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an IRB approved clinical trial protocol, VRC 200 - ClinicalTrials.gov Identifier NCT00067054) and a healthy control donor from the NIH blood bank pre-SARS-CoV-2 pandemic.In the U.S., little is known about the neighborhoods where youth in out-of-home care live prior to emancipation. This study describes the socioeconomic characteristics of such neighborhoods. Addresses for 229 youth aged 16-20 years and residing in out-of-home care in a single Midwest county were used. Addresses were geocoded and linked to U.S. Census' data at the census tract level. Neighborhoods, or tracts, with youth in out-of-home care were significantly more disadvantaged across five area-based socioeconomic indicators. Findings suggest that youth in out-of-home care live in neighborhoods with disproportionately high rates of socioeconomic disadvantage.In Sub-Saharan Africa, sweetpotato pre-basic seed is multiplied in screenhouses using a sterilized soil substrate. This is expensive and unsustainable. The use of sand substrate with a fertigation system ("sandponics"), is an alternative. The study compared the cost-effectiveness for pre-basic seed production using the sandponics system to the conventional soil substrate for four genotypes. A randomized complete block split plot design was used, and data collected on vine traits over six harvests. Real-time cost data were collected for cost-effectiveness analysis. Results showed a highly significant (p less then .0001) 21.8% increase in the vine multiplication rate under the sandponics system. The cost of producing one sweetpotato node in sandponics was significantly lower by 0.009 US$. The cost-effectiveness of producing pre-basic seed in sandponics varied among the genotypes. The future use of sandponics is discussed with respect to the availability of soluble inorganic fertilizers, varietal specific response to nutrients, and labor implications.
Recent changes in healthcare have placed increased emphasis on price transparency, quality measures, and improving the patient experience. However, limited information is available for patient cost of obtaining a hip MRI and factors associated with cost variability. For a patient with femoroacetabular impingement (FAI), this study sought to report (1) the availability of pricing and quality information for a hip magnetic resonance imaging (MRI) in the state of Iowa, (2) the time investment required to obtain pricing and quality information, and (3) factors that influence hip MRI cost, quality and the time investment required for patients to obtain cost and quality information.
Within the state of Iowa, 126 unique hospital institutions and 30 active, private orthopaedic practices were identified. All 156 providers were contacted via telephone using a standardized script of a hypothetical 25-year-old adult male patient with FAI requesting a quote for a hip MRI. Cost of the MRI and its components, availabilitial time burden for patients with FAI. Surgeons, healthcare systems, and policy makers should be cognizant of the large price differences for a hip MRI and the time burden placed on patients with FAI to obtain this information.
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MRI cost varies widely across the state of Iowa and within individual metropolitan areas. Hip MRIs cost less at independent imaging centers compared to hospital locations. The amount of time required to obtain quality and cost data for a hip MRI presents a substantial time burden for patients with FAI. Surgeons, healthcare systems, and policy makers should be cognizant of the large price differences for a hip MRI and the time burden placed on patients with FAI to obtain this information.Level of Evidence IV.
Many US health care institutions have adopted compensation models based on work relative value units (wRVUs) to standardize payments and incentivize providers. Among other factors, a major determinant of payment and wRVU assignments is operative time. Our objective was to determine whether differences in estimated operative times between the Centers for Medicare & Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP) contribute to payment and wRVU misvaluation for the most common hospital-based hand and upper extremity procedures.
Data on wRVUs, surgeon payment, and estimated operative times were collected from CMS for 53 procedures. We used regression models to compare relationships between these variables, in addition to actual median operative times as reported in the NSQIP database, from 2011 to 2016. We then determined the relative valuation of each procedure based on operative time.
There was a wide discrepancy between CMS and NSQIP operative times (R
=0.49), we to inaccurate operative time estimates. By identifying which procedures are misvalued in terms of payment and wRVU per operative time, providers and payors may be able to address these imbalances and maximize appropriate care delivery incentives.
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CMS may misvalue payment and wRVU rates of hospital-based hand procedures due to inaccurate operative time estimates. By identifying which procedures are misvalued in terms of payment and wRVU per operative time, providers and payors may be able to address these imbalances and maximize appropriate care delivery incentives.Level of Evidence III.
Bilateral femur fractures are rare in the pediatric population with few cases reported in the literature. The purpose of this study was to review our institutional experience with a case series of simultaneous bilateral femur fractures to highlight the presentation, treatment, and outcomes of these rare injuries as well as perform a preliminary comparison to similar unilateral femur fractures in order to identify any clinically relevant differences that may guide future management.
We undertook a retrospective chart review of patients who had presented with simultaneous bilateral femur fractures between 2007 and 2017 with a minimum of 1-year of follow-up. Descriptive information was provided about the case series of bilateral femur fracture patients with subsequent further analysis comparing unilateral and bilateral femur fractures.
Eight patients (7 males, 1 female) were identified after chart review. Mean age at the time of injury was 11 years (8 to 15 years). selleck products Mechanism of injury was high energy trauma in 7 of 8 patients.