Healthcare practitioners' views of self-harm management practices in older adults in Ireland: A qualitative study.

Objectives: To explore healthcare practitioners' views on management practices of self-harm in older adults.

Methods: Semi-structured interviews were conducted with healthcare practitioners, including consultant psychiatrists, general practitioners, clinical psychologists, psychotherapists, clinical nurse specialists and social workers. Purposeful sampling was used to recruit participants in the Republic of Ireland ensuring diverse perspectives of healthcare practitioners were included.

International Prescription Drug Price Comparisons: Estimates Using 2022 Data.

Understanding the extent to which prescription drug prices are higher in the United States than in other countries-after accounting for differences in the volume and mix of drugs-is useful when developing and targeting policies to address both growth in drug spending and the financial impact of prescription drugs on consumers. This study summarizes findings from comparisons of drug prices in the United States and other high-income countries based on 2022 data and presents results for specific types of drugs, including brand-name originator drugs and unbranded generic drugs, and from sensitivity analyses.

The infant health effects of doulas: Leveraging big data and machine learning to inform cost-effective targeting.

Doula services represent an underutilized maternal and child health intervention with the potential to improve outcomes through the provision of physical, emotional, and informational support. However, there is limited evidence of the infant health effects of doulas despite well-established connections between maternal and infant health. Moreover, because the availability of doulas is limited and often not covered by insurers, existing evidence leaves unclear if or how doula services should be allocated to achieve the greatest improvements in outcomes.

Hospital-presenting self-harm among older adults living in Ireland: a 13-year trend analysis from the National Self-Harm Registry Ireland.

Objectives: To examine trends in rates of self-harm among emergency department (ED) presenting older adults in Ireland over a 13-year period.

Design: Population-based study using data from the National Self-Harm Registry Ireland.

Setting: National hospital EDs.

A Needs Assessment of Women Veterans in Western Pennsylvania: Final Report to Adagio Health.

Women make up an increasingly large share of the U.S. veteran population, and their numbers continue to grow while the overall number of veterans is on the decline.

Atypical atrial flutter catheter ablation in the era of high-density mapping.

Background: Mapping and ablating atypical atrial flutters (AAFLs) have evolved greatly with advances in high-density 3D mapping systems over the last years.

Methods: The objectives are to evaluate the feasibility of AAFL catheter ablation based on high-density mapping and minimizing entrainment and to better characterize AAFL circuits. Consecutive patients who underwent AAFL ablation using the EnSite Precision™ system and HD Grid™ mapping catheter (Abbott, Chicago, IL) between 06/2018 and 1/2022 were included.

Variation in the infant health effects of the women, infants, and children program by predicted risk using novel machine learning methods.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has an extensive literature documenting positive effects on infant health outcomes, specifically preterm birth, low birthweight, small size for gestational age, and infant mortality. However, existing studies focus on average effects for these relatively infrequent outcomes, thus providing no evidence for how WIC affects those at greatest risk of negative infant health outcomes. Our study focuses on documenting how WIC's infant health effects vary by level of risk.

Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data.

Medicare payment for many health care procedures covers not only the procedure itself but also most post-operative care over a fixed period of time (the ""global period""). The Centers for Medicare & Medicaid Services (CMS) sets payment rates assuming that a certain number and type of post-operative visits specific to each procedure typically occur. This article describes how CMS might use claims-based data on the number of post-operative visits to adjust valuation for procedures with 10- and 90-day global periods.

Life rather than climate influences diversity at scales greater than 40 million years.

The diversity of life on Earth is controlled by hierarchical processes that interact over wide ranges of timescales. Here, we consider the megaclimate regime at scales ≥1 million years (Myr). We focus on determining the domains of 'wandering' stochastic Earth system processes ('Court Jester') and stabilizing biotic interactions that induce diversity dependence of fluctuations in macroevolutionary rates ('Red Queen').

Tackling Persistent and Large Disparities in Birth Outcomes in Allegheny County, Pennsylvania.

Objectives: Based in Allegheny County, a coalition of local stakeholders took note of the region's infant mortality rates, particularly the stark disparities observed by race, and established a vision to reduce infant mortality in the region. The group undertook a multi-faceted effort to (1) develop predictive models of infant mortality risk; (2) evaluate the effectiveness of available interventions; and (3) combine these tools in order to tailor intervention referrals based on maternal risk profiles. With this effort, the coalition sought to address the apparent disconnect between the region's robust maternal and child health care system and relatively poor birth and infant outcomes and racial disparities.

An observation-based scaling model for climate sensitivity estimates and global projections to 2100.

We directly exploit the stochasticity of the internal variability, and the linearity of the forced response to make global temperature projections based on historical data and a Green's function, or Climate Response Function (CRF). To make the problem tractable, we take advantage of the temporal scaling symmetry to define a scaling CRF characterized by the scaling exponent , which controls the long-range memory of the climate, i.e.

Toddler's Fractures: Time to Weight-bear With Regard to Immobilization Type and Radiographic Monitoring.

Background: The toddler's fracture is a common pediatric nondisplaced spiral tibia fracture that is considered stable with a course of immobilization. However, there is no widely accepted type of immobilization, expected time to weight-bear, nor guidelines for radiographic monitoring. We aimed to compare immobilization type with respect to displacement and time to weight-bear, as well as determine the usefulness of follow-up radiographs.

A Clinical Prediction Algorithm to Stratify Pediatric Musculoskeletal Infection by Severity.

Objective: There are currently no algorithms for early stratification of pediatric musculoskeletal infection (MSKI) severity that are applicable to all types of tissue involvement. In this study, the authors sought to develop a clinical prediction algorithm that accurately stratifies infection severity based on clinical and laboratory data at presentation to the emergency department.

Methods: An IRB-approved retrospective review was conducted to identify patients aged 0 to 18 who presented to the pediatric emergency department at a tertiary care children's hospital with concern for acute MSKI over a 5-year period (2008 to 2013).

Patterns of Postoperative Visits Among Medicare Fee-for-service Beneficiaries.

Objective: To describe patterns of postoperative visits reported for Medicare fee-for-service (FFS) patients.

Background: Payment for most surgical procedures bundles postoperative visits within a global period of either 10 or 90 days after a procedure. There is concern that payments for some procedures are excessive because the number of postoperative visits provided is less than the number of postoperative visits used to help determine payment.

C-Reactive Protein Predicts Risk of Venous Thromboembolism in Pediatric Musculoskeletal Infection.

Background: The rate of venous thromboembolism in children with musculoskeletal infections (MSKIs) is markedly elevated compared with hospitalized children in general. Predictive biomarkers to identify high-risk patients are needed to prevent the significant morbidity and rare mortality associated with thrombotic complications. We hypothesize that overactivation of the acute phase response is associated with the development of pathologic thrombi and we aim to determine whether elevations in C-reactive protein (CRP) are associated with increased rates of thrombosis in pediatric patients with MSKI.

Dilutional coagulopathy in pediatric scoliosis surgery: A single center report.

Background: Children undergoing posterior spinal fusion experience high blood loss often necessitating transfusion. An appropriately activated coagulation system provides hemostasis during surgery, but pathologic dysregulation can cause progressive bleeding and increased transfusions. Despite receiving antifibrinolytics for clot stabilization, many patients still require transfusions.

Spectra, intermittency, and extremes of weather, macroweather and climate.

It was recently found that the accepted picture of atmospheric variability was in error by a large factor. Rather than being dominated by a series of narrow scale-range quasi-oscillatory processes with an unimportant white noise "background", it turned out that the variance was instead dominated by a few wide range scaling processes albeit occasionally interspersed with superposed quasi-oscillations. Although the classical model implied that successive million year global temperature averages would differ by mere micro Kelvins, the implausibility had not been noticed.

The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Tibia Fracture Pearls and Pitfalls.

Tibial fractures in children present a wide array of challenges to the managing orthopaedic surgeon. Injuries cover a spectrum from subtle tibial spine fractures to comminuted high-energy shaft fractures requiring free flap coverage. Significant risks range from malunion and leg length discrepancy to infected nonunions and Volkmann ischemic contracture.

Evaluation Design Recommendations for the Certified Community Behavioral Health Clinic Demonstration Program.

This article provides information and recommendations regarding the evaluation design of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Mandated by Congress in Section 223 of the Protecting Access to Medicare Act of 2014, the CCBHC is a new model of specialty behavioral health clinic, designed to provide comprehensive and integrated care for adults with mental health or substance-use disorders and children with serious emotional distress. Certification criteria for the CCBHCs have been specified by Substance Abuse and Mental Health Services Administration covering six core areas: staffing; accessibility; care coordination; scope of services; quality and other reporting; and organizational authority, governance, and accreditation.

Leptin Elevation as a Risk Factor for Slipped Capital Femoral Epiphysis Independent of Obesity Status.

Background: Slipped capital femoral epiphysis (SCFE) is strongly associated with childhood obesity, yet the prevalence of obesity is orders of magnitude greater than the prevalence of SCFE. Therefore, it is hypothesized that obesity is not, by itself, a sufficient condition for SCFE, but rather one component of a multifactorial process requiring preexisting physeal pathology. Leptin elevation is seen to varying degrees in patients with obesity, and as leptin has been shown to cause physeal pathology similar to the changes seen in SCFE, we propose that leptin may be a factor distinguishing between patients with SCFE and equally obese children without hip abnormalities.

Double-Edged Sword: Musculoskeletal Infection Provoked Acute Phase Response in Children.

The acute phase response has a crucial role in mounting the body's response to tissue injury. Excessive activation of the acute phase response is responsible for many complications that occur in orthopedic patients. Given that infection may be considered continuous tissue injury that persistently activates the acute phase response, children with musculoskeletal infections are at markedly increased risk for serious complications.

Authorities and Mechanisms for Purchased Care at the Department of Veterans Affairs.

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the authorities and mechanisms by which the Department of Veterans Affairs (VA) pays for health care services from non-VA providers.