Excess mortality in the United States during the first three months of the COVID-19 pandemic.

Deaths are frequently under-estimated during emergencies, times when accurate mortality estimates are crucial for emergency response. This study estimates excess all-cause, pneumonia and influenza mortality during the coronavirus disease 2019 (COVID-19) pandemic using the 11 September 2020 release of weekly mortality data from the United States (U.S.) Mortality Surveillance System (MSS) from 27 September 2015 to 9 May 2020, using semiparametric and conventional time-series models in 13 states with high reported COVID-19 deaths and apparently complete mortality data: California, Colorado, Connecticut, Florida, Illinois, Indiana, Louisiana, Massachusetts, Michigan, New Jersey, New York, Pennsylvania and Washington. We estimated greater excess mortality than official COVID-19 mortality in the U.S. (excess mortality 95% confidence interval (CI) 100 013-127 501 vs. 78 834 COVID-19 deaths) and 9 states: California (excess mortality 95% CI 3338-6344) vs. 2849 COVID-19 deaths); Connecticut (excess mortality 95% CI 3095-3952) vs. 2932 COVID-19 deaths); Illinois (95% CI 4646-6111) vs. 3525 COVID-19 deaths); Louisiana (excess mortality 95% CI 2341-3183 vs. 2267 COVID-19 deaths); Massachusetts (95% CI 5562-7201 vs. 5050 COVID-19 deaths); New Jersey (95% CI 13 170-16 058 vs. 10 465 COVID-19 deaths); New York (95% CI 32 538-39 960 vs. 26 584 COVID-19 deaths); and Pennsylvania (95% CI 5125-6560 vs. 3793 COVID-19 deaths). Conventional model results were consistent with semiparametric results but less precise. Significant excess pneumonia deaths were also found for all locations and we estimated hundreds of excess influenza deaths in New York. We find that official COVID-19 mortality substantially understates actual mortality, excess deaths cannot be explained entirely by official COVID-19 death counts. Mortality reporting lags appeared to worsen during the pandemic, when timeliness in surveillance systems was most crucial for improving pandemic response.

Subtle orthopedic fractures: teleradiology workstation versus film interpretation.

The purpose of this study was to evaluate whether radiologists perform equally well with plain radiographs or digitized images displayed on a video monitor in interpretation of difficult orthopedic trauma cases. Interpretations with film and those made from a teleradiology system with spatial resolution of 2.35 line pairs per millimeter were compared in 120 difficult cases, 60 with the selected abnormality (ie, fracture or dislocation) and 60 that were control cases. Seven senior radiology residents and one radiology fellow each interpreted 60 randomly ordered cases with the teleradiology system (1,280 x 1,024-pixel monitors) and 60 cases with the original radiographs. The overall accuracy of the readers was 80.6% for film interpretations and 59.6% for teleradiology screen readings (P < .001). Sensitivity was 78.5% for film and 48.8% for on-screen images (P < .001), and specificity was 83.2% for film and 72.3% for on-screen images (P < .025). Receiver operating characteristic analysis showed rejection of the null hypothesis in favor of film interpretation (P < .0049). It was concluded that the teleradiology system was not acceptable for primary diagnostic interpretation of difficult fracture cases.

The premed stereotype.

For this study of attitudes surrounding premedical education, the authors examined the consequences of competitive pressure for admission to medical school. Responses of premedical and other students were compared on a number of topics including: self-descriptions, premedical stereotypes, occupational values, attitudes toward various occupations, and perceptions of college pressures. Differences are reported for premedical subgroups, including science and nonscience majors, men and women, and minority group members and others.