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Background: The COVID-19 pandemic raised novel challenges in communicating reliable, continually changing health information to a broad and sometimes skeptical public, particularly around COVID-19 vaccines, which, despite being comprehensively studied, were the subject of viral misinformation. Chatbots are a promising technology to reach and engage populations during the pandemic. To inform and communicate effectively with users, chatbots must be highly usable and credible. Objective: We sought to understand how young adults and health workers in the United States assessed the usability and credibility of a web-based chatbot called Vira, created by the Johns Hopkins Bloomberg School of Public Health and IBM Research using natural language processing technology. Using a mixed method approach, we sought to rapidly improve Vira's user experience to support vaccine decision-making during the peak of the COVID-19 pandemic. Methods: We recruited racially and ethnically diverse young people and health workers, with both groups from urban areas of the United States. We used the validated Chatbot Usability Questionnaire to understand the tool's navigation, precision, and persona. We also conducted 11 interviews with health workers and young people to understand the user experience, whether they perceived the chatbot as confidential and trustworthy, and how they would use the chatbot. We coded and categorized emerging themes to understand the determining factors for participants' assessment of chatbot usability and credibility. Results: In all, 58 participants completed a web-based usability questionnaire and 11 completed in-depth interviews. Most questionnaire respondents said the chatbot was "easy to navigate" (51/58, 88%) and "very easy to use" (50/58, 86%), and many (45/58, 78%) said its responses were relevant. The mean Chatbot Usability Questionnaire score was 70.2 (SD 12.1) and scores ranged from 40.6 to 95.3. Interview participants felt the chatbot achieved high usability due to its strong functionality, performance, and perceived confidentiality and that the chatbot could attain high credibility with a redesign of its cartoonish visual persona. Young people said they would use the chatbot to discuss vaccination with hesitant friends or family members, whereas health workers used or anticipated using the chatbot to support community outreach, save time, and stay up to date. Conclusions: This formative study conducted during the pandemic's peak provided user feedback for an iterative redesign of Vira. Using a mixed method approach provided multidimensional feedback, identifying how the chatbot worked well--being easy to use, answering questions appropriately, and using credible branding--while offering tangible steps to improve the product's visual design. Future studies should evaluate how chatbots support personal health decision-making, particularly in the context of a public health emergency, and whether such outreach tools can reduce staff burnout. Randomized studies should also be conducted to measure how chatbots countering health misinformation affect user knowledge, attitudes, and behavior. [ABSTRACT FROM AUTHOR]

Introduction: The cumulative burden of coronavirus disease 2019 (COVID-19) on the United States’ healthcare system is substantial. To help mitigate this burden, novel solutions including telehealth and dedicated screening facilities have been used. However, there is limited data on the efficacy of such models and none assessing patient comfort levels with these changes in healthcare delivery. The aim of our study was to evaluate patients’ perceptions of a drive-through medical treatment system in the setting of the COVID-19 pandemic. Method: Patients presenting to a drive-through COVID-19 medical treatment facility were surveyed about their experience following their visit. An anonymous questionnaire consisting of five questions, using a five-point Likert scale was distributed via electronic tablet. Results: We obtained 827 responses over two months. Three quarters of respondents believed care received was similar to that in a traditional emergency department (ED). Overall positive impression of the drive-through was 86.6%, and 95% believed that it was more convenient. Conclusion: Overall, the drive-through medical system was perceived as more convenient than the ED and was viewed as a positive experience. While representing a dramatic change in the delivery model of medical care, if such systems can provide comparable levels of care, they may be a viable option for sustained and surge healthcare delivery. [ABSTRACT FROM AUTHOR]

Although economic mobility is an objectively defined term, lay beliefs about mobility—the configuration of ideas and attitudes about economic mobilitythat isnot necessarily grounded in economic data—are often formed in a subjective manner. Drawing on research from the United States and beyond, we propose a novel framework for understanding how people construe, think about, and understand economic mobility. We highlight the importance of systematically examining the type, time frame, trajectory, and target of mobility that people have in mind for understanding when they most and least strongly believe in it. In addition, our framework offers a conceptual roadmap for examining the factors that influence lay beliefs about mobility, including individual differences in these lay beliefs and their important downstream consequences. Finally, we outline several important open questions that are highlighted by our framework as a guide for future research on lay beliefs about economic mobility. [ABSTRACT FROM AUTHOR]

Through an analysis of the FDA's approval of the controversial anti-influenza drug Relenza (zanamivir), we interrogate distinct social scientific theories of pharmaceutical regulation. We investigate why, despite internal negative opinions and an Advisory Committee's non-approval recommendation, the FDA approved Relenza in the late 1990s. Based on a close reading of FDA documents, we show how agency officials guided the manufacturer's analyses and participated in constructing a tenuous argument for approval. We show how regulators may strategically design drug labels that can justify their permissive regulation. We consider the explanatory power of official accounts and alternative, partially overlapping, theories of pharmaceutical regulation in the Relenza case, and develop new insights into the institutional dynamics of regulator-industry relations. We find little or no evidence that the FDA was primarily driven by public health concerns, pressure from disease-based patient activism, or a consumerist and neoliberal regulatory logic, although some of these explanations provided managers with convenient rhetoric to rationalize their actions. Rather, we argue that the Relenza case highlights contradictions between a scientific culture at FDA, conducive to rigorous product evaluations, and the agency's attempts to accommodate higher-level political (i.e. Congress) and industry demands conducive of permissive regulation – consistent with some aspects of reputational and capture theories, as well as with corporate bias theory. [ABSTRACT FROM AUTHOR]

Background: Fluoroscopy use during ERCP exposes patients and providers to deleterious effects of radiation. Formal training in fluoroscopy/radiation protection is not widely emphasized during therapeutic endoscopy training, and radiation use during GI endoscopy has not previously been characterized in the USA. In this study, we evaluated radiation training, fluoroscopy use patterns, and radiation protection practices among US therapeutic endoscopists.Methods: An anonymous electronic survey was distributed to US therapeutic endoscopists, and responses were analyzed using descriptive statistics. State-specific requirements for fluoroscopy utilization were determined from state radiologic health branches.Results: A total of 159 endoscopists (response rate 67.8%) predominantly those working in university hospitals (69.2%) with > 5 years of experience performing ERCP (74.9%) completed the questionnaire. Although the majority of endoscopists (61.6%) reported that they personally controlled fluoroscopy during ERCP, most (56.6%) had not received training on operating their fluoroscopy system. Only a minority (18-31%) of all respondents reported consistently utilizing modifiable fluoroscopy system parameters that minimize patient radiation exposure (pulsed fluoroscopy, frame rate modification or collimation). Endoscopists appear to undertake adequate personal radiation protective measures although use of a dosimeter was not consistent in half of respondents. The majority of states (56.8%) do not have any stated requirement for certification of non-radiologist physicians who intend to operate fluoroscopy.Conclusions: Most US gastroenterologists performing ERCP have not received formal training in operating their fluoroscopy system or in minimizing radiation exposure to themselves and to their patients. Such formal training should be included in all therapeutic endoscopy training programs, and fluoroscopy system-specific training should be offered at all hospitals. [ABSTRACT FROM AUTHOR]

Three concerns are inherent to the power of eminent domain -- when a government forcibly takes away private property to provide a social good: abuse of this power, unfair distribution of burdens among members of society, and inefficient implementation of the government project. To protect against these undesirable outcomes, expropriation laws in most Western jurisdictions incorporate three safeguards: due process, a public use requirement, and mandatory compensation. While jurisdictions implement these safeguards in different ways, most demand their implementation as a prerequisite for legitimate expropriation. Arguably, the purpose of allowing governments to expropriate private property is to provide for important societal needs. But this conflicts with the idea that the government ought to perfectly adhere to the three aforementioned safeguards at all times. Imperfect circumstances, such as times of crisis, likely require governments to provide for the needs of their citizens, but afford insufficient time for standard due process. Imperfect implementation of the three safeguards may also be necessary when authorities struggle with budgetary limitations that prevent full compensation, or when they are unable to meet a social need without the involvement of private entities. In all these imperfect circumstances, at least one of the safeguards might be compromised if the government is to provide required social needs through expropriation. This Article proposes a novel model to conceptualize eminent domain, which identifies an interplay among expropriation laws ' three safeguards. It further recognizes that each of these safeguards protects, to some extent, against all three of the potential dangers inherent in government's expropriation power. This innovative interplay model legitimizes compromise, such that it is appropriate for there to be only partial implementation of one safeguard as long as the other two are strictly applied. The interplay model proposed in this Article, therefore, allows the government to exercise its expropriation power properly even in imperfect circumstances, while still sufficiently protecting property owners and society from abuse of that power. [ABSTRACT FROM AUTHOR]

This paper investigates the consequences of liquidation and reorganization on the allocation and subsequent utilization of assets in bankruptcy. Using the random assignment of judges to bankruptcy cases as a natural experiment that forces some firms into liquidation, we find that the long‐run utilization of assets of liquidated firms is lower relative to assets of reorganized firms. These effects are concentrated in thin markets with few potential users and in areas with low access to finance. These findings suggest that when search frictions are large, liquidation can lead to inefficient allocation of assets in bankruptcy. [ABSTRACT FROM AUTHOR]

Many countries use tax-related whistleblowing programs, but the evidence on these programs suggests information provided by whistleblowers yields modest tax collections. However, when every citizen could become a whistleblower, deterrence from tax evasion can by itself increase tax collections. We find that tax collections significantly increased after the introduction of the whistleblowing mechanism in Israel in February 2013, although this mechanism directly yielded little or no tax collections. In support of the hypothesis that deterrence led to the increase in tax collections, we find that collections increased in industries with high tax-evasion risk, but not in industries with low tax-evasion risk. Furthermore, the increase in tax collections occurred in corporations, where the timing and magnitude of tax payments are more discretionary, but not from employees, for whom employers directly deduct taxes. Eventually, following reports that the whistleblowing mechanism is ineffective, deterrence diminished and tax collections decreased, suggesting the deterrence effect was temporary. [ABSTRACT FROM AUTHOR]

Abstract Although the rates of economic inequality in the United States are at their highest since the onset of The Great Depression, many Americans do not seem as concerned as may be expected. This apparent lack of concern has been attributed to people's deeply-entrenched belief in economic mobility – the belief that through hard work, determination, and skill people are able to rise up the economic ladder. Little is known, however, about why Americans so strongly believe in economic mobility. In five studies (N = 3112, including two pre-registered studies, one with a large, income-stratified sample), I examine the relationship between economic inequality and the belief in economic mobility. I find that people (accurately) perceive a negative relationship between economic inequality and economic mobility, and that this is due to the attributions they make about wealth and poverty. As economic inequality rises, people increasingly attribute economic success and failure to external factors that are beyond a person's control (vs. internal dispositions), and therefore expect economic mobility to drop. As a consequence, people's tendency to underestimate economic inequality reinforces their belief in economic mobility. I discuss how these findings contribute to our understanding of lay beliefs about the economic system and public opinion regarding inequality. Highlights • People strongly believe in economic mobility because they underestimate economic inequality. • High economic inequality leads people to attribute wealth/poverty relatively more to external factors than to internal factors. • Attributing wealth/poverty more to external than internal factors reduces the belief in economic mobility. • As a result, high economic inequality weakens the belief in economic mobility. [ABSTRACT FROM AUTHOR]

Intersectionality theory calls for the understanding of race/ethnicity, sex/gender and class as interlinked. Intersectional analysis can contribute to public health both through furthering understanding of power dynamics causing health disparities, and by pointing to heterogeneities within, and overlap between, social groups. The latter places the usefulness of social categories in public health under scrutiny. Drawing on McCall we relate the first approach to categorical and the second to anti-categorical intersectionality. Here, we juxtapose the categorical approach with traditional between-group risk calculations (e.g. odds ratios) and the anti-categorical approach with the statistical concept of discriminatory accuracy (DA), which is routinely used to evaluate disease markers in epidemiology. To demonstrate the salience of this distinction, we use the example of racial/ethnic identification and its value for predicting influenza vaccine uptake compared to other conceivable ways of organizing attention to social differentiation. We analyzed data on 56,434 adults who responded to the NHFS. We performed logistic regressions to estimate odds ratios and computed the area under the receiver operating characteristic curve (AU-ROC) to measure DA. Above age, the most informative variables were education and household poverty status, with race/ethnicity providing minor additional information. Our results show that the practical value of standard racial/ethnic categories for making inferences about vaccination status is questionable, because of the high degree of outcome variability within, and overlap between, categories. We argue that, reminiscent of potential tension between categorical and anti-categorical perspectives, between-group risk should be placed and understood in relationship to measures of DA, to avoid the lure of misguided individual-level interventions. [ABSTRACT FROM AUTHOR]

The article discusses findings of the United States Court of Appeals, Eighth Circuit in the case "Troy L. Freyermuth v. Credit Bureau Services" and argues that the court incorrectly interprets the protections afforded by the Fair Debt Collection Practices Act (FDCPA). It reports that the court determined that creditors could attempt to collect time-barred debt without violating the FDCPA if legal action was not threatened or taken.

Background: Relenza represents the first neuraminidase inhibitor (NI), a class of drugs that also includes the drug Tamiflu. Although heralded as breakthrough treatments in influenza, NI efficacy has remained highly controversial. A key unsettled question is why the United States Food and Drug Administration (FDA) has approved more cautious efficacy statements in labelling than European regulators for both drugs.Methods: We conducted a qualitative analysis of United States and European Union regulatory appraisals for Relenza to investigate the reasons for divergent regulatory interpretations, pertaining to Relenza's capacity to alleviate symptoms and reduce frequency of complications of influenza.Results: In Europe, Relenza was evaluated via the so-called national procedure with Sweden as the reference country. We show that FDA reviewers, unlike their European (i.e. Swedish) counterpart, (1) rejected the manufacturer's insistence on pooling efficacy data, (2) remained wary of subgroup analyses, and (3) insisted on stringent statistical analyses. These differences meant that the FDA was less likely to depart from prevailing regulatory and scientific standards in interpreting trial results. We argue that the differences are explained largely by divergent institutionalised review methodologies, i.e. the European regulator's reliance on manufacturer-compiled summaries compared to the FDA's examination of original data and documentation from trials.Conclusions: The FDA's more probing and meticulous evaluative methodology allowed its reviewers to develop 'deep' knowledge concerning the clinical and statistical facets of trials, and more informed opinions regarding suitable methods for analysing trial results. These findings challenge the current emphasis on evaluating regulatory performance mainly in terms of speed of review. We propose that persistent uncertainty and knowledge deficits regarding NIs could have been ameliorated had regulators engaged in the public debates over the drugs' efficacy and explained their contrasting methodologies and judgments. Regulators use major resources to evaluate drugs, but if regulators' assessments are not effectively disseminated and used, resources are used inefficiently. [ABSTRACT FROM AUTHOR]

Compensation for expropriation in most western jurisdictions aims to provide justice. Yet, while this quest for justice is inherent in expropriation laws, they nevertheless say little, if any, about the underlying conception of justice or how justice should be pursued. A closer examination of courts’ judgments, as well as scholarly discourse on the quest for justice in expropriations reveals a muddled dialogue in which divergent justifications pull one towards different normative and positive conclusions. Currently, expropriation doctrine purports to incorporate a sense of fair dealings with those who become victim to legal devices such as eminent domain. However, based on current case law, the reality of expropriation laws fails to reflect any true practice of justice.This Article suggests a conceptual change in expropriation laws’ remedial scheme by embracing restorative justice as the underlying concept of what constitutes justice in expropriation law. By establishing expropriation law on a restorative conception of justice, a coherent framework will emerge that is circumstances attentive and will provide practical instruments to overcome some of current law’s most significant challenges. This opens a new venue for both expropriation law and restorative justice. Equally important, the Article provides a novel opportunity to consider restorative justice beyond the borders of criminal law. [ABSTRACT FROM PUBLISHER]

This article employs an Afrocentric perspective as an alternative theoretical lens to provide an overview of the national security challenges facing the United States of America (US) within the context of its engagement in Africa. It also demonstrates the reactions of the US to African security threats (real or imagined) to its national wellbeing. At the centre of the discussion in this article is the articulation of the main issues about the US national security strategy in relation to Africa. The objective is to unravel the myth that Africa is a threat to US national security and the reality about its dismissed importance to the US within the context of the current global discourse on security. In order to provide a wider context for understanding the security dimension of US foreign policy towards Africa and to foster epistemic justice, the viewpoints of Africans and others whose fate is tied to this continent were obtained. This article relies heavily on a critical analysis of the discourse on security in the broadest sense of the term. [ABSTRACT FROM AUTHOR]

ABSTRACT We show that venture capitalists' (VCs) on-site involvement with their portfolio companies leads to an increase in both innovation and the likelihood of a successful exit. We rule out selection effects by exploiting an exogenous source of variation in VC involvement: the introduction of new airline routes that reduce VCs' travel times to their existing portfolio companies. We confirm the importance of this channel by conducting a large-scale survey of VCs, of whom almost 90% indicate that direct flights increase their interaction with their portfolio companies and management, and help them better understand companies' activities. [ABSTRACT FROM AUTHOR]

The article focuses on the laws governing the same-sex marriages in the U.S. focusing on Obergefell v. Hodges court case. Topics discussed include analysis of Obergefell case in which the court held that the fundamental right to marry is guaranteed to same-sex couples by Due Process Clause and Equal Protection Clause of the Fourteenth Amendment to the U.S. Constitution; tension between the liberal state and illiberal communities; and Bob Jones University v. United States court case on same.

Background: European Union law prohibits companies from marketing drugs off-label. In the United Kingdom--as in some other European countries, but unlike the United States--industry self-regulatory bodies are tasked with supervising compliance with marketing rules. The objectives of this study were to (1) characterize off-label promotion rulings in the UK compared to the whistleblower-initiated cases in the US and (2) shed light on the UK self-regulatory mechanism for detecting, deterring, and sanctioning off-label promotion.Methods and Findings: We conducted structured reviews of rulings by the UK self-regulatory authority, the Prescription Medicines Code of Practice Authority (PMCPA), between 2003 and 2012. There were 74 off-label promotion rulings involving 43 companies and 65 drugs. Nineteen companies were ruled in breach more than once, and ten companies were ruled in breach three or more times over the 10-y period. Drawing on a typology previously developed to analyse US whistleblower complaints, we coded and analysed the apparent strategic goals of each off-label marketing scheme and the practices consistent with those alleged goals. 50% of rulings cited efforts to expand drug use to unapproved indications, and 39% and 38% cited efforts to expand beyond approved disease entities and dosing strategies, respectively. The most frequently described promotional tactic was attempts to influence prescribers (n = 72, 97%), using print material (70/72, 97%), for example, advertisements (21/70, 30%). Although rulings cited prescribers as the prime target of off-label promotion, competing companies lodged the majority of complaints (prescriber: n = 16, 22%, versus companies: n = 42, 57%). Unlike US whistleblower complaints, few UK rulings described practices targeting consumers (n = 3, 4%), payers (n = 2, 3%), or company staff (n = 2, 3%). Eight UK rulings (11%) pertaining to six drugs described promotion of the same drug for the same off-label use as was alleged by whistleblowers in the US. However, while the UK cases typically related to only one or a few claims made in printed material, several complaints in the US alleged multifaceted and covert marketing activities. Because this study is limited to PMCPA rulings and whistleblower-initiated federal cases, it may offer a partial view of exposed off-label marketing.Conclusion: The UK self-regulatory system for exposing marketing violations relies largely on complaints from company outsiders, which may explain why most off-label promotion rulings relate to plainly visible promotional activities such as advertising. This contrasts with the US, where Department of Justice investigations and whistleblower testimony have alleged complex off-label marketing campaigns that remain concealed to company outsiders. UK authorities should consider introducing increased incentives and protections for whistleblowers combined with US-style governmental investigations and meaningful sanctions. UK prescribers should be attentive to, and increasingly report, off-label promotion. [ABSTRACT FROM AUTHOR]

A core tenet of the American ethos is that there is considerable economic mobility. Americans seem willing to accept vast financial inequalities as long as they believe that everyone has the opportunity to succeed. We examined whether people’s beliefs about the amount of economic mobility in the contemporary United States conform to reality. We found that (a) people believe there is more upward mobility than downward mobility; (b) people overestimate the amount of upward mobility and underestimate the amount of downward mobility; (c) poorer individuals believe there is more mobility than richer individuals; and (d) political affiliation influences perceptions of economic mobility, with conservatives believing that the economic system is more dynamic—with more people moving both up and down the income distribution—than liberals do. We discuss how these findings can shed light on the intensity and nature of political debate in the United States on economic inequality and opportunity. [ABSTRACT FROM AUTHOR]

This Article argues that individuals who live in highly cooperative common interest communities should, in certain instances, be entitled to additional compensation or other remedies when their property is taken through eminent domain. The exclusive takings remedy of monetary compensation equal to the fair market value of the property cannot always account for loss of communality. This Article offers guidelines for allocation of additional remedies (monetary and in-kind) that recognize such loss. This proposal is grounded in a pluralistic conception of property, which holds that the state should support individuals' use of property as a social instrument to fulfill diverse values and beliefs. To that end, the state should balance several factors to determine whether a member of a community, or a community as a whole, should be entitled to remedies for communal loss: (1) the size and scope of the taking with in the comm unity ; (2) the role, if any, of the community's cooperation in its members ' realization of a shared conception of the good; (3) the community's social legitimacy as determined primarily by its structural openness, that is, its members ' ability to simultaneously belong to other communities; and (4) the community's ability to self-rehabilitate as determined by its political and economic strength. The state should also consider these factors in determining which of several types of remedies for communality loss would be most appropriate. [ABSTRACT FROM AUTHOR]

Monoamine theories associate depression with reduced brain monoamine levels. These theories achieved broad popularity in the mid-1960s. The present article reviews the historical development of monoamine theories and their subsequent impact on biomedical research. Alleged divisions between West European and US researchers over competing versions of the theories are investigated using bibliometrics. Subsequently, the application of monoamine theories in the NIMH Collaborative Program on the Psychobiology of Depression is covered. The article argues that the impact of monoamine theories is best explained by the ability of researchers, governmental agencies, and pharmaceutical companies to invoke theories that advance various projects and agendas. [ABSTRACT FROM PUBLISHER]

The article looks at the experiences of Jewish immigrants from France in the U.S. south in the context of larger Jewish migration patterns in France, America, and Germany. According to the author, factors in settlement patterns among French Jews in America included economic opportunity and chain migration. It is suggested that French Jews became to some extent integrated into the U.S. German Jewish population as part of the process of acculturation. Particular focus is given to Jewish immigrants from the French regions of Alsace and Lorraine. Topics discussed include identity, houses of worship, and Americanization.

The article examines the ways in which three common law countries--the United Kingdom, the United States, and Israel--have introduced new rules for the revocation of citizenship that diverge from the traditional common law model. The main thrust of the article is to demonstrate how these new regulations are based on three distinct models of citizenship: citizenship as security, citizenship as a social contract, and citizenship as an ethnonational bond. Instead of critically evaluating each model, the article offers a fourth model for revocation based on the civic notion of citizenship. This model offers a new formulation of the traditional common law duty of allegiance, of its breach, and of the revocation of citizenship as punishment. The article will conclude with the suggestion that this model may be able simultaneously to guarantee the protection of political rights and to safeguard the political community. [ABSTRACT FROM AUTHOR]

The following paper calls for a shift of views from bioethics to bio-optics, from asking what we should do, to wondering about how things appear and are. It takes as a case study the stem cell controversy and juxtaposes its regulation in Israel and in the United States. As an ethical debate, the embryonic stem cell controversy is often cast as a dispute between liberals and conservatives, scientists and religious fundamentalists. From a bio-optical point of view, however, one may notice a surprising affinity between science and the most extreme religious groups. [ABSTRACT FROM AUTHOR]

This Article discusses the continuing contraction of business reorganization under the Bankruptcy Code. It argues that it is wrong to assume that there is no need for a business reorganization law in a modern, service-oriented economy that has well-developed capital markets. The Article first analyzes and contrasts bankruptcy law in the United States under the Chandler Act of 1938, which fostered the concept of reorganization and rehabilitation of distressed business entities, and under the Bankruptcy Reform Act of 1978, which built upon lessons learned under the Chandler Act and pursuant to which bankruptcy reorganization became an appropriate and necessary vehicle to preserve and protect the values of major business organizations. The Article then traces the economic, legal, political, and ideological changes that threaten the viability of corporate rehabilitation, including the passage of the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005. Finally, this Article responds directly to anti-Chapter 11 theorists, arguing: (1) reorganization remains relevant to preserving going-concern values in today's economy, (2) Chapter 11 has significant value as a transparent, neutral, multi-party forum to address the insolvency of a business, even when a marketplace exists for the debtor's assets, and (3) the privatization of the insolvency process is both unworkable and undesirable. [ABSTRACT FROM AUTHOR]

Background: Care transitions are commonplace for ill older adults, but no studies to our knowledge have examined the occurrence of iatrogenic harm from medication changes during patient transfer. Objectives: To identify medication changes during transfer between hospital and nursing home and adverse drug events (ADEs) caused by these changes. Methods: Participants were residents of 4 nursing homes in the New York City metropolitan area admitted to 2 academic hospitals. Nursing home and hospital medical records were reviewed to identify changes in medication regimens between sites. Medications were matched and compared regarding dosage, route, and frequency of administration. Two physician investigators used structured implicit review to identify ADEs attributable to transfer-related medication changes. Results: During a total of 122 admissions, the mean numbers of medications altered during transfer from nursing home to hospital and hospital to nursing home were 3.1 and 1.4, respectively (P<.001 for comparison). Most changes in drug use were discontinuations, followed by dose changes and class substitutions. Of 71 bidirectional transfers that were reviewed by 2 physician investigators, ADEs attributable to medication changes occurred during 14 (20%). The overall risk of ADE per drug alteration (n = 320) was 4.4% (95% confidence interval, 2.5%-7.4%). Although most medication changes (8/14) implicated in causing ADEs occurred in the hospital, most ADEs (12/14) occurred in the nursing home after nursing home readmission. Conclusions: Medication changes are common during transfer between hospital and nursing home and are a cause of ADEs. Research is needed on interinstitutional patient care and systems interventions designed to prevent ADEs. [ABSTRACT FROM AUTHOR]

Analyzes the architectural history of the bimah, the spatial locus of the religious service in American synagogues. Theatricality shared by religious ritual and secular performances; Paralllelism between reconfigurations of the bimah and the modern stage.

Investigates the possible causes of residential fire deaths to children in Philadelphia, Pennsylvania from 1989 to 2000. Causes of fatal fires; Death rates among racial and ethnic groups; Logistics regression analysis of child mortality by fire.

Throughout the late nineteenth and early twentieth centuries, the American Jewish population was heavily concentrated in the large and mid-size cities of the United States. At the same time, however, tens of thousands of Jews lived in America's smaller cities and towns as well. This essay examines how some of the basic features of Jewish life in the immigrant era were manifested in America's less visible Jewish centers. It discusses the nature of East European Jewish culture in small towns, and demonstrates that factors such as kinship, residential and occupational patterns, the use of Yiddish, and local institutional frameworks all promoted more highly integrated and intensively Jewish ethnic communities than might have been expected in small-town America. The essay also examines the relationship between German Jews and East Europeans in small towns and considers various other aspects of communal dynamics. In doing so, it describes how in some places a kind of cooperation and creative compromise developed that did not emerge in larger communities, and it reveals how in other places communal divisions persisted despite environmental factors that should have promoted their moderation. Ultimately, this essay demonstrates that the communities of America's smaller cities and towns in the decades before World War II were not simply miniature versions of the communities of larger metropolitan areas, and it suggests that for those interested in the dynamics of Jewish communal life, smaller Jewish settlements can provide valuable laboratories in which to study the role of place in conditioning the American Jewish experience. [ABSTRACT FROM AUTHOR]

Recent decades have seen much interest in racial and ethnic differences in drug response. The most emblematic example is the heart drug BiDil, approved by the US Food and Drug Administration in 2005 for "self-identified blacks." Previous social science research has explored this "racialization of pharmaceutical regulation" in the USA, and discussed its implications for the "pharmaceuticalization of race" in terms of reinforcing certain taxonomic schemes and conceptualizations. Yet, little is known about the racialization of pharmaceutical regulation in the USA after BiDil, and how it compares with the situation in the EU, where political and regulatory commitment to race and ethnicity in pharmaceutical medicine is weak. We have addressed these gaps by investigating 397 product labels of all novel drugs approved in the USA (n = 213) and the EU (n = 184) between 2014 and 2018. Our analysis considered statements in labeling and the racial/ethnic categories used. Overall, it revealed that many labels report race/ethnicity demographics and subgroup analyses, but that there are important differences between the USA and the EU. Significantly more US labels specified race/ethnicity demographics, as expected given the USA's greater commitment to race and ethnicity in pharmaceutical medicine. Moreover, we found evidence that reporting of race/ethnicity demographics in EU labels was driven, in part, by statements in US labels, suggesting the spillover of US regulatory standards to the EU. Unexpectedly, significantly more EU labels reported differences in drug response, although no drug was restricted to a racial/ethnic population in a manner similar to BiDil. Our analysis also noted variability and inconsistency in the racial/ethnic taxonomy used in labels. We discuss implications for the racialization of pharmaceutical regulation and the pharmaceuticalization of race in the USA and EU. • We compare race/ethnicity labeling of hundreds of new drugs in the USA and the EU. • Many labels report race/ethnicity demographics of trials, more often in the USA. • Fewer labels report race/ethnicity differences in response, more often in the EU. • Racial/ethnic taxonomy used in labels is variable and inconsistent. • The racialization of pharmaceutical regulation differs between the USA and the EU. [ABSTRACT FROM AUTHOR]

Objectives. High density lipoprotein (HDL) cholesterol is known to be positively related to moderate alcohol consumption from studies in selected populations. This study describes the association in a representative sample of the US adult population. Methods. Stratification and multivariate regression analyses were used to examine HDL cholesterol levels and alcohol consumption. Results. Fewer women than men reported consumption of alcohol at any frequency. Similar percentages of Whites and Blacks reported alcohol consumption. Age-adjusted mean HDL cholesterol levels were higher among alcohol drinkers than among nondrinkers in all sex-race strata. Mean HDL cholesterol levels of Whites and Blacks of both sexes increases consistently with increases frequency of consumption of beer, wine, and liquor. With age, education, body mass index, smoking, and physical activity controlled for, there were higher age-adjusted HDL cholesterol levels with increasing reported quantities of alcohol consumed. Daily or weekly use of alcohol led to an increase of 5.1 mg/dL in mean HDL cholesterol level, whereas consumption 1g of alcohol led to an increase of 0.87 mg/dL. Conclusion. Even if there is a causal association between alcohol consumption and higher HDL cholesterol levels, it is suggested that efforts to reduce coronary heart disease risks concentrate on the cessation of smoking and weight control. [ABSTRACT FROM AUTHOR]

Background: Framingham Study findings suggest that total cholesterol (TC):High density lipoprotein cholesterol (HDL-C) ratio is a useful summary of the joint contribution of TC and HDL-C to coronary heart disease (CHD) risk. Information on the distribution of TC:HDL-C in the US population is limited to selected populations and the relationship of the ratio distribution and its correlates has received little attention. Method: TC/HDL-C ratios were examined in a representative sample of the United States adult population ages 20 to 74 years, between February 1976 and February 1980 during NHANES II, using stratification and multivariate regression analyses. Results: Age-adjusted mean ratios were higher in men compared with women and were higher in Whites compared with Blacks. White men had the highest TC/HDL-C mean ratios. These relationships remained after stratification by age, education, body mass index, alcohol use, cigarette smoking, and physical activity. Using multivariate analyses, the ratios were positively related to BMI, age, and smoking; and negatively related to female sex, alcohol use, being Black, and physical activity. Conclusions: Using a ratio reference point of greater than or equal to 4.5 from the Framingham study, at least an estimated 44 million persons ages 25 to 74 years in the US were found to be at higher risk of developing coronary heart disease. [ABSTRACT FROM AUTHOR]

An editorial is presented protesting the decision of the U.S. government withdrawing funding from the East Jerusalem Hospital Network (EJHN). They state the U.S. government is withdrawing up to 25 million dollars in funding from the EJHN which is comprised of six institutions and which the World Health Organization describes as the primary provider of tertiary referral care for Palestinians in the Gaza Strip and West Bank. They comment the withdrawal of support will only result in harm accruing.

A retrospective chart review of children who had rigid esophagoscopy for potential foreign body ingestion from 1998 to 2001 was conducted at Children''s Hospital of Michigan Detroit. All pediatric patients less than 11 years of age who presented with suspected foreign body ingestion in a hospital setting over a 4-year period were retrospectively studied. Patient characteristics noted included age, sex and clinical presentation. Pre-operative radiographic findings, esophagoscopy findings, clinical presentations and types of foreign bodies were recorded. A history compatible with foreign body ingestion dictates diagnostic endoscopy with or without radiographic confirmation, and an acceptable rate of performing esophagoscopy without finding a foreign body was found to be 6.2%. [Copyright &y& Elsevier]

INTRODUCTION: There has been increasing interest in artificial intelligence in gastroenterology. To reduce miss rates during colonoscopy, there has been significant exploration in computer-aided detection (CADe) devices. In this study, we evaluate the use of CADe in colonoscopy in community-based, nonacademic practices. METHODS: Between September 28, 2020, and September 24, 2021, a randomized controlled trial (AI-SEE) was performed evaluating the impact of CADe on polyp detection in 4 community-based endoscopy centers in the United States Patients were block-randomized to undergoing colonoscopy with or without CADe (EndoVigilant). Primary outcomes measured were adenomas per colonoscopy and adenomas per extraction (the percentage of polyps removed that are adenomas). Secondary end points included serrated polyps per colonoscopy; nonadenomatous, nonserrated polyps per colonoscopy; adenoma and serrated polyp detection rates; and procedural time. RESULTS: A total of 769 patients were enrolled (387 with CADe), with similar patient demographics between the 2 groups. There was no significant difference in adenomas per colonoscopy in the CADe and non-CADe groups (0.73 vs 0.67, P5 0.496). Although the use of CADe did not improve identification of serrated polyps per colonoscopy (0.08 vs 0.08, P 5 0.965), the use of CADe increased identification of nonadenomatous, nonserrated polyps per colonoscopy (0.90 vs 0.51, P < 0.0001), resulting in detection of fewer adenomas per extraction in the CADe group. The adenoma detection rate (35.9 vs 37.2%, P 5 0.774) and serrated polyp detection rate (6.5 vs 6.3%, P 5 1.000) were similar in the CADe and non-CADe groups. Mean withdrawal time was longer in the CADe group compared with the non-CADe group (11.7 vs 10.7 minutes, P 5 0.003). However, when no polyps were identified, there was similar mean withdrawal time (9.1 vs 8.8 minutes, P 5 0.288). There were no adverse events. DISCUSSION: The use of CADe did not result in a statistically significant difference in the number of adenomas detected. Additional studies are needed to better understand why some endoscopists derive substantial benefits from CADe and others do not. ClinicalTrials.gov number: NCT04555135. [ABSTRACT FROM AUTHOR]

The article examines how Rabbi Menahem Mendel Lefin utilized the U.S. statesman Benjamin Franklin's writing on ethical guidelines for self-improvement in his own works dealing with the spiritual enlightenment of Jews. Lefin believed Franklin provided a practical method for personal refinement and psychological conditioning that was not present in the work of past rabbis. Lefin's work, entitled "The Book of Spiritual Accounting," would later be republished by Rabbi Yisroel Salanter and come to influence his Mussar movement. In this way, elements of the American Enlightenment came to influence Judaism.