"Privilege" vs. "Right" in healthcare is a failed political binary because it has divided the nation. The "my privilege" end of this false choice has been damaging, shifting the burden to the patient and away from the physician. It is medicine's historic privilege to care for any human but obligation has waned being plagued by opportunism. Also, what we have a right to or are privileged to receive is undefined. Past premises for the privilege are untrue, based on Health = medical care. Present assessments of the privilege are unfair, deeming American medicine a sickness. Future solutions for the privilege are untenable, if "equality" is the goal. The framework for healthcare's obligation-to-give already surrounds us, emerging from the American Revolution with its idea of individual dignity as to priority, checks and balances as to protection and Federalism as to improvement. American medicine has followed this idea albeit misused and unfulfilled. The null hypothesis of this debate must be fairly tested - that American medicine is the worst form of healthcare delivery - except for all the rest. Both Big Business and Big Politics in healthcare have become ends unto themselves and therefore neither can solve the privilege question nor bear the weight of our obligation-to-give. The patient-as-obligation must be our aim. Copyright© South Dakota State Medical Association.Hepatitis C is a bloodborne viral infection that often leads to liver disease. Individuals born between 1945-1965 (baby boomer birth cohort) are five times more likely to have hepatitis C than other age groups due to blood transfusions and medical procedures performed before the discovery of the virus. The Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend a one-time screening for individuals in the baby boomer birth cohort. Even with these recommendations, national screening rates remain low at around 13 percent, suggesting a need for improvement. In this study we reviewed the electronic medical record (EMR) data for a rural primary care clinic and determined the percentage of individuals screened in the baby boomer birth cohort in a one-year time period. Interventions (provider/nursing education, community education) were implemented over a four-month period. We compared the EMR data from before, during, and after interventions. Pearson's chi-squared analysis was used to evaluate differences in proportions. The results showed no statistical significance between the three timeframes measured (p-value 0.6164). We can conclude that the interventions used in this study were not adequate in producing a statistically significant change in the percentage of baby boomers screened at our local clinic. These results could be due to interventions not being implemented simultaneously, lack of follow-up with staff regarding interventions, and a short time frame for measuring post-intervention changes. Future projects may benefit from modifying interventions and their implementation. Copyright© South Dakota State Medical Association.The year 2018 continued a three-year trend of decreasing live resident births in South Dakota with increased racial diversity among the minority cohort of newborns. In 2018 there was a decrease in very low birth weight newborns and this was reflected in a decline from the previous year's infant mortality rate (IMR) of 7.8 to 5.9 per 1,000 births. The state's 2018 IMR also is lower than its previous five year (2013-17) mean rate of 6.5 and is not significantly different than the most current 2017 rate (5.8) for the U.S. Decreases from 2017 were also seen in the state's neonatal mortality rate for its white and minority populations, although not for its post neonatal mortality rate. The distribution of causes of infant death in 2014-18 in South Dakota show that compared to the U.S. (2017), a lower percent of infant deaths were caused by perinatal causes and a higher percent were caused by sudden unexpected infant death (SUID). In South Dakota, there is a significantly higher rate of death due to SUID among its minority than white infants and the state's rate of death due to this cause is significanly higher than what is observed nationally in 2017. The complexity of addressing this cause of death in the state is discussed. Copyright© South Dakota State Medical Association.Objective To examine the effect of a novel antistigma intervention curriculum (ASIC) in reducing stigma toward psychiatry among medical students. Methods Medical students from 8 hospitals in central Israel were divided into intervention (n = 57) and control (n = 163) arms. The students completed the 30-item Attitudes Toward Psychiatry (ATP-30) and the Attitudes Toward Mental Illness (AMI) scales at psychiatry rotation onset and conclusion. The ASIC was designed to target prejudices and stigma through direct informal encounters with people with serious mental illness (SMI) during periods of remission and recovery. Supervised small-group discussions followed those encounters to facilitate processing of thoughts and emotions that ensued and to discuss salient topics in psychiatry. The study was conducted between November 2017 and July 2018. Results Significant between-group differences were found at endpoint for attitudes toward psychiatry and psychiatric patients (P less then .001). Although changing attitudes toward psychiatry as a career choice was not part of the ASIC, a significant between-group difference emerged by endpoint (P less then .001). Conclusions Implementation of an ASIC that includes contact with individuals with lived SMI experience followed by supervised small-group discussions is effective in reducing stigma in medical students' perceptions of people with mental illness and psychiatry. Further evaluation is warranted with regard to the long-term destigmatizing effects of an ASIC. https://www.selleckchem.com/products/mpp-dihydrochloride.html Trial Registration ClinicalTrials.gov identifier NCT03907696. © Copyright 2020 Physicians Postgraduate Press, Inc.BACKGROUND In the case of liver metastasis (LM), tumors showing the replacement growth pattern (RGP), in which metastatic cells infiltrate and replace hepatocytes with minimal desmoplastic reaction and inflammatory cell infiltration, associate with a poor prognosis. The heterogeneity, frequency, and prognostic value of the RGP in LM from pancreatic cancer (PCa) are not well known. METHODS In the circumference of treatment-naïve resected LMs from patients with PCa, the heterogeneity of the GP was assessed. Next, the clinicopathological features of LMs showing the RGP in needle biopsy specimens were investigated in patients with treatment-naïve advanced PCa. RESULTS Thirteen of the 14 (93%) in all resected LMs and 7 of the 9 (78%) in RGP component GP in resected LMs showed homogeneous GP. A RGP was found in 50% of the needle biopsy specimens of LMs obtained from 107 patients. The median overall survival times in the RGP group and non-RGP group were 3.6 and 10.4 months. Multivariate analysis identified RGP as an independent poor prognostic factor.