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To evaluate the prevalence of burnout and satisfaction with work-life balance in physicians and US workers in 2014 relative to 2011. From August 28, 2014, to October 6, 2014, we surveyed both US physicians and a probability-based sample of the general US population using the methods and measures used in our 2011 study. Burnout was measured using validated metrics, and satisfaction with work-life balance was assessed using standard tools. Of the 35,922 physicians who received an invitation to participate, 6880 (19.2%) completed surveys. When assessed using the Maslach Burnout Inventory, 54.4% (n=3680) of the physicians reported at least 1 symptom of burnout in 2014 compared with 45.5% (n=3310) in 2011 (P<.001). Satisfaction with work-life balance also declined in physicians between 2011 and 2014 (48.5% vs 40.9%; P<.001). Substantial differences in rates of burnout and satisfaction with work-life balance were observed by specialty. In contrast to the trends in physicians, minimal changes in burnout or satisfaction with work-life balance were observed between 2011 and 2014 in probability-based samples of working US adults, resulting in an increasing disparity in burnout and satisfaction with work-life balance in physicians relative to the general US working population. After pooled multivariate analysis adjusting for age, sex, relationship status, and hours worked per week, physicians remained at an increased risk of burnout (odds ratio, 1.97; 95% CI, 1.80-2.16; P<.001) and were less likely to be satisfied with work-life balance (odds ratio, 0.68; 95% CI, 0.62-0.75; P<.001). Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout.

This article summarizes the report of the American Medical Association’s (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and telemedicine. Through its reports and recommendations, CEJA is responsible for maintaining and updating the AMA Code of Medical Ethics (Code). CEJA reports are developed through an iterative process of deliberation with input from multiple stakeholders; report recommendations, once adopted by the AMA House of Delegates, become ethics policy of the AMA and are issued as Opinions in the Code. To provide enduring guidance for the medical profession as a whole, CEJA strives to articulate expectations for conduct that are as independent of specific technologies or models of practice as possible. The present report, developed at the request of the House of Delegates, provides broad guidance for ethical conduct relating to key issues in telehealth/telemedicine. The report and recommendations were debated at meetings of the House in June and November 2015; recommendations were adopted in June 2016 and published as Opinion E-1.2.12, Ethical Practice in Telemedicine, in November 2016. A summary of the key points of the recommendations can be found in Appendix A (online), and the full text of the opinion can be found in Appendix B (online).

Background In China, the incidence of autoimmune diseases is gradually increasing. To decrease the misdiagnosis rate of autoimmune diseases, we conducted an epidemiological investigation about the presence of antinuclear antibody (ANA) in healthy populations and analyzed the clinical characteristics of healthy population with both high titer of ANA and positive anti‐SSA and AMA‐M2. Methods Serum ANA titers were detected by indirect immunofluorescence (IIF), and other 15 types of ANA‐specific antibodies were detected by line immunoassays. Results In 25 110 individuals for routine examination, the positive rate of ANA titer >1:100 was 14.01%, of which the positive rate of female (19.05%) was higher than that of male (9.04%; P < 0.01). The positive rate of ANA titer >1:320 was 5.93%, of which the positive rate of female (8.68%) was higher than that of male (3.21%; P < 0.01). The specific antibodies were detected in 1489 of ANA‐positive people with titer >1:320, and the top three detected antibodies were anti‐Ro‐52 (212), AMA‐M2 (189), and anti‐SSA (144). The abnormal rate of blood routine test, liver function test, and other clinical indicators in AMA‐M2–positive population was significantly different from those in the control group. The abnormal rate of blood routine test, liver function test, and immune index in anti‐SSA–positive population was higher than those in control group. Conclusion There was a high prevalence of ANA positive in healthy population. To avoid misdiagnosis, those who had symptoms of abdominal discomfort, pruritus, or fatigue with abnormal results of blood routine and liver function test should be examined for ANA, AMA‐M2, anti‐SSA as early as possible.

A poem is presented.

Tongue examination has been documented in Ayurveda and other medical systems. The severity of tongue coating (TC), an indicator of Ama in Ayurveda, can be clinically assessed by the Winkel tongue coating index (WTCI) through the analysis of smartphone images. This pilot study examines the relationship between TC and disease severity, as well as TC and Ama severity, in patients with Rheumatoid Arthritis (RA), a prototype of Amavata. Consecutive outpatients suffering from RA (diagnosed as per ACR/EULAR criteria, 2010) were divided into two groups- Group A: Treatment naïve patients with active disease, and Group B: patients on treatment in remission as determined by Clinical Disease Activity Index (CDAI). The Ama-severity in these subjects was assessed by a validated Ama-instrument. A photograph of the tongue obtained by a smartphone was selected, edited, and marked into sextants for WTCI assessment. These photographs were randomized and submitted for TC analysis to five expert clinicians. Eleven images in each group could be analysed by all assessors. The clinical records of the respective patients were used for statistical analysis (GraphPad InStat Version 3.6 software). Twenty-two cases, 11 with active, untreated RA (Group A), and 11 in remission (Group B), were studied. All patients were females except one. Patients in Group A were older, less educated, and had a lower BMI than those in Group B. There was moderate inter-rater agreement (0.76 in Group A and 0.73 in Group B). There was no significant correlation between CDAI and WTCI (Spearman r = −0.08356, P = 0.7116, 95 % CI = −0.4981 - 0.3621) as well as between Ama Score and WTCI (Spearman r = - 0.1608, P = 0.4748, 95 % CI = −0.5548 - 0.2921). However, the Bonferroni correction indicated a statistically significant association between WTCI and the Ama-score. Moreover, the Friedman test revealed maximum coating in the posterior-middle area (area B, Fr = 57.728; P = < 0.0001, 95 % CI 1.645 to 1.937). Also, a moderately positive correlation between the TC score in area B and Ama-score (Spearman r = 0.4790, P = 0.0241, 95 % CI = 0.05858–0.7551) as well as between TC Score in area B and CDAI (r = 0.4393, P = 0.0408, 95 % CI = 0.008332 to 0.7327) was observed. This pilot study indicates that there is a positive association between WTCI and Ama-score in Amavata (RA). A moderately positive correlation between the severity of TC in the posterior-middle area and the severity of Ama in Amavata (RA) implies a careful examination of the posterior tongue in these patients. The inter-observer reliability was moderate during this study. Studies with a larger sample size are recommended based on observations of this study.

BackgroundHospitalized persons who inject drugs are at a greater risk of adverse hospital outcomes including discharge against medical advice, inpatient illicit drug use, overdose, and death. However, there are limited data on the frequency and outcomes of these events in the United States.MethodsThis retrospective analysis included patients with injection-related infections receiving a protocol for injection drug use (IDU) at University of Alabama at Birmingham Hospital from 2016 to 2017. In-hospital IDU was suspected or reported drug usage plus confirmatory drug screen, and documented discharges “against medical advice” were deemed patient-directed discharges (PDD). We analyzed the frequency of and associations between in-hospital IDU, PDD, 30-day readmission, and deaths (between 2016 and 2019) using McNemar’s tests. Logistic regression models evaluated the association between PDD, in-hospital IDU, readmission, and death.ResultsOverall, 83 patients met inclusion criteria: 28 (34%) with in-hospital IDU, 12 (14%) PDD, 9 (11%) died, and 12 (14%) 30-day readmission. In-hospital IDU was significantly associated with PDD (P = .003), 30-day readmission (P = .005), and death (P = .0003). Patient-directed discharges and 30-day readmission were not significantly associated with death nor with each other.ConclusionsIn a cohort of patients receiving inpatient care for injection-related infections, illicit drug use, PDD, 30-day readmissions, and death were common. Furthermore, patients who use illicit drugs while hospitalized are significantly more likely to leave early, be readmitted, and/or die. We must design models of care that prevent adverse outcomes, including drug use and PDD, to reduce barriers to evidence-based treatment of infections.In hospitalized patients with injection related infections, we found that illicit drug use, premature discharge, readmissions and death were common. Further, those who use illicit drugs while hospitalized are significantly more likely to leave early, be readmitted and die.

Purpose The technique of adjusted mechanical alignment (AMA) in total knee arthroplasty (TKA) has been described to achieve alignment and balancing goals in varus knees in a high percentage, albeit at the price of non-anatomical bone cuts. The purpose of this study was to analyze (1) whether AMA achieves similar alignment and balancing results in different types of deformity and (2) whether they can be achieved without altering the native anatomy. Methods A series of 1000 patients with hip–knee–ankle (HKA) angles from 165° to 195° were analyzed. All patients were operated using AMA technique. According to the preoperative HKA angle, three groups of knee phenotypes (varus, straight, valgus) were defined. The bone cuts were analyzed for being anatomic (< 2 mm deviation of individual joint surface) or non-anatomic (> 4 mm deviation of individual joint surface). Results AMA reached the goals for postoperative HKA in over 93% in every group (varus: 636 cases, 94%, straight: 191 cases, 98%, valgus: 123 cases, 98%). In 0° extension, the gaps were balanced in varus knees in 654 cases (96%), in straight knees in 189 cases (97%) and in valgus knees in 117 cases (94%). A balanced flexion gap was found in a similar number of cases (varus: 657 cases, 97%, straight: 191 cases, 98%, valgus: 119 cases, 95%). In the varus group, non-anatomical cuts were performed at the medial tibia (89%) and the lateral posterior femur (59%). The straight group showed similar values and distribution for non-anatomical cuts (medial tibia: 73%; lateral posterior femur 58%). Valgus knees showed a different distribution of values, being non-anatomical at the lateral tibia (74%), distal lateral femur (67%) and posterior lateral femur (43%). Conclusion In all knee phenotypes, the AMA goals were achieved in a high percentage by altering the patients’ native anatomy. In varus knees, the alignment was corrected by non-anatomical cuts at the medial tibia, and in valgus knees at the lateral tibia and the lateral distal femur. All phenotypes showed non-anatomical resections on the posterior lateral condyle in approximately 50% of cases. Level of evidence III.

Some authors have recently suggested that it is time to consider rights for robots. These suggestions are based on the claim that the question of robot rights should not depend on a standard set of conditions for ‘moral status’; but instead, the question is to be framed in a new way, by rejecting the is/ought distinction, making a relational turn, or assuming a methodological behaviourism. We try to clarify these suggestions and to show their highly problematic consequences. While we find the suggestions ultimately unmotivated, the discussion shows that our epistemic condition with respect to the moral status of others does raise problems, and that the human tendency to empathise with things that do not have moral status should be taken seriously—we suggest that it produces a “derived moral status”. Finally, it turns out that there is typically no individual in real AI that could even be said to be the bearer of moral status. Overall, there is no reason to think that robot rights are an issue now.

The automated modal analysis (AMA) technique has attracted significant interest over the last few years, because it can track variations in modal parameters and has the potential to detect structural changes. In this paper, an improved density-based spatial clustering of applications with noise (DBSCAN) is introduced to clean the abnormal poles in a stabilization diagram. Moreover, the optimal system model order is also discussed to obtain more stable poles. A numerical simulation and a full-scale experiment of an arch bridge are carried out to validate the effectiveness of the proposed algorithm. Subsequently, the continuous dynamic monitoring system of the bridge and the proposed algorithm are implemented to track the structural changes during the construction phase. Finally, the artificial neural network (ANN) is used to remove the temperature effect on modal frequencies so that a health index can be constructed under operational conditions.