Establishing a Microsurgical Practice in a Limited Resource African Setting: The Kapsowar Hospital Experience.

Background: Microsurgical technique is still not readily available in many low- and middle-income countries. Few works in the scholarly literature describe the establishment of microsurgical practice on the African continent, and there are virtually no descriptions of the financial aspects of free flap performance by locally staffed teams in sub-Saharan Africa. The Kapsowar Hospital is a hospital in rural Kenya with 2 plastic and reconstructive surgeons certified by the American Board of Plastic Surgery and has recently expanded clinical practice to include microsurgical procedures.

The Burden of Plastic Surgery in Rural Kenya: The Kapsowar Hospital Experience.

Purpose: Both governmental and nongovernmental training programs are expanding efforts to train the next generation of plastic surgeons who will work in low- and middle-income countries (LMICs). Sufficient training is dependent on acquiring the appropriate skillset for these contexts. Few studies have characterized the spectrum of practice of plastic surgeons in LMICs and their relative disparity.

The Pattern and Profile of Orofacial Clefts in Somaliland: A Review of 40 Consecutive Cleft Lip and Palate Surgical Camps.

Introduction: Somaliland is an autonomously run country that is not internationally recognized. As such, it has been largely excluded by global health development programs despite being the world's fourth poorest country. The purpose of this study was to provide the first known description of the pattern and clinical profile of patients with cleft lip and palate from this nation.

Cleft Lip and Palate Surgery at a Rural African Hospital: A 13-Year Experience From Western Kenya.

Introduction: Most studies on the treatment of cleft lip and palate (CLP) in low-income and middle-income countries have reported on the experience of urban centers or surgical mission trips to rural locations. There is a paucity of literature on the experience of local teams providing orofacial cleft surgery in rural Sub-Saharan Africa. This study reports the efficacy and cost-effectiveness of cleft surgery performed by an all-local team in rural Kenya.

Studying Parole Revocation Practices: Accounting for Dependency Between Competing Events.

When individuals are released from prison, they typically enter a period of post confinement community supervision. While under community supervision, their behaviors are subject to special conditions requiring them to report to supervisors and prohibiting certain behaviors such as drug and alcohol use. Many supervisees are returned to prison because they violate those special conditions, or because they commit minor crimes that would not result in prison were they not being supervised.

Management of Human Bites in a Rural Kenyan Setting: A Plastic Surgeon's 8-Year Experience.

Introduction: The treatment of human bites is a common issue facing healthcare practitioners in the developing countries of Sub-Saharan Africa where it has been noted as a growing public health concern. Generally, the desired outcomes from surgical management are healing, function, and aesthetics. We share our 8-year experience at Kapsowar Hospital in Kenya with the presentation, management, and outcome of human bites.

Autoimmune hepatitis and overlap syndrome among Alaska Native people: Prevalence, clinical characteristics, and remission.

Background And Aim: High autoimmune hepatitis (AIH) and overlap syndrome (OS) prevalence have been previously documented among Alaska Native people. The purpose of this project is to report changes in AIH/OS prevalence over time, clinical characteristics, and factors associated with biochemical remission.

Methods: We reviewed medical records for Alaska Native/American Indian (AN/AI) patients diagnosed with AIH/OS between 1984 and 2021.

The Alaska Native/American Indian experience of hepatitis C treatment with sofosbuvir-based direct-acting antivirals.

Background: Direct-acting antiviral (DAA) drugs have been effective in the treatment of chronic hepatitis C virus (HCV) infection. Limited data are available on safety, tolerability, and efficacy in American Indian or Alaska Native people. We aim to evaluate the treatment outcomes of sofosbuvir- based regimens for treatment of HCV in a real life setting in Alaska Native/American Indian (AN/AI) people.

Real-world use of bevacizumab-awwb, a bevacizumab biosimilar, in US patients with metastatic colorectal cancer.

Evaluated real world use of bevacizumab-awwb (MVASI), a bevacizumab biosimilar, for treating metastatic colorectal cancer (mCRC). Adult mCRC patients who received bevacizumab-awwb during the first year after market availability were identified from the ConcertAI oncology dataset. Of 304 patients, 47% initiated bevacizumab-awwb as reference product (RP) naive patients and 53% received bevacizumab-awwb with prior exposure to RP.

Healthcare resource utilization and cost among patients treated for early-stage triple-negative breast cancer.

This retrospective, observational study examined real-world healthcare resource utilization (HCRU) and costs in 308 patients diagnosed with early-stage (II-IIIB) triple-negative breast cancer between 1 March 2008 and 31 March 2016. HCRU and costs were evaluated for two time periods: from neoadjuvant treatment start date to surgery (Time 1) and after surgery to recurrence or death (Time 2). The sample included 236 patients who received neoadjuvant treatment without subsequent adjuvant treatment (Neo) and 72 patients who received neoadjuvant treatment followed by adjuvant treatment (Neo + adj).

Real-world treatment patterns and effectiveness outcomes in patients with early-stage triple-negative breast cancer.

This retrospective, observational study examined real-world treatment patterns and effectiveness outcomes in 450 patients with stage II-IIIB early-stage triple-negative breast cancer treated in the community oncology setting. Kaplan-Meier methods were used to evaluate event-free survival (EFS), time to recurrence and overall survival (OS). Cox regression models were used to evaluate predictors of EFS and OS by pathological complete response (pCR) status.

Impact of Broadening Trial Eligibility Criteria for Patients with Advanced Non-Small Cell Lung Cancer: Real-World Analysis of Select ASCO- Recommendations.

Purpose: Cancer clinical trials often accrue slowly or miss enrollment targets. Strict eligibility criteria are a major reason. Restrictive criteria also limit opportunities for patient participation while compromising external validity of trial results.

Estimating the Distribution of Treatment Effects From Random Design Experiments.

Background: Random design experiments are a powerful device for estimating average treatment effects, but evaluators sometimes seek to estimate the distribution of treatment effects. For example, an evaluator might seek to learn the proportion of treated units who benefit from treatment, the proportion who receive no benefit, and the proportion who are harmed by treatment.

Method: Imbens and Rubin (I&R) recommend a Bayesian approach to drawing inferences about the distribution of treatment effects.

Guideline-Driven Care Improves Outcomes in Patients with Traumatic Rib Fractures.

There is no established national standard for rib fracture management. A clinical practice guideline (CPG) for rib fractures, including monitoring of pulmonary function, early initiation of aggressive loco-regional analgesia, and early identification of deteriorating respiratory function, was implemented in 2013. The objective of the study was to evaluate the effect of the CPG on hospital length of stay.

Treating Decompression Sickness: Military Flight Simulation Site-Community Hospital Partnership.

Background: High-altitude flight simulation familiarizes military trainees with the symptoms of hypoxia to prepare them for emergency situations. Decompression sickness (DCS) can occur as a result of these simulations. In cases when ground-level supplemental oxygen does not resolve symptoms, hyperbaric oxygen (HBO) therapy is indicated.

High-security communication by coherence modulation at the photon-counting level.

We show that key-specified interferometer path-length difference modulation (often referred to as coherence modulation), operating in the photon-counting regime with a broadband source, can provide a quantifiably high level of physics-guaranteed security for binary signal transmission. Each signal bit is associated with many photocounts, perhaps numbering in the thousands. Of great importance, the presence of an eavesdropper can be quickly detected.

Improving prediction of fall risk among nursing home residents using electronic medical records.

Objective: Falls are physically and financially costly, but may be preventable with targeted intervention. The Minimum Data Set (MDS) is one potential source of information on fall risk factors among nursing home residents, but its limited breadth and relatively infrequent updates may limit its practical utility. Richer, more frequently updated data from electronic medical records (EMRs) may improve ability to identify individuals at highest risk for falls.

Change in perceived health insurance coverage among people with multiple sclerosis.

Background: Previous research suggests that most people with multiple sclerosis (MS) in the United States have health insurance. However, little is known about their coverage or how it differs between public and private insurance. We examined whether the perceived change in health insurance coverage from the previous year differs between individuals with MS who are privately insured compared with those who are publicly insured.

Pairwise cluster randomization: an exposition.

Background: Cluster randomization (CR) is often used for program evaluation when simple random assignment is inappropriate or infeasible. Pairwise cluster random (PCR) assignment is a more efficient alternative, but evaluators seemed to be deterred from PCR because of bias and identification problems. This article explains the problems, argues that they can be mitigated through design choices, and demonstrates that the suitability of PCR can be tested using Monte Carlo procedures.

Regression discontinuity design in criminal justice evaluation: an introduction and illustration.

Background: Corrections agencies frequently place offenders into risk categories, within which offenders receive different levels of supervision and programming. This supervision strategy is seldom evaluated but often can be through routine use of a regression discontinuity design (RDD). This article argues that RDD provides a rigorous and cost-effective method for correctional agencies to evaluate and improve supervision strategies and advocates for using RDD routinely in corrections administration.

Evaluation of AHRQ's on-time pressure ulcer prevention program: a facilitator-assisted clinical decision support intervention for nursing homes.

Background: Pressure ulcers present serious health and economic consequences for nursing home residents. The Agency for Healthcare Research & Quality, in partnership with the New York State Department of Health, implemented the pressure ulcer module of On-Time Quality Improvement for Long Term Care (On-Time), a clinical decision support intervention to reduce pressure ulcer incidence rates.

Objective: To evaluate the effectiveness of the On-Time program in reducing the rate of in-house-acquired pressure ulcers among nursing home residents.

Determination of flow orientation of an optically active turbulent field by means of a single beam.

The cross-flow orientation of an optically active turbulent field was determined by Fourier transforming the wander of a laser beam propagating in the ocean. A simple physical model for the measured effect is offered, and numerical simulations are performed. The simulations are in good agreement with measurements, validating the assumptions made in the model.

Potentially avoidable hospitalizations for elderly long-stay residents in nursing homes.

Background: Hospitalizations of long-stay nursing home (NH) residents are common. The high estimates of potentially avoidable hospitalizations in NHs suggest that efforts to reduce avoidable hospitalizations may be effective in lowering health care expenditures as well as improving the quality of care for NH residents.

Objective: To determine the relationship between clinical risk factors, facility characteristics and State policy variables, and both avoidable and unavoidable hospitalizations.