Tuberculosis

A 72-year-old woman with past medical history of hypertention and type 2 diabsetes presented to the emergency department for one day history of fevers, poor oral intake, and fatigue

Integration of Medication Abortion into Primary Care Practice and Teaching: An Intersection of Patient Care, Reproductive Justice and Advocacy

Presentation: 50:45 Note: PowerPoint slides are located at the bottom of this page

Complication Rates in Resident Cataract Surgery After Elective Operating Room Shutdown During the COVID-19 Pandemic

Purpose: To assess the types of cataract surgeries being performed at one large eye institute from before and after the COVID-19 induced shutdown of elective surgeries in Spring 2020. Methods: This is a retrospective chart review study of operative reports from resident performed cataract surgeries from January 1st, 2020 through July 31st, 2020. Cataract surgeries were categorized into Pre-COVID (Jan – Mar 2020) if they occurred prior to operating room (OR) shutdown on March 18th, 2020 and Post COVID for all cases which occurred after the shutdown orders were lifted (May – July 2020). A resident survey was also used to gather data regarding resident case numbers and resident concern performing cataract upon re-opening of the operating room for elective surgeries. Results: A total of 480 cases (n=306 Pre-COVID and n=174 Post-COVID) were analyzed. Our study shows a higher frequency of complex cataract surgeries being boarded after the COVID-19 pandemic induced shutdown of elective surgeries in Michigan (P\u3c0.0001). However, the incidence rate of complications in resident performed cataract surgeries was not significantly higher immediately following the government induced shutdown. Complications analyzed included anterior rent or capsulorrhexis, wound burn, placement of iris dilator, posterior capsular rupture, anterior vitrectomy, and capsular ring tension. Survey results showed that phacoemulsification was the step of cataract surgery which residents were most concerned about when returning to the OR after their hiatus from operating. Conclusion: Significantly more complex cataract surgeries were performed immediately after opening of the OR, however, there was no significant increase in resident complications in performing cataract surgery

Focal Laser Photocoagulation for Diabetic Macular Edema Done by Resident Physicians: Predictors of Effective Treatment

Purpose: To evaluate the effectiveness of focal laser for the treatment of diabetic macular edema (DME) performed by ophthalmology residents. Methods: This retrospective chart review studies DME patients treated in a resident clinic with focal laser. Visual acuity (VA), OCT central subfield thickness (CST), and maximum subfield thickness (MST) at initial, 1-month, and 6-month visits were recorded. Results: For 32 reviewed patients, the average VA was 20/58 initially and 20/39 at 6 months (p=0.18). Mean CST was 311 µm initially and 305 µm at 6 months (p=0.09). Mean MST was 413 µm initially and 382 µm at 6 months (p=0.007). Factors favoring success are initial CST \u3c400 µm, treatment of localized microaneurysms, and prior focal laser treatments. Conclusion: Focal laser performed by residents was effective in decreasing MST and maintained visual acuity. Initial CST, localized microaneurysms, and repeat focal treatment predicted improved outcomes