How do hospitals exert market power? Evidence from health systems and commercial health plan prices.

Consolidation of independent hospitals and physician practices into integrated health systems has reshaped the delivery of health care. While the literature suggests that provider consolidation raises prices, few studies have examined the interplay of health systems and insurers in relation to prices. Using negotiated price data that commercial insurers recently released under the Transparency in Coverage Final Rule, we examined the association between hospital concentration under health systems and prices for outpatient procedures in local health care markets with different levels of insurer concentration.

Challenges of Treating a C2 Odontoid Fracture in an Elderly Patient With Multiple Comorbidities: A Case Report.

An 88-year-old male with a history of cervical spondylosis (status post laminectomy of C2-C3 and laminoplasty of C4-C5), chronic congestive heart failure (CHF), pulmonary embolism, and lumbar spinal stenosis presented to an outpatient sports medicine clinic with neck pain following a fall five days prior due to loss of balance. He reported pain on the left side worsened by movement and accompanied by neck "clicking." A physical exam showed severe limitation in cervical spine extension limited by pain and loss of lordotic curve and a neurologic exam demonstrated weakness in the left leg secondary to a previous back surgery.

Attention-dependent attribute comparisons underlie multi-attribute decision-making in orbitofrontal cortex.

Economic decisions often require weighing multiple dimensions, or attributes. The orbitofrontal cortex FC) is thought to be important for computing the integrated value of an option from its attributes and comparing lues to make a choice. Although OFC neurons are known to encode integrated values, evidence for value mparison has been limited.

Neural populations in macaque anterior cingulate cortex encode social image identities.

The anterior cingulate cortex gyrus (ACCg) has been implicated in prosocial behaviors and reasoning about social cues. While this indicates that ACCg is involved in social behavior, it remains unclear whether ACCg neurons also encode social information during goal-directed actions without social consequences. To address this, we assessed how social information is processed by ACCg neurons in a reward localization task.

Multiattribute Decision-making in Macaques Relies on Direct Attribute Comparisons.

In value-based decisions, there are frequently multiple attributes, such as cost, quality, or quantity, that contribute to the overall goodness of an option. Because one option may not be better in all attributes at once, the decision process should include a means of weighing relevant attributes. Most decision-making models solve this problem by computing an integrated value, or utility, for each option from a weighted combination of attributes.

Global assessment of military and civilian trauma systems integration: a scoping review.

Background: The global burden of trauma disproportionately affects low-income countries and middle-income countries (LMIC), with variability in trauma systems between countries. Military and civilian healthcare systems have a shared interest in building trauma capacity for use during peace and war. However, in LMICs it is largely unknown if and how these entities work together.

Identifying delay in glymphatic clearance of labeled protons post-acute head trauma utilizing 3D ASL MRI (arterial spin labeling): a pilot study.

This study correlated mild traumatic brain injury (mTBI) cognitive changes with ASL-MRI glymphatic clearance rates (GCRs) and recovery with GCR improvement. mTBI disrupts the blood brain barrier (BBB), reducing capillary mean transit time and GCRs. mTBI is clinically diagnosed utilizing history/examination findings with no physiologic biomarkers.

Hospital outpatient department billing is a poor indicator of primary care practice integration with hospital systems.

Objective: To test the reliability of Medicare claims in measuring vertical integration. We assess the accuracy of a commonly used measure of integration, primary care physician (PCP) practices billing Medicare as a hospital outpatient department (HOPD) in claims.

Data Sources And Study Setting: Medicare fee-for-service claims, IQVIA, and CPC+ practice surveys for this study.

Nutritional Status and Incidence of Radiation-Induced Oral Mucositis in Nasopharyngeal Carcinoma Patients Treated with Chemoradiotherapy.

Malnutrition is prevalent among patients with nasopharyngeal carcinoma undergoing radiotherapy. This study examined the nutritional status and incidence of radiation-induced oral mucositis (RIOM) in patients with nasopharyngeal carcinoma. A retrospective analysis was conducted to compare the incidence of RIOM, Nutritional Risk Screening (NRS) 2002 score, weight, body mass index (BMI), and hemoglobin levels in 338 patients treated with induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) or treated with CCRT alone.

Multi-attribute decision-making in macaques relies on direct attribute comparisons.

Unlabelled: In value-based decisions, there are frequently multiple attributes, such as cost, quality, or quantity, that contribute to the overall goodness of an option. Since one option may not be better in all attributes at once, the decision process should include a means of weighing relevant attributes. Most decision-making models solve this problem by computing an integrated value, or utility, for each option from a weighted combination of attributes.

Anti-SMN autoantibodies in mixed connective tissue disease are associated with a severe systemic sclerosis phenotype.

Objectives: The survival of motor neuron (SMN) complex has an essential role in the assembly of small nuclear ribonucleoproteins (RNP). Recent reports have described autoantibodies (aAbs) to the SMN complex as novel biomarkers in anti-U1RNP+ myositis patients. The aim of this study was to compare phenotypic features of anti-U1RNP+ mixed connective tissue disease (MCTD) patients with and without anti-SMN aAbs.

Autonomous artificial intelligence increases real-world specialist clinic productivity in a cluster-randomized trial.

Autonomous artificial intelligence (AI) promises to increase healthcare productivity, but real-world evidence is lacking. We developed a clinic productivity model to generate testable hypotheses and study design for a preregistered cluster-randomized clinical trial, in which we tested the hypothesis that a previously validated US FDA-authorized AI for diabetic eye exams increases clinic productivity (number of completed care encounters per hour per specialist physician) among patients with diabetes. Here we report that 105 clinic days are cluster randomized to either intervention (using AI diagnosis; 51 days; 494 patients) or control (not using AI diagnosis; 54 days; 499 patients).

The Lived Experience of Ambulatory and Perioperative RNs Displaced During the COVID-19 Pandemic: A Phenomenological Study.

During the patient surge associated with the onset of the COVID-19 pandemic in the spring of 2020, perioperative and ambulatory RNs at an acute-care specialty orthopedic hospital were redeployed to medical-surgical inpatient nursing units to care for patients with the disease. The purpose of this phenomenological study was to describe perioperative and ambulatory RNs' experiences during the redeployment. We used purposeful sampling to obtain representatives who worked routinely in perioperative (including postanesthesia care) and ambulatory settings before redeployment.

Association of the Range of Outpatient Services Provided by Primary Care Physicians with Subsequent Health Care Costs and Utilization.

Background: Broader primary care practice range of services (ROS), defined as the diversity of professional services delivered, is associated with lower utilization. ROS provided by individual primary care physicians (PCPs) varies considerably with unclear implications for patients.

Objectives: Create a PCP-ROS measure covering six categories of outpatient services, including expanded codes for mental health counseling services and point of care ultrasound (POCUS) technology in physician offices.

Abstraction of Reward Context Facilitates Relative Reward Coding in Neural Populations of the Macaque Anterior Cingulate Cortex.

The anterior cingulate cortex (ACC) is believed to be involved in many cognitive processes, including linking goals to actions and tracking decision-relevant contextual information. ACC neurons robustly encode expected outcomes, but how this relates to putative functions of ACC remains unknown. Here, we approach this question from the perspective of population codes by analyzing neural spiking data in the ventral and dorsal banks of the ACC in two male monkeys trained to perform a stimulus-motor mapping task to earn rewards or avoid losses.

Reducing Acute Hospitalizations at High-Performing CPC+ Primary Care Practice Sites: Strategies, Activities, and Facilitators.

Purpose: Despite evidence suggesting that high-quality primary care can prevent unnecessary hospitalizations, many primary care practices face challenges in achieving this goal, and there is little guidance identifying effective strategies for reducing hospitalization rates. We aimed to understand how practices in the Comprehensive Primary Care Plus (CPC+) program substantially reduced their acute hospitalization rate (AHR) over 2 years.

Methods: We used Bayesian analyses to identify the CPC+ practice sites having the highest probability of achieving a substantial reduction in the adjusted Medicare AHR between 2016 and 2018 (referred to here as AHR high performers).

Quadriceps Dysfunction Following Joint Preservation Surgery: A Review of the Pathophysiologic Basis and Mitigation Strategies.

Purpose Of Review: To characterize quadriceps muscle dysfunction associated with knee joint preservation surgery, with a focus on its pathophysiology and promising approaches to mitigate its impact on clinical outcomes.

Recent Findings: Quadriceps dysfunction (QD) associated with knee joint preservation surgery results from a complex interplay of signaling, related to changes within the joint and from those involving the overlying muscular envelope. Despite intensive rehabilitation regimens, QD may persist for many months postoperatively and negatively impact clinical outcomes associated with various surgical procedures.

Effects of Integrated Vector Management in the Control of Malaria Infection: An Intervention Study in a Malaria Endemic Community in Nigeria.

Background/aim: Malaria is a vector borne disease with high morbidity and mortality in endemic regions. In view to eliminating the disease, integrated vector and environmental hygiene practices have been advocated. There is paucity of studies on the effect of vector control measures on asymptomatic malaria infection which has been observed to be a reflection of malaria transmission.

Prevalence estimates of trafficking in persons using statistical definitions: a cross-sectional high-risk community survey in Cape Town, South Africa.

Objectives: Current research on trafficking in persons (TIP) relies heavily on legal and prosecutorial definitions. A public health approach has called for population-level assessment; however, identification of TIP victims lacks a standardised operational definition. This study applied the Prevalence Reduction Innovation Forum (PRIF) statistical definitions, developed by the US Department of State, to a community survey in Cape Town, South Africa.

Optimizing national border reopening policies in the COVID-19 pandemic: A modeling study.

Objective: After emergence of the COVID-19 pandemic and subsequent restrictions, countries worldwide have sought to reopen as quickly as possible. However, reopening involves the risk of epidemic rebound. In this study, we investigated the effective policy combination to ensure safe reopen.

Medicare beneficiaries with more comprehensive primary care physicians report better primary care.

Objective: To examine whether primary care physician (PCP) comprehensiveness is associated with Medicare beneficiaries' overall rating of care from their PCP and staff.

Data Sources: We linked Medicare claims with survey data from Medicare beneficiaries attributed to Comprehensive Primary Care Plus (CPC+) physicians and practices.

Study Design: We performed regression analyses of the associations between two claims-based measures of PCP comprehensiveness in 2017 and beneficiaries' rating of care from their PCP and practice staff in 2018.

Identifying identity and attributing value to attributes: reconsidering mechanisms of preference decisions.

Although the orbitofrontal cortex (OFC) robustly encodes value during preference decisions, it also encodes multiple non-value features of choice options. The role of this information, and its relationship to the options' overall value remain open questions. In this opinion, we attempt to disentangle oft-studied categories of option information - identity and attributes - in the context of both classic theories of economic choice and contradicting evidence of choice biases in multi-attribute decisions.