Financial impact of low pathogenic avian influenza virus subtype H9N2 on commercial broiler chicken and egg layer production systems in Pakistan.

Low Pathogenic Avian Influenza (LPAI) subtype H9N2 is endemic in Pakistan and impacts poultry farming through disease related mortality, poor weight gain and reduced egg production. This study aims to estimate the farm-level financial impact of LPAI H9N2 infection on commercial broiler and layer production systems in Pakistan. A questionnaire based cross-sectional survey of 138 broiler farms and 136 layer farms in Pakistan was conducted in 2019. Primary data collected by cross-sectional survey along with expert opinion and published literature were used to parameterize five stochastic production and gross margin models for three broiler and two layer production systems: fully integrated production (FIP), partially integrated production (PIP) and independent farming production (IP) systems. Partial budget analysis were then carried out to estimate the financial impact of LPAI H9N2. Results indicate that in broiler production systems, starting with 35,000 day old chicks (DOC) per batch, the net cost of disease (million PKR/production cycle) was estimated at 4.10 (14,862 USD), 4.62 (16,747 USD) and 2.46 (8917 USD) for IP, PIP and FIP systems, respectively. The disease produced a negative gross margin (defined here as revenue minus replacement and variable costs) in IP (-53 PKR (-0.19 USD)/DOC bought) and PI (-25 PKR (-0.091 USD)/DOC bought) systems, while remained positive for FIP systems (87 PKR (0.32 USD)/DOC bought). For layer production systems, (mean flock size as 48,000 DOCs) the net cost (million PKR/production cycle) was 29.75 (107,095.21 USD) and 29.51 (106,223.45 USD) IP and PIP systems, respectively, and produced negative gross margin in both systems. The outcomes of the study highlight the vulnerability of independent and partially integrated production systems to the disease. These findings also offer a decision-making tool to the farmers and policy makers to evaluate avian influenza surveillance systems and control interventions in Pakistan.

The cost of care in maxillofacial fractures treatment in relation to the type of fixation and length of stay at a tertiary care hospital of Karachi, Pakistan: A retrospective chart review.

In addition to the clinical burden of trauma, the financial burden is an important aspect of care globally, especially for patients in low- and middle-income countries. The current retrospective review was done of data from January 2015 to December 2020 related to patients of oral maxillofacial trauma management in a tertiary care setting. Analysis of variance was used to determine the mean difference in the cost incurred depending upon the type of trauma and the number of bone plates used in fracture management. Pearson correlation was applied to explore any correlation involving patient age, aetiology and type of fracture, number of bone plates employed and the length of stay in the hospital. No statistically significant differences were noted in the cost among the different groups. The cost of care was significantly (p<0.001) correlated to the length of stay. Other variables, such as the type of fractures and the number of plates, had no significant impact (p>0.05).

A scoping review of the impact of COVID-19 on dentistry: financial aspects.

BACKGROUND: The technological advancements of the past few decades in various aspects that are directly or indirectly related to health, along with the emphasis on public health in societal development, have improved the quality of life. However, the occurrence of pandemics and crises underscores how various aspects of individual life can be impacted. The financial consequences resulting from the COVID-19 pandemic have particularly affected the field of dentistry and public oral health. This study aims to investigate the financial effects of the COVID-19 virus on dentistry through a scoping review. METHODS: A comprehensive literature search was conducted across four databases (Medline through PubMed, Embase, Scopus, and Cochrane Central) using keywords such as COVID-19 and its equivalents, dentistry, oral health, dental education, dental services, dental clinics, financial impact, financial opportunities and economic impact. Articles addressing the financial impact of COVID-19 on dentistry and oral health were then screened and reviewed. RESULTS: Out of 1015 articles related to COVID-19 and dentistry, 84 were focused on the financial impact of COVID-19 on dentistry. The majority of these articles originated from the United States, Brazil, and Saudi Arabia, with a prevalence of cross-sectional and review articles. The review categorized the articles into two main themes: financial problems and proposed solutions. Moreover, the following themes were extracted: the effects of practice closure on dentists and staff, increased treatment costs and impacts on oral health, personal protective equipment and unforeseen costs, psychological effects of financial issues, and financial challenges within the dental education system. CONCLUSIONS: While many high-income countries seem able to mitigate COVID-19-induced financial problems, the economic effects on dentistry might persist despite the pandemic's end. These financial challenges have spurred new opportunities and infrastructure development but can pose significant risks to community oral health. This study aimed to highlight these problems and propose solutions, contributing to efforts to improve the oral health of communities globally. Further research is needed to understand long-term impacts.

Impact of an Outpatient Word Catheter Program for Bartholin cysts and abscesses: A retrospective cohort study.

OBJECTIVE: To assess the impact of an Outpatient Word Catheter Program (OWCP) on outcomes in women presenting with Bartholin cysts or abscesses (BC/BAs). . METHODS: This retrospective cohort study reviewed 408 women presenting with BC/BAs to our tertiary unit from 2017-2022. Analysis of medical records, with subgroup analysis of pregnant patients, and comparative analysis between pre- and post-intervention groups, was completed. Financial impact analysis using national activity-based funding pricing guidance to estimate cost was conducted. RESULTS: Pre-intervention, 65% (n = 34) of procedures were completed in theater, but after the introduction of OWCP, 61% (n = 213) of cases were treated in the day ward (χ2 = 67.43, P <0.001). Similarly, inpatient admissions reduced; 94.2% (n = 49) pre-intervention versus 26% (n = 92) post-intervention (χ2 = 92.25, P <0.001). The mean all patient admission duration decreased from 1.52 ± 0.89 days to 0.69 ± 0.59 days (P <0.001). The mean cost for those women attending in the pre-OWCP period was €4798, versus €2704 in the women who attended post-OWCP introduction (P < 0.001). CONCLUSION: After OWCP introduction, there were significant decreases in inpatient admissions, surgical procedures in theater, general anesthetic exposure, and duration of admission. Financial impact analysis revealed a significant cost reduction of ~€2100 per patient. Outpatient or day-care Word catheter programs are feasible, affordable and acceptable services to provide to women presenting with BC/BAs.

Parents' attitudes towards the No Jab No Play legislation in Western Australia: a mixed methods study.

BACKGROUND: Mandates provide a relatively cost-effective strategy to increase vaccinate rates. Since 2014, five Australian states have implemented No Jab No Play (NJPlay) policies that require children to be fully immunised to attend early childhood education and childcare services. In Western Australia, where this study was conducted, NJNPlay legislation was enacted in 2019. While most Australian families support vaccine mandates, there are a range of complexities and unintended consequences for some families. This research explores the impact on families of the NJNPlay legislation in Western Australia (WA). METHODS: This mixed-methods study used an online parent/carer survey (n = 261) representing 427 children and in-depth interviews (n = 18) to investigate: (1) the influence of the NJNPlay legislation on decision to vaccinate; and (2) the financial and emotional impacts of NJNPlay legislation. Descriptive and bivariate tests were used to analyse the survey data and open-ended questions and interviews were analysed using reflexive thematic analysis to capture the experience and the reality of participants. RESULTS: Approximately 60% of parents intended to vaccinate their child. Parents who had decided not to vaccinate their child/ren were significantly more likely to experience financial [p < 0.001] and emotional impacts [p < 0.001], compared to those who chose to vaccinate because of the mandate. Qualitative data were divided with around half of participants supporting childhood immunisation and NJNPlay with others discussing concerns. The themes (a) belief in the importance of vaccination and ease of access, (b) individual and community protection, and (c) vaccine effectiveness, safety and alternatives help understand how parents' beliefs and access may influence vaccination uptake. Unintended impacts of NJNPlay included: (a) lack of choice, pressure and coercion to vaccinate; (b) policy and community level stigma and discrimination; (c) financial and career impacts; and (d) loss of education opportunities. CONCLUSIONS: Parents appreciation of funded immunisation programs and mandates which enhance individual and community protection was evident. However for others unintended consequences of the mandate resulted in significant social, emotional, financial and educational impacts. Long-term evidence highlights the positive impact of immunisation programs. Opinions of impacted families should be considered to alleviate mental health stressors.

Financial impact of donation after circulatory death heart transplantation: A single-center analysis.

INTRODUCTION: Clinical success of donation after circulatory death (DCD) heart transplantation is leading to growing adoption of this technique. In comparison to procurement from a brain-dead donor, DCD requires additional resources. The economic impact of DCD heart transplantation from the hospital perspective is not well known. METHODS: We compared the financial data of patients who received DCD allografts to those who received a DBD organ at our institution from January 1, 2021 to December 31, 2022. We also compared the cost of ex-situ machine perfusion to in-situ organ perfusion employed during DCD recovery. RESULTS: We performed 58 DBD and 22 DCD heart-alone transplantations during the study period. Out of 22 DCD grafts, 16 were recovered with thoracoabdominal normothermic regional perfusion (TA-NRP) and six with direct procurement followed by normothermic machine perfusion (DP-NMP). The contribution margin per case for DBD versus DCD was $234,362 and $235,440 (P = .72). The direct costs did not significantly differ between the two groups ($171,949 and 186,250; P = .49). In comparing the two methods of procuring hearts from DCD donors, the direct cost of TA-NRP was $155,955 in comparison to $223,399 for DP-NMP (P = .21). This difference translated into a clinically meaningful but not statistically significant greater contribution margin for TA-NRP ($242, 657 vs. $175,768; P = .34). CONCLUSIONS: Our data showed that the adoption of DCD procurement did not have a negative financial impact on the contribution margin in our institution. Programs considering starting DCD heart transplantation, and those who are currently performing DCD procurement should evaluate their own financial situation.

Cost awareness among intensivists in their daily clinical practice: a prospective multicentre study.

BACKGROUND: Better cost-awareness is a prerogative in achieving the best benefit/risk/cost ratio in the care. We aimed to assess the cost-awareness of intensivists in their daily clinical practice and to identify factors associated with accurate estimate of cost (50-150% of the real cost). METHODS: We performed a prospective observational study in seven French ICUs. We compared the estimate of intensivists of the daily costs of caring with the real costs on a given day. The estimates covered five categories (drugs, laboratory tests, imaging modalities, medical devices, and waste) whose sum represented the overall cost. RESULTS: Of the 234 estimates made by 65 intensivists, 70 (29.9%) were accurate. The median overall cost estimate (€330 [170; 620]) was significantly higher than the real cost (€178 [124; 239], p < 0.001). This overestimation was found in four categories, in particular for waste (€40 [15; 100] vs. €1.1 [0.6; 2.3], p < 0.001). Only the laboratory tests were underestimated (€65 [30; 120] vs. €106 [79; 138], p < 0.001). Being aware of the financial impact of prescriptions was factor associated with accurate estimate (OR: 5.05, 95%CI:1.47-17.4, p = 0.01). However, feeling able to accurately perform estimation was factor negatively associated with accurate estimate (OR: 0.11, 95%CI: 0.02-0.71, p = 0.02). CONCLUSION: French intensivists have a poor awareness of costs in their daily clinical practice. Raising awareness of the financial impact of prescriptions, and of the cost of laboratory tests and waste are the main areas for improvement that could help achieve the objective of the best care at the best cost.

Mitigation of gaseous emissions from dairy livestock: A farm-level method to examine the financial implications.

Feeding the world's population while minimising the contribution of agriculture to climate change is one of the greatest challenges facing modern society. This challenge is particularly pronounced for dairy production where the carbon footprint of products and the mitigation costs are high, relative to other food stuffs. This paper reviews a number of mitigation measures that may be adopted by dairy farmers to reduce greenhouse gas emissions from their farms. A simulation model is developed to assess the cost-benefit of a range of mitigation measures. The model is applied to data from Ireland, a country with a large export-oriented dairy industry, for a range of farms including top, middle and bottom performing farms from a profitability perspective. The mitigation measures modelled included animal productivity, grass production and utilisation, better reproductive performance, early compact calving, reduced crude protein, decreased fertiliser N, protected urea, white clover, slurry tank cover and low emission slurry spreading (LESS). The results show that over half of the greenhouse gas abatement potential and most of the ammonia abatement potential were realised with cost-beneficial measures. Animal and feed-related measures that increased efficiency drove the abatement of GHG emissions. Low-emission slurry spreading was beneficial for the bottom and middle one-third of farms, while protected urea and reducing nitrogen use accounted for most of the ammonia abatement potential for the most profitable farms. Results showed that combining mitigation measures resulted in a decrease of 23%, 19%, and 12% in GHG emissions below 2020 levels for the bottom, middle, and top performing dairy farms, respectively. The findings imply that top dairy farms, that are already managed efficiently and optimally, may struggle to achieve the national and international GHG reduction targets with existing technologies and practices.

The Role of a "Technology Navigator" in an Academic Diabetes Clinic: A Feasibility Evaluation.

Patient-generated device data play an important role in diabetes management. However, acquiring these data remains a challenge. This project aimed to understand whether implementing dedicated "Technology Navigator" (TN) personnel at a large academic diabetes clinic could facilitate access to device data without increasing work for clinic staff. A sample of visits pre- and post-TN implementation (n = 173) showed a 22% (41% vs. 19%) increase in patients who successfully shared their data from home before their visit and a 52% (67% vs. 15%) increase in visits where data were available to the provider for review before the appointment, whereas billing claims for continuous glucose monitor interpretation increased by 86% during the same period. Time analysis suggests that home uploads could save up to 747 h in medical assistant labor annually. Incorporating a TN may improve data availability, decrease time spent on nonbillable activities, and support data interpretation and billing.

Assessment of clinical miscoding errors and potential financial their implications on healthcare management - A case of local hospital in Najran, Saudi Arabia.

Background: Healthcare systems can potentially improve their safety, quality of service, and performance efficiency with a cost reduction, through the introduction and implementation of healthcare information management systems. This study aims to examine the frequency of miscoding errors in principal and secondary diagnoses, exploring demographic and coder-related factors contributing to these errors through the use of the QuadraMed system. The study also investigates the association of coding errors with patient safety and service quality to estimate the potential financial implications resulting from these inaccuracies in the healthcare system. Methods: This analytical cross-sectional retrospective study was conducted at a local hospital in Najran, Saudi Arabia, from July 2021 to February 2022 using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding system. The costing and financial data were collected from the reimbursement department for eligible 750 patient cases in terms of payment mode, services availed, and length of stay. The financial claims were evaluated to estimate the impact on the quality of service and patient safety. The reimbursement amount was calculated based on codes. The data were analyzed using SPSS and the odds ratio was calculated to estimate the risk of major coding errors in different departments. Results: Primary codes 240 (32%) and 40 (5.3) secondary codes were reviewed and percentages and inaccuracies were calculated after recording. The percentage of inaccurate medical codes in principal diagnosis was 57(26.8%) and the percentage of inaccurate medical codes in secondary diagnosis was 21 (9.9%). The primary diagnostic codes have more coding errors with a total number of 240 (32%) coding errors with a moderate level of agreement between the original coder and independent coder with a kappa value of 0.462. The identified recording was done by the independent coder, and the secondary diagnostic code showed 40 (5.3%) cases, with a poor kappa value of 0.128. The results showed the highest number of primary diagnostic codes was among surgery clinics 79 (63.2%). The highest number of secondary diagnostic codes were reported among consultant clinics 12 (9.6%). Conclusions: The study concludes that the identification of miscoding in the healthy population has a financial impact on the healthcare organization's infrastructure.

Sociodemographic factors affecting not receiving COVID-19 vaccine in Japan among people who originally intended to vaccinate: a prospective cohort study.

Objective: Vaccine hesitancy is a major issue for acquiring herd immunity. However, some individuals may go unvaccinated owing to inhibitory factors other than vaccine hesitancy. If there is even a small number of such people, support is needed for equitable vaccine distribution and acquiring herd immunity. We investigated sociodemographic factors that affected not undergoing COVID-19 vaccination in Japan among individuals who had strong intention to vaccinate before beginning the vaccination. Methods: We conducted this prospective cohort study on workers aged 20-65 years from December 2020 (baseline), to December 2021 using a self-administered questionnaire survey. There were 27,036 participants at baseline and 18,560 at follow-up. We included 6,955 participants who answered yes to this question at baseline: "Would you like to receive a COVID-19 vaccine as soon as it becomes available?" We applied multilevel logistic regression analyses to examine the association between sociodemographic factors and being unvaccinated at follow-up. Results: In all, 289 participants (4.2%) went unvaccinated. The odds ratios (ORs) for being unvaccinated were significantly higher for participants aged 30-39 and 40-49 than those aged 60-65 years. Being divorced, widowed, or single, having low income, and having COVID-19 infection experience also had higher ORs. Discussion: We found that some participants who initially had strong intention to vaccinate may have gone unvaccinated owing to vaccine side effects and the financial impact of absenteeism due to side effects. It is necessary to provide information repeatedly about the need for vaccination as well as social support to ensure that those who intend to vaccinate are able to do so when aiming for acquiring herd immunity through vaccination against COVID-19 as well as other potential infection pandemics in the future.

Healthcare Cost and Outcomes Associated With Surgical Site Infection and Patient Outcomes in Low- and Middle-Income Countries.

Surgical site infection (SSI) is a growing global concern. The principal explanation for this is its adverse clinical outcomes, such as morbidity and mortality. However, the link between the economic burden of SSIs and patient outcomes needs to be sufficiently characterized. This review aims to describe the financial implications of SSIs on patient outcomes in low- and middle-income countries (LMIC). Despite the heterogeneity in study designs from multiple LMIC countries, there is a significant correlation between SSI-associated healthcare costs from increased length of stay (LOS), readmissions, reoperations, and adverse patient outcomes. This varies based on the size, degree of infection, or other patient comorbidities. SSIs are much more prevalent in LMICs. The additional financial burden incurred in managing SSIs reinforces the need to prioritize practicing interventions to prevent this complication, which resource-limited health institutions are unequipped to do and consequently have significant adverse patient outcomes.

Disparities in household material hardship, financial toxicity, and income loss in pediatric cancer.

BACKGROUND: Based on previous reports of disparities in financial burden following a cancer diagnosis, this study aims to characterize mechanisms of disparities experienced by caregivers of children with cancer, including the impact of work flexibility and social support. METHODS: Cross-sectional survey (in English or Spanish) of caregivers of children with cancer that assessed household material hardship (HMH), financial toxicity, and income change. RESULTS: Of 156 caregivers surveyed, 32% were Hispanic and 32% were low income. Hispanic caregivers were more likely to report HMH and financial toxicity compared to non-Hispanic White and Asian (HMH: 57% vs. 21% vs. 19%, p < .001; financial toxicity: 73% vs. 52% vs. 53%, p = .07). Low- and middle-income caregivers were more likely to experience HMH and financial toxicity compared to high-income caregivers (HMH: 68% low vs. 38% middle vs. 8.7% high, p < .001; financial toxicity: 81% vs. 68% vs. 44%, p < .001). All income categories demonstrated significant increases in HMH 1 year after diagnosis. Seventeen percent reported more than 40% income loss, more of whom were low income than high income (27% vs. 12%, p = .20). Work flexibility and social support were associated with income and financial toxicity. CONCLUSION: HMH, financial toxicity, and income loss are prevalent after a child's cancer diagnosis, suggesting that screening should be incorporated into routine care. This financial burden disproportionately affects low-income and Hispanic caregivers. Further research is needed to elucidate the roles of work flexibility and social support, how safety net services are utilized by families, and how best to support families with HMH.

Financial impact of nosocomial infections on surgical patients in an eastern Chinese hospital: a propensity score matching study.

This study, conducted at Zhejiang Taizhou Hospital, China, aimed to examine the financial impact of nosocomial infections on surgical patients. A retrospective case-control study using propensity score matching was conducted over a 9-month period from January to September 2022. The study included 729 surgical patients with nosocomial infections and 2187 matched controls without infections. Medical expenses, length of hospitalization and total economic burden were compared between the two groups. The rate of nosocomial infections in surgical cases was 2.66%. The median hospitalization cost for patients with nosocomial infections was US$8220, compared with US$3294 for controls. The overall additional medical expenditure attributable to nosocomial infections amounted to US$4908. Notable median differences were observed between cases with nosocomial infections and controls in terms of total hospitalization cost, nursing services, medication, treatment, materials, test fees and blood transfusion fees. In each age group, medical costs for patients with nosocomial infections were more than twice those of controls. Additionally, hospital stays for surgical patients with nosocomial infections were, on average, 13 days longer compared with controls. These findings highlight the importance of implementing effective infection control measures in hospitals to reduce the financial burden on patients and the healthcare system.

The financial impact of the COVID-19 pandemic on sleeve gastrectomy at a major academic institution.

INTRODUCTION: The COVID-19- pandemic significantly impacted metabolic and bariatric surgery (MBS) practices due to large-scale surgery cancellations along with staff and supply shortages. We analyzed sleeve gastrectomy (SG) hospital-level financial metrics before and after the COVID-19 pandemic. METHODS: Hospital cost-accounting software (MicroStrategy, Tysons, VA) was reviewed for revenues, costs, and profits per SG at an academic hospital (2017-2022). Actual figures were obtained, not insurance charge estimates or hospital projections. Fixed costs were obtained through surgery-specific allocation of inpatient hospital and operating-room costs. Direct variable costs were analyzed with sub-components including: (1) labor and benefits, (2) implants, (3) drug costs, and 4) medical/surgical supplies. The pre-COVID-19 period (10/2017-2/2020) and post-COVID-19 period (5/2020-9/2022) financial metrics were compared with student's t-test. Data from 3/2020 to 4/2020 were excluded due to COVID-19-related changes. RESULTS: A total of 739 SG patients were included. Average length of stay (LOS), Center for Medicaid and Medicare Case Mix Index (CMI), and percentage of patients with commercial insurance were similar pre vs. post-COVID-19 (p > 0.05). There were more SG performed per quarter pre-COVID-19 than post-COVID-19 (36 vs. 22; p = 0.0056). Pre-COVID-19 and post-COVID-19 financial metrics per SG differed significantly for, respectively, revenues ($19,134 vs. $20,983) total variable cost ($9457 vs. $11,235), total fixed cost ($2036 vs. $4018), total profit ($7571 vs. $5442), and labor and benefits cost ($2535 vs. $3734; p < 0.05). CONCLUSIONS: The post-COVID-19 period was characterized by significantly increased SG fixed cost (i.e., building maintenance, equipment, overhead) and labor costs (increased contract labor), resulting in precipitous profit decline that crosses the break-even in calendar year quarter (CQ) 3, 2022. Potential solutions include minimizing contract labor cost and decreasing LOS.

Economic impact of COVID-19 across national boundaries: The role of government responses.

This Research Note provides an assessment of the burgeoning interdisciplinary literature surrounding the COVID-19 pandemic and its impact on both individuals and firms, with a particular focus on the heterogeneity in government responses and their implications for international finance and IB research. In particular, we discuss disparities in vaccine distribution, government policy responses, and impacts in low-income versus high-income countries, as well as lessons learned from the pandemic. We describe an important source of data in this area and provide ideas for future research.

Cette note de recherche vise à évaluer la florissante littérature interdisciplinaire entourant la pandémie de COVID-19 et son impact à la fois sur les individus et les entreprises, avec une attention particulière portée sur l'hétérogénéité des réponses gouvernementales et leurs implications pour la recherche en affaires et finance internationales. En particulier, nous discutons des disparités dans la distribution des vaccins, des réponses des politiques gouvernementales et des impacts dans les pays à faible revenu par rapport aux pays à revenu élevé, ainsi que des leçons tirées de la pandémie. Nous décrivons une importante source de données dans ce domaine et proposons des idées pour de futures recherches.

Esta Nota de Investigación suministra una evaluación de la floreciente literatura interdisciplinario alrededor de la pandemia del COVID-19 y su impacto en tanto los individuos y las empresas con un enfoque particular en la heterogeneidad de las respuestas gubernamentales y sus implicaciones para la investigación en finanzas internacional y negocios internacionales. En particular, discutimos las disparidades en la distribución de vacunas, las respuestas a políticas de gobierno, y los impactos en países de bajos ingresos en comparación con los de altos ingresos, y también las lecciones aprendidas de la pandemia. Describimos una fuente importante de datos en esta área y damos ideas para investigación futura.

Esta Nota de Pesquisa fornece uma avaliação da crescente literatura interdisciplinar a respeito da pandemia COVID-19 e seu impacto tanto em indivíduos quanto empresas, com foco particular na heterogeneidade nas respostas governamentais e suas implicações para finanças internacionais e pesquisa em IB. Em particular, discutimos disparidades na distribuição de vacinas, respostas de políticas governamentais e impactos em países de baixa renda em relação a países de alta renda, bem como lições aprendidas com a pandemia. Descrevemos uma importante fonte de dados nesta área e fornecemos ideias para pesquisas futuras.

Financial Impact of the Indiana University Student-Run Free Clinic.

Student-run free clinics (SRFCs) serve as an important public safety-net for un- and under-insured patients. Few studies have investigated their financial impact or return of investment to the community. The aim of this study was to estimate the financial impact of the Indiana University Student Outreach Clinic (IUSOC) using national market values of medical visits and lab services in 2021.From internal triage classification records maintained from March to December 2021, Current Procedural Terminology (CPT) codes were assigned corresponding to "New Patient," "Returning Quick or Long" and "Fast Track" visits. Total Work Relative Value Units (wRVUs) were calculated to then estimate the total monetary value for medical services. Similarly, the collection of laboratory services rendered from March to December 2021 were assigned costs using the 2021 Center for Medicare and Medicaid Services (CMS) fee schedule.There were a total of 1475 medical visits identified in this study under the triage categories of interest, with 440 New Patient visits, 1032 Returning Quick and Long visits, and 3 Fast Track visits. From the calculated total wRVUs, the estimated monetary value for medical services was $95,413.79. Additionally, there were 3633 eligible lab tests ordered; almost half of these (1523, 41.9%) were categorized as routine lab tests (CMP, BMP, CBC, lipid panel). The estimated value of lab services was $56,296.81.Our estimates reveal that the IUSOC provided nearly $150,000 worth of free healthcare to the community in 2021. Further, most patients were seen for return visits, revealing the opportunity to streamline logistics.

Deferral of elective surgeries during the COVID-19 pandemic and its impact on Palestinian patients: a cross-sectional study.

BACKGROUND: During the Covid-19 epidemic, the increased number of people seeking medical attention worsened hospital shortages. This shortage required reallocating the workforce, personal protective equipment (PPE), medical equipment, medical disposables, and hospital wards. This reallocation delayed a number of elective surgeries. This study explored the financial, physical, and psychological implications of deferring elective surgeries on Palestinians in three West Bank hospitals during the pandemic. METHODS: This cross-sectional study included 398 patients from tertiary hospitals in Palestine whose elective surgical procedures were deferred due to the COVID-19 pandemic. Between 8/8/2021 and 6/9/2021, data were collected on patients who had elective surgery deferral at three government hospitals in the West Bank of the Palestinian territories. There were five parts to the study tool; personal information, access to the health system, physical affection, financial effect, and psychological effect. Statistical analysis included a univariate, bivariate and multivariate. RESULTS: The healthcare system's response to the COVID-19 epidemic directly affected patients whose surgeries were deferred. The healthcare system's response was the cause of the delay in 91.5% of the cases. Orthopedic and neurological surgeries account for 48.3% of deferred surgery. Other than delayed surgeries, 30.2% of patients were unable to get additional health care services. Physically, 55.5% of patients were impacted, 45% were anxious, and 29.6% were depressed. CONCLUSIONS: Patients who had procedures deferred as a result of the healthcare system's response to the COVID-19 epidemic were impacted physically, financially, and psychologically. There should bea better crisis management strategyto ensure that certain hospitals are able to operate regularly despite the situation.

Financial impact of oral cancer treatment on the households in rural India.

Background: Oral cancer ranks second and accounts for over 20% of all cancers reported in India. Like management of all other cancers, oral cancers bring a heavy financial burden to their families. This study analyzes the financial burden on families during the management of oral cancer at Kasturba Hospital, Sewagram, a government-aided tertiary health care facility in central India. Methods: The hospital-based cross-sectional study was conducted in the cancer unit of a government-aided tertiary hospital of central India. A total of 100 patients with oral cancer being treated in the hospital were included in the study. Information regarding cost incurred on management of oral cancer was inquired from a close family member or a caregiver of the study subjects. Results: The out-of-pocket expenditure on treatment of oral cancer was approximately INR 100,000 (USD 1363). It has been found that 96% of families experienced catastrophic health expenditure as a result of treatment. Conclusion: Although India aims for universal health coverage, it is important to protect cancer patients from catastrophic health expenditure.

Will genetically modified late blight resistant potatoes be the first GM crops to be approved for commercial growing in Norway?

Last decade's advances in biotechnology, with the introduction of CRISPR, have challenged the regulatory framework for competent authorities all over the world. Hence, regulatory issues related to gene editing are currently high on the agenda both in the EU and in the European Economic Area (EEA) Agreement country of Norway, particularly with regards to sustainable agriculture. During the negotiations on the EEA Agreement, Norway was allowed to retain three extra aims in the Gene Technology Act: "That the production and use of GMO happens in an ethical way, is beneficial to society and is in accordance with the principle of sustainable development". We argue the case that taking sustainability into the decisions on regulating gene edited products could be easier in Norway than in the EU because of these extra aims. Late blight is our chosen example, as a devastating disease in potato that is controlled in Norway primarily by high levels of fungicide use. Also, many of these fungicides are being banned due to negative environmental and health effects. The costs of controlling late blight in Norway were calculated in 2006, and since then there have been new cultivars developed, inflation and an outbreak of war in Europe increasing farm input costs. A genetically modified (GM) cisgenic late blight resistant (LBR) potato presents a possible solution that could reduce fungicide use, but this could still be controversial. This paper aims to discuss the advantages and disadvantages of approving the commercial use of a GM LBR potato cultivar in Norway and compare these against currently used late blight management methods and conventional potato resistance breeding. We argue that a possible route for future regulatory framework could build upon the proposal by the Norwegian Biotechnology Advisory Board from 2019, also taking sustainability goals into account. This could favour a positive response from the Competent Authorities without breeching the European Economic Area (EEA) Agreement. Perhaps the EU could adopt a similar approach to fulfil their obligations towards a more sustainable agriculture?