Cost Benefit Analysis of Athletic Team Coverage by an Orthopaedic Practice

Introduction - Coverage of high school football by an orthopaedic practice is considered standard of care in many localities. - Taking time away from an orthopaedic practice to provide on ­field athletic care has potential advantages and disadvantages. - To this date, the economic value of this endeavor has never been investigated. - Purpose: to perform a cost/benefi­t analysis of local high school sports coverage by an orthopaedic sports medicine practice

Increasing the rate of excisional lymph node biopsies at easily accessible sites when ruling out lymphoma

The aim of this study is to increase the rate of excisional lymph node biopsies from 78% to 95% in patients presenting to the Center City campus with lymphadenopathy at easily accessible sites by September 2021

Measuring vaccine confidence: introducing a global vaccine confidence index.

BACKGROUND: Public confidence in vaccination is vital to the success of immunisation programmes worldwide. Understanding the dynamics of vaccine confidence is therefore of great importance for global public health. Few published studies permit global comparisons of vaccination sentiments and behaviours against a common metric. This article presents the findings of a multi-country survey of confidence in vaccines and immunisation programmes in Georgia, India, Nigeria, Pakistan, and the United Kingdom (UK) - these being the first results of a larger project to map vaccine confidence globally. METHODS: Data were collected from a sample of the general population and from those with children under 5 years old against a core set of confidence questions. All surveys were conducted in the relevant local-language in Georgia, India, Nigeria, Pakistan, and the UK. We examine confidence in immunisation programmes as compared to confidence in other government health services, the relationships between confidence in the system and levels of vaccine hesitancy, reasons for vaccine hesitancy, ultimate vaccination decisions, and their variation based on country contexts and demographic factors. RESULTS: The numbers of respondents by country were: Georgia (n=1000); India (n=1259); Pakistan (n=2609); UK (n=2055); Nigerian households (n=12554); and Nigerian health providers (n=1272). The UK respondents with children under five years of age were more likely to hesitate to vaccinate, compared to other countries. Confidence in immunisation programmes was more closely associated with confidence in the broader health system in the UK (Spearman's ρ=0.5990), compared to Nigeria (ρ=0.5477), Pakistan (ρ=0.4491), and India (ρ=0.4240), all of which ranked confidence in immunisation programmes higher than confidence in the broader health system. Georgia had the highest rate of vaccine refusals (6 %) among those who reported initial hesitation. In all other countries surveyed most respondents who reported hesitating to vaccinate went on to receive the vaccine except in Kano state, Nigeria, where the percentage of those who ultimately refused vaccination after initially hesitating was as high as 76%) Reported reasons for hesitancy in all countries were classified under the domains of "confidence," "convenience," or "complacency," and confidence issues were found to be the primary driver of hesitancy in all countries surveyed

Assessment of the Diagnostic Accuracy of Core Needle Biopsies in the Diagnosis of Lymphoma

Introduction: Excisional biopsy remains the gold standard in the diagnosis of lymphomas. However, recent studies have shown that core needle biopsy (CNB) may have similar accuracy. CNB offers several advantages over excisional biopsy, including reduced cost and morbidity, thus we set out to determine the diagnostic accuracy of CNB at Thomas Jefferson University Hospital (TJUH) to understand if this approach should be utilized more in our system. Methods: We performed a retrospective chart review of all suspected new diagnosis of lymphoma at TJUH from January 1st, 2016 to December 31st, 2019. All CNB and excisional biopsies were reviewed. Samples were deemed inadequate if they 1. Did not provide enough tissue for a diagnosis or 2. Were too limited to fully characterize the disease. We determined the accuracy of each biopsy type, as well as their diagnostic odds ratio using a Baptista-Pike model. Results: Excisional biopsy was found to be adequate 97% (328/339) of the time, while CNB was adequate 57% (67/122) of the time. The diagnostic odds ratio for CNB was found to be 0.03583 [95% confidence interval {CI}: 0.01695 to 0.07532] (Baptista-Pike), p \u3c0.0001 (Chi square). Discussion: Our results indicate that excisional biopsy should remain the standard of care in the diagnosis of lymphoma for most cases at TJUH. Based on this research, a quality improvement initiative is being implemented to increase the number of excisional biopsies done at TJUH, especially in easily accessible areas

Assessment of the Diagnostic Accuracy of Core Needle Biopsy in the Diagnosis of Lymphoma

Introduction: Excisional biopsy (EB) of lymph nodes is the gold standard for diagnosing lymphoma. Recent literature suggests that diagnostic techniques such as immunohistochemistry, flow cytometry and FISH/Cytogenetics yield similar diagnostic adequacy rates when paired with less invasive procedures, like Core Needle Biopsy (CNB). We were interested in comparing the diagnostic odds ratio and adequacy of patients suspected of lymphoma who underwent CNB to EB at Thomas Jefferson University Hospital (TJUH). Methods: We performed a retrospective cohort study on biopsies collected from 01/01/2016 and 12/31/2019 at TJUH. Specimens were considered diagnostically inadequate if there was not enough lesional tissue for diagnosis or the disease process was unable to be fully characterized. The diagnostic odds ratio and confidence intervals were calculated using the Baptista-Pike method. Adequacy of the specimens was then compared for statistical significance using a chi-squared test. Results: A total of 457 biopsy samples were included in the final analysis, consisting of 339 EB samples and 118 CNB samples. EBs had adequate tissue to make a diagnosis 96.8% (328) of the time, while CNB’s had adequate tissue 56.8% (67) of the time. The diagnostic odds ratio of CNB was determined to be 0.03583, [95% confidence interval {CI}: 0.01695 to 0.07532] (Baptista-Pike), p\u3c0.0001 (Chi square). Discussion: TJUH has begun moving away from EBs in recent years, but our results indicate that EB should remain the standard of care. Additional research is needed to understand the reason for this recent trend as well as how ancillary studies could enhance CNB diagnostic accuracy

Eurasian Arctic greening reveals teleconnections and the potential for novel ecosystems

Arctic warming has been linked to observed increases in tundra shrub cover and growth in recent decades on the basis of significant relationships between deciduous shrub growth/biomass and temperature. These vegetation trends have been linked to Arctic sea ice decline and thus to the sea ice/albedo feedback known as Arctic amplification. However, the interactions between climate, sea ice and tundra vegetation remain poorly understood. Here we reveal a 50- year growth response over a >100,000 km2 area to a rise in summer temperature for alder (Alnus) and willow (Salix), the most abundant shrub genera respectively at and north of the continental treeline. We demonstrate that whereas plant productivity is related to sea ice in late spring, the growing season peak responds to persistent synoptic-scale air masses over West Siberia associated with Fennoscandian weather systems through the Rossby wave train. Substrate is important for biomass accumulation, yet a strong correlation between growth and temperature encompasses all observed soil types. Vegetation is especially responsive to temperature in early summer. These results have significant implications for modelling present and future Low Arctic vegetation responses to climate change, and emphasize the potential for structurally novel ecosystems to emerge fromwithin the tundra zone.Vertaisarviointia edeltävä käsikirjoitu