Trends in Traumatic Brain Injury Related to Consumer Products Among U.S. School-aged Children Between 2000 and 2019.

INTRODUCTION: Consumer product‒related traumatic brain injury in children is common, but long-term trends have not been well characterized. Understanding the long-term trends in consumer product‒related traumatic brain injury may inform prevention efforts. The study objective is to examine the trends in consumer product‒related traumatic brain injury in school-aged children. METHODS: Data were extracted from the National Electronic Injury Surveillance System-All Injury Program for initial emergency department visits for consumer product‒related traumatic brain injury (2000-2019) in school-aged children and analyzed in 2021. RESULTS: Approximately 6.2 million children presented to emergency department with consumer product‒related traumatic brain injury during 2000-2019. Consumer product‒related traumatic brain injury increased from 4.5% of overall consumer product‒emergency department visits in 2000 to 12.3% in 2019, and its incidence rate (cases per 100,000 population) was higher in males (681.2; 95% CI=611.2, 751.2) than in females (375.8; 95% CI=324.1, 427.6). The annual percentage change in consumer product‒related traumatic brain injury was 3.6% from 2000 to 2008, 13.3% from 2008 to 2012, and ‒2.0% through 2019. Average annual percentage change was higher in females (5.1%; 95% CI=3.4, 6.8) than in males (2.8%; 95% CI=1.6, 3.9). Consumer product‒related traumatic brain injury increased from 2000 to 2012 in females and then remained stable. In males, annual percentage change increased from 2008 to 2012 and then declined through 2019. CONCLUSIONS: Traumatic brain injury incidence rate in school-aged children increased from 2000 to 2019, peaked in 2012, and then declined in males but not in females. Percentage increases were highest in females. Prevention strategies should continue, with a specific focus on reducing consumer product‒related traumatic brain injury in female children.

Stochasticity among Victims of COVID-19 Pandemic.

This article provides a thorough explanation of methods and theoretical concepts to detect infectivity of COVID-19. The concept of heterogeneity is discussed and its impacts on COVID-19 pandemics are explored. Observable heterogeneity is distinguished from non-observable heterogeneity. The data support the concepts of heterogeneity and the methods to extract and interpret the data evidence for the conclusions in this paper. Heterogeneity among the vulnerable to COVID-19 is a significant factor in the contagion of COVID-19, as demonstrated with incidence rates using data of a Diamond Princess cruise ship. Given the nature of the pandemic, its heterogeneity with different social norms, pre- and post-voyage quick testing procedures ought to become the new standard for cruise ship passengers and crew. With quick testing, identification of those infected and thus, not allowing to embark on a cruise or quarantine those disembarking, and other mitigation strategies, the popular cruise adventure could become norm for safe voyage. The novel method used in this article adds valuable insight in the modeling of disease and specifically, the COVID-19 virus.

Predicting COVID-19 cases with unknown homogeneous or heterogeneous resistance to infectivity.

We present a restricted infection rate inverse binomial-based approach to better predict COVID-19 cases after a family gathering. The traditional inverse binomial (IB) model is inappropriate to match the reality of COVID-19, because the collected data contradicts the model's requirement that variance should be larger than the expected value. Our version of an IB model is more appropriate, as it can accommodate all potential data scenarios in which the variance is smaller, equal, or larger than the mean. This is unlike the usual IB, which accommodates only the scenario in which the variance is more than the mean. Therefore, we propose a refined version of an IB model to be able to accommodate all potential data scenarios. The application of the approach is based on a restricted infectivity rate and methodology on COVID-19 data, which exhibit two clusters of infectivity. Cluster 1 has a smaller number of primary cases and exhibits larger variance than the expected cases with a negative correlation of 28%, implying that the number of secondary cases is lesser when the number of primary cases increases and vice versa. The traditional IB model is appropriate for Cluster 1. The probability of contracting COVID-19 is estimated to be 0.13 among the primary, but is 0.75 among the secondary in Cluster 1, with a wider gap. Cluster 2, with a larger number of primary cases, exhibits smaller variance than the expected cases with a correlation of 79%, implying that the number of primary and secondary cases do increase or decrease together. Cluster 2 disqualifies the traditional IB model and requires its refined version. The probability of contracting COVID-19 is estimated to be 0.74 among the primary, but is 0.72 among the secondary in Cluster 2, with a narrower gap. The advantages of the proposed approach include the model's ability to estimate the community's health system memory, as future policies might reduce COVID's spread. In our approach, the current hazard level to be infected with COVID-19 and the odds of not contracting COVID-19 among the primary in comparison to the secondary groups are estimable and interpretable.

Influences of reopening businesses and social venues: COVID-19 incidence rate in East Texas county.

As the on-going severe acute respiratory syndrome coronavirus 2 pandemic, we aimed to understand whether economic reopening (EROP) significantly influenced coronavirus disease 2019 (COVID-19) incidence. COVID-19 data from Texas Health and Human Services between March and August 2020 were analysed. COVID-19 incidence rate (cases per 100 000 population) was compared to statewide for selected urban and rural counties. We used joinpoint regression analysis to identify changes in trends of COVID-19 incidence and interrupted time-series analyses for potential impact of state EROP orders on COVID-19 incidence. We found that the incidence rate increased to 145.1% (95% CI 8.4-454.5%) through 4th April, decreased by 15.5% (95% CI -24.4 -5.9%) between 5th April and 30th May, increased by 93.1% (95% CI 60.9-131.8%) between 31st May and 11th July and decreased by 13.2% (95% CI -22.2 -3.2%) after 12 July 2020. The study demonstrates the EROP policies significantly impacted trends in COVID-19 incidence rates and accounted for increases of 129.9 and 164.6 cases per 100 000 populations for the 24- or 17-week model, respectively, along with other county and state reopening ordinances. The incidence rate decreased sharply after 12th July considering the emphasis on a facemask or covering requirement in business and social settings.

Examining the Return on Investment of the Breath of Life Mobile Pediatric Asthma Clinic in a Rural Region with Small Metropolitan Statistical Areas.

The current study sought to examine the return on investment (ROI) of a mobile pediatric asthma clinic in a rural region with small metropolitan statistical areas, in terms of reduced costs attributed to preventable emergency department visits, inpatient admission, school absenteeism, cost of education, and parent work absenteeism. For fiscal years 2015 and 2016, an average return of $1.32 and a community ROI of $1.45 was estimated. Estimated benefits were $445,125.00 and cost avoidance was $263,853.01. A mobile pediatric asthma clinics operating in less densely populated regions is able to yield a positive ROI.

An Analysis of the Massachusetts Healthcare Law.

Healthcare in the United States has been one topic of the debates and discussion in the country for many years. The challenge for affordable, accessible, and quality healthcare for most Americans has been on the agenda of federal and state legislatures. There is probably no other state that has drawn as much individual attention regarding this challenge as the state of Massachusetts. While researching the topic for this article, it was discovered that financial and political perspectives on the success or failure of the healthcare model in Massachusetts vary depending on the aspect of the system being discussed. In this article the authors give a brief history and description of the Massachusetts Healthcare Law, explanation of how the law is financed, identification of the targeted populations in Massachusetts for which the law provides coverage, demonstration of the actual benefit coverage provided by the law, and review of the impact of the law on healthcare providers such as physicians and hospitals. In addition, there are explanations about the impact of the law on health insurance companies, discussion of changes in healthcare premiums, explanation of costs to the state for the new program, reviews of the impact on the health of the insured, and finally, projections on the changes that healthcare facilities will need to make to maintain fiscal viability as a result of this program.

Converting ICD-9 to ICD-10.

Implementing the International Classification of Diseases, Ninth Revision (ICD-9) to International Classification of Diseases, Tenth Revision (ICD-10) conversion on October 1, 2015, in the United States has been a long-term goal. While most countries in the world converted more than 10 years ago, the United States was still using ICD-9. Many countries in the world have a single-payer healthcare system, while there are thousands of different healthcare organizations (providers and payers) that presently exist in the United States. With so many different software platforms for healthcare providers and payers, the conversion had become that much more complicated and capital intensive for all healthcare organizations in the country. A few of the present delay reasons to the ICD-10 conversion in past years were the concurrent timelines for meeting meaningful use requirements for the electronic health record, testing with external payers and upgrades from vendors which added complexities and extra costs. The authors examine the reasoning behind the conversion as well as the delays, before making the conversion on October 1, 2015, and review the question regarding whether the government's decision to push the date back a year would have been helpful.

The influence of race on end-of-life choices following a counselor-based palliative consultation.

Black Americans are more likely than whites to choose aggressive medical care at the end of life. We present a retrospective cohort study of 2843 patients who received a counselor-based palliative care consultation at a large US southeastern hospital. Before the palliative consultation, 72.8% of the patients had no restrictions in care, and only 4.6% had chosen care and comfort only (CCO). After the consult, these choices dramatically changed, with only 17.5% remaining full code and 43.3% choosing CCO. Both before and after palliative consultation, blacks chose more aggressive medical care than whites, but racial differences diminished after the counselor-based consultation. Both African American and white patients and families receiving a counselor-based palliative consultation in the hospital make profound changes in their preferences for life-sustaining treatments.

Sticker shock: an exploration of supply charge capture outcomes.

Do you find supply item charge stickers in shocking places in nursing units? Capturing supply item charges to increase net revenue or achieve break-even are based on efficiency. To determine practical efficiency for a hospital in supply charge capture, the authors examined the quantity of supply charge capture items, volume, and relative size of the hospital in 10 hospitals in the midwestern and southeastern United States. What differences in supply charge capture information can determine if a hospital can break even? Results show that hospital size and number of supply charge capture items to manage are important factors.

Effects of outsourced nursing on quality outcomes in long-term acute-care hospitals.

Use of outsourced nurses is often a stop-gap measure for unplanned vacancies in smaller healthcare facilities such as long-term acute-care hospitals (LTACHs). However, the relationship of utilization levels (low, medium, or high percentages) of nonemployees covering staff schedules often is perceived to have negative relationships with quality outcomes. To assess this issue, the authors discuss the outcomes of their national study of LTACH hospitals that indicated no relationship existed between variations in percentage of staffing by contracted nurses and selected outcomes in this post-acute-care setting.

Use of outsourced nurses in long-term acute care hospitals: outcomes and leadership preferences.

When staffing effectiveness is not maintained over time, the likelihood of negative outcomes increases. This challenge is particularly problematic in long-term acute care hospitals (LTACHs) where use of outsourced temporary nurses is common when providing safe, sufficient care to medically complex patients who require longer hospital stays than normally would occur. To assess this issue, the authors discuss the outcomes of their survey of LTACH chief nursing officers that demonstrated LTACH quality indicators and overall patient satisfaction were within nationally accepted benchmarks even with higher levels of outsourced nurses used in this post-acute care setting.

Real healthcare reform: focus on primary care access.

Primary care coverage for the uninsured is the first necessary step to reform and can be more cost effective and tolerable than a major system reform. By providing foundational care to the uninsured, more care resources are targeted to those that most need the services, while providing benefits such as increased productivity and reduced inappropriate emergency department utilization. The authors aimed to design a primary care coverage system in the United States for the uninsured using established reimbursement, budgeting, and compliance methods. Providing four primary care visits for acute care, four associated ancillary and four fulfilled pharmaceutical-treatment prescriptions, and one preventive primary care visit per year for nearly 48,000,000 uninsured would cost $36 per month for every working American and legal alien resident. Theoretical and empirical literature was reviewed and the authors applied practical knowledge based on their experience in healthcare systems to develop the Access America Program.

Predictors of communication quality: the patient, provider, and nurse call center triad.

The purpose of this study was to examine characteristics of communication quality in a managed care context in which a nurse call center was used as the patient point of entry to the health system. The study sought to determine the level of communication quality among patients, health care providers, and nurses in the call center. Having measured the timeliness, accuracy, usefulness, and quantity of communication variables, a reasonable picture of communication quality emerged. The study explored patient differences in their perception of communication quality due to socioeconomic status, needs, experience, age, and various other factors. Likewise, providers who differ in training, specialty, and experience should have different perceptions and expectations of communication through nurse call center interaction.

Robbing Peter to pay Paul: smarter re-allocation of dollars bring relief!

The dynamic tension facing health care organizations today is that of lower third-party payments and higher costs. The ever-present financial squeeze results in daily stressors for health care executives attempting to provide services with diminishing resources. How can one continue to "rob Peter to pay Paul," to make ends meet and stretch every dollar?