Weekend Briefing from NEJM.org

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Weekend Briefing July 3, 2021

IMAGES IN CLINICAL MEDICINE An 83-year-old woman presented with swelling and discoloration of the right side of the tongue. An electrocardiogram revealed atrial fibrillation. CT angiography was performed, and a diagnosis of right lingual-artery thromboembolism was made. Read the article. VIEW MORE IMAGES »

To access the CME exam, look for the CME icon in the toolbar on the article page. ORIGINAL ARTICLE Daratumumab-Based Treatment for Immunoglobulin Light-Chain Amyloidosis REVIEW ARTICLE Cerebral Venous Thrombosis CLINICAL PROBLEM-SOLVING A Brewing Back Pain FIND MORE CME »

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PERSPECTIVE The CT Scan after 50 years — Continuity and Change J.D. Howell The CT scan was just one development in a centuries-long quest to more precisely visualize lesions in the human body, but its invention also marked a radical change. A half-century later, the CT scanner has become part of the fabric of routine medical care. Read the article.

FACEBOOK Azithromycin or Doxycycline for Asymptomatic Rectal Chlamydia trachomatis TWITTER Nasal Cauterization with Silver Nitrate for Recurrent Epistaxis INSTAGRAM Stress Incontinence in Women

ORIGINAL ARTICLE Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons T.T. Shimabukuro and Others Preliminary data from the CDC “v-safe after vaccination health checker” surveillance system, the v-safe pregnancy registry, and the Vaccine Adverse Event Reporting System did not show any obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines. More data are needed to better inform maternal, pregnancy, and infant outcomes. Read the article.

PERSPECTIVE Advancing the Learning Health System J.M. McGinnis, H.V. Fineberg, and V.J. Dzau Recognizing that technological and methodologic advances could improve on the pace, generalizability, and costs of innovation in health and medicine, the National Academy of Medicine has helped steward the evolution of a continuously learning health system. Read the article. LISTEN TO THE PODCAST »

A Randomized Trial of a Transglutaminase 2 Inhibitor for Celiac Disease Read the related article. VIEW ALL QUICK TAKES »

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Physician Jobs July 3, 2021 Family Medicine Illinois Seeking full-time physician in Lena SSM Health Lena, IL Clinic is actively recruiting a full-time (0.8-1.0FTE) Physician to join the Family Medicine department at our Lena, IL location. Opportunity Highlights: Daytime clinical hours Monday through Friday 8am-5pm, no weekends; Will work in our Freeport clinic one day a week; Outpatient based practice; Call schedule is approximately twice per month.... Family Medicine Wisconsin Family Medicine opportunity in Columbus SSM Health Dean Medical Group, a 500+ physician multispecialty group, is seeking a Family Physician to join its clinic in Columbus, Wisconsin. Additional details. The Opportunity: Traditional Inpatient and Outpatient opportunity; Obstetrics is optional; Community call for Inpatient will be 1:7 (weekdays/weekends); weekday calls vary from 0-4 admissions.… Looking for a new practice opportunity? View these jobs and other listings at NEJM CareerCenter. Search now for both permanents and locum tenens job in many specialties.

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As a valued reader of NEJM, you are receiving this Weekend Briefing because you selected to receive the NEJM Weekly Table of Contents. The Weekend Briefing is a companion to the Table of Contents. To ensure consistent delivery of NEJM emails, please add webm...@n.nejm.org to your Contacts or Address Book. Click here to unsubscribe from Weekend Briefing. If you prefer not to receive content alerts, information about updates, services, or special offers from NEJM.org, sign in to My NEJM Alerts to update your email preferences. The New England Journal of Medicine 860 Winter Street Waltham, MA 02451 USA Copyright © 2021 Massachusetts Medical Society. All rights reserved.

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Weekend Briefing July 10, 2021

IMAGES IN CLINICAL MEDICINE A 34-year-old woman presented with a rash on both cheeks that spared the nasolabial folds and with joint pain in her hands and knees. Laboratory studies showed leukopenia and positive anti-Smith and anti-RNP antibodies, and a diagnosis of systemic lupus erythematosus was made. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Randomized Trial of Fetal Surgery for Severe Left Diaphragmatic Hernia ORIGINAL ARTICLE Bimekizumab versus Adalimumab in Plaque Psoriasis REVIEW ARTICLE Hematuria in Adults FIND MORE CME »

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PERSPECTIVE Averting Future Vaccine Injustice S. Moon, A. Alonso Ruiz, and M. Vieira As high-income countries have secured much of the Covid vaccine supply, many low-income countries have barely begun the immunization process. We need political courage to end vaccine injustice now and political vision to negotiate rules for averting future inequities. Read the article. PERSPECTIVE Medical Home R. Montoya This Graphic Perspective tells the story of a 47-year-old woman receiving a follow-up Pap smear at a Planned Parenthood clinic. Aside from the protesters she encounters outside the building, her experience is no different from a visit to any other welcoming doctor. Read the article.

FACEBOOK Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines TWITTER Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile INSTAGRAM Confronting Our Next National Health Disaster — Long-Haul Covid

ORIGINAL ARTICLE Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons T.T. Shimabukuro and Others Preliminary data from the CDC “v-safe after vaccination health checker” surveillance system, the v-safe pregnancy registry, and the Vaccine Adverse Event Reporting System did not show any obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines. More data are needed to better inform maternal, pregnancy, and infant outcomes. Read the article.

PERSPECTIVE Addressing Vaccine Hesitancy in BIPOC Communities — Toward Trustworthiness, Partnership, and Reciprocity S.C. Quinn and M.P. Andrasik As Covid vaccines are rolled out, it’s time to shift the focus from a sole emphasis on changing hearts and minds among members of BIPOC communities to ensuring that institutions are trustworthy, transparent, and engaged with communities. Read the article. LISTEN TO THE PODCAST »

Fetal Surgery for Severe Left Diaphragmatic Hernia

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Physician Jobs July 10, 2021

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Weekend Briefing July 17, 2021

IMAGES IN CLINICAL MEDICINE A 16-day-old girl who had not returned to her birth weight was brought to the emergency department with lethargy. She was found to have marked hepatomegaly, and ultrasonography showed numerous rounded hypoechoic lesions in the liver. A diagnosis of infantile hepatic hemangiomas was made. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Physical Rehabilitation for Older Patients Hospitalized for Heart Failure CLINICAL PRACTICE Initial Management of Seizure in Adults CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL Case 21-2021: A 33-Year-Old Pregnant Woman with Fever, Abdominal Pain, and Headache FIND MORE CME »

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PERSPECTIVE Medical–Financial Partnerships — Beyond Traditional Boundaries L.E. Marcil, K.G. Barnett, and B. Zuckerman By directly addressing patients’ financial status, including income, assets, and financial empowerment, clinicians can promote individual and community health. This issue is particularly relevant in the midst of the economic crisis associated with the Covid-19 pandemic. Read the article. PERSPECTIVE Virchow at 200 and Lown at 100 — Physicians as Activists S. Mangione and M.L. Tykocinski The Covid-19 pandemic has forced many people to reconsider what medicine is all about. But debate over what doctoring is — and what it is not — is nothing new, and 2021 marks significant anniversaries of the births of two physicians who took a broad view of medicine. Read the article. PERSPECTIVE One Hundred Years of Insulin for Some A. Moran-Thomas In July 1921, researchers in Canada isolated the hormone insulin. This discovery profoundly changed the lives of people with diabetes. But insulin remains unaffordable and inaccessible in many parts of the world. Read the article.

FACEBOOK Effectiveness of the BNT162b2 Covid-19 Vaccine against the B.1.1.7 and B.1.351 Variants TWITTER Breakthrough SARS-CoV-2 Infections in Prison After Vaccination INSTAGRAM History of Medicine: The CT Scan after 50 years — Continuity and Change

ORIGINAL ARTICLE

Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile A. Jara and Others In a national prospective cohort study involving 10.2 million participants in Chile, the effectiveness of an inactivated SARS-CoV-2 vaccine, which had been developed in China and administered in two doses 28 days apart, was estimated. Effectiveness among fully immunized persons was estimated at 65.9% for Covid-19 and at 87.5% for hospitalization, 90.3% for ICU admission, and 86.3% for death. Read the article.

PERSPECTIVE Averting Future Vaccine Injustice

S. Moon, A. Alonso Ruiz, and M. Vieira

As high-income countries have secured much of the Covid vaccine supply, many low-income countries have barely begun the immunization process. We need political courage to end vaccine injustice now and political vision to negotiate rules for averting future inequities. Read the article.

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Decoding Speech in a Paralyzed Person with Anarthria

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Physician Jobs July 17, 2021 Gastroenterology Arizona Opportunity for a General Gastroenterology position in Phoenix We have an outstanding opportunity for a General Gastroenterology position with special interest in motility, nutrition, or women’s health to join a thriving academic GI division in an academic health science center that focuses on supporting research in clinical and scholarship endeavors with faculty appointments and rank at the University of Arizona College of Medicine – Phoenix.... Pulmonary/Critical Care Arizona Tucson openings BC/BE Pulmonary Critical Care physicians Banner University Medical Center (BUMC-T) is recruiting BC/BE Pulmonary Critical Care physicians for a mixture of inpatient coverage and evaluation of patients in the outpatient setting. The qualified physician will participate in the teaching and mentoring of residents and medical students from the COM-Tucson and will receive a faculty appointment to the University of Arizona.…

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As a valued reader of NEJM, you are receiving this Weekend Briefing because you selected to receive the NEJM Weekly Table of Contents. The Weekend Briefing is a companion to the Table of Contents. To ensure consistent delivery of NEJM emails, please add webm...@n.nejm.org to your Contacts or Address Book. Click here to unsubscribe from Weekend Briefing. If you prefer not to receive content alerts, information about updates, services, or special offers from NEJM.org, sign in to My NEJM Alerts to update your email preferences. The New England Journal of Medicine 860 Winter Street Waltham, MA 02451 USA Copyright © 2021 Massachusetts Medical Society. All rights reserved.

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NEJM Editorial Fellows

The Journal invites applications from medical professionals at any career stage for four one-year, full-time, paid editorial fellowships beginning in July 2022. The editorial fellows will work on new offerings for residents and other Journal features and will participate in the day-to-day editorial activities of the Journal. Deadline for applications is August 15, 2021. Learn more.

Weekend Briefing July 24, 2021

IMAGES IN CLINICAL MEDICINE A 68-year-old man presented with skin changes on his chest and back and with shortness of breath. Examination showed “salt-and-pepper” skin changes, and computed tomography revealed fibrotic changes in the lower lobes of both lungs. A diagnosis of systemic sclerosis was made. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction ORIGINAL ARTICLE Trial of Pimavanserin in Dementia-Related Psychosis REVIEW ARTICLE Substance Use among Men Who Have Sex with Men FIND MORE CME »

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PERSPECTIVE From Crime to Care — On the Front Lines of Decarceration N.P. Morris Many clinicians are working on the front lines of decarceration, supporting and treating patients who might once have been incarcerated. Models for decarceration involving problem-solving courts and treatment are not perfect, but they allow physicians to do their part. Read the article. PERSPECTIVE Health Care Budgets for Rural Providers — Opportunities for Payment Reform J.T. Kannarkat and E.T. Roberts Policymakers are moving forward with payment models that establish budgets for rural health care organizations. Such programs reflect an attempt to help remedy what ails rural health care: insufficient investment, high costs, and unstable and decreasing patient volume. Read the article. PERSPECTIVE A Child’s Loss D. Guyer The 11-year-old girl knew that her mother had cancer, but it fell to me to tell her that the cancer had spread to her mother’s brain. Breaking such devastating news to a patient’s young child is not normally my job, though I am no stranger to devastation. Read the article.

FACEBOOK Neuroprosthesis for Decoding Speech in a Paralyzed Person with Anarthria TWITTER Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant INSTAGRAM Hepatocellular Carcinoma — Origins and Outcomes

ORIGINAL ARTICLE

Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons

T.T. Shimabukuro and Others

Preliminary data from the CDC “v-safe after vaccination health checker” surveillance system, the v-safe pregnancy registry, and the Vaccine Adverse Event Reporting System did not show any obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines. More data are needed to better inform maternal, pregnancy, and infant outcomes. Read the article.

PERSPECTIVE Medical–Financial Partnerships — Beyond Traditional Boundaries

L.E. Marcil, K.G. Barnett, and B. Zuckerman

By directly addressing patients’ financial status, including income, assets, and financial empowerment, clinicians can promote individual and community health. This issue is particularly relevant in the midst of the economic crisis associated with the Covid-19 pandemic. Read the article.

LISTEN TO THE PODCAST »

Multivessel PCI Guided by FFR or Angiography for MI

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Physician Jobs July 24, 2021

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Weekend Briefing July 31, 2021

IMAGES IN CLINICAL MEDICINE Pain in the right armpit developed in a 26-year-old woman 2 days after a normal vaginal delivery. Examination revealed an axillary mass that was consistent with polymastia. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Duration of Adjuvant Aromatase-Inhibitor Therapy in Postmenopausal Breast Cancer REVIEW ARTICLE Depression in Adolescents INTERACTIVE MEDICAL CASE A Periodic Problem

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 23-2021: A 41-Year-Old Woman with Bloody Stools and Thrombocytopenia FIND MORE CME »

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PERSPECTIVE Keeping Our Promise — Supporting Trainees from Groups That Are Underrepresented in Medicine M.B. Vela, M.H. Chin, and M.E. Peek After a recommitment to racial equity by academic medical centers, some institutions are celebrating recruiting their most diverse intern class to date. It will be important to ensure that they are prepared to support new trainees on arrival and throughout residency. Read the article.

FACEBOOK Covid-19 Breakthrough Infections in Vaccinated Health Care Workers TWITTER Vaccine Effectiveness Studies in the Field INSTAGRAM Controversy and Progress in Alzheimer’s Disease — FDA Approval of Aducanumab

ORIGINAL ARTICLE

Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant J. Lopez Bernal and Others The B.1.617.2 (delta) Covid-19 variant has surged in India and spread worldwide. In a test-negative case–control study, the effectiveness of two doses of BNT162b2 was 94% against the B.1.1.7 (alpha) variant and 88% against delta; with the ChAdOx1 nCoV-19 vaccine, effectiveness was 74% and 67%, respectively. Protection after a single vaccine injection was low; two doses are needed. Read the article.

PERSPECTIVE From Crime to Care — On the Front Lines of Decarceration N.P. Morris

Many clinicians are working on the front lines of decarceration, supporting and treating patients who might once have been incarcerated. Models for decarceration involving problem-solving courts and treatment are not perfect, but they allow physicians to do their part. Read the article.

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Treating Hormone-Receptor–Positive Breast Cancer

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Physician Jobs July 31, 2021

Gastroenterology Arizona Opportunity for a General Gastroenterology position in Phoenix We have an outstanding opportunity for a General Gastroenterology position with special interest in motility, nutrition, or women’s health to join a thriving academic GI division in an academic health science center that focuses on supporting research in clinical and scholarship endeavors with faculty appointments and rank at the University of Arizona College of Medicine – Phoenix....

Family Medicine Colorado Family Medicine Physician to join an established practice in Fort Morgan/Brush Excellent employed position in Brush, Colorado, 1 hour NE of Denver. Situated in the agriculturally-rich South Platte River Valley, Brush is home to 5,500 people and serves over 28,000, which includes the majority of Morgan County residents. Experience the relief of practicing with a large, integrated health system that offers its physicians a financially stable environment, resources .…

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As a valued reader of NEJM, you are receiving this Weekend Briefing because you selected to receive the NEJM Weekly Table of Contents. The Weekend Briefing is a companion to the Table of Contents. To ensure consistent delivery of NEJM emails, please add webm...@n.nejm.org to your Contacts or Address Book. Click here to unsubscribe from Weekend Briefing. If you prefer not to receive content alerts, information about updates, services, or special offers from NEJM.org, sign in to My NEJM Alerts to update your email preferences. The New England Journal of Medicine 860 Winter Street Waltham, MA 02451 USA Copyright © 2021 Massachusetts Medical Society. All rights reserved.

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Weekend Briefing August 7, 2021

IMAGES IN CLINICAL MEDICINE A 42-year-old woman was admitted to the hospital to receive induction chemotherapy for acute monocytic leukemia. On hospital day 10, edematous, erythematous plaques developed on her cheeks, forehead, and neck. A biopsy was performed, and a diagnosis of neutrophilic eccrine hidradenitis was made. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes CLINICAL PRACTICE Age-Related Macular Degeneration CLINICAL PROBLEM-SOLVING Turning Purple with Pain FIND MORE CME »

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PERSPECTIVE When Low Tech Wins J. Baras Shreibati Just as people with visual impairment may have heightened use of their other senses, for one physician in a safety-net system, a year of telephone care during the Covid-19 pandemic cultivated a capacity to connect with patients solely through sound. Read the article.

FACEBOOK An Icteric Tongue TWITTER Depression in Adolescents INSTAGRAM A Periodic Problem

ORIGINAL ARTICLE

Covid-19 Breakthrough Infections in Vaccinated Health Care Workers M. Bergwerk and Others Among 1497 health care workers who were fully vaccinated against Covid-19 and had full testing results, 39 breakthrough infections were detected between January 20 and April 28, 2021. The infected workers had mild symptoms or were asymptomatic and had lower titers of peri-infection neutralizing antibody than coworkers who were not infected. Read the article.

PERSPECTIVE The Complementarity of Public Health and Medicine — Achieving “the Highest Attainable Standard of Health” D.J. Hunter The approaches and achievements of public health and clinical medicine are often framed as dichotomies — “prevention versus cure” or “individual versus population health.” But the two fields are complementary, as their practitioners are increasingly recognizing. Read the article. LISTEN TO THE PODCAST »

CRISPR-Cas9 In Vivo Gene Editing for Transthyretin Amyloidosis

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Physician Jobs August 7, 2021 Hematology/Oncology Illinois Hem/Onc physician needed to join growing team in Mt. Vernon SSM Health - Illinois in conjunction with Oza Cancer Center seeks a Hematology/Oncology Physician to join its growing team. This position will be located in our Mt. Vernon, Illinois location, practicing in a recently renovated Cancer Center. This is an employed position with SSM Health Medical Group, a premier multispecialty group located in Mt. Vernon and Centralia, Illinois.... Family Medicine Wisconsin Seeking Family Physician to join clinic in Beaver Dam SSM Health Dean Medical Group, a 500+ physician multispecialty group, is seeking a Family Physician to join its clinic in Beaver Dam, Wisconsin. This Family Medicine physician will work at the new state-of-the-art multispecialty clinic opening in February 2021. Additional details: The Opportunity: Full-time opportunity (0.8-1.0 FTE), outpatient only practice with daytime clinical hours .…

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As a valued reader of NEJM, you are receiving this Weekend Briefing because you selected to receive the NEJM Weekly Table of Contents. The Weekend Briefing is a companion to the Table of Contents. To ensure consistent delivery of NEJM emails, please add webm...@n.nejm.org to your Contacts or Address Book. Click here to unsubscribe from Weekend Briefing. If you prefer not to receive content alerts, information about updates, services, or special offers from NEJM.org, sign in to My NEJM Alerts to update your email preferences. The New England Journal of Medicine 860 Winter Street Waltham, MA 02451 USA Copyright © 2021 Massachusetts Medical Society. All rights reserved.

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Weekend Briefing August 14, 2021

IMAGES IN CLINICAL MEDICINE A 62-year-old woman presented with pruritic, draining nodules on her back and buttocks after recent travel to South America. The physical examination showed nodules with drainage, and larval movement was observed. Six human botfly larvae were extracted (shown in a video). Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant ORIGINAL ARTICLE Cabotegravir for HIV Prevention in Cisgender Men and Transgender Women

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 24-2021: A 63-Year-Old Woman with Fever, Sore Throat, and Confusion FIND MORE CME »

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PERSPECTIVE Medicare Physician Payment Reform — Enhancing Incentives for Value-Based Care R. Mechanic and A. Perlman Models that hold organizations responsible for managing patients’ total cost of care are an important tool for payment reform. Bringing more clinicians into such models is essential, and strengthening current participation incentives could generate long-term benefits. Read the article.

FACEBOOK Evaluation of mRNA-1273 SARS-CoV-2 Vaccine in Adolescents TWITTER Randomized Trial of a Third Dose of mRNA-1273 Vaccine in Transplant Recipients INSTAGRAM Myiasis from Larvae of Human Botfly

ORIGINAL ARTICLE

Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant

J. Lopez Bernal and Others

The B.1.617.2 (delta) Covid-19 variant has surged in India and spread worldwide. In a test-negative case–control study, the effectiveness of two doses of BNT162b2 was 94% against the B.1.1.7 (alpha) variant and 88% against delta; with the ChAdOx1 nCoV-19 vaccine, effectiveness was 74% and 67%, respectively. Protection after a single vaccine injection was low; two doses are needed. Read the article.

PERSPECTIVE Confronting Our Next National Health Disaster — Long-Haul Covid S. Phillips and M.A. Williams

Some 10 to 30% of Americans who’ve been infected with SARS-CoV-2 are still having debilitating symptoms months later, a trend that suggests that “long Covid” is our next public health disaster in the making. What form will this disaster take, and what can we do about it? Read the article. LISTEN TO THE PODCAST »

Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant

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Physician Jobs August 14, 2021

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Weekend Briefing August 21, 2021

IMAGES IN CLINICAL MEDICINE A 26-year-old woman with the Peutz–Jeghers syndrome presented with abdominal pain and vomiting. Computed tomography of the abdomen revealed multiple gastric polyps and gastrogastric intussusception. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Atogepant for the Preventive Treatment of Migraine REVIEW ARTICLE Long-Term Survival after Kidney Transplantation

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 25-2021: A 48-Year-Old Man with Fatigue and Leg Swelling FIND MORE CME »

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PERSPECTIVE A Pink Salwar P. Papineni Throughout the course of the past year, patients with Covid-19 — people of all ages — have continued to fill the hospital beds. The city outside may be eerily quiet, the seasons changing as smoothly and beautifully as ever, but the virus is wicked and keeps taking. Read the article.

FACEBOOK Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant TWITTER Reframing Immune-Mediated Inflammatory Diseases through Signature Cytokine Hubs INSTAGRAM Intussusception in the Peutz–Jeghers Syndrome

PERSPECTIVE

Confronting Our Next National Health Disaster — Long-Haul Covid S. Phillips and M.A. Williams Some 10 to 30% of Americans who’ve been infected with SARS-CoV-2 are still having debilitating symptoms months later, a trend that suggests that “long Covid” is our next public health disaster in the making. What form will this disaster take, and what can we do about it? Read the article.

PERSPECTIVE California v. Texas — Ending the Campaign to Undo the ACA in the Courts N. Bagley In June, the U.S. Supreme Court rejected what will probably be the last major case seeking to uproot the ACA. The Court’s decision most likely marks an end to Republicans’ efforts to achieve in the courts what they have been unable to achieve in Congress. Read the article. LISTEN TO THE PODCAST »

Pembrolizumab after Nephrectomy in Renal-Cell Carcinoma

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Physician Jobs August 21, 2021

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Weekend Briefing August 28, 2021

IMAGES IN CLINICAL MEDICINE A 30-year-old man presented with a circinate rash on his face, hands, and feet. A Venereal Disease Research Laboratory test was positive at a titer of 1:32, which confirmed a diagnosis of syphilis. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

A Monoclonal Antibody for Malaria Prevention ORIGINAL ARTICLE Triple Therapy for Cystic Fibrosis Phe508del–Gating and –Residual Function Genotypes

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 26-2021: A 49-Year-Old Man with Relapsed Acute Myeloid Leukemia FIND MORE CME »

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PERSPECTIVE Population Health and Human Rights J. Frenk and O. Gómez-Dantés The way a society protects and promotes human rights shapes public policies, determines the distribution of resources and access to services, and ultimately affects population health. Scholarship and action on human rights have been foundational to the public health field. Read the article. PERSPECTIVE Covid-Induced Changes in Health Care Delivery — Can They Last? R.M. Werner and S.A. Glied The rapid pace of delivery-system change during the pandemic revealed the limitations of new delivery modes and raises questions about whether our current health care system, and its financing, can support these changes and ensure that they improve quality and equity. Read the article. PERSPECTIVE Paying for Digital Health Care — Problems with the Fee-for-Service System J. Adler-Milstein and A. Mehrotra After a substantial investment in information technology, providing digital health care is technically feasible. But patients and physicians can’t reap the benefits because payers don’t know how to pay for new digital health options. Read the article.

FACEBOOK Breakthrough Infections in BNT162b2-Vaccinated Health Care Workers TWITTER Circinate Syphilitic Lesions INSTAGRAM Lorlatinib in a Child with ALK-Fusion–Positive High-Grade Glioma

CORRESPONDENCE Myocarditis after Covid-19 mRNA Vaccination A.K. Verma, K.J. Lavine, and C.-Y. Lin Two patients who had received Covid-19 mRNA vaccination are described. One received the BNT162b2 vaccine; the other received the mRNA-1273 vaccine. Myocarditis, confirmed on histologic examination, developed in both patients within 2 weeks after vaccination. One patient died and the other recovered. Read the article.

PERSPECTIVE Controversy and Progress in Alzheimer’s Disease — FDA Approval of Aducanumab G.D. Rabinovici The FDA’s accelerated approval of aducanumab represents a landmark moment, though the drug’s road to the clinic has been rocky and contentious. The hope is that despite its limitations, this first-in-class drug will open the door to more efficacious therapies. Read the article. LISTEN TO THE PODCAST »

Therapeutic Anticoagulation in Hospitalized Patients with Covid-19

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Physician Jobs August 28, 2021

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Weekend Briefing September 4, 2021

IMAGES IN CLINICAL MEDICINE A 54-year-old-woman presented with fevers, weight loss, and abdominal pain. Imaging showed an intrauterine device surrounded by multiple abdominopelvic abscesses. Actinomyces israelii was grown on culture. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

MRI-Targeted or Standard Biopsy in Prostate Cancer Screening REVIEW ARTICLE Chronic Meningitis CLINICAL PROBLEM-SOLVING Inadequate Support FIND MORE CME »

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PERSPECTIVE Supporting Value-Based Health Care — Aligning Financial and Legal Accountability M.M. Zaki, A.B. Jena, and A. Chandra Under value-based payment models, there is a misalignment between organizations’ incentives to spend wisely and individual physicians’ incentives to reduce malpractice liability risk. One idea that has been proposed to correct this mismatch is enterprise liability. Read the article.

FACEBOOK Empagliflozin in Heart Failure with a Preserved Ejection Fraction TWITTER Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation INSTAGRAM

Triple Therapy for Cystic Fibrosis

ORIGINAL ARTICLE Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting N. Barda and Others Among more than 1.7 million persons, BNT162b2 vaccination was associated with increased risks of myocarditis (risk ratio, 3.24), lymphadenopathy, appendicitis, and herpes zoster infection; in comparison, Covid-19 increased the risks of myocarditis (risk ratio, 18.28), pericarditis, arrhythmia, deep-vein thrombosis, pulmonary embolism, myocardial infarction, intracranial hemorrhage, and thrombocytopenia. Read the article.

PERSPECTIVE Population Health and Human Rights

J. Frenk and O. Gómez-Dantés

The way a society protects and promotes human rights shapes public policies, determines the distribution of resources and access to services, and ultimately affects population health. Scholarship and action on human rights have been foundational to the public health field. Read the article.

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Efpeglenatide for Type 2 Diabetes

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Physician Jobs September 4, 2021 Psychiatry Washington State Leadership opportunity in Seattle Join the renowned Swedish Cancer Institute as a full-time Psychiatrist. In this role, you will lead a comprehensive, multidisciplinary team and work with the Psycho-Oncology program to provide behavioral health care to Oncology patients. You will provide Psychiatric expertise, as well as aid in the development of a networked Psychosocial support program for patients at the Swedish Cancer Institute.... Cardiology New York Syracuse opportunity for non-Invasive physician St. Joseph's Health Cardiovascular Institute is seeking a Non-Invasive Cardiology physician to join its nationally recognized, multispecialty team. This established group has practice locations across the Central/Upstate New York region and is committed to a patient safety through their team approach model. Come enjoy unparalleled quality of life in the welcoming community of Syracuse.…

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Weekend Briefing September 11, 2021

IMAGES IN CLINICAL MEDICINE A 7-year-old girl presented with an itchy rash after 1 week of treatment with amoxicillin for pharyngitis. She had erythematous papules and macules on her face, trunk, arms, and legs. The result of a mononuclear spot test was positive, and a diagnosis of amoxicillin rash in infectious mononucleosis was made. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Prospective, Multicenter, Controlled Trial of Mobile Stroke Units REVIEW ARTICLE Challenges of Sarcoidosis and Its Management

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 27-2021: A 16-Year-Old Boy Seeking Human Immunodeficiency Virus Prophylaxis FIND MORE CME »

IMAGES IN CLINICAL MEDICINE LEARN MORE »

PERSPECTIVE State Public Option Plans — Too Modest to Improve Affordability? E.C. Fuse Brown, K.L. Gudiksen, and J.S. King Facing daunting political, legal, and fiscal challenges, the public option health plans recently enacted by Washington State, Nevada, and Colorado have been narrowed to such an extent that they may fail to meet their affordability and coverage goals. Read the article. PERSPECTIVE Medicare for More — Why We Still Need a Public Option and How to Get There J.S. Hacker Public Option 2.0 may be the most realistic way to guarantee universal coverage with a broad choice of providers and with medical prices held down by the government. If the United States is to achieve this elusive goal, however, advocates need to lay the groundwork now. Read the article. PERSPECTIVE Treatment of Older Adults with Cancer — Addressing Gaps in Evidence M.M. Bertagnolli and H. Singh Older adults with cancer are underrepresented in clinical research. Because of insufficient data, such patients and their physicians must make life-altering treatment decisions without adequate evidence-based guidance. Read the article.

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Effectiveness of an Inactivated SARS-CoV-2 Vaccine

TWITTER Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health INSTAGRAM Clinical Problem Solving: Inadequate Support

CORRESPONDENCE Resurgence of SARS-CoV-2 Infection in a Highly Vaccinated Health System Workforce J. Keehner and Others From March through July 2021, a total of 227 health care workers at UCSD, 57% of whom were fully vaccinated, tested positive for SARS-CoV-2; the delta variant was the dominant isolate. No deaths were recorded. Vaccine effectiveness fell from over 90% in March to 65.5% in July. A trend was observed for greater risk as a function of time since full vaccination. Read the article.

PERSPECTIVE SARS-CoV-2 Human Challenge Studies — Establishing the Model during an Evolving Pandemic G. Rapeport and Others

While commentators have made theoretical arguments for and against SARS-CoV-2 challenge studies, a consortium of academics, industry collaborators, and the British government has proceeded to address the technical and ethical considerations to enable such studies. Read the article. LISTEN TO THE PODCAST »

Clinical Outcomes with Mobile Stroke Units

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Physician Jobs September 11, 2021

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Weekend Briefing September 18, 2021

Race in Medicine — Genetic Variation, Social Categories, and Paths to Health Equity

Watch the new Perspective Roundtable on Race in Medicine, in which experts from diverse clinical and biomedical fields discuss complex questions about race in medicine and how to build a system of equitable health for all. View the video, listen to the audio, or read the transcript. Read more articles from the Race and Medicine collection.

IMAGES IN CLINICAL MEDICINE A 50-year-old man presented with a red lesion in his left eye and purple plaques on his skin. A test for infection with HIV type 1 was positive. Kaposi’s sarcoma with conjunctival involvement was diagnosed on skin biopsy. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Lutetium-177–PSMA-617 for Metastatic Castration-Resistant Prostate Cancer ORIGINAL ARTICLE Safety and Efficacy of a Typhoid Conjugate Vaccine in Malawian Children CLINICAL PRACTICE Treatment of Acute Uncomplicated Appendicitis FIND MORE CME »

IMAGES IN CLINICAL MEDICINE LEARN MORE »

PERSPECTIVE Mask Wars D.S. Jones and S.H. Podolsky This Graphic Perspective explores the fraught history of masking as a preventive intervention in public health crises. Masks themselves have evolved, but the existence of mask slackers and questions about balancing individual rights with the public good are not new. Read the article.

FACEBOOK Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months TWITTER Striving for Diversity in Research Studies INSTAGRAM Peak Moments — When Kindergarten Is High Risk

ORIGINAL ARTICLE Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings M.G. Thompson and Others A study with a test-negative design analyzed 41,552 admissions to 187 hospitals and 21,522 visits to 221 EDs or urgent care clinics. The mRNA-based vaccines (≥14 days after the second dose) were highly effective against SARS-CoV-2 infection leading to hospitalization (89%), ICU admission (90%), or an urgent care visit (91%). Read the article.

PERSPECTIVE State Public Option Plans — Too Modest to Improve Affordability?

E.C. Fuse Brown, K.L. Gudiksen, and J.S. King

Facing daunting political, legal, and fiscal challenges, the public option health plans recently enacted by Washington State, Nevada, and Colorado have been narrowed to such an extent that they may fail to meet their affordability and coverage goals. Read the article.

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Salt Substitution and Cardiovascular Events and Death

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Physician Jobs September 18, 2021

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Weekend Briefing September 25, 2021

IMAGES IN CLINICAL MEDICINE A 73-year-old man presented to the eye clinic with blurred vision, photophobia, and a rash. Eye examination showed symblepharon. Linear IgA bullous dermatosis was identified on biopsy of the skin. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Overall Survival Benefit with Tebentafusp in Metastatic Uveal Melanoma REVIEW ARTICLE Perspectives on the Treatment of Malignant Pleural Mesothelioma

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 29-2021: A 12-Month-Old Boy with Fever and Developmental Regression FIND MORE CME »

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PERSPECTIVE Toward a New Era for the Indian Health System J. Leston and B. Reilley The Indian Health System is poorly resourced and understaffed. Now is a promising time to reflect on big solutions for fostering a transformative, rather than transactional, relationship between the federal government and tribal nations. Read the article. PERSPECTIVE Cool Water B.W. Frush The patient’s eyes say I know that you know that I know. I know that I am dying, and you know that I am dying, and you won’t say it; you can hide behind your prim white coat, but I see you and I demand that you behold me. Read the article.

FACEBOOK Efficacy of the mRNA-1273 SARS-CoV-2 Vaccine at Completion of Blinded Phase TWITTER Placenta Increta INSTAGRAM Symblepharon in Linear IgA Bullous Dermatosis

ORIGINAL ARTICLE

Protection of BNT162b2 Vaccine Booster against Covid-19 in Israel Y.M. Bar-On and Others Since July 30, 2021, more than a million fully vaccinated Israeli residents who were 60 years of age or older have received a third dose of the BNT162b2 mRNA vaccine. As of August 31, the rate of confirmed Covid-19 infection was lower in the booster group than in the nonbooster group by a factor of 11.3, and the rate of severe illness was lower by a factor of 19.5. Read the article.

PERSPECTIVE Public Health Law after Covid-19 M.M. Mello and W.E. Parmet To combat the pandemic, officials imposed extensive mitigation measures using their emergency powers. In response, more than 1000 suits challenged orders shuttering businesses, banning indoor worship services, restricting travel, and mandating mask wearing. Read the article. LISTEN TO THE PODCAST »

NVX-CoV2373 Covid-19 Vaccine

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Physician Jobs September 25, 2021

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Weekend Briefing October 2, 2021

How Do We Dismantle Structural Racism in Medicine?

Watch a new Perspective Roundtable, Race in Medicine – Genetic Variation, Social Categories, and Paths to Health Equity, in which a panel of clinical and biomedical experts discuss complex questions about race in medicine and how to achieve equitable health for all. View the video, listen to the audio, or read the transcript. Read more articles from the Race and Medicine collection.

IMAGES IN CLINICAL MEDICINE A 65-year-old man presented with a 5-day history of a painful, symmetric rash on his hands and elbows. Skin biopsy revealed leukemia cutis. Findings on bone marrow biopsy were consistent with chronic myelomonocytic leukemia. Read the article. VIEW MORE IMAGES »

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Maintenance or Discontinuation of Antidepressants in Primary Care ORIGINAL ARTICLE Ozanimod as Induction and Maintenance Therapy for Ulcerative Colitis INTERACTIVE MEDICAL CASE Hard to Swallow

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 30-2021: A 47-Year-Old Man with Recurrent Unilateral Head and Neck Pain FIND MORE CME »

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PERSPECTIVE Methods of Public Health Research — Strengthening Causal Inference from Observational Data M.A. Hernán For researchers using observational data, a useful way to answer a causal question is to design the target trial that would answer it and then emulate its protocol. The example of the HIV-treatment-as-prevention strategy illustrates the benefits of this approach. Read the article. PERSPECTIVE Integrating Research into Community Practice — Toward Increased Diversity in Clinical Trials J. Woodcock, R. Araojo, T. Thompson, and G.A. Puckrein Many strategies have been developed to increase enrollment of diverse populations in clinical trials, but they have produced mixed results. One strategy that has not been scaled up in a sustainable way is engaging community clinicians in research. Read the article.

FACEBOOK Audio Interview: Vaccine Efficacy and Boosters in Covid-19 TWITTER Leukemia Cutis INSTAGRAM In Gratitude for mRNA Vaccines

ORIGINAL ARTICLE

Efficacy of the mRNA-1273 SARS-CoV-2 Vaccine at Completion of Blinded Phase H.M. El Sahly and Others The mRNA-1273 vaccine was approved for emergency use in December 2020; trial participants who received placebo were informed of the results and offered vaccination. At the close of the blinded phase of the trial, the vaccine efficacy in preventing Covid-19 illness was 93.2%, and the efficacy against severe disease was 98.2%. No new safety issues were identified. Read the article.

PERSPECTIVE Toward a New Era for the Indian Health System

J. Leston and B. Reilley

The Indian Health System is poorly resourced and understaffed. Now is a promising time to reflect on big solutions for fostering a transformative, rather than transactional, relationship between the federal government and tribal nations. Read the article.

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Relapse after Discontinuing Antidepressants

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Physician Jobs October 2, 2021 Family Medicine Missouri Family Medicine opening in Belle We would like to invite you to share that gift as part of the Family Medicine team at SSM Health-Belle Family Medicine Clinic in Belle, MO. We are seeking a Family Medicine Physician to join our well-established clinic. Are you a board-certified Family Medicine physician who has a proven ability to engage with their colleagues and patients and who shares our dedication to exceptional care and outcomes?.... Family Medicine Missouri Florissant opportunity for Family Medicine physician SSM Health is a Catholic not-for-profit health system serving the comprehensive health needs of communities across the Midwest through a robust and fully integrated health care delivery system. Headquartered in St. Louis, SSM Health has care delivery sites in Missouri, Illinois, Oklahoma, and Wisconsin. The health system includes 24 hospitals, more than 300 physician offices and other outpatient care sites.…

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As a valued reader of NEJM, you are receiving this Weekend Briefing because you selected to receive the NEJM Weekly Table of Contents. The Weekend Briefing is a companion to the Table of Contents. To ensure consistent delivery of NEJM emails, please add webm...@n.nejm.org to your Contacts or Address Book. Click here to unsubscribe from Weekend Briefing. If you prefer not to receive content alerts, information about updates, services, or special offers from NEJM.org, sign in to My NEJM Alerts to update your email preferences. The New England Journal of Medicine 860 Winter Street Waltham, MA 02451 USA Copyright © 2021 Massachusetts Medical Society. All rights reserved.

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Weekend Briefing October 9, 2021

IMAGES IN CLINICAL MEDICINE A 70-year-old man presented with a 2-month history of pruritus and a sense of fullness in the right ear. There was no hearing impairment, tinnitus, or otorrhea. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis ORIGINAL ARTICLE Bamlanivimab plus Etesevimab in Mild or Moderate Covid-19 REVIEW ARTICLE Autoimmune Hemolytic Anemias FIND MORE CME »

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PERSPECTIVE Eviction and the Necessary Conditions for Health K. Moran-McCabe and S. Burris Safe, affordable housing is a foundation of good health. But housing is often viewed as a commodity or a business, rather than as a social determinant of health. The Covid-19 pandemic both highlighted eviction as a public health crisis and exacerbated the problem. Read the article. PERSPECTIVE The Drug-Dosing Conundrum in Oncology — When Less Is More M. Shah, A. Rahman, M.R. Theoret, and R. Pazdur Doses and schedules of oncology drugs are sometimes inadequately characterized before registration trials. The “more is better” paradigm is still used for dose selection, despite the recognition that targeted therapies require alternative approaches to dose optimization. Read the article. PERSPECTIVE A Good Death? R.E. Leiter The promise of the “good death” was one of the outcomes that had inspired the physician to pursue a career in palliative care. But not all patients’ stories play out according to this script, and we need to admit that for some patients, death can be difficult to tame. Read the article.

FACEBOOK Kayser–Fleischer Rings in Wilson’s Disease TWITTER Waning of BNT162b2 Vaccine Protection against SARS-CoV-2 Infection in Qatar INSTAGRAM

Case 30-2021: A 47-Year-Old Man with Recurrent Unilateral Head and Neck Pain

ORIGINAL ARTICLE

Protection of BNT162b2 Vaccine Booster against Covid-19 in Israel

Y.M. Bar-On and Others

Since July 30, 2021, more than a million fully vaccinated Israeli residents who were 60 years of age or older have received a third dose of the BNT162b2 mRNA vaccine. As of August 31, the rate of confirmed Covid-19 infection was lower in the booster group than in the nonbooster group by a factor of 11.3, and the rate of severe illness was lower by a factor of 19.5. Read the article.

PERSPECTIVE Methods of Public Health Research — Strengthening Causal Inference from Observational Data M.A. Hernán

For researchers using observational data, a useful way to answer a causal question is to design the target trial that would answer it and then emulate its protocol. The example of the HIV-treatment-as-prevention strategy illustrates the benefits of this approach. Read the article.

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Covid-19 Vaccine Effectiveness against Severe Disease

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Physician Jobs October 9, 2021

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Weekend Briefing October 16, 2021

Medical Fiction Contest: Inner Storytellers Found

Treat yourself to the best of short, medical fiction. The winners of this year’s NEJM Medical Fiction Contest, selected from more than 325 submissions, are “The Billboard,” “Emperor of the Empire,” and “Slack Tide.” Read the winning stories at www.NEJM.org/medicine-and-society

IMAGES IN CLINICAL MEDICINE An 80-year-old immunocompromised man presented to the emergency department with confusion. He later became obtunded, and magnetic resonance imaging of the head revealed ring-enhancing lesions. A cerebrospinal fluid culture grew Nocardia farcinica. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Empagliflozin in Heart Failure with a Preserved Ejection Fraction REVIEW ARTICLE Aspergillus Infections

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 31-2021: A 21-Year-Old Man with Sore Throat, Epistaxis, and Oropharyngeal Petechiae FIND MORE CME »

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PERSPECTIVE Blood Donation by Gay and Bisexual Men — The Need for a Policy Update A.S. Miller and S. Cahill The United Kingdom recently amended its eligibility criteria for blood donation to screen out potential donors on the basis of individualized risk assessment rather than blanket criteria excluding all men who have had sex with men. The United States should follow suit. Read the article. PERSPECTIVE “All Labor Has Dignity” — The Case for Wage Equity for Essential Health Care Workers L. Ung, F.C. Stanford, and J. Chodosh Clinicians need look no further than their own institutions to find large groups of employees facing economic and social deprivation. Racial justice in health care cannot be achieved without addressing the economic and social neglect of our low-paid colleagues. Read the article.

FACEBOOK Audio Interview: Are Covid-19 Vaccine Boosters Necessary? TWITTER Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults INSTAGRAM Intracardiac Cement Embolism

ORIGINAL ARTICLE

Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel D. Mevorach and Others In an Israeli Ministry of Health database, 136 definite or probable cases of myocarditis were detected among 5 million vaccinated persons. The rate ratio after two doses as compared with unvaccinated persons was 2.35, with the highest risk among male recipients between the ages of 16 and 19 years. Read the article.

PERSPECTIVE Vigilante Injustice — Deputizing and Weaponizing the Public to Stop Abortions R.A. Charo Besides its flagrant disregard for Roe v. Wade, the most damaging element of the new Texas abortion law is its citizen-posse enforcement scheme. And the mischief the law can cause goes further than some might imagine. Read the article. LISTEN TO THE PODCAST »

Empagliflozin in HF with Preserved Ejection Fraction

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Physician Jobs October 16, 2021 Family Medicine Oklahoma Join a talented team in Midwest city SSM Health St. Anthony Hospital is seeking a Family Medicine physician to join our talented team of multidisciplinary providers. Ideal candidates will be BC/BE in Family Medicine and will be dedicated to providing exceptional, compassionate care for Oklahomans. Full-Time, Employed Opportunity - Immediate Openings! Competitive Pay + Comprehensive Benefits + Excellent Retirement; Join Team of Experienced PCPs.... Pulmonary Medicine Oklahoma Oklahoma City opportunity for talented, BC Pulmonologist SSM Health Medical Group in Oklahoma City, OK is seeking a talented, board certified Pulmonologist to be a part of our Pulmonology Team. One who has a proven ability to engage with their colleagues and patients and who share our dedication to exceptional care and outcomes. Opportunity Highlights: Outpatient Practice and Inpatient Pulmonary Consults; Critical Care Covered by Intensivist Program.…

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Weekend Briefing October 23, 2021

IMAGES IN CLINICAL MEDICINE An 82-year-old man presented to the emergency department with fever and confusion. Computed tomography of the abdomen showed gas in the liver, and a diagnosis of emphysematous hepatitis was made after cultures grew extended-spectrum beta-lactamase Klebsiella pneumoniae. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

A Randomized, Controlled Trial of the Pan-PPAR Agonist Lanifibranor in NASH REVIEW ARTICLE Point-of-Care Ultrasonography

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 32-2021: A 14-Year-Old Girl with Swelling of the Jaw and Hypercalcemia FIND MORE CME »

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PERSPECTIVE Uncomfortable Truths — What Covid-19 Has Revealed about Chronic-Disease Care in America M.H. Chin Chronic-disease care in the United States doesn’t support optimal patient health and experience, especially for marginalized populations. Too often, care systems are based on tradition, self-interest, and revenue generation. Read the article. PERSPECTIVE The 2021 Reauthorization of CAPTA — Letting Public Health Lead M.H. Lloyd Sieger, R. Rebbe, and S.W. Patrick The latest Child Abuse Prevention and Treatment Act reauthorization bill would change the way families of substance-exposed infants are treated. The Biden administration could also leverage prevention and public health systems to achieve the policy’s objectives. Read the article. PERSPECTIVE A Therapeutic Relationship E. Adler “Everything hurts,” the elderly woman reports through the Tigrinya interpreter. When the physician begins examining her back for the source of the pain, the patient responds to her touch with delight, and the two begin forging a deep and mutually therapeutic bond. Read the article.

FACEBOOK Empagliflozin in Heart Failure with a Preserved Ejection Fraction TWITTER Correspondence: Differential Kinetics of Immune Responses Elicited by Covid-19 Vaccines INSTAGRAM Intranasal Oxytocin in Children and Adolescents with Autism Spectrum Disorder

ORIGINAL ARTICLE

Covid-19 Breakthrough Infections in Vaccinated Health Care Workers M. Bergwerk and Others Among 1497 health care workers who were fully vaccinated against Covid-19 and had full testing results, 39 breakthrough infections were detected between January 20 and April 28, 2021. The infected workers had mild symptoms or were asymptomatic and had lower titers of peri-infection neutralizing antibody than coworkers who were not infected. Read the article.

PERSPECTIVE Peak Moments — When Kindergarten Is High Risk S.D. Mallett As the new school year approaches, an immunocompromised mother faces a different risk–benefit calculus from most moms in sending her son off to kindergarten during a pandemic. But having saved up her “risk dollars,” she is ready to spend some on a return to normalcy. Read the article. LISTEN TO THE PODCAST »

A Pan-PPAR Agonist in NASH

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Physician Jobs October 23, 2021 OB/GYN Oklahoma Seeking talented, BC OB/GYN, Oklahoma City SSM Health Medical Group in Oklahoma City, OK is seeking a talented, board certified OB/GYN to join a team of talented providers. Ideal candidates will have a proven ability to engage with their colleagues and patients and who share our dedication to exceptional care and outcomes. Opportunity Highlights: Full-Time, Employed Position; Located in Midtown OKC - SSM Health St. Anthony Hospital; Clinic Attached to Hospital.... Critical Care Oklahoma Seeking Intensivist to join talented team in Oklahoma City SSM Health St. Anthony Hospital is seeking a Critical Care Intensivist to join our talented team of multidisciplinary providers. Ideal candidates will be BC/BE in Critical Care Medicine and will be dedicated to providing exceptional, compassionate care for Oklahomans. SSM Health St. Anthony has created a practice model that affords physicians an interesting mix of cases, manageable volumes, and the opportunity to expand.…

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Weekend Briefing October 30, 2021

IMAGES IN CLINICAL MEDICINE A 49-year-old woman with a history of kidney transplantation presented with headache and umbilicated skin papules. Levels of cryptococcal antigen in the serum and cerebrospinal fluid were high. A skin biopsy was performed, and a diagnosis of disseminated cryptococcosis was confirmed. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk CLINICAL PRACTICE Management of Abdominal Aortic Aneurysms

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 33-2021: A 68-Year-Old Man with Painful Mouth Ulcers FIND MORE CME »

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PERSPECTIVE Applying a Subpopulation Lens to Population Health E. Fuentes-Afflick Populations are composed of myriad subpopulations, each with its own health profile. A key subpopulation that must be considered in efforts to enhance population health is children, a group whose characteristics pose distinct opportunities and challenges. Read the article. PERSPECTIVE Racial and Ethnic Diversity at Medical Schools — Why Aren’t We There Yet? J.P. Guevara, R. Wade, and J. Aysola In medicine, diversity at all levels is an essential component of efforts to achieve equity. But there has been little or no progress in recent years in the relative diversity of medical school matriculants and faculty. Read the article. PERSPECTIVE None of the Above — The Patient beyond the Multiple Choice C. Grinberg Real patients cannot be easily reduced to five-sentence clinical vignettes. Transitioning from student to practitioner requires a shift in mindset: to see a patient as a person, not a paragraph; to see the right answer as layered and complex, not a single choice. Read the article.

FACEBOOK A Randomized, Controlled Trial of the Pan-PPAR Agonist Lanifibranor in NASH TWITTER Waning Immunity after the BNT162b2 Vaccine in Israel INSTAGRAM Perspective: Is It Finally Time for a Medicare Dental Benefit?

CORRESPONDENCE Toxic Effects from Ivermectin Use Associated with Prevention and Treatment of Covid-19 C. Temple, R. Hoang, and R.G. Hendrickson The Oregon Poison Center received calls at a rate of 0.25 per month in all of 2020, as compared with 21 calls in August 2021 alone, regarding toxic effects from ivermectin in persons who used the drug for the prevention or treatment of Covid-19. Symptoms included gastrointestinal distress, confusion, ataxia, and seizures, and 6 of the 21 persons were hospitalized. Read the article.

PERSPECTIVE Uncomfortable Truths — What Covid-19 Has Revealed about Chronic-Disease Care in America M.H. Chin

Chronic-disease care in the United States doesn’t support optimal patient health and experience, especially for marginalized populations. Too often, care systems are based on tradition, self-interest, and revenue generation. Read the article.

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Dual Antiplatelet Therapy Post-PCI in Patients at High Bleeding Risk

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Physician Jobs October 30, 2021

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Weekend Briefing November 6, 2021

IMAGES IN CLINICAL MEDICINE A 26-year-old woman presented with intermittent small-volume hemoptysis coinciding with her menses. CT of the chest showed a cavitary nodule that was then resected. Histopathological analysis of the lesion revealed endometrial glands, consistent with a diagnosis of thoracic endometriosis. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months REVIEW ARTICLE Peritoneal Dialysis CLINICAL PROBLEM-SOLVING Copycat FIND MORE CME »

IMAGES IN CLINICAL MEDICINE LEARN MORE »

PERSPECTIVE The Future of SARS-CoV-2 Vaccination — Lessons from Influenza A.S. Monto Given the parade of SARS-CoV-2 variants, their increasing transmissibility, and concern about antigenic changes affecting vaccine protection, we need long-term plans for dealing with this virus. Pandemic and seasonal influenza may provide appropriate models. Read the article. PERSPECTIVE When Women and Children Made the Policy Agenda — The Sheppard–Towner Act, 100 Years Later J.P. Baker One hundred years ago, the Sheppard–Towner Maternity and Infancy Protection Act launched a striking policy experiment. Had the program survived, the country might have developed a model for promoting child health that integrated preventive care with social services. Read the article.

FACEBOOK Management of Abdominal Aortic Aneurysms TWITTER Clinical Features of VITT INSTAGRAM

Case 33-2021: A 68-Year-Old Man with Painful Mouth Ulcers

ORIGINAL ARTICLE

Waning Immunity after the BNT162b2 Vaccine in Israel

Y. Goldberg and Others A resurgence of Covid-19 in mid-June prompted an examination of Covid-19 immunity as a function of month of vaccination in Israel. Data on confirmed infection and severe disease among fully vaccinated persons were collected from July 11 to 31, 2021. Relative and absolute rates of infection and severe disease increased with time since the second vaccine dose in all age groups. Read the article.

PERSPECTIVE Applying a Subpopulation Lens to Population Health E. Fuentes-Afflick

Populations are composed of myriad subpopulations, each with its own health profile. A key subpopulation that must be considered in efforts to enhance population health is children, a group whose characteristics pose distinct opportunities and challenges. Read the article.

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Estimating Kidney Function without Race

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Physician Jobs November 6, 2021 Chiefs/Directors Massachusetts Holden opening for Site Chief of Family Practice Reliant Medical Group is seeking a physician or APC leader to join our growing care team in Holden, Massachusetts as Site Chief of Family Practice. As part of the Optum family, we are a physician-led multispecialty practice leading healthcare transformation nationally through engaged and purpose-driven physicians, while providing care locally within our communities. Join an organization supported by a global care company.... Internal Medicine Massachusetts Multiple opportunities available in central Massachusetts Reliant Medical Group is seeking Internal Medicine Physicians to join our growing care teams in Massachusetts. As part of the Optum family, we are a physician-led multispecialty practice leading healthcare transformation nationally through engaged and purpose-driven physicians, while providing care locally within our communities. Join an organization supported by a global care company.…

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Weekend Briefing November 13, 2021

IMAGES IN CLINICAL MEDICINE A 53-year-old woman presented with pain, swelling, and discoloration of her finger after being bitten by a yellow sac spider. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Angiotensin Receptor–Neprilysin Inhibition in Acute Myocardial Infarction REVIEW ARTICLE Pollution and the Heart

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 34-2021: A 38-Year-Old Man with Altered Mental Status and New Onset of Seizures FIND MORE CME »

IMAGES IN CLINICAL MEDICINE LEARN MORE »

PERSPECTIVE Regulating Drug Prices while Increasing Innovation R.M. Conti, R.G. Frank, and J. Gruber To save money on drugs while encouraging high-value pharmaceutical innovation, we need to better reward value, increase NIH funding for early-stage research, and reduce expenses and risks for developers of drugs whose social value exceeds their financial value. Read the article. PERSPECTIVE Drug-Pricing Debate Redux — Should Cost-Effectiveness Analysis Be Used Now to Price Pharmaceuticals? P.J. Neumann, J.T. Cohen, and D.A. Ollendorf The idea of permitting the government to negotiate pharmaceutical prices raises a question about the basis for negotiations: how to judge what’s a fair price. Absent well-functioning markets, cost-effectiveness analyses can clarify the value that therapies deliver. Read the article. PERSPECTIVE Revival J. Schor, N. Koscal, and K. Knoper In this Graphic Perspective, a physician traveler responding to a medical crisis on the train he’s taking is moved and inspired by the conductor whose quick action, dedication, and compassion save the day. Read the article.

FACEBOOK Efficacy of mRNA-1273 SARS-CoV-2 Vaccine TWITTER Evaluation of the BNT162b2 Covid-19 Vaccine in Children 5 to 11 Years of Age INSTAGRAM

Racial and Ethnic Diversity at Medical Schools — Why Aren’t We There Yet?

ORIGINAL ARTICLE

Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months S.J. Thomas and Others In a multinational, observer-blinded, randomized trial involving 44,165 participants 16 years of age or older and 2264 participants 12 to 15 years of age, the efficacy of the BNT162b2 vaccine was 91% against Covid-19 and 97% against severe disease through 6 months of follow-up. In South Africa, where the beta variant was widespread, vaccine efficacy was 100%. Late toxic effects from the vaccine were not observed. Read the article.

PERSPECTIVE When Women and Children Made the Policy Agenda — The Sheppard–Towner Act, 100 Years Later J.P. Baker

One hundred years ago, the Sheppard–Towner Maternity and Infancy Protection Act launched a striking policy experiment. Had the program survived, the country might have developed a model for promoting child health that integrated preventive care with social services. Read the article.

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IV Alteplase before Endovascular Stroke Treatment

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Weekend Briefing November 20, 2021

IMAGES IN CLINICAL MEDICINE A 61-year-old woman presented with a rapidly growing pigmented gingival lesion. Incisional biopsy revealed melanoma. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Hematopoietic Stem- and Progenitor-Cell Gene Therapy for Hurler Syndrome ORIGINAL ARTICLE Early Treatment for Covid-19 with SARS-CoV-2 Neutralizing Antibody Sotrovimab

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 35-2021: A 50-Year-Old Woman with Pain in the Left Upper Quadrant and Hypoxemia FIND MORE CME »

IMAGES IN CLINICAL MEDICINE LEARN MORE »

PERSPECTIVE Why Is Aducanumab Priced at $56,000 per Patient? Lessons for Drug-Pricing Reform J.C. Robinson Aducanumab’s price can inform the drug-pricing policy debate because it responds to key features of the market environment for physician-administered drugs: Medicare’s reimbursement formula, payment to physicians for infused drugs, and cost-sharing requirements. Read the article. PERSPECTIVE Medicare Coverage of Aducanumab — Implications for State Budgets R.E. Sachs and N. Bagley CMS is considering whether and under what circumstances Medicare will pay for aducanumab for Alzheimer’s disease. A restrictive coverage determination could save the federal government money, but it would also shift substantial costs to states. Read the article. PERSPECTIVE The Little Things J.C. Stuart “This guy was on the brink of death 10 days ago, but really he just wants his cheeseburger.” The medical team chuckles, but one member, a former patient, understands that this focus on the small, pragmatic things derives from some fundamental aspects of being a patient. Read the article.

FACEBOOK Pollution and the Heart TWITTER 24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk INSTAGRAM The IARC Perspective on Cervical Cancer Screening

ORIGINAL ARTICLE

Evaluation of the BNT162b2 Covid-19 Vaccine in Children 5 to 11 Years of Age E.B. Walter and Others After a dose for further testing was determined in a phase 1 study, a phase 2–3 trial was initiated in which two 10-μg doses of BNT162b2 were given 21 days apart to children 5 to 11 years of age. No serious adverse events were observed. High levels of neutralizing antibodies were induced, and vaccine efficacy 7 days or more after the second dose was 90.7%. Read the article.

PERSPECTIVE Regulating Drug Prices while Increasing Innovation

R.M. Conti, R.G. Frank, and J. Gruber

To save money on drugs while encouraging high-value pharmaceutical innovation, we need to better reward value, increase NIH funding for early-stage research, and reduce expenses and risks for developers of drugs whose social value exceeds their financial value. Read the article.

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Sotrovimab for Early Covid-19

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Physician Jobs November 20, 2021

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Weekend Briefing November 27, 2021

IMAGES IN CLINICAL MEDICINE A 50-year-old woman with Crohn’s disease presented with painful, shallow erosions in “snail track” formations on her dorsal tongue and inner cheek and with peripheral-blood eosinophilia. A biopsy revealed findings consistent with pyostomatitis vegetans. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults REVIEW ARTICLE New Horizons in the Treatment of Osteosarcoma

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 36-2021: A 22-Year-Old Man with Pain and Erythema of the Left Hand FIND MORE CME »

IMAGES IN CLINICAL MEDICINE LEARN MORE »

PERSPECTIVE Using Policy Tools to Improve Population Health — Combating the U.S. Opioid Crisis C.L. Barry and B. Saloner Policy has been critical to achieving major public health advances, including in tobacco control, maternal and child health, and injury prevention. The opioid crisis illustrates five steps essential for using policy to produce substantial gains in population health. Read the article. PERSPECTIVE The Web We Weave M. Hedlin The traditional model of autonomy sees patients as atomistic, and the clinician’s duty as providing information and protecting the patient from undue influence. But people are interconnected and interdependent, shaped by communities and relationships with loved ones. Read the article.

FACEBOOK Insights into Salt Handling and Blood Pressure TWITTER Multiyear Factor VIII Expression after AAV Gene Transfer for Hemophilia A INSTAGRAM Eliminating the “Hanger” from Hunger

ORIGINAL ARTICLE

Early Treatment for Covid-19 with SARS-CoV-2 Neutralizing Antibody Sotrovimab A. Gupta and Others

In this ongoing, randomized, phase 3 trial, sotrovimab (a SARS-CoV-2–targeted monoclonal antibody) or placebo was administered to outpatients within 5 days after the onset of Covid-19 symptoms. The incidence of hospitalization for any cause or death was lower among patients who received sotrovimab (1% vs. 7%). Read the article.

PERSPECTIVE Why Is Aducanumab Priced at $56,000 per Patient? Lessons for Drug-Pricing Reform J.C. Robinson

Aducanumab’s price can inform the drug-pricing policy debate because it responds to key features of the market environment for physician-administered drugs: Medicare’s reimbursement formula, payment to physicians for infused drugs, and cost-sharing requirements. Read the article.

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Belzutifan for VHL Disease–Associated Renal Cell Carcinoma

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Weekend Briefing December 4, 2021

IMAGES IN CLINICAL MEDICINE A 38-year-old man presented to the otolaryngology clinic with a long history of difficulty in breathing through his right nostril. Rhinoscopy and computed tomographic imaging showed an inverted ectopic tooth in the nasal cavity. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Randomized Trial of Cytoreductive Surgery for Relapsed Ovarian Cancer REVIEW ARTICLE Spontaneous Intracranial Hypotension CLINICAL PROBLEM-SOLVING A “Fluid” Diagnosis FIND MORE CME »

IMAGES IN CLINICAL MEDICINE LEARN MORE »

PERSPECTIVE Covid-19 and the Safety Net — Moving from Straining to Sustaining J. Knudsen and D.A. Chokshi As we enter a new stage of pandemic response and recovery — in which we must address issues of racial health inequities, frontline health care infrastructure, and community preparedness — what constitutes adequate support for the U.S. health care safety net? Read the article. PERSPECTIVE Inequitable Access to Hospital Care — Protecting Disadvantaged Populations during Public Health Emergencies D.B. White, L. Villarroel, and J.L. Hick Load balancing among hospitals is a critical public health intervention during emergencies: failing to balance patient loads will cause unnecessary loss of life, particularly in historically marginalized racial and ethnic groups and rural or low-income communities. Read the article.

FACEBOOK A Nobel Prize for Sensational Research TWITTER Comparative Effectiveness of BNT162b2 and mRNA-1273 Vaccines in U.S. Veterans INSTAGRAM

Case 36-2021: A 22-Year-Old Man with Pain and Erythema of the Left Hand

CLINICAL IMPLICATIONS OF BASIC RESEARCH A Possible Role for Anti-idiotype Antibodies in SARS-CoV-2 Infection and Vaccination W.J. Murphy and D.L. Longo The authors hypothesize that anti-idiotype immune responses may contribute to rare adverse events, such as myocarditis, after SARS-CoV-2 vaccination, as well as to sequelae of Covid-19 that persist after the resolution of infection. Read the article.

PERSPECTIVE Using Policy Tools to Improve Population Health — Combating the U.S. Opioid Crisis

C.L. Barry and B. Saloner

Policy has been critical to achieving major public health advances, including in tobacco control, maternal and child health, and injury prevention. The opioid crisis illustrates five steps essential for using policy to produce substantial gains in population health. Read the article.

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Cytoreductive Surgery in Relapsed Ovarian Cancer

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Physician Jobs December 4, 2021 Neurology Colorado Clinical and medical leadership position in Loveland UCHealth is establishing a mechanical thrombectomy-capable stroke center at Medical Center of the Rockies in Loveland CO. An experienced neurointerventional provider, with a strong interest in program development, serving as medical director for the program is being sought for full-time employment at an established certified Primary Stroke Center... Hematology/Oncology Colorado Join growing department in Greeley The UCHealth Cancer Care team, which includes hematology/oncology physicians, radiation oncologists and a comprehensive supportive care team for patients, is ready to welcome a new hematologist/oncologist in our growing department in Greeley, Colorado as well as assist in our outreach efforts in southwest Nebraska. In your practice, you will provide general hematology and oncology care with the ability to develop.…

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As a valued reader of NEJM, you are receiving this Weekend Briefing because you selected to receive the NEJM Weekly Table of Contents. The Weekend Briefing is a companion to the Table of Contents. To ensure consistent delivery of NEJM emails, please add webm...@n.nejm.org to your Contacts or Address Book. Click here to unsubscribe from Weekend Briefing. If you prefer not to receive content alerts, information about updates, services, or special offers from NEJM.org, sign in to My NEJM Alerts to update your email preferences. The New England Journal of Medicine 860 Winter Street Waltham, MA 02451 USA Copyright © 2021 Massachusetts Medical Society. All rights reserved.

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Weekend Briefing December 11, 2021

IMAGES IN CLINICAL MEDICINE A neonate had a diffuse “blueberry muffin” rash at birth. Skin biopsy showed congenital Langerhans-cell histiocytosis. The infant’s skin-limited disease had resolved without treatment at 6 weeks. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Dupilumab in Children with Uncontrolled Moderate-to-Severe Asthma CLINICAL PRACTICE Latent Tuberculosis Infection

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 37-2021: A 60-Year-Old Man with Fevers, Fatigue, Arthralgias, a Mouth Ulcer, and a Rash FIND MORE CME »

IMAGES IN CLINICAL MEDICINE LEARN MORE »

PERSPECTIVE A Failure to Disseminate Transformative Science — HIV Treatment as Prevention, 10 Years On J. Bor, D. Onoya, B. Richman, and K.H. Mayer HIV treatment leading to viral suppression prevents transmission. Despite widespread awareness of the therapeutic benefits of HIV treatment, there are large global disparities in knowledge about the efficacy of treatment as prevention. Read the article. PERSPECTIVE E66.01 and Our Culture of Shame S. Hagan Weight bias remains common in health care settings, and many practitioners believe that obesity results primarily from lifestyle choices. But diet and exercise interventions alone consistently fail to help most people with obesity maintain substantial weight loss. Read the article. PERSPECTIVE Ms. Omega One M. Wilbur What we knew about Ms. Omega One was limited to her presentation: dark-skinned Black female, about 20 years old, with a gunshot wound to the neck — and most likely a new mother. And as with so many Black people killed in Black neighborhoods, there was no news report. Read the article.

FACEBOOK Audio Interview: The Omicron Variant of SARS-CoV-2 TWITTER Spontaneous Intracranial Hypotension INSTAGRAM Clinical Problem-Solving: A “Fluid” Diagnosis

ORIGINAL ARTICLE

Comparative Effectiveness of BNT162b2 and mRNA-1273 Vaccines in U.S. Veterans

B.A. Dickerman and Others In an observational study involving nearly 440,000 veterans, both the BNT162b2 vaccine and the mRNA-1273 vaccine were highly effective at preventing infection, hospitalization, and death from Covid-19. Infection risks were approximately 21% lower with mRNA-1273 than with BNT162b2. Follow-up included periods when either the alpha variant or the delta variant was dominant. Read the article.

PERSPECTIVE Covid-19 and the Safety Net — Moving from Straining to Sustaining

J. Knudsen and D.A. Chokshi

As we enter a new stage of pandemic response and recovery — in which we must address issues of racial health inequities, frontline health care infrastructure, and community preparedness — what constitutes adequate support for the U.S. health care safety net? Read the article.

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Tapinarof Cream for Plaque Psoriasis

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Physician Jobs December 11, 2021

Neurology Colorado Clinical and medical leadership position in Loveland

UCHealth is establishing a mechanical thrombectomy-capable stroke center at Medical Center of the Rockies in Loveland CO. An experienced neurointerventional provider, with a strong interest in program development, serving as medical director for the program is being sought for full-time employment at an established certified Primary Stroke Center..... Hematology Colorado

Join growing department in Greeley

The UCHealth Cancer Care team, which includes hematology/oncology physicians, radiation oncologists and a comprehensive supportive care team for patients, is ready to welcome a new hematologist/oncologist in our growing department in Greeley, Colorado as well as assist in our outreach efforts in southwest Nebraska. In your practice, you will provide general hematology and oncology care with the ability to develop....

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Weekend Briefing December 18, 2021

IMAGES IN CLINICAL MEDICINE A 74-year-old woman presented to the emergency department with tongue necrosis and sudden-onset monocular vision loss. Biopsy specimens of the temporal arteries confirmed giant-cell arteritis. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Daprodustat for the Treatment of Anemia in Patients Not Undergoing Dialysis REVIEW ARTICLE Pulmonary Arterial Hypertension

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 38-2021: A 76-Year-Old Woman with Abdominal Pain, Weight Loss, and Memory Impairment FIND MORE CME »

IMAGES IN CLINICAL MEDICINE LEARN MORE »

PERSPECTIVE In Clinical Care, What Will Amazon Deliver? E. Rourke Amazon has been rolling out Amazon Care, a service combining telemedicine with some in-home care provided by nurses. What will the retail behemoth’s new venture mean for patients, primary care physicians, and the already fragmented U.S. health care system? Read the article. PERSPECTIVE Covid-19 Vaccination in American Indians and Alaska Natives — Lessons from Effective Community Responses R. Foxworth and Others Vaccination rates among American Indians and Alaska Natives are higher than average. Since early in the pandemic, these communities have worked to protect their members, including by adapting community mitigation and vaccination strategies to their diverse cultures. Read the article. PERSPECTIVE Tobacco-free Nicotine — New Name, Same Scheme? S.N. Cwalina, R. McConnell, N.L. Benowitz, and J.L. Barrington-Trimis E-cigarettes that claim to contain “tobacco-free” synthetic nicotine — nicotine that isn’t derived from tobacco — are proliferating. Such products may threaten ongoing public health efforts to reduce e-cigarette use among adolescents and young adults. Read the article.

FACEBOOK Case 37-2021: A 60-Year-Old Man with Fevers, Fatigue, Arthralgias, a Mouth Ulcer, and a Rash TWITTER Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma INSTAGRAM

Covid-19 and the Safety Net — Moving from Straining to Sustaining

ORIGINAL ARTICLE

BNT162b2 Vaccine Booster and Mortality Due to Covid-19 R. Arbel and Others Among 843,208 participants in Israel who were 50 years of age or older and had received two doses of the BNT162b2 vaccine at least 5 months earlier, those who received a booster had 90% lower mortality due to Covid-19 than those who did not receive a booster. The study period was 54 days; adverse effects were not recorded. Read the article.

PERSPECTIVE A Failure to Disseminate Transformative Science — HIV Treatment as Prevention, 10 Years On

J. Bor, D. Onoya, B. Richman, and K.H. Mayer

HIV treatment leading to viral suppression prevents transmission. Despite widespread awareness of the therapeutic benefits of HIV treatment, there are large global disparities in knowledge about the efficacy of treatment as prevention. Read the article.

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Daprodustat for Anemia in CKD Not Requiring Dialysis

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Physician Jobs December 18, 2021 Internal Medicine Massachusetts Family Physician or Internal Medicine Physician in Greater Boston, MA At Village Medical we believe a primary care provider is most successful caring for patients in the communities where they live and work. We started our company in the hopes to help make the United States a global leader in health outcomes. We empower our primary care physicians to deliver person to person care that lets you do what you do best. We will support you with evidence based best practices, multi-disciplinary team to help you provide the best care for your patient with the latest tools to enable you to provide modern high-tech care with a human touch.... Cardiology Colorado General Cardiologist South Denver Cardiology Associates, headquartered in Littleton, Colorado is seeking a full-time general cardiologist to join the largest private cardiology practices in Colorado. This multispecialty group is looking for a board certified (or eligible) cardiologist in Cardiovascular Disease; proficiency in additional imaging modalities (Echocardiography, Nuclear Medicine, and Cardiac CT) is highly desired....

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Weekend Briefing December 25, 2021

IMAGES IN CLINICAL MEDICINE A 37-year-old man presented to the neurosurgery clinic with diplopia, upward gaze palsy, and headache. He was found to have pupillary light–near dissociation on examination, as seen on a video. A midbrain lesion was seen on MRI, and biopsy showed a nonsecreting germinoma. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Protection against Covid-19 by BNT162b2 Booster across Age Groups ORIGINAL ARTICLE Trial of Spesolimab for Generalized Pustular Psoriasis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 39-2021: A 26-Year-Old Woman with Respiratory Failure and Altered Mental Status FIND MORE CME »

IMAGES IN CLINICAL MEDICINE LEARN MORE »

PERSPECTIVE First Impressions — Should We Include Race or Ethnicity at the Beginning of Clinical Case Presentations? A.S. Brett and C.W. Goodman Given persistent racism in medicine and the growing recognition that racial and ethnic categories are socially constructed and not biologically coherent, the practice of mentioning race or ethnicity immediately in case presentations is worth revisiting. Read the article. PERSPECTIVE Calling Out Aversive Racism in Academic Medicine C.L. Chen, G.J. Gold, M. Cannesson, and J.M. Lucero Aversive racism is defined as exhibiting racist tendencies while denying that one’s thoughts, behaviors, or motives are racist. Aversive racism is pervasive in academic medicine and impedes diversity, equity, and inclusion efforts. Read the article. PERSPECTIVE Trust, Faith, and Covid E. Rittenberg When a physician’s long-time patient says she doesn’t believe in the Covid vaccine and that God will keep her safe, the moment feels fragile — the physician recognizes that she must tread carefully if the lines of therapeutic communication are to remain open. Read the article.

FACEBOOK Pulmonary Arterial Hypertension TWITTER Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients INSTAGRAM “Please Don’t Keep Me”

ORIGINAL ARTICLE

Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients A. Jayk Bernal and Others Oral outpatient treatment for Covid-19 is needed. In this phase 3, double-blind, randomized, controlled trial, molnupiravir, a small-molecule antiviral, was studied in unvaccinated patients with less than 5 days of Covid-19 illness. By day 29, hospitalization for progression of Covid-19 was lower with molnupiravir (6.8%) than with placebo (9.7%). Read the article.

PERSPECTIVE Covid-19 Vaccination in American Indians and Alaska Natives — Lessons from Effective Community Responses R. Foxworth and Others

Vaccination rates among American Indians and Alaska Natives are higher than average. Since early in the pandemic, these communities have worked to protect their members, including by adapting community mitigation and vaccination strategies to their diverse cultures. Read the article.

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BNT162b2 Vaccine Booster and Mortality

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Physician Jobs December 25, 2021 Neurology Colorado Physician - Neurology

UCHealth is establishing a mechanical thrombectomy-capable stroke center at Medical Center of the Rockies in Loveland CO. An experienced neurointerventional provider, with a strong interest in program development, serving as medical director for the program is being sought for full-time employment at an established certified Primary Stroke Center....

Hematology Colorado Physician

The UCHealth Cancer Care team, which includes hematology/oncology physicians, radiation oncologists and a comprehensive supportive care team for patients, is ready to welcome a new hematologist/oncologist in our growing department in Greeley, Colorado as well as assist in our outreach efforts in southwest Nebraska. In your practice, you will provide general hematology and oncology care with the ability to develop....

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Weekend Briefing January 1, 2022

IMAGES IN CLINICAL MEDICINE A 65-year-old man presented with a 7-month history of painless skin thickening over the left side of his chest and on his left arm. Examination showed sclerotic skin changes with lymphedema in the left arm and axillary lymphadenopathy. Examination of a skin-biopsy specimen revealed cutaneous breast cancer metastasis, which indicated a diagnosis of carcinoma en cuirasse. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease ORIGINAL ARTICLE Ticagrelor versus Clopidogrel in CYP2C19 Loss-of-Function Carriers with Stroke or TIA CLINICAL PRACTICE Determination of Brain Death FIND MORE CME »

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PERSPECTIVE The Patchwork U.S. Public Health System M. Wallace and J.M. Sharfstein The U.S. public health system is an uneven patchwork. In the shadow of a pandemic, understanding this haphazard architecture is a step toward elucidating the U.S. paradox of enormous health expenditures but poor outcomes for population health. Read the article. PERSPECTIVE Obstacles to Physicians’ Emotional Health — Lessons from History A. Arnold-Forster, J.D. Moses, and S.V. Schotland Though the current conditions of the physician-burnout crisis are unique, medical professionals have struggled in the past, and remedies have been tried. History may help explain why physicians are under such strain and reveal why so many proposed solutions have fallen short. Read the article. PERSPECTIVE The Doctor’s Oldest Tool E.H. Geng For a primary care physician, widespread Covid denialism triggers memories of a patient dying of AIDS who insisted that HIV was not the cause of the disease. Getting through to him had turned out to be a matter of human relations rather than scientific facts. Read the article.

FACEBOOK Case 39-2021: A 26-Year-Old Woman with Respiratory Failure and Altered Mental Status TWITTER Third BNT162b2 Vaccination Neutralization of SARS-CoV-2 Omicron Infection INSTAGRAM Adolescents, Parents, and Covid-19 Vaccination — Who Should Decide?

ORIGINAL ARTICLE

Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients R.L. Gottlieb and Others Among nonhospitalized patients with Covid-19–related symptoms that began less than a week previously, a 3-day course of remdesivir resulted in an 87% lower risk of hospitalization or death than placebo. Adverse effects in the remdesivir group were similar to those in the placebo group. Read the article.

PERSPECTIVE Calling Out Aversive Racism in Academic Medicine

C.L. Chen, G.J. Gold, M. Cannesson, and J.M. Lucero

Aversive racism is defined as exhibiting racist tendencies while denying that one’s thoughts, behaviors, or motives are racist. Aversive racism is pervasive in academic medicine and impedes diversity, equity, and inclusion efforts. Read the article.

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Chlorthalidone in Advanced Chronic Kidney Disease

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Physician Jobs January 1, 2022 Neurology Colorado Seeking experienced neurointerventional provider in Loveland

UCHealth is establishing a mechanical thrombectomy-capable stroke center at Medical Center of the Rockies in Loveland CO. An experienced neurointerventional provider, with a strong interest in program development, serving as medical director for the program is being sought for full-time employment at an established certified Primary Stroke Center.... Hematology Colorado

Seeking physician to join growing department in Greeley

The UCHealth Cancer Care team, which includes hematology/oncology physicians, radiation oncologists and a comprehensive supportive care team for patients, is ready to welcome a new hematologist/oncologist in our growing department in Greeley, Colorado as well as assist in our outreach efforts in southwest Nebraska. In your practice, you will provide general hematology and oncology care with the ability to develop.... Looking for a new practice opportunity? View these jobs and other listings at NEJM CareerCenter. Search now for both permanents and locum tenens job in many specialties.

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Weekend Briefing January 8, 2022

IMAGES IN CLINICAL MEDICINE A 48-year-old woman presented with fatigue and painful, swollen, whitened gums. Her white-cell count was 225,000 per cubic millimeter, and peripheral-blood flow cytometry and bone marrow biopsy revealed 89% myeloblasts. A diagnosis of acute monocytic leukemia was made, and the gingival swelling abated with chemotherapy. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Eltrombopag Added to Immunosuppression in Severe Aplastic Anemia REVIEW ARTICLE Snake Envenomation CLINICAL PROBLEM-SOLVING Confused about Confusion FIND MORE CME »

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PERSPECTIVE Reengineering GME in a Pandemic — Looking Back, and Forward D.F. Weinstein Both the challenges and bright spots of Covid’s impact on graduate medical education provide important lessons. We can mine lessons learned during this crisis to better protect trainees and their education during future emergencies and to improve GME overall. Read the article. PERSPECTIVE Expanded Lung and Colorectal Cancer Screening — Ensuring Equity and Safety under New Guidelines D.M. Horn and J.S. Haas New guidelines recommend expansions of the populations that should undergo screening for lung or colorectal cancer. Without other changes, a substantial increase in screening could exacerbate inequities in access and delay follow-up of abnormal test results. Read the article.

FACEBOOK Effect of Covid-19 Vaccination on Transmission of Alpha and Delta Variants TWITTER Quick Take: Chlorthalidone in Advanced Chronic Kidney Disease INSTAGRAM Covid-19’s Devastating Effect on Tuberculosis Care — A Path to Recovery

CORRESPONDENCE Effectiveness of BNT162b2 Vaccine against Omicron Variant in South Africa S. Collie and Others Using a test-negative study design focused on the period of dominance of the B.1.1.529 (omicron) variant in South Africa, investigators found that two doses of the BNT162b2 vaccine had an efficacy of 50 to 70% against hospitalization caused by omicron in Gauteng province. Read the article.

PERSPECTIVE The Patchwork U.S. Public Health System

M. Wallace and J.M. Sharfstein

The U.S. public health system is an uneven patchwork. In the shadow of a pandemic, understanding this haphazard architecture is a step toward elucidating the U.S. paradox of enormous health expenditures but poor outcomes for population health. Read the article.

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Eltrombopag in Severe Aplastic Anemia

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Physician Jobs January 8, 2022 Family Medicine Wisconsin Join group of 10 physicians in Madison SSM Health Dean Medical Group, a 500-physician multispecialty group, is looking for a Family Medicine physician to join our ten Family Physicians at the West Clinic in Madison, WI. Additional details include: Outpatient Opportunity; Established Hospitalist program which admits and cares for the hospital patients; Excellent work/life balance; Saturday morning clinic is shared by the providers and rotated.... Family Medicine Wisconsin Seeking FM physician for Wisconsin Dells practice SSM Health Dean Medical Group, a 500+ physician multispecialty group, is seeking a Family Physician to join its clinic in Wisconsin Dells, WI. Additional details: We would like to invite you to share that gift as part of the Family Medicine team at SSM Health Dean Medical Group in Wisconsin. We are seeking a talented, engaged, and committed Board Eligible or Board Certified FM Physician....

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Weekend Briefing January 15, 2022

Announcing NEJM Evidence, a new digital journal from NEJM Group

NEJM Evidence, a new journal from NEJM Group, presents innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making. Explore the free first issue’s innovative studies and special features including Curbside Consults, Tomorrow’s Trial, Patient Platform, Stats STAT! video, and more. Continuously published with a new issue each month, sign up to receive a weekly email with the latest from the front lines of medical research.

IMAGES IN CLINICAL MEDICINE A 59-year-old man presented with fatigue and hyperpigmentation on his palms and soles. Physical examination showed a smooth tongue with areas of darkening. Laboratory tests showed pancytopenia, a low vitamin B12 level, and an elevated intrinsic factor antibody level, findings consistent with vitamin B12 deficiency due to autoimmune gastritis. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Fractional Flow Reserve–Guided PCI as Compared with Coronary Bypass Surgery REVIEW ARTICLE Biologic Therapies for Severe Asthma

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 1-2022: A 67-Year-Old Man with Motor Neuron Disease and Odd Behaviors during Sleep FIND MORE CME »

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PERSPECTIVE Combating Structural Inequities — Diversity, Equity, and Inclusion in Clinical and Translational Research L.E. Boulware and Others If the clinical and translational research enterprise is to help resolve health crises and ensure that all people in the United States have the opportunity to live healthy lives, it must shift paradigms and begin to center equity, diversity, and inclusion in its work. Read the article. PERSPECTIVE Research Participation in Marginalized Communities — Overcoming Barriers K. Armstrong and C. Ritchie Despite an increased focus on community engagement in research, barriers persist, including burdensome institutional and federal policies regarding payment for research participation and inadequate mechanisms to support longitudinal commitments to community partners. Read the article. PERSPECTIVE Disability Inclusion as a Key Component of Research Study Diversity B. Swenor and J.A. Deal The Covid-19 pandemic has deepened commitments to enhancing the diversity of the populations participating in research studies. But people with disabilities have been left out of most of these initiatives. Read the article.

FACEBOOK Effectiveness of Covid-19 Vaccines over a 9-Month Period in North Carolina TWITTER SARS-CoV-2 Omicron Variant Neutralization in Serum from Vaccinated and Convalescent Persons INSTAGRAM Perspective: Obstacles to Physicians’ Emotional Health — Lessons from History

CLINICAL PRACTICE Rapid Diagnostic Testing for SARS-CoV-2 P.K. Drain

RDTs for SARS-CoV-2 — either molecular nucleic acid amplification tests or antigen-based immunoassays to detect proteins — are approved for persons with Covid-19 symptoms and asymptomatic persons with known exposure to SARS-CoV-2 or those in a high-transmission setting. Antigen-based tests have lower sensitivity than PCR tests, but they may correlate better with replication-competent virus. Read the article.

PERSPECTIVE Reengineering GME in a Pandemic — Looking Back, and Forward D.F. Weinstein

Both the challenges and bright spots of Covid’s impact on graduate medical education provide important lessons. We can mine lessons learned during this crisis to better protect trainees and their education during future emergencies and to improve GME overall. Read the article.

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Comparative Effectiveness of mRNA Covid-19 Vaccines

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Physician Jobs January 15, 2022

Family Medicine Wisconsin Join group of 10 physicians in Madison SSM Health Dean Medical Group, a 500-physician multispecialty group, is looking for a Family Medicine physician to join our ten Family Physicians at the West Clinic in Madison, WI. Additional details include: Outpatient Opportunity; Established Hospitalist program which admits and cares for the hospital patients; Excellent work/life balance; Saturday morning clinic is shared by the providers and rotated.... Family Medicine Wisconsin Seeking FM physician for Wisconsin Dells practice SSM Health Dean Medical Group, a 500+ physician multispecialty group, is seeking a Family Physician to join its clinic in Wisconsin Dells, WI. Additional details: We would like to invite you to share that gift as part of the Family Medicine team at SSM Health Dean Medical Group in Wisconsin. We are seeking a talented, engaged, and committed Board Eligible or Board Certified FM Physician.... Looking for a new practice opportunity? View these jobs and other listings at NEJM CareerCenter. Search now for both permanents and locum tenens job in many specialties.

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Weekend Briefing January 22, 2022

IMAGES IN CLINICAL MEDICINE A 35-year-old woman with idiopathic pulmonary arterial hypertension and a known pulmonary-artery aneurysm presented with a 1-day history of chest pain. A new pulmonary-artery dissection flap was observed on imaging. She received extracorporeal membrane oxygenation as a bridge to bilateral lung transplantation and replacement of the main pulmonary artery and valve. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Randomized Trial of Closed-Loop Control in Very Young Children with Type 1 Diabetes

CLINICAL PRACTICE Rapid Diagnostic Testing for SARS-CoV-2

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 2-2022: A 70-Year-Old Man with a Recurrent Left Pleural Effusion FIND MORE CME »

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PERSPECTIVE Transparency and the Doctor–Patient Relationship — Rethinking Conflict-of-Interest Disclosures E.Y. Adashi, I.G. Cohen, and J.T. Elberg To reduce the harm associated with improper financial relationships between manufacturers and physicians, practitioners could be required to disclose such relationships directly to patients. Read the article.

FACEBOOK Immunogenicity and Reactogenicity of Vaccine Boosters after Ad26.COV2.S Priming TWITTER Quick Take: Comparative Effectiveness of mRNA Covid-19 Vaccines INSTAGRAM Visual Abstract: Covid-19 Vaccine Effectiveness in New York State

ORIGINAL ARTICLE Duration of Protection against Mild and Severe Disease by Covid-19 Vaccines N. Andrews and Others A test-negative case–control study involving more than 6 million persons in England who received two doses of the ChAdOx1-S or BNT162b2 vaccine (interval, 3 to 12 weeks) showed high vaccine effectiveness against hospitalization and death from Covid-19 at 20 weeks or more after vaccination. Protection against infection waned. Waning was greater in older persons and those with underlying risk factors. Read the article.

PERSPECTIVE Combating Structural Inequities — Diversity, Equity, and Inclusion in Clinical and Translational Research L.E. Boulware and Others

If the clinical and translational research enterprise is to help resolve health crises and ensure that all people in the United States have the opportunity to live healthy lives, it must shift paradigms and begin to center equity, diversity, and inclusion in its work. Read the article.

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Closed-Loop Therapy in Young Children with Type 1 Diabetes

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Physician Jobs January 22, 2022

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Weekend Briefing January 29, 2022

IMAGES IN CLINICAL MEDICINE A 48-year-old woman with advanced cirrhosis presented with fatigue. She was found to have nonimmune hemolytic anemia with acanthocytes, or spur cells, on a peripheral-blood smear. A diagnosis of spur-cell hemolytic anemia was made. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients ORIGINAL ARTICLE Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation INTERACTIVE MEDICAL CASE Up in the Air

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 3-2022: A 14-Year-Old Boy with Fever, Joint Pain, and Abdominal Cramping FIND MORE CME »

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PERSPECTIVE Trade-offs and Policy Options — Using Insights from Economics to Inform Public Health Policy T. Green and A.S. Venkataramani Although public health practitioners and researchers focus primarily on improving health, economists view health as but one important component of what people may value. This insight is a key aspect of economics’ utility for informing public health policy. Read the article. PERSPECTIVE Automatic Insurance Policies — Important Tools for Preventing Coverage Loss A. McIntyre and M. Shepard Policies that broaden eligibility for affordable coverage, though necessary, do little to address the administrative burdens involved in securing and maintaining coverage. Automatic insurance policies could remove barriers and make it easier for people to stay insured. Read the article. PERSPECTIVE The Care I Needed J. Gregg When a physician finds herself in pain and in need of health care, she discovers both the frustrations of telehealth and some moments of humanity and grace with physicians and patients alike. How do we reconcile these healing moments with our broken system of care? Read the article.

FACEBOOK Case 3-2022: A 14-Year-Old Boy with Fever, Joint Pain, and Abdominal Cramping TWITTER Homologous and Heterologous Covid-19 Booster Vaccinations INSTAGRAM

Case 2-2022: A 70-Year-Old Man with a Recurrent Left Pleural Effusion

ORIGINAL ARTICLE

Immunogenicity and Reactogenicity of Vaccine Boosters after Ad26.COV2.S Priming R.S.G. Sablerolles and Others A trial involving 434 participants examined the effects of no boosting or of boosting with one of the three approved Covid-19 vaccines — Ad26.COV2.S, mRNA-1273, or BNT162b2 — 3 months after the primary vaccination. All the vaccines increased neutralizing-antibody levels and T-cell responses, but the increases with the mRNA vaccines were higher. Read the article.

PERSPECTIVE Universal Coronavirus Vaccines — An Urgent Need D.M. Morens, J.K. Taubenberger, and A.S. Fauci

We need a research approach that can characterize the global coronaviral universe, characterize the natural history and pathogenesis of coronaviruses in animals and humans, and apply this information in developing broadly protective “universal” vaccines. Read the article. LISTEN TO THE PODCAST »

CV and Cancer Risk with Tofacitinib in RA

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Physician Jobs January 29, 2022 Emergency Medicine Ohio Seeking 2 BC/BE physicians for Cleveland opening Louis Stokes Cleveland VA Medical Center Section of Acute Medicine is seeking two full-time Board Certified/Board Eligible staff physicians interested in a Nocturnist Acute Medicine position. Primary clinical responsibilities include off-hours and overnight patient care duties on the inpatient medical wards and Community Living Center post-acute and dementia care units in addition to solo overnight coverage.... Psychiatry Colorado BE/BC physician sought for Loveland practice Step into an established, successful practice with Banner Medical Group in Loveland, CO. This is a unique opportunity to be a part of a dynamic quickly growing Psychiatric Team doing great things! Based out of McKee Medical Center in Loveland, you will provide inpatient care to adult psychiatric patients including admission, daily rounding, and discharge. Opportunity to also provide care in an outpatient setting....

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Weekend Briefing February 5, 2022

IMAGES IN CLINICAL MEDICINE A 40-year-old man with a history of neurofibromatosis type 1 presented for a routine eye examination. On examination of the anterior segment, he was found to have multiple brown iris nodules consistent with Lisch nodules. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Betibeglogene Autotemcel Gene Therapy for Non–β0/β0 Genotype β-Thalassemia ORIGINAL ARTICLE Nivolumab Combination Therapy in Advanced Esophageal Squamous-Cell Carcinoma REVIEW ARTICLE Fever of Unknown Origin FIND MORE CME »

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PERSPECTIVE Racial Biology and Medical Misconceptions A. Deyrup and J.L. Graves, Jr. Much of the medical community continues to view socially defined races as if they are accurate reflections of biologic variation; the racialization of disease is further propagated in textbooks and licensing exams. How do we solve this deeply ingrained problem? Read the article. PERSPECTIVE Beyond Diversity — Time for New Models of Health J.L. Delgado Hispanic Americans’ health profile doesn’t adhere to the paradigm in which minority ethnic or poverty status determines poor health outcomes. But the U.S. health enterprise has not used this information to recalibrate or rethink our models of health and risk factors. Read the article. PERSPECTIVE Roulette T.J. McGarrity While facing an ophthalmic cancer diagnosis and treatment of his own, a gastroenterologist refocuses his good eye on his patients, helping them play whatever cards they have been dealt, as his scar is etched in survivor’s guilt. Read the article.

FACEBOOK Fever of Unknown Origin TWITTER Perspective: Challenges in Inferring Intrinsic Severity of the SARS-CoV-2 Omicron Variant INSTAGRAM Medical Conditions and High-Altitude Travel

CORRESPONDENCE Myocarditis after BNT162b2 Vaccination in Israeli Adolescents D. Mevorach and Others In an active surveillance program from the Israeli Ministry of Health, estimates of myocarditis risk in the 21 days after a first and second dose of vaccine were, respectively, 0.56 per 100,000 and 8.09 per 100,000 among male recipients and 0 per 100,000 and 0.69 per 100,000 among female recipients. Read the article.

PERSPECTIVE Trade-offs and Policy Options — Using Insights from Economics to Inform Public Health Policy

T. Green and A.S. Venkataramani

Although public health practitioners and researchers focus primarily on improving health, economists view health as but one important component of what people may value. This insight is a key aspect of economics’ utility for informing public health policy. Read the article.

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Early-Childhood Mosquito Net Use and Long-Term Survival

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Physician Jobs February 5, 2022 Chiefs/Directors/Dept. Heads Massachusetts Opportunity to lead Family Practice in Worcester Reliant Medical Group is seeking a physician leader to join our growing care team in Worcester, Massachusetts as Site Chief of Family Practice. As part of the Optum family, we are a physician-led multispecialty practice leading healthcare transformation nationally through engaged and purpose-driven physicians, while providing care locally within our communities. Join an organization supported by a global care company.... Family Medicine Indiana Seeking Primary Care Physician for Lafayette practice As a part of the OptumCare network, American Health Network is seeking a Primary Care Physician to join our growing team in Indiana with multiple practice locations available. At Optum, we are transforming healthcare nationally while providing physician-led care locally. Work with the largest care delivery organization in the world and start doing your life's best work.....

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Weekend Briefing February 13, 2022

IMAGES IN CLINICAL MEDICINE A 60-year-old man with HIV infection presented with a 4-month history of lesions on his eyelids and face. Intracytoplasmic eosinophilic inclusion bodies were observed in a biopsy specimen, confirming a diagnosis of molluscum contagiosum. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Survival with Cemiplimab in Recurrent Cervical Cancer REVIEW ARTICLE Marginal-Zone Lymphomas

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 4-2022: A 55-Year-Old Man with Bilateral Hearing Loss and Eye Redness FIND MORE CME »

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PERSPECTIVE Health Care Safety during the Pandemic and Beyond — Building a System That Ensures Resilience L.A. Fleisher, M. Schreiber, D. Cardo, and A. Srinivasan Since the pandemic began, U.S. health care safety has declined severely, suggesting that our system lacks a sufficiently resilient safety culture and infrastructure. We need to build a more resilient delivery system, capable of maintaining high safety levels in crises. Read the article. PERSPECTIVE Inherited Patients Taking Opioids for Chronic Pain — Considerations for Primary Care P.O. Coffin and A.M. Barreveld Patients who have taken opioids for years for chronic pain must be treated differently from those who have not because such therapies cause profound physiological and neurologic changes. Reflexive approaches to tapering or discontinuing opioids should be avoided. Read the article. PERSPECTIVE Home Help R. Srivastava When her mother is discharged from rehab after a fall that caused multiple pelvic fractures, a doctor experiences first-hand the frustrations of getting the requisite home help up and running. Even in a generous health system, time, advocacy, and resources are required. Read the article.

FACEBOOK Protection against the Omicron Variant from Previous SARS-CoV-2 Infection TWITTER Calm before the Storm INSTAGRAM Marginal-Zone Lymphomas

PERSPECTIVE

Challenges in Inferring Intrinsic Severity of the SARS-CoV-2 Omicron Variant

R.P. Bhattacharyya and W.P. Hanage Omicron’s spread in South Africa has led to fewer hospitalizations and deaths per documented case than were seen during previous waves. But caution is warranted when it comes to making inferences about omicron’s intrinsic severity using population-level observations. Read the article.

PERSPECTIVE Racial Biology and Medical Misconceptions

A. Deyrup and J.L. Graves, Jr.

Much of the medical community continues to view socially defined races as if they are accurate reflections of biologic variation; the racialization of disease is further propagated in textbooks and licensing exams. How do we solve this deeply ingrained problem? Read the article.

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Oral Molnupiravir to Treat Mild-to-Moderate Covid-19

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Physician Jobs February 12, 2022

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Weekend Briefing February 19, 2022

IMAGES IN CLINICAL MEDICINE A 21-year-old woman presented with abdominal pain and constipation and was found to have hypertension with renal failure. Imaging showed an obstructive mass. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma REVIEW ARTICLE Electroconvulsive Therapy

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 5-2022: A 65-Year-Old Woman with Rapidly Progressive Weakness in the Right Arm and Recurrent Falls FIND MORE CME »

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PERSPECTIVE Stabilizing Health Care’s Share of the GDP J. Skinner, E. Cahan, and V.R. Fuchs Since the 1980s, policymakers and private health insurers have implemented various interventions aimed at “bending the cost curve.” But the long-term growth of health care expenditures as a share of the GDP has continued, with negative implications for American workers. Read the article.

FACEBOOK Case 4-2022: A 55-Year-Old Man with Bilateral Hearing Loss and Eye Redness TWITTER Electroconvulsive Therapy INSTAGRAM Visual Abstract: Pembrolizumab for Early Triple-Negative Breast Cancer

CORRESPONDENCE

Protection against the Omicron Variant from Previous SARS-CoV-2 Infection

H.N. Altarawneh and Others Using a national Covid-19 database in Qatar, investigators found that previous SARS-CoV-2 infection provided protection against subsequent reinfection that ranged from 85% to 92% for the alpha, beta, and delta strains and was approximately 60% protective against the omicron variant. Previous infection also appeared to protect against severe disease, hospitalization, and death. Read the article.

PERSPECTIVE Health Care Safety during the Pandemic and Beyond — Building a System That Ensures Resilience

L.A. Fleisher, M. Schreiber, D. Cardo, and A. Srinivasan

Since the pandemic began, U.S. health care safety has declined severely, suggesting that our system lacks a sufficiently resilient safety culture and infrastructure. We need to build a more resilient delivery system, capable of maintaining high safety levels in crises. Read the article.

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LentiGlobin for Sickle Cell Disease

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Physician Jobs February 19, 2022

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Weekend Briefing February 26, 2022

IMAGES IN CLINICAL MEDICINE A 50-year-old man underwent intubation for hypercarbic respiratory failure. Multiple pale, rubbery, branching casts were removed by means of bronchoscopy, and the patient ultimately received a diagnosis of plastic bronchitis. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Effectiveness of BNT162b2 Vaccine against Critical Covid-19 in Adolescents REVIEW ARTICLE Reassessing Human Adipose Tissue

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 6-2022: A 68-Year-Old Man with Fatigue, Weight Loss, and Hyperglycemia FIND MORE CME »

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PERSPECTIVE Fundamentals of Public Health: U.S. Public Health Law — Foundations and Emerging Shifts

M.M. Mello and W.E. Parmet

The Covid pandemic has focused attention on the complex relationship between individual rights and public health protection. This tension has long occupied U.S. courts, but today some long-settled understandings in public health law are being contested and disrupted. Read the article. PERSPECTIVE Oral Health for All — Realizing the Promise of Science R.N. D’Souza, F.S. Collins, and V.H. Murthy The highest burden of dental and oral disease is shouldered by marginalized and chronically underserved groups. Moving forward, we will need to forge a path for oral health care that prioritizes overall health, prevention, expanded access, affordability, and equity. Read the article. PERSPECTIVE Holding the Baby K.M. Puterbaugh When an obstetrician with a personal history of maternal struggle cares for a patient facing a repeated painful tragedy, she realizes she can help by responding not as a physician, but as a mother. Read the article.

FACEBOOK Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19 TWITTER Perspective: Inherited Patients on Opioids for Chronic Pain — Considerations for Primary Care INSTAGRAM Perspective: A Call for Antiracist Action

ORIGINAL ARTICLE Protection against SARS-CoV-2 after Covid-19 Vaccination and Previous Infection V. Hall and Others Among more than 35,000 health care workers, those who received two doses of BNT162b2 vaccine had a high level of protection against serious Covid-19, regardless of the between-dose interval, but efficacy began to wane after 6 months. Immunity in vaccinated, previously infected persons was more effective and durable (>1 year) than that in vaccinated persons who had not been infected. Read the article.

PERSPECTIVE State Restrictions on Mifepristone Access — The Case for Federal Preemption P.J. Zettler and A. Sarpatwari States have long engaged in efforts to restrict mifepristone access. But medication-abortion laws, particularly those that are grounded in drug-safety arguments, encroach on the FDA’s purview over drug safety and effectiveness and may be vulnerable to legal challenges. Read the article. LISTEN TO THE PODCAST »

Effectiveness of Covid-19 Vaccine in Adolescents

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Physician Jobs February 26, 2022

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Weekend Briefing March 5, 2022

IMAGES IN CLINICAL MEDICINE A 31-year-old man presented with progressive digital clubbing and bony proliferation of his fingers and toes. Evaluation for secondary causes was negative, and primary hypertrophic osteoarthropathy was diagnosed. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults CLINICAL PRACTICE Chronic Pancreatitis CLINICAL PROBLEM-SOLVING Craving Answers FIND MORE CME »

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PERSPECTIVE Step Therapy’s Balancing Act — Protecting Patients while Addressing High Drug Prices R.E. Sachs and M.A. Kyle The debate regarding step therapy reflects a tension between two important policy goals: safeguarding patients’ access to high-quality care and constraining spending on prescription drugs, including by limiting the overuse of costly medications with uncertain efficacy. Read the article. PERSPECTIVE The Catfish King M.A. Pacult and S. Williams In this Graphic Perspective, a medical student gets a taste of the life of an old-fashioned country doctor — the simplicity, the deep human connections … and the threat of extinction, as corporate medicine makes inroads into rural areas. Read the article.

FACEBOOK Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant TWITTER Reassessing Human Adipose Tissue INSTAGRAM Cellular Memories — More Than Skin Deep

ORIGINAL ARTICLE

Population Immunity and Covid-19 Severity with Omicron Variant in South Africa S.A. Madhi and Others In Gauteng, where the omicron variant was first identified, two thirds of unvaccinated residents were seropositive for SARS-CoV-2, which indicates past infection. Omicron peaked just 1 month after being detected; hospitalizations and deaths did not increase in proportion to cases. Whether this change is related to widespread preexisting immunity or to features of the virus is unclear. Read the article.

PERSPECTIVE U.S. Public Health Law — Foundations and Emerging Shifts

M.M. Mello and W.E. Parmet

The Covid pandemic has focused attention on the complex relationship between individual rights and public health protection. This tension has long occupied U.S. courts, but today some long-settled understandings in public health law are being contested and disrupted. Read the article.

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Troponin I after Cardiac Surgery and 30-Day Mortality

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Physician Jobs March 5, 2022 Nephrology Massachusetts Nephrology opportunity in Cambridge Cambridge Health Alliance (CHA), an award-winning public healthcare system, is recruiting a Nephrologist to join our existing nephrology team within the Department of Medicine. CHA provides innovative primary, specialty and emergency care to our diverse patient population through an established network of outpatient clinics, two full service hospitals and urgent care services. CHA is a teaching affiliate of both Harvard Medical School.... Gastroenterology Massachusetts Join team of 7 MDs in Cambridge practice Cambridge Health Alliance (CHA), an award-winning public healthcare system, is recruiting a Gastroenterologist to join our existing team of 7 MDs and 3 PAs, within the Department of Medicine. CHA provides innovative primary, specialty and emergency care to our diverse patient population through an established network of outpatient clinics, two full service hospitals and urgent care services,....

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Weekend Briefing March 12, 2022

IMAGES IN CLINICAL MEDICINE A 48-year-old woman from rural India presented with a 6-month history of diarrhea and a symmetric, photosensitive rash on her neck and forearms. On the basis of her symptoms and the typical appearance of the Casal’s necklace rash, pellagra was diagnosed. Her condition improved with intravenous vitamin B complex. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Shorter Treatment for Nonsevere Tuberculosis in African and Indian Children ORIGINAL ARTICLE Thyroidectomy without Radioiodine in Patients with Low-Risk Thyroid Cancer

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 7-2022: A 65-Year-Old Woman with Depression, Recurrent Falls, and Inability to Care for Herself FIND MORE CME »

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PERSPECTIVE A Malaria Vaccine for Africa — An Important Step in a Century-Long Quest P.L. Alonso and K.L. O’Brien Malaria continues to devastate people’s health and livelihoods worldwide. In October 2021, the WHO for the first time recommended the large-scale use of a malaria vaccine for children living in areas with moderate-to-high malaria transmission. Read the article. PERSPECTIVE Where Americans Die — Is There Really “No Place Like Home”? M.W. Wachterman, E.A. Luth, R.S. Semco, and J.S. Weissman The perception that a good death is one that occurs at home is ingrained in our cultural and social history. But palliative care clinicians have begun to question this idea. What is needed is high-quality end-of-life care that aligns with individual goals and needs. Read the article. PERSPECTIVE The Patient Resident N.Z. Rabinowitz Steele The patient’s eyes close as his diagnosis sinks in. The resident sits with him in a silence filled with racing fears of the unknown. It’s that moment when everything has changed for this man: he’s gone from before to after. The resident knows this moment all too well. Read the article.

FACEBOOK Effect of mRNA Vaccine Boosters against SARS-CoV-2 Omicron Infection in Qatar TWITTER Quick Take: Balanced Multielectrolyte Solution vs. Saline in ICUs INSTAGRAM Extracorporeal Kidney-Replacement Therapy for Acute Kidney Injury

ORIGINAL ARTICLE

Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant N. Andrews and Others In a large case–control study in England, immunity to the omicron variant was very low and less than that to the delta variant 20 weeks after the second vaccine dose, regardless of the initial vaccine type. A booster dose of one of the mRNA vaccines improved efficacy to approximately 65 to 70%, but protection waned over a 10-week period. Read the article.

PERSPECTIVE Step Therapy’s Balancing Act — Protecting Patients while Addressing High Drug Prices

R.E. Sachs and M.A. Kyle

The debate regarding step therapy reflects a tension between two important policy goals: safeguarding patients’ access to high-quality care and constraining spending on prescription drugs, including by limiting the overuse of costly medications with uncertain efficacy. Read the article.

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Shorter Treatment for Nonsevere TB in Children

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Weekend Briefing March 19, 2022

Explore Free Content from NEJM Evidence

NEJM Evidence, a new journal from NEJM Group, offers unique new features that spark debate, challenge the status quo, and connect evidence with medical practice. Explore the free first issue with innovative studies and special features including Tomorrow’s Trial, Patient Platform, Stats STAT! video, and more. Stay in touch with the front lines of medical research: sign up for a weekly email alert and recommend a subscription for your institution.

IMAGES IN CLINICAL MEDICINE A 42-year-old man with untreated HIV infection presented with ulcerating skin lesions and systemic symptoms. The rapid plasma reagin titer was 1:512, and a skin-biopsy sample showed spirochetes. A diagnosis of malignant syphilis, an uncommon form of secondary syphilis, was made. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Homologous and Heterologous Covid-19 Booster Vaccinations REVIEW ARTICLE Cryptogenic Organizing Pneumonia

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 8-2022: A 54-Year-Old Woman with Episodes of Swelling FIND MORE CME »

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PERSPECTIVE Digital Inclusion as Health Care — Supporting Health Care Equity with Digital-Infrastructure Initiatives J.A. Rodriguez, C. Shachar, and D.W. Bates Digital inclusion is becoming intertwined with health care equity. The Infrastructure Investment and Jobs Act addresses drivers of digital health disparities, offers opportunities for community-based digital inclusion, and could be a lever for improving access to care. Read the article. PERSPECTIVE NPO A. Aalipour Mr. O.’s achalasia had worsened beyond what his body could compensate for. His saliva kept entering his lungs, his oxygen levels dropping dangerously each time. He needed endoscopy, urgently. The problem was that Mr. O. didn’t share our concern. And he wanted to eat. Read the article.

FACEBOOK Efficacy of Antiviral Agents against the SARS-CoV-2 Omicron Subvariant BA.2 TWITTER Visual Abstract: Effectiveness of Covid-19 Vaccines over a 9-Month Period INSTAGRAM Videos in Clinical Medicine: Use of eFAST in Patients with Injury to the Thorax or Abdomen

ORIGINAL ARTICLE

Effect of mRNA Vaccine Boosters against SARS-CoV-2 Omicron Infection in Qatar L.J. Abu-Raddad and Others In persons who had received the BNT162b2 vaccine in Qatar, the incidence of infection with the omicron variant after 35 days of observation was 2.4% among those who had received three doses and 4.5% among those who were vaccinated but not boosted; among those who had received the mRNA-1273 vaccine, the incidence was 1.0% with a boost and 1.9% without. Read the article.

PERSPECTIVE Where Americans Die — Is There Really “No Place Like Home”?

M.W. Wachterman, E.A. Luth, R.S. Semco, and J.S. Weissman

The perception that a good death is one that occurs at home is ingrained in our cultural and social history. But palliative care clinicians have begun to question this idea. What is needed is high-quality end-of-life care that aligns with individual goals and needs. Read the article.

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Donidalorsen for Hereditary Angioedema

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Physician Jobs March 19, 2022

Nephrology Massachusetts Nephrology opportunity in Cambridge Cambridge Health Alliance (CHA), an award-winning public healthcare system, is recruiting a Nephrologist to join our existing nephrology team within the Department of Medicine. CHA provides innovative primary, specialty and emergency care to our diverse patient population through an established network of outpatient clinics, two full service hospitals and urgent care services. CHA is a teaching affiliate of both Harvard Medical School.... Gastroenterology Massachusetts

Gastroenterology Massachusetts Cambridge Health Alliance (CHA), an award-winning public healthcare system, is recruiting a Gastroenterologist to join our existing team of 7 MDs and 3 PAs, within the Department of Medicine. CHA provides innovative primary, specialty and emergency care to our diverse patient population through an established network of outpatient clinics, two full service hospitals and urgent care services....

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Weekend Briefing March 26, 2022

IMAGES IN CLINICAL MEDICINE A 37-year-old man with cystinuria and a recent urinary tract infection presented to the nephrology clinic for follow-up. Microscopic examination of a spun urine specimen showed concomitant triple phosphate and cystine crystals. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Single-Dose Liposomal Amphotericin B Treatment for Cryptococcal Meningitis CLINICAL PRACTICE Current Management of Glycemia in Children with Type 1 Diabetes Mellitus

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 9-2022: A 56-Year-Old Woman with Fever, Myalgias, Diarrhea, and Cough FIND MORE CME »

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PERSPECTIVE Restrictive State Abortion Bans — A Reproductive Injustice B. Wilkinson, C. Onwuzurike, and D. Bartz The Supreme Court recently heard oral arguments in Dobbs v. Jackson Women’s Health Organization, which challenges the essential holdings of Roe v. Wade. If Roe is reversed, already stark inequities will be exacerbated. Read the article. PERSPECTIVE “The Sombre Aspect of the Entire Landscape” — Epidemiology and the Faroe Islands P. Klass and A.J. Ratner In 1846, Peter Ludvig Panum investigated a measles epidemic in the Faroe Islands, where the unusual geography and isolated population facilitated analysis of the spread of a highly contagious disease. Today, study of Covid-19 in the Faroes offers new epidemiologic lessons. Read the article.

FACEBOOK Images in Clinical Medicine: Pellagra TWITTER Unclouded Judgment — Global Health and the Moral Clarity of Paul Farmer INSTAGRAM Images in Clinical Medicine: Lymphatic Plastic Bronchitis

CORRESPONDENCE Neutralization Profile after Recovery from SARS-CoV-2 Omicron Infection A. Rössler, L. Knabl, D. von Laer, and J. Kimpel Although considerable data show cross-reactivity among antibodies generated by infection with the various SARS-CoV-2 variants of interest, a group of persons who were not previously vaccinated but were recovering from infection with the omicron BA.1 variant were found to have antibodies that were largely ineffective in neutralizing the other viral strains. Read the article.

PERSPECTIVE Digital Inclusion as Health Care — Supporting Health Care Equity with Digital-Infrastructure Initiatives

J.A. Rodriguez, C. Shachar, and D.W. Bates

Digital inclusion is becoming intertwined with health care equity. The Infrastructure Investment and Jobs Act addresses drivers of digital health disparities, offers opportunities for community-based digital inclusion, and could be a lever for improving access to care. Read the article.

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Single-Dose Liposomal Amphotericin B for Cryptococcal Meningitis

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Physician Jobs March 26, 2022 Chiefs/Directors/Dept. Heads Massachusetts Cambridge opening for Senior Director of Population Health CHA is recruiting a Senior Medical Director of Population Health Management Outcomes. As an integral part of the Population Health Management leadership team the incoming Senior Medical Director will provide oversight and guidance for population health performance goals and objectives. Work closely with the CMO and population health team to set priorities; Collaborate with clinical providers, staff, and others to improve utilization, quality of care.... Chiefs/Directors/Dept. Heads Massachusetts Seeking Director of new Neurodevelopmental Disorders Program in Cambridge The Department of Psychiatry at Cambridge Health Alliance (CHA), a primary affiliate of Harvard Medical School (HMS), is seeking a full-time child/adolescent psychiatrist to serve as the Director of the new Neurodevelopmental Disorders Program. The successful candidate will be an innovative, strategic leader with a national and/or international reputation in neurodevelopmental disorders and a passion for building a nationally recognized program in neurodevelopmental disorders....

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Weekend Briefing April 2, 2022

IMAGES IN CLINICAL MEDICINE A 63-year-old man undergoing stenting of the left common carotid artery had shivering, sweating, and confusion, as well as livedo reticularis on the left side of his face. Cholesterol embolization syndrome was diagnosed. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Single-Incision Mini-Slings for Stress Urinary Incontinence in Women ORIGINAL ARTICLE Higher-Dose Primaquine to Prevent Relapse of Plasmodium vivax Malaria

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 10-2022: A 78-Year-Old Man with Marked Ventricular Wall Thickening FIND MORE CME »

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PERSPECTIVE Ten Years of Choosing Wisely to Reduce Low-Value Care E.J. Rourke The Choosing Wisely initiative was a public relations win for the medical profession in 2012: doctors were stepping up to address low value and high costs in medicine. Today, it’s clear that making lists and publicizing them are not sufficient to reduce low-value care. Read the article. PERSPECTIVE After COP26 — Putting Health and Equity at the Center of the Climate Movement J.M. Balbus, C.J. McCannon, A. Mataka, and R.L. Levine The Department of Health and Human Services has made commitments to climate-change resilience in U.S. communities and decarbonization in our health systems, but myriad public and private organizations will have to be mobilized to achieve these goals. Read the article.

FACEBOOK BNT162b2 Protection against the Omicron Variant in Children and Adolescents TWITTER Two Phase 3 Trials of Baricitinib for Alopecia Areata INSTAGRAM Visual Abstract: Hydrocortisone to Improve Survival without Bronchopulmonary Dysplasia

ORIGINAL ARTICLE Effect of Early Treatment with Ivermectin among Patients with Covid-19 G. Reis and Others Multiple medications in common use have been considered for the treatment of Covid-19. In this double-blind, randomized, placebo-controlled trial, ivermectin that was administered within 7 days after Covid-19 symptom onset was shown not to be of any clinical benefit. Read the article.

PERSPECTIVE When Desperate Patients Go to Court for Unproven Treatments — The Battle for Hospital Independence C. Robertson and M. Houtz During the Covid-19 pandemic, patients have asked courts to compel hospitals to administer unproven therapies, including ivermectin. These lawsuits have called into question the judiciary’s role in medical decision making. Read the article. LISTEN TO THE PODCAST »

SARS-CoV-2 Infection after Vaccination and Previous Infection

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Physician Jobs April 2, 2022 Internal Medicine New York Outpatient IM needed to join team in Syracuse St. Joseph's Health is seeking a full-time outpatient Internal Medicine physician to join their team in Syracuse, New York. Join an established, comprehensive medical group that is committed to patient safety in a team approach model and serves an adult patient population. Enjoy unparalleled quality of life in the welcoming community of Syracuse, on the shores of beautiful Lake Ontario. Monday to Friday. 8:00 a.m. to 5:00 p.m.... Gastroenterology California BC Psychiatrist sought for Loma Linda opening Join Providence St. Joseph Hospital Eureka as a board-certified/board-eligible Gastroenterologist and be part of a compassionate team of providers located in Eureka, California. This is a great opportunity to join an advanced practice GI group that offers ERCP as well as endoscopic ultrasound. The facility is a full-service, Level III Trauma hospital that has a distinguished residency program where you will collaborate with general surgeons....

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Weekend Briefing April 9, 2022

IMAGES IN CLINICAL MEDICINE A 53-year-old man presented with itching of the right eye after gardening near a sheep farm. On examination, numerous mobile, translucent larvae were observed on the cornea and conjunctiva, as shown in a video. The larvae were removed and identified as Oestrus ovis, the sheep bot fly. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Endovascular Therapy for Acute Stroke with a Large Ischemic Region ORIGINAL ARTICLE Oral Tebipenem Pivoxil Hydrobromide in Complicated Urinary Tract Infection REVIEW ARTICLE Laboratory Diagnosis of Creutzfeldt–Jakob Disease FIND MORE CME »

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PERSPECTIVE How Can We Fully Realize SNAP’s Health Benefits? C. Gundersen and H. Seligman The inability to afford enough food is associated with numerous short-term and downstream health consequences. Recent increases in Supplemental Nutrition Assistance Program benefits are important, but barriers to food security remain for many households. Read the article. PERSPECTIVE The 2022 Child Nutrition Reauthorization — An Opportunity to Advance Children’s Health D. Mozaffarian and D.R. Glickman In 2022, Congress will undertake the process of reviewing and advancing legislation related to major child nutrition programs. Actions taken as part of Child Nutrition Reauthorization could support child health and health equity. Read the article. PERSPECTIVE From Resentment to Reconnection — Reflections on Caring for the Unvaccinated A.C. Garfinkel As cautious, fully vaccinated, but immunocompromised people die of Covid, a physician finds herself resenting the patients filling up the hospital after declining vaccination. Then an encounter with one very ill and frightened patient changes her perspective. Read the article.

FACEBOOK Protection with a Third Dose of mRNA Vaccine against SARS-CoV-2 Variants in Frontline Workers TWITTER Treatment for Mild Chronic Hypertension during Pregnancy INSTAGRAM Laboratory Diagnosis of Creutzfeldt–Jakob Disease

ORIGINAL ARTICLE

Protection by a Fourth Dose of BNT162b2 against Omicron in Israel Y.M. Bar-On and Others The spread of the omicron variant produced an increase in Covid-19 in Israel in late 2021, and a second boost of BNT162b2 vaccine was authorized in early January 2022. This article reports the efficacy of the fourth dose among Israeli citizens 60 years of age or older. Rates of severe illness were reduced by a factor of 3.5 in the fourth week after the second boost. Read the article.

PERSPECTIVE Ten Years of Choosing Wisely to Reduce Low-Value Care E.J. Rourke

The Choosing Wisely initiative was a public relations win for the medical profession in 2012: doctors were stepping up to address low value and high costs in medicine. Today, it’s clear that making lists and publicizing them are not sufficient to reduce low-value care. Read the article.

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Endovascular Therapy for Large Cerebral Infarction

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Physician Jobs April 9, 2022 Hematology Texas Seeking a board-eligible/board-certified Gynecology Oncology physician in Lubbock Seeking a board-eligible/board-certified Gynecology Oncology physician to join a team of seven medical oncologists and two radiation oncologists at Covenant Medical Group's well-established Joe Arrington Cancer Research and Treatment Center, a center of excellence bringing world-class cancer care to the West Texas and Eastern New Mexico region. Enjoy a meaningful career and outstanding quality of life.... Family Medicine New York Seeking BC/BE Family Medicine physician for Binghamton practice Lourdes Physician Network, an association of 15 primary care practices closely associated with Our Lady of Lourdes Memorial Hospital is seeking an outstanding BC/BE Family Medicine physician. Join a dedicated, innovative team of providers that enjoy collegial relationships with their fellow providers and a community that is extremely loyal to the Lourdes system of care. Come to Binghamton, the jewel in New York State's Southern Tier!....

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Weekend Briefing April 16, 2022

IMAGES IN CLINICAL MEDICINE A 30-year-old man with Crohn’s disease presented with multiple painful ulcers in his groin and perineal area. Physical examination of the skin showed deep, linear erosions. Skin swabs were negative for bacterial, fungal, herpes simplex viral, and tubercular infections. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19 ORIGINAL ARTICLE Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture CLINICAL PRACTICE Cancer-Associated Hypercalcemia FIND MORE CME »

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PERSPECTIVE Crossing Lines — A Change in the Leading Cause of Death among U.S. Children L.K. Lee, K. Douglas, and D. Hemenway For more than 60 years, motor vehicle crashes were the leading cause of injury-related death among young people. Beginning in 2017, however, firearm-related injuries took their place to become the most common cause of death from injury. Read the article.

FACEBOOK Video in Clinical Medicine: Prone Positioning of Intubated Patients with an Elevated Body-Mass Index TWITTER NEJM Quick Take: Oral Antibiotic for Complicated Urinary Tract Infection INSTAGRAM The Developmental Origin of Calcific Aortic Stenosis

ORIGINAL ARTICLE

Fourth Dose of BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting O. Magen and Others In Israel, the use of a fourth dose of BNT162b2 vaccine was initiated on January 3, 2022. As of February 18, a fourth dose produced a 45% reduction in the incidence of infection, a 55% reduction in symptomatic infection, a 68% reduction in hospitalization, and a 74% reduction in Covid-19–related death 7 to 30 days after vaccination. Read the article.

PERSPECTIVE How Can We Fully Realize SNAP’s Health Benefits?

C. Gundersen and H. Seligman

The inability to afford enough food is associated with numerous short-term and downstream health consequences. Recent increases in Supplemental Nutrition Assistance Program benefits are important, but barriers to food security remain for many households. Read the article.

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Nirmatrelvir for High-Risk Covid-19 Outpatients

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Physician Jobs April 16, 2022

Internal Medicine New York Outpatient IM needed to join team in Syracuse St. Joseph's Health is seeking a full-time outpatient Internal Medicine physician to join their team in Syracuse, New York. Join an established, comprehensive medical group that is committed to patient safety in a team approach model and serves an adult patient population. Enjoy unparalleled quality of life in the welcoming community of Syracuse, on the shores of beautiful Lake Ontario. Monday to Friday. 8:00 a.m. to 5:00 p.m.... Gastroenterology California

Seeking BC/BE Gastroenterologist for Eureka opening

Join Providence St. Joseph Hospital Eureka as a board-certified/board-eligible Gastroenterologist and be part of a compassionate team of providers located in Eureka, California. This is a great opportunity to join an advanced practice GI group that offers ERCP as well as endoscopic ultrasound. The facility is a full-service, Level III Trauma hospital that has a distinguished residency program where you will collaborate with general surgeons....

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Weekend Briefing April 23, 2022

IMAGES IN CLINICAL MEDICINE A 64-year-old man had mild diarrhea and an itchy, migratory, serpiginous rash develop after initiation of glucocorticoid therapy for malignant spinal cord compression. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Calorie Restriction with or without Time-Restricted Eating in Weight Loss ORIGINAL ARTICLE Reliever-Triggered Inhaled Glucocorticoid in Black and Latinx Adults with Asthma REVIEW ARTICLE Increasing Incidence of Early-Onset Colorectal Cancer FIND MORE CME »

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PERSPECTIVE The E-Cigarette Flavor Debate — Promoting Adolescent and Adult Welfare A.S. Friedman and K.E. Warner Although restricting access to nontobacco flavors of e-cigarettes may reduce vaping among adolescents and mitigate associated risks, it could also impede smoking cessation among adults, thereby increasing smoking-attributable mortality. But policy solutions could exist. Read the article. PERSPECTIVE Needlestick O.M.T. Davies and Others Already uncertain that she deserves to be in medical school, a medical student is thrown into despair when she accidentally sticks herself with a needle in the operating room in this Graphic Perspective. Read the article.

FACEBOOK Intramuscular AZD7442 (Tixagevimab–Cilgavimab) for Prevention of Covid-19 TWITTER Cancer-Associated Hypercalcemia INSTAGRAM Visual Abstract: Mitapivat vs. Placebo for Pyruvate Kinase Deficiency

ORIGINAL ARTICLE

Calorie Restriction with or without Time-Restricted Eating in Weight Loss D. Liu and Others This trial evaluated the efficacy and safety of time-restricted eating as compared with daily calorie restriction for weight loss at 1 year among patients with obesity. Time-restricted eating did not produce additional benefits with regard to the reduction from baseline in body weight, body fat, and metabolic risk factors as compared with daily calorie restriction. Read the article.

PERSPECTIVE Crossing Lines — A Change in the Leading Cause of Death among U.S. Children

L.K. Lee, K. Douglas, and D. Hemenway

For more than 60 years, motor vehicle crashes were the leading cause of injury-related death among young people. Beginning in 2017, however, firearm-related injuries took their place to become the most common cause of death from injury. Read the article.

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Inhaled Glucocorticoids in Black and Latinx Adults with Asthma

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Physician Jobs April 23, 2022 Hematology Texas Lubbock opportunity for Gynecology Oncology Physician

Seeking a board-eligible/board-certified Gynecology Oncology physician to join a team of seven medical oncologists and two radiation oncologists at Covenant Medical Group's well-established Joe Arrington Cancer Research and Treatment Center, a center of excellence bringing world-class cancer care to the West Texas and Eastern New Mexico region. Enjoy a meaningful career and outstanding quality of life.... Family Medicine New York

Seeking an outstanding BC/BE Family Medicine physician in Binghamton Lourdes Physician Network, an association of 15 primary care practices closely associated with Our Lady of Lourdes Memorial Hospital is seeking an outstanding BC/BE Family Medicine physician. Join a dedicated, innovative team of providers that enjoy collegial relationships with their fellow providers and a community that is extremely loyal to the Lourdes system of care....

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Weekend Briefing April 30, 2022

IMAGES IN CLINICAL MEDICINE A 56-year-old man with sickle cell disease presented for a routine eye examination. He was asymptomatic, but examination showed iris atrophy in both eyes. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

CT or Invasive Coronary Angiography in Stable Chest Pain ORIGINAL ARTICLE Prefusion F Protein–Based Respiratory Syncytial Virus Immunization in Pregnancy ORIGINAL ARTICLE Nasal High-Flow Therapy during Neonatal Endotracheal Intubation FIND MORE CME »

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PERSPECTIVE Designing Cures 2.0 — From Corridors to Cornerstones K.T. Kadakia and H.M. Krumholz The Cures 2.0 Act represents an opportunity to advance policies that encourage the use of digital tools, incorporate more efficient and patient-centered research designs, and clarify expectations for evidence generation throughout the life cycle of medical products. Read the article. PERSPECTIVE Real-World Evidence — Where Are We Now? J. Concato and J. Corrigan-Curay Notwithstanding ongoing confusion over the concepts of “real-world data” and “real-world evidence” in 2022, more than 5 years after the passage of the 21st Century Cures Act, the FDA continues to evaluate such data and evidence as it considers regulatory decisions. Read the article.

FACEBOOK Visual Abstract: Effectiveness of Covid-19 Vaccines against the Omicron Variant TWITTER Current Causes of Death in Children and Adolescents in the United States INSTAGRAM Images in Clinical Medicine: Congenital Diaphragmatic Hernia in an Adult

EDITORIAL Covid-19 Boosters — Where from Here? P.A. Offit Researchers in Israel found that in a study population with a median age of 72 years, protection against severe disease was improved by a fourth dose of mRNA vaccine during the wave of infections caused by the omicron variant. However, people are now confused about what it means to be fully vaccinated. Read the article.

PERSPECTIVE The E-Cigarette Flavor Debate — Promoting Adolescent and Adult Welfare

A.S. Friedman and K.E. Warner

Although restricting access to nontobacco flavors of e-cigarettes may reduce vaping among adolescents and mitigate associated risks, it could also impede smoking cessation among adults, thereby increasing smoking-attributable mortality. But policy solutions could exist. Read the article.

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CT in Stable Chest Pain

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Physician Jobs April 30, 2022 Internal Medicine New York Seeking full-time IM to join team in Syracuse St. Joseph's Health is seeking a full-time outpatient Internal Medicine physician to join their team in Syracuse, New York. Join an established, comprehensive medical group that is committed to patient safety in a team approach model and serves an adult patient population. Enjoy unparalleled quality of life in the welcoming community of Syracuse, on the shores of beautiful Lake Ontario.... Gastroenterology California Join an advanced practice group in Eureka Join Providence St. Joseph Hospital Eureka as a board-certified/board-eligible Gastroenterologist and be part of a compassionate team of providers located in Eureka, California. This is a great opportunity to join an advanced practice GI group that offers ERCP as well as endoscopic ultrasound. The facility is a full-service, Level III Trauma hospital that has a distinguished residency program where you will collaborate with general surgeons who perform....

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Weekend Briefing May 7, 2022

IMAGES IN CLINICAL MEDICINE A 53-year-old landscaper presented with a 4-month history of red, raised, itchy skin lesions on his left lower back and buttock. On examination, numerous verrucous nodules and plaques with crusting were seen. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Two Phase 3 Trials of Baricitinib for Alopecia Areata CLINICAL PRACTICE Nonspecific Low Back Pain CLINICAL PROBLEM-SOLVING Looking Back FIND MORE CME »

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PERSPECTIVE Supporting Innovation in Medicaid Policy — Interventions to Increase Adoption of RCTs J. Wallace, J. Smith, and A. Venkataramani Randomized, controlled trials remain underutilized within the Medicaid program, even though state Medicaid programs regularly implement new policies that require evaluation. What are the key barriers to implementing RCTs in Medicaid, and how can we increase their use? Read the article. PERSPECTIVE Unmute M. Nolan Early in the Covid pandemic, the lead staffer on a state ventilator allocation committee follows the group’s virtual deliberations, while attending to the constant needs of her children and trying to avert exposure from her husband who’s caring for patients in the ICU. Read the article.

FACEBOOK Graphic Perspective: Needlestick TWITTER Quick Take: CT in Stable Chest Pain INSTAGRAM Images in Clinical Medicine: Ocular Gonorrhea

ORIGINAL ARTICLE

Effect of Early Treatment with Ivermectin among Patients with Covid-19 G. Reis and Others

Multiple medications in common use have been considered for the treatment of Covid-19. In this double-blind, randomized, placebo-controlled trial, ivermectin that was administered within 7 days after Covid-19 symptom onset was shown not to be of any clinical benefit. Read the article.

PERSPECTIVE Designing Cures 2.0 — From Corridors to Cornerstones

K.T. Kadakia and H.M. Krumholz

The Cures 2.0 Act represents an opportunity to advance policies that encourage the use of digital tools, incorporate more efficient and patient-centered research designs, and clarify expectations for evidence generation throughout the life cycle of medical products. Read the article.

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Baricitinib for Alopecia Areata

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Physician Jobs May 7, 2022 Hospitalist Colorado Fort Carson opening for Hospitalists Evans Army Community Hospital is seeking HOSPITALISTS to meet the medical needs of our growing military and civilian population at Fort Carson, Colorado. Competitive salaries, generous benefits package, to include retirement and matched 401K programs, health/life/disability insurance, federal malpractice coverage, CME allowance, and an opportunity for professional growth are all part of this unique employment opportunity.... Cardiology Texas Opportunity for Non-Invasive Cardiologist at Fort Hood Serves as attending physician on the cardiology inpatient consult service. Attends inpatient multi-disciplinary rounds Monday-Friday of each work week. Must be available on-call from home up to 14 days per month. Must be available for telephonic or personal consultation for inpatient care when on call. Examines, diagnoses, treats, and follows outpatients with cardiology problems of all complexities.....

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Weekend Briefing May 14, 2022

After Roe — Contingency Planning for Patients and Trainees

A leaked Supreme Court draft opinion suddenly made the prospect of overturning Roe v. Wade an imminent reality. How have health care organizations and OB/GYN training programs been preparing for a post-Roe world? Lisa Harris, MD, PhD, Professor of Reproductive Health in Obstetrics and Gynecology and Director of the Fellowship Program in Family Planning at the University of Michigan, discusses her institution’s preparations in an interview with Rachel Gotbaum, a freelance health care journalist. Listen to the interview and read two free articles written by Dr. Harris on preparing for a post-Roe world.

IMAGES IN CLINICAL MEDICINE A 74-year-old man with end-stage kidney disease and coronary artery disease presented with decreased responsiveness, anorexia, and generalized weakness. Computed tomography of the chest showed intramural gas in the ascending and descending aorta. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Treatment for Mild Chronic Hypertension during Pregnancy REVIEW ARTICLE Preeclampsia

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 14-2022: A 57-Year-Old Man with Chylous Ascites FIND MORE CME »

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PERSPECTIVE Reforming Nursing Home Financing, Payment, and Oversight R.M. Werner, R.T. Konetzka, D.C. Grabowski, and D.G. Stevenson More than 30 years after the Nursing Home Reform Act, the United States still fails to protect nursing home residents and provide them with high-quality care. The Covid-19 pandemic’s devastating effect on nursing homes reminds us that further reforms are sorely needed. Read the article. PERSPECTIVE Only Halfway There with Sudden Infant Death Syndrome R.D. Goldstein, H.C. Kinney, and A.E. Guttmacher Medicine promotes a logically inconsistent message regarding SIDS: authoritative statements imply that SIDS is a consequence of unsafe sleep in biologically normal children, but there is vague acknowledgment that important biologic factors are involved in these deaths. Read the article. PERSPECTIVE Roundtable: Long-Term Care in the United States — Problems and Solutions S.L. Mitchell and Others Although the Covid pandemic drew renewed attention to problems in U.S. nursing homes, the underlying issues with long-term care are long-standing. Susan Mitchell moderates a Perspective Roundtable about shortcomings and possible solutions. View the video.

FACEBOOK Clinical Problem-Solving: Looking Back TWITTER Perspective: Navigating Loss of Abortion Services — A Large Academic Medical Center Prepares for the Overturn of Roe v. Wade INSTAGRAM Case 14-2022: A 57-Year-Old Man with Chylous Ascites

ORIGINAL ARTICLE

Evaluation of mRNA-1273 Covid-19 Vaccine in Children 6 to 11 Years of Age C.B. Creech and Others In part 1 of a phase 2–3 trial, a 50-μg dose of mRNA-1273 vaccine was safe and immunogenic. In part 2, nearly 4000 6-to-11-year-olds received two doses of vaccine or placebo and were followed for a median of 82 days. The vaccine had mainly mild adverse effects and was immunogenic in 99%, similar to the results in 18-to-25-year-olds. Vaccine efficacy during a delta-variant period was 88%. Read the article.

PERSPECTIVE Health Care Reform under the Biden Administration — Broad Ambitions, Narrow Majorities J. Oberlander The Biden administration has made important incremental progress in expanding access to affordable health insurance. But its struggles to enact a broader reform agenda reflect the daunting political constraints that limit U.S. health policy. Read the article. LISTEN TO THE PODCAST »

Treating Mild Chronic Hypertension during Pregnancy

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Physician Jobs May 14, 2022

Hospitalist Colorado Fort Carson opening for Hospitalists

Evans Army Community Hospital is seeking HOSPITALISTS to meet the medical needs of our growing military and civilian population at Fort Carson, Colorado. Competitive salaries, generous benefits package, to include retirement and matched 401K programs, health/life/disability insurance, federal malpractice coverage, CME allowance, and an opportunity for professional growth are all part of this unique employment opportunity.....

Cardiology Texas Opportunity for Non-Invasive Cardiologist at Fort Hood Serves as attending physician on the cardiology inpatient consult service. Attends inpatient multi-disciplinary rounds Monday-Friday of each work week. Must be available on-call from home up to 14 days per month. Must be available for telephonic or personal consultation for inpatient care when on call. Examines, diagnoses, treats, and follows outpatients with cardiology problems of all complexities..... Looking for a new practice opportunity? View these jobs and other listings at NEJM CareerCenter. Search now for both permanents and locum tenens job in many specialties.

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Weekend Briefing May 21, 2022

NEJM Editorial Fellows

The New England Journal of Medicine invites applications from physicians at any career stage for a one-year, full-time, paid editorial fellowship beginning in July 2023. Several fellows will be selected for the 2023–24 year; applications are due by August 15, 2022. Learn more.

IMAGES IN CLINICAL MEDICINE A 73-year-old man presented with fatigue and diffuse bone pain. Workup showed pancytopenia, long-bone osteonecrosis, and Gaucher’s cells on bone marrow biopsy. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

BNT162b2 Protection against the Omicron Variant in Children and Adolescents REVIEW ARTICLE Brain Tumors in Children

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 15-2022: A 57-Year-Old Man with Persistent Cough and Pulmonary Opacities FIND MORE CME »

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PERSPECTIVE The Importance of Federal Action Supporting Overdose-Prevention Centers A.H. Naeem, C.S. Davis, and E.A. Samuels There is mounting interest among state and local officials in the United States in opening overdose-prevention centers, but there remains one fundamental barrier: the interpretation and enforcement of federal law. Read the article. PERSPECTIVE When Naloxone Isn’t Enough S. Messmer and J. Jarrett Not all people who use drugs are interested in recovery support or medications for opioid use disorder. For patients who decline such care, the health care system does next to nothing to reduce the risk of death — but not because nothing can be done. Read the article. PERSPECTIVE E Pluribus Unum I. Mulasi A case that would otherwise have set off an avalanche of investigations and therapeutics, family meetings, and consultations was quietly referred for charity hospice care, though Ms. M.’s immigration status made acceptance even by a hospice agency precarious. Read the article.

FACEBOOK Preeclampsia TWITTER Trial of a Preferential Phosphodiesterase 4B Inhibitor for Idiopathic Pulmonary Fibrosis INSTAGRAM Results of Two Cases of Pig-to-Human Kidney Xenotransplantation

ORIGINAL ARTICLE

Albuterol–Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma A. Papi and Others Among patients with moderate-to-severe asthma who were receiving a range of inhaled glucocorticoid maintenance therapies, the risk of severe asthma exacerbation was significantly lower with as-needed use of a fixed-dose combination of 180 μg of albuterol and 160 μg of budesonide than with albuterol alone. Read the article.

PERSPECTIVE Progress toward Pig-to-Human Xenotransplantation R.N. Pierson III In light of the recent clinical cases of pig-to-human kidney and heart transplantation, taking stock of progress in xenotransplantation can help us set realistic expectations for clinical adoption of this promising technology. Read the article. LISTEN TO THE PODCAST »

Childhood CV Risk Factors and Adult CV Events

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Physician Jobs May 21, 2022 Neurology Georgia Neurologist needed for Fort Gordon practice This position is located in the Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia. This is an employed civilian Physician (Neurology TBI) position that affords job security, a competitive salary, bonuses, moving expenses, full malpractice coverage, student loan repayment, up to 26 days paid vacation, 10 days paid Federal Holidays, a sick leave benefit, CME opportunities, and a first-class health and retirement benefit package..... Obstetrics & Gynecology New York OB/GYN needed for Fort Drum practice This position will be located at Deputy Commander for Clinical Services, Primary Care Clinic, Fort Drum, NY. A recruitment or relocation bonus may be authorized. Fort Drum, home of the 10th Mountain Division, is located in Northern New York's picturesque North County, one of the most historically unique and geographically beautiful areas of the United States, offering bountiful outdoor recreational opportunities from hunting and fishing to winter sports of all types....

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Weekend Briefing May 28, 2022

IMAGES IN CLINICAL MEDICINE A 40-year-old man presented with a foot rash, joint swelling, and low back pain after having recently had urethral discharge. Conjunctivitis, migratory glossitis, and circinate balanitis were also noted on examination. Read the article. VIEW MORE IMAGES »

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ORIGINAL ARTICLE

Tranexamic Acid in Patients Undergoing Noncardiac Surgery REVIEW ARTICLE Gliflozins in the Management of Cardiovascular Disease

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL

Case 16-2022: A 55-Year-Old Man with Fevers, Night Sweats, and a Mediastinal Mass FIND MORE CME »

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PERSPECTIVE Perverse Incentives — HIV Prevention and the 340B Drug Pricing Program J.L. Marcus, A. Killelea, and D.S. Krakower A decade after preexposure prophylaxis against HIV became available, less than a quarter of people in the United States who could benefit from PrEP are taking it. The failure is a perverse outcome of a system that relies on high drug prices to fund HIV prevention. Read the article. PERSPECTIVE Daughters’ Keeper — The Care and Treatment of Black Girls in America K.M. Simon Black girls in America are harmed by intersecting racism and sexism, which manifest in biases, stereotypes, and practices that render them vulnerable to abuse, dehumanization, and death. Our silence about Black girls has clinical consequences throughout their life span. Read the article.

FACEBOOK Perspective: Physicians Spreading Misinformation on Social Media — Do Right and Wrong Answers Still Exist in Medicine? TWITTER Use of a Drone-Delivered Automated External Defibrillator in an Out-of-Hospital Cardiac Arrest INSTAGRAM Brain Tumors in Children

CORRESPONDENCE

Current Causes of Death in Children and Adolescents in the United States

J.E. Goldstick, R.M. Cunningham, and P.M. Carter Firearm-related injury is now the leading cause of death among children and teens. We continue to fail to protect our youth from a preventable cause of death. Read the article.

PERSPECTIVE The Importance of Federal Action Supporting Overdose-Prevention Centers

A.H. Naeem, C.S. Davis, and E.A. Samuels

There is mounting interest among state and local officials in the United States in opening overdose-prevention centers, but there remains one fundamental barrier: the interpretation and enforcement of federal law. Read the article.

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Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer

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Physician Jobs May 28, 2022

Neurology Georgia Neurologist needed for Fort Gordon practice This position is located in the Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia. This is an employed civilian Physician (Neurology TBI) position that affords job security, a competitive salary, bonuses, moving expenses, full malpractice coverage, student loan repayment, up to 26 days paid vacation, 10 days paid Federal Holidays, a sick leave benefit, CME opportunities, and a first-class health and retirement benefit package..... Obstetrics & Gynecology New York OB/GYN needed for Fort Drum practice

This position will be located at Deputy Commander for Clinical Services, Primary Care Clinic, Fort Drum, NY. A recruitment or relocation bonus may be authorized. Fort Drum, home of the 10th Mountain Division, is located in Northern New York's picturesque North County, one of the most historically unique and geographically beautiful areas of the United States, offering bountiful outdoor recreational opportunities from hunting and fishing to winter sports of all types.....

Looking for a new practice opportunity? View these jobs and other listings at NEJM CareerCenter. Search now for both permanents and locum tenens job in many specialties.