Strengthening measurement and performance of HIV prevention programmes.

Indicators for the measurement of programmes for the primary prevention of HIV are less aligned than indicators for HIV treatment, which results in a high burden of data collection, often without a clear vision for its use. As new evidence becomes available, the opportunity arises to critically evaluate the way countries and global bodies monitor HIV prevention programmes by incorporating emerging data on the strength of the evidence linking various factors with HIV acquisition, and by working to streamline indicators across stakeholders to reduce burdens on health-care systems. Programmes are also using new approaches, such as targeting specific sexual networks that might require non-traditional approaches to measurement.

High variability in the measurement of HIV primary prevention activities and outcomes.

Introduction: While there is a global consensus on monitoring Human Immunodeficiency Virus (HIV) treatment progress, there has been less attention to the degree of consistency of the measurement of HIV prevention programmes-and the global prevention response is not on-track to achieve 2020 goals. In this paper, we assess the degree of variability in primary prevention indicators selected by national strategic plans (NSPs) and global stakeholder monitoring and evaluation (M&E) strategies.

Methods: We obtained the most recent NSPs from low and middle income Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast-Track countries, and M&E documents from The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), President's Emergency Plan for AIDS Relief (PEPFAR), UNAIDS, the Global HIV Prevention Coalition and the World Health Organization (WHO).

Timing of Surgery for Thoracolumbar Spine Trauma: Patients With Neurological Injury.

Study Design: Large multicenter retrospective cohort study.

Objective: The objective of this study was to analyze the effect of fusion timing on inpatient outcomes in a nationally representative population with thoracolumbar fracture and concurrent neurological injury.

Summary Of Background Data: Among thoracolumbar trauma admissions, concurrent neurological injury is associated with greater long-term morbidity.

Critical Assessment of the Contemporary Orthopaedic Surgery Residency Application Process.

Background: Matching into orthopaedic surgery residency in the United States has become an increasingly competitive process because of the large number of well-qualified applicants. Over the past several years, applicants have sought to maximize their chances of matching by submitting an increasing number of applications. The purpose of this study was to assess trends in application numbers, applicant qualifications, and application reviews, with the goal of obtaining data to help inform future improvements in the orthopaedic surgery residency application process.

Proximal junctional failure prevention in adult spinal deformity surgery utilizing interlaminar fixation constructs.

Proximal junctional kyphosis (PJK) is a common complication following fusion for Adult Spinal Deformity. PJK and proximal junctional failure (PJF) may lead to pain, neurological injury, reoperation, and increased healthcare costs. Efforts to prevent PJK and PJF have aimed to preserve or reconstruct the posterior spinal tension band and/or modifying instrumentation to allow for more gradual transitions in stiffness at the cranial end of long spinal constructs.

Exploring the potential public health benefits of universal influenza vaccine.

: Broadly protective, long-lasting universal influenza vaccines are under development in response to low-moderate seasonal vaccine effectiveness, frequent genetic changes in circulating viruses and extended turnaround for vaccine manufacture. Because a long-lasting vaccine might be less effective than a seasonal vaccine that has been matched to current circulating strains, the public health impact of its introduction should be evaluated.: A modified agent-based model (ABM) examined multi-year effects of a universal vaccine among 18 to 49-year-olds, given in Year 1 only.

How Introducing a Registry With Automated Alerts for Carbapenem-resistant Enterobacteriaceae (CRE) May Help Control CRE Spread in a Region.

Background: Regions are considering the use of electronic registries to track patients who carry antibiotic-resistant bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). Implementing such a registry can be challenging and requires time, effort, and resources; therefore, there is a need to better understand the potential impact.

Methods: We developed an agent-based model of all inpatient healthcare facilities (90 acute care hospitals, 9 long-term acute care hospitals, 351 skilled nursing facilities, and 12 ventilator-capable skilled nursing facilities) in the Chicago metropolitan area, surrounding communities, and patient flow using our Regional Healthcare Ecosystem Analyst software platform.

Longer Operative Time in Elderly Patients Undergoing Posterior Lumbar Fusion Is Independently Associated With Increased Complication Rate.

Study Design: Retrospective cohort study.

Objective: To determine the effects of operative time on postoperative complications in patients age 65 and older undergoing posterior lumbar fusion.

Methods: All patients age 65 and older undergoing posterior lumbar fusion were identified in the 2012 to 2015 American College of Surgeons National Surgical Quality Improvement Program database.

Sex- and Sport-Specific Epidemiology of Cervical Spine Injuries Sustained During Sporting Activities.

Background: Although several investigations have examined the epidemiology of cervical spine injuries in sports, few studies have analyzed the nationwide incidence and sex-specific epidemiology of cervical spine injuries.

Method: The National Electronic Injury Surveillance System database, which collects information on patients presenting to the emergency department at 100 hospitals across the United States, was queried for neck sprains and cervical fractures associated with sporting activities from 2000-2015.

Result: A total of 26,380 neck sprains and 1166 fractures were identified.

Compressed Influenza Vaccination in U.S. Older Adults: A Decision Analysis.

Introduction: Tradeoffs exist between efforts to increase influenza vaccine uptake, including early season vaccination, and potential decreased vaccine effectiveness if protection wanes during influenza season. U.S.

The potential effects of introducing microneedle patch vaccines into routine vaccine supply chains.

Background: Microneedle patch (MNP) technology is designed to simplify the process of vaccine administration; however, depending on its characteristics, MNP technology may provide additional benefits beyond the point-of-use, particularly for vaccine supply chains.

Methods: Using the HERMES modeling software, we examined replacing four routine vaccines - Measles-containing vaccine (MCV), Tetanus toxoid (TT), Rotavirus (Rota) and Pentavalent (Penta) - with MNP versions in the routine vaccine supply chains of Benin, Bihar (India), and Mozambique.

Results: Replacing MCV with an MNP (5 cm-per-dose, 2-month thermostability, current single-dose price-per-dose) improved MCV availability by 13%, 1% and 6% in Benin, Bihar and Mozambique, respectively, and total vaccine availability by 1% in Benin and Mozambique, while increasing the total cost per dose administered by $0.

The value of tailoring vial sizes to populations and locations.

Background: Frequently, a country will procure a single vaccine vial size, but the question remains whether tailoring the use of different size vaccine vial presentations based on populations or location characteristics within a single country could provide additional benefits, such as reducing open vial wastage (OVW) or reducing missed vaccination opportunities.

Methods: Using the Highly Extensible Resource for Modeling Supply Chains (HERMES) software, we built a simulation model of the Zambia routine vaccine supply chain. At baseline, we distributed 10-dose Measles-Rubella (MR) vials to all locations, and then distributed 5-dose and 1-dose MR vials to (1) all locations, (2) rural districts, (3) rural health facilities, (4) outreach sites, and (5) locations with average MR session sizes <5 and <10 children.

Potential Cost-Effectiveness of a Universal Influenza Vaccine in Older Adults.

Background And Objectives: "Universal" vaccines that could have multistrain and multiyear effectiveness are being developed. Their potential cost-effectiveness in geriatric populations is unknown.

Research Design And Methods: A Markov model estimated effects of a theoretical universal influenza vaccine compared with available seasonal vaccines in hypothetical cohorts of U.

Machine learning modeling for predicting hospital readmission following lumbar laminectomy.

In BriefAuthors of this study analyzed hospital readmissions following laminectomy and developed predictive models to identify readmitted patients with an accuracy >95% when using all variables and >79% when using only predischarge variables. A model capable of predicting 40% of readmitted patients was created using only the variables known predischarge. This investigation is important in its provision of data that will assist the development of predictive models for readmission as well as interventions to prevent readmission in high-risk patients.

Tobacco Use and Complications Following Spinal Fusion: A Comparison of the National Surgical Quality Improvement Program and National Inpatient Sample Datasets.

Background: Smoking is a known risk factor for inferior health outcomes. Retrospective analyses of large datasets may assess whether such risk is manifested or mitigated in clinical practice. Although many risk factor analyses use the National Surgical Quality Improvement Program (NSQIP) and National (Nationwide) Inpatient Sample (NIS), such investigations have seldom been directly compared.

Early Subspecialization in Orthopedic Surgery Training.

Recent studies have shown that applicants to the American Board of Orthopaedic Surgery Part II examination are performing fewer procedures outside of their chosen subspecialty. In this study, the authors assessed whether trainees are beginning their subspecialization during residency. The authors reviewed the chosen fellowships and case logs of 231 residents graduating from 5 academic orthopedic residency training programs from 2002 to 2017.

Trends in the Orthopaedic Surgery Subspecialty Fellowship Match: Assessment of 2010 to 2017 Applicant and Program Data.

Background: Orthopaedic surgery has become increasingly specialized, and most trainees currently complete subspecialty fellowship training. The purposes of this investigation were to evaluate recent trends in U.S.

Physician and patients factors associated with outcome of spinal epidural abscess related malpractice litigation.

Spinal epidural abscesses (SEA) can be challenging to diagnose and may result in serious adverse outcomes sometimes leading to neurologic compromise, sepsis, and even death. While SEA may lead to litigation for healthcare providers, little is known about the medicolegal factors predicting case outcome of SEA related litigation cases. Three large medicolegal databases (VerdictSearch, Westlaw, and LexisNexis) were queried for SEA-related malpractice cases.

Epidemiologic and economic impact of pharmacies as vaccination locations during an influenza epidemic.

Introduction: During an influenza epidemic, where early vaccination is crucial, pharmacies may be a resource to increase vaccine distribution reach and capacity.

Methods: We utilized an agent-based model of the US and a clinical and economics outcomes model to simulate the impact of different influenza epidemics and the impact of utilizing pharmacies in addition to traditional (hospitals, clinic/physician offices, and urgent care centers) locations for vaccination for the year 2017.

Results: For an epidemic with a reproductive rate (R0) of 1.

Dual-chamber injection device for measles-rubella vaccine: The potential impact of introducing varying sizes of the devices in 3 countries.

Introduction: By pairing diluent with vaccines, dual-chamber vaccine injection devices simplify the process of reconstituting vaccines before administration and thus decrease associated open vial wastage and adverse events. However, since these devices are larger than current vaccine vials for lyophilized vaccines, manufacturers need guidance as to how the size of these devices may affect vaccine distribution and delivery.

Methods: Using HERMES-generated immunization supply chain models of Benin, Bihar (India), and Mozambique, we replace the routine 10-dose measles-rubella (MR) lyophilized vaccine with single-dose MR dual-chamber injection devices, ranging the volume-per-dose (5.

Predictive factors of positive online patient ratings of spine surgeons.

Background: Online physician rating websites are increasingly used by patients to evaluate their doctors. The purpose of this investigation was to evaluate factors associated with better spine surgeon ratings.

Methods: Orthopedic spine surgeons were randomly selected from the North American Spine Society directory utilizing a random number generator.

Predictors of Nonneurologic Complications and Increased Length of Stay After Cervical Spine Osteotomy.

Background: Although previous studies have used National Surgical Quality Improvement Program (NSQIP) data to study complications of thoracolumbar spinal deformity surgery, investigation of cervical spine deformity surgery has been limited. We performed a retrospective analysis of the NSQIP database to identify predictors of complications after cervical spine osteotomy.

Methods: Patients undergoing cervical spine osteotomy were identified in the NSQIP dataset using Current Procedural Terminology codes from years 2007-2016.

Risk Factors for Unplanned Reoperation Within 30 Days Following Elective Posterior Lumbar Spinal Fusion.

Study Design: Retrospective cohort study.

Objectives: Unplanned reoperation following lumbar spinal fusion is detrimental to patients, providers, and health systems. The aim of this study was to identify risk factors associated with unplanned reoperation following elective posterior lumbar spinal fusion and assess the reasons for reoperation.

Rod Fracture After Apparently Solid Radiographic Fusion in Adult Spinal Deformity Patients.

Background: Rod fracture occurs with delayed fusion or pseudarthrosis after adult spinal deformity (ASD) surgery. Rod fracture after apparent radiographic fusion has not been previously investigated.

Methods: Patients with ASD in a multicenter database were assessed for radiographic fusion by a committee of 3 spinal deformity surgeons.

Timing of complications following posterior cervical fusion.

Study Design: Retrospective cohort study.

Objective: To characterize the timing of complications after posterior cervical fusion.

Summary Of Background Data: Understanding the expected timing of postoperative complications facilitates early diagnosis of potential adverse events and is important for optimizing postoperative care.