Telehealth Support of Managed Care for a Correctional System: The Open Architecture Telehealth Model.

INTRODUCTION: The intent was to evaluate time to match initial investment of a new, statewide correctional system telehealth program based upon cumulative savings by avoidance of transportation and custody-related costs. MATERIALS AND METHODS: The setting was a statewide correctional system where prisoners received medical care through enhanced telemedicine technology supported by newly recruited specialty providers delivered through an open architecture system. The patients were incarcerated persons requiring nonemergent consultations in 10 specialties. A financial model was created to estimate transportation expenses, including vehicular use and custody staff, during the out of prison travel for traditional face-to-face care. Cost savings were then estimated by multiplying transportation expenses by the number of telehealth encounters (avoided cost) and summed cumulatively. Savings were mapped monthly. Private sector specialists were recruited, provided security clearance, trained in the use of the technology, and provided a secure site to provide services. MEASUREMENTS AND MAIN RESULTS: Based on the financial model, 1.2 million dollars in savings, equaling the initial capital investment, were achieved at 32 months. The total number of patient telemedicine encounters increased from 2,365 (±98/month) to 3,748 during the first 32 months of operation (July 2013 through January 2016: ±117/month) with 89% of the established specialties performed by telemedicine technologies. DISCUSSION: It was initially estimated to require 48 months to achieve the investment savings, but savings were achieved in 32 months, demonstrating greater adoption than expected. While finances were quantifiable, enhanced public safety by avoidance of out of prison time is unquantifiable, but judged to be significant.

A new ceratopsian dinosaur from the Javelina Formation (Maastrichtian) of West Texas and implications for chasmosaurine phylogeny.

Bravoceratops polyphemus gen. et sp. nov. is a large chasmosaurine ceratopsid from the lowermost part of the Javelina Formation (early Maastrichtian) of Big Bend National Park, TX, USA. B. polyphemus has a distinctive narrow snout, a long fenestrate frill, and a fan-shaped median parietal bar with a midline epiparietal on its posterior margin, as well as a symmetrical depression on its dorsal surface at the nexus of the parietal rami. This depression is interpreted to be the attachment point for a second midline epiparietal. This parietal morphology is distinct from that exhibited by Anchiceratops or Pentaceratops. The posterior midline epiparietal in B. polyphemus and its bifurcated quadratojugal-squamosal joint are features shared with the most derived chasmosaurines, Torosaurus and Triceratops. The combination of primitive and derived traits exhibited by B. polyphemus, and its stratigraphic position, is compatible with the gradual transition from basal, to intermediate, to derived chasmosaurines observed throughout the western interior of North America, and with phylogenetic analysis, which suggests that Bravoceratops may be closely related to Coahuilaceratops.