Search

This session will explore the real-world impact value-based procurement and subsequent contracting, and health technology pricing in the context of value-based care. We will delve into innovative business models that are reshaping the healthcare landscape, promoting cost-effectiveness, and enhancing patient outcomes. Attendees will gain valuable insights into the evolving strategies driving value-based care and its implications for healthcare providers, payers, and patients. Learning Objectives • Understand the concept of value-based care and its significance in the current healthcare environment • Explore the real-world impact of value-based pricing on healthcare delivery and patient outcomes • Examine the role of value-based procurement/contracting in driving cost-effective healthcare solutions • Gain insights into health technology pricing models and their impact on value-based care initiatives • Identify innovative business models that support value-based care and improve patient outcomes

Abstract— The main objective of this cross-sectional investigation was to assess biomarkers associated with liver fibrosis, namely Tissue inhibitor of metalloproteinase 1 TIMP-1, Glutamate-pyruvic transaminase GPT, glutamic-oxaloacetic transaminase GOT, and Alkaline phosphatase ALP. which conduct in Tikrit University, College of Science /Biology Department the study samples collected from patients in Dialysis Unit in Tikrit Teaching Hospital, ninty subjects where sub-divided to 60 patients of age (20– 68) years, the Ages of Patients Chronic hepatitis B Ranged From (20-67) years( 19 males and 11 females ) And The Ages Of Patients with chronic hepatitis B suffered of chronic kidney diseases (24-68) Years ( 18males and 12 females) and 30 as control group aged (20-67) years, in this investigation Enzyme linked immunosorbent assay (ELISA) kites were employed to assess serum concentrations of (TIMP-1), Whereas used Monarch-240 to detect the activity of enzymes such as GPT, GOT and ALP. The findings of the present investigation demonstrated in chronic hepatitis patients there were significant increased (P≤0.05) in the levels of TIMP-1, and activity of GPT and ALP whereas no significant rise (P≥0.05) for activity of GOT when compared with control. In patients with chronic hepatitis B (CHB) suffered of chronic kidney diseases(CKD) there were significant raised (P

In thymus, CD8 showed -ve expression at one week age. At one and two months old, strongly +ve were observed within the thymic parenchyma and around Hassall's corpuscles. At seven months old, CD8 showed variable degrees of +ve expression especially around blood vessels but less frequency than that of the younger ages due to the retarded activity of the thymus gland. CD268 cells showed –ve expressions in cortex and medulla of thymus at the 1st week of age . At the age of one month old Peacock the CD268 exhibited high degree of +ve appearance for B cells. At the age of two months old, CD268 displayed +ve expression in thymic cortex particularly around the septae. At age of seven months old Peacocks, the adult cellular population were formed the whole parenchyma of thymus gland therefore CD268 give slightly +ve expression in the cortex mainly around the septae. While in the spleen, CD8 were showed –ve expression at the age of one week Peacock poult . At the age of (1,2 and 7) months old spleen have great role in the immunity. CD268 indicated –ve expressions at one week of age, because of most of the cells at this age immatured. Few numbers of B lymphocytes were showing +ve expression at one month of age .At age of two months old Peacock B cells showed highly +ve expression. At age of seven months old Peacocks showed +ve expression, and highly increase in the number of mature B lymphocytes compared with other previous younger ages

Summary: As countries pursue power system decarbonization, a well-intentioned strategy being pursued in jurisdictions like China is the strict integration target, often in the form of a curtailment cap. The effects of these curtailment caps have not been systematically studied. Here, we evaluate the effects of these caps on the decarbonization of one provincial power system using a capacity expansion model. Results reveal that curtailment caps yield deleterious effects that do not align with the stated goals of these policies. Capping curtailment significantly increases storage capacity (+43% with a 5% curtailment cap) and reduces renewable capacity (−17%). Even with the increase in flexible storage capacity, the policy still jeopardizes power system reliability by increasing occurrences of over or under generation. It also suppresses power generation from hydropower and reduces energy storage utilization while increasing fossil fuel utilization. Capping curtailment increases economic costs (+6% with a 5% curtailment cap) and CO2 emissions (+7%).

Objective: There is growing attention toward the implications of race and ethnicity on health disparities within otolaryngology. While race is an established predictor of adverse head and neck oncologic outcomes, there is paucity in the literature on studies employing national, multi‐institutional data to assess the impact of race and ethnicity on head and neck autograft surgery. Methods: Using the National Surgical Quality Improvement Program (NSQIP) database, trends in 30 days outcomes were assessed. Patients with ICD‐10 codes for malignant head and neck neoplasms were isolated. Autograft surgeries were selected using Current Procedural Terminology (CPT) codes for free flap and pedicled flap reconstruction. Primary outcomes included surgical complications, reoperation, readmission, extended length of stay and operation time. Each binary categorical variable was compared to racial/ethnic identity via binary logistic regression. Results: The study cohort consisted of 2447 patients who underwent head and neck autograft surgery (80.71% free flap reconstruction and 19.39% pedicled flap reconstruction). Black patients had significantly higher odds of overall surgical complications (odds ratio [OR] 1.583, 95% confidence interval [CI] 1.091, 2.298, p = 0.016) with much higher odds of perioperative blood transfusions (OR 2.291, 95% CI 1.532, 3.426, p = <.001). Hispanic patients were more likely to undergo reoperation within 30 days after surgery and were more likely to be hospitalized for more than 30 days post‐operatively (OR 1.566, 95% CI 1.015, 2.418, p = 0.043 and OR 12.224, 95% CI 2.698, 55.377, p = 0.001, respectively). Conclusions: Race and ethnicity serve as independent predictors of complications in the post‐operative period following head and neck autograft surgery. Level of Evidence: 3 Laryngoscope, 134:3595–3603, 2024 [ABSTRACT FROM AUTHOR]

The atmospheric constituents generated by the activities of an urban area may affect UV radiation reaching the ground. In this study, two areas were chosen in Baghdad city (Zafaraniyah and Abu Ghraib). Parameters of the pollutants data (Total column NO2 and Total column CO) and UV radiation for specific bands were collected and analyzed for the period of three years (2017-2019) were taken hourly from the European Center for Medium-Range Weather Forecasts (ECMWF) for each parameter through the years. The results show that the concentrations of pollutants in Zafaraniyah higher than Abu Ghraib throughout the year, Where total column NO2 reaching to about 9.6 * 10-5 kg m-2 in 2019 for Zafaraniyah and 8.48 * 10-5 kg m-2 for Abu Ghraib. While total column CO reaching to about 45 * 10-4 kg m-2 in 2019 for Zafaraniyah and 43 * 10-4 kg m-2 for Abu Ghraib in the same year. While the values of UV radiation in Abu Ghraib higher value 487.3W/m2 than 443.7 W/m2 Zafaraniyah throughout the year.

Governments may struggle to impose costly polices on vital industries, resulting in a greater need for negative emissions. Here, the authors model a direct air capture crash deployment program, finding it can remove 2.3 GtCO2 yr–1 in 2050, 13–20 GtCO2 yr–1 in 2075, and 570–840 GtCO2 cumulative over 2025–2100.

Introduction: Lag screw cut-out is a serious complication of dynamic hip screw fixation of trochanteric hip fractures. The lag screw position has been acknowledged as one of the important factors affecting the lag screw cut-out. We propose a modification of the Tip Apex Distance (TAD) and hypothesise that it could improve the reliability of predicting lag screws cut-out in these injuries. Materials and Methods: A retrospective study was conducted for hip fracture entries in the period from Jan 2018 to July 2022. A hundred and nine patients were suitable for the final analysis. The modified TAD was measured in millimetres based on the sum of the traditional TAD in the lateral view and the net value of two distances in the AP view, the first distance is from the tip of the lag screw to the opposite point on the femoral head along the axis of the lag screw while the second distance is from that point to the femoral head apex. The first distance is a positive value, whereas the second distance is positive if the lag screw is superior and negative if inferior. A receiver operating characteristic curve was used to evaluate the reliability of the different parameters assessing the lag screw position within the femoral head. Results: Reduction quality, fracture pattern as per the AO/OTA classification, TAD, Calcar Referenced TAD, Axis Blade Angle, Parker’s ration in the AP view, Cleveland Zone 1, and modified TAD were statistically associated with lag screw cut-out. Among the tested parameters, the modified TAD had 90.1% sensitivity and 90.9% specificity for lag screw cut-out at a cut-off value of 25 mm with a P-value

Canada has more than 350 remote and northern communities, most of which rely on diesel for their electric and thermal needs. This reliance is deleterious to climate, health, albedo, and energy security—all diesel must be imported. The government is working to transition these communities to climate-friendly and sustainable alternatives, but assessments of this transition are hampered by limited data availability, especially the absence of hourly thermal load profiles. Here, we develop a method for estimating the thermal load profiles of these communities; apply it to 40 communities that vary across characteristics like population, location, accessibility, and Indigenous identity; and seek to validate these profiles with the few empirical data that exist. We also develop a model to predict the thermal load of a remote and northern community using limited, available information like population and location. This paper represents the first attempt to simulate hourly thermal load profiles for these communities. We find that thermal loads are large—the hourly thermal load can be up to 23 times the hourly electrical load in winter, which has implications for investment planning. Our research helps communities, investors, and analysts develop robust transition plans as they seek to decarbonize northern communities’ energy systems.

A central challenge for sustaining international cooperation to cut global greenhouse gas emissions is confidence that national policy efforts are leading to a meaningful impact on the climate. Here, we apply a detection protocol to determine when the measurable signal of atmospheric CO _2 can be distinguished from the noise of the carbon cycle and uncertainties in emission trends. We test that protocol with a database of 226 emission mitigation scenarios—the universe of scenarios vetted by the Intergovernmental Panel on Climate Change. These scenarios are descriptive of ‘baseline’ trajectories of emissions trends in the absence of new policies along with trajectories that reflect substantial policy efforts to stop warming at 1.5 °C–2 °C above pre-industrial levels, as embodied in the Paris Agreement. The most aggressive mitigation scenarios (i.e. 1.5 °C) require 11–16 years to detect a signal of demonstrable progress from the noise; 2 °C scenarios lengthen detection by at least a decade. As more climate policy analysts face the reality that goals of 1.5 °C–2 °C seem infeasible, they have developed ‘overshoot’ scenarios with emissions that rise above the agreed goal and then, later on, fall aggressively to achieve it. These pathways come at the political cost of a 1–2 decade delay in detection, even for the 1.5 °C scenarios. The Paris Agreement requires a global ‘stocktake’ that interrogates national mitigation efforts; our results suggest that this effort must grapple with the question of when the world can gain confidence that the diplomacy on climate is demonstrably making an impact.

Background and objectives: Premarital screening is an effective method for monitoring, reducing, and avoiding genetic abnormalities and certain viral infections. This study aimed to explore the attitudes of couples who attended a family counselling clinic in Sulimani City towards the premarital screening and genetic counselling programme. Methods: A cross-sectional, descriptive-analytic study was carried out on 310 couples attending the family counselling clinic in Sulaimani City. The statistical analysis was performed by using descriptive and inferential statistical data analysis including frequency, percentage, mean and stranded deviation, independent samples T-Test and one way ANOVA (F-test). Results: The study findings revealed that the majority of the study participants were 20-30 years old. In terms of attitudes, 73.55% of the couples had a favourable attitude toward premarital screening and genetic counselling. There were statistically significant differences between couples' attitudes and age (p=0.012), educational level (p=0.013), and consanguinity (P < 0.001), but there were no statistically significant differences between couples' attitudes and gender (p=0.49), employment (p=0.785), residential area (0.116), and family history of hereditary blood disease (p=0.45) because of p-value >0.05. Conclusion: Couples' attitudes about premarital screening and genetic counselling programmes are positive.

Background and objectives: In women worldwide, breast cancer is the most common can-cer. It is one of the leading causes of cancer death in women, accounting for 15% of all cancer deaths in the female population. In most countries, breast cancer incidence rates are higher than they have ever been at an early age. This study aimed to identify the level of nurses’ awareness towards risk factors of breast cancer. Methods: A cross-sectional study was carried out among 341 nurses from different de-partments in three Kirkuk city hospitals (Azadi Teaching Hospital, Kirkuk General Hospital, and Pediatric Hospital) from 25 February to 25 June 2021. A non-probability/convenient sampling technique was utilized to collect data. A socio-demographic characteristics data form and awareness of breast cancer risk factors form were used to collect data through face-to-face interviews. Data were analyzed using Statistical Package for the Social Scienc-es, version 21, presenting descriptive and inferential statistics comprising frequency, per-centage and chi-square test. Results: Out of the 341 nurses, 44.9% were from Azadi Teaching Hospital, while more than one-third (38.1%) were from Kirkuk General Hospital, and 17% were from Pediatric Hospi-tal. Most of the nurses, 38.4%, were between the ages of 21 and 25, 64.8% were female, and 66.9% were married. About 36.1% of nurses report acceptable level of awareness and 5.9% report being with good level of awareness about risk factors associated with breast cancer. Conclusion: The awareness level of breast cancer risk factors among nurses working in Kirkuk city hospitals was generally high. Younger age was associated with higher level of awareness of risk factors. Regarding to the gender was highly significant differences be-tween the nurses’ awareness of breast cancer risk factors.

Background: The COVID-19 pandemic contributes to a significant mental health crisis. This pandemic caused a widening economic crisis, growing financial loss, and numerous uncertainties. This pandemic brought alarming implications and overall increased risk for psychiatric illness. This study explores the psychological impact experienced by patients who tested positive from coronavirus disease in the Najran region, Saudi Arabia. Design and Methods: This exploratory analysis included 210 COVID-19 positive patients. The study was conducted during a six month period starting from March to September 2020, in two tertiary government hospitals in Najran, Saudi Arabia. Samples were selected using purposive sampling. The researches utilized survey questionnaire and face-to-face interview to collect the data. The statistical data were calculated using IBM Statistical Package for Social Sciences version 2.0 to compute the following statistical formulas: percentage distribution, mean, standard deviation, and Chi-square test of independence. Results: The findings of this study revealed that the majority of COVID-19 positive patients were middle-aged adults (n=98 or 46.7%), male (n=178 or 84.8%), and were non-Saudi nationals (n=132 or 62.9%). It was found out that COVID-19 patients experienced bothersome behaviour at a very high level (x̅=2.63 ± 0.6734). Meanwhile, depression (x̅=2.51 ± 0.7070), worry (x̅=2.23 ± 0.8811), and anxiety (x̅=2.21 ± 0.8719) was only at a high level. Conclusions: The study findings revealed that the majority of participants had high levels of depression, anxiety and bothersome behaviours. However, demographic characteristics like age, sex, and nationality were not significantly related to coronavirus patients' psychological health problems during the pandemic. Assessment and interventions for psychosocial concerns, integration of mental health considerations, consultation with specialists, and treatment for severe psychosocial consequences must be administered in COVID-19 care facilities.

Cochlear implant is one of the treatments for deafness. child cochlear, purpsive sample their children have (CI) from hearing and speech rehabilitation centers in Mousl city. During a peroid 10 january 2018 to 28 february 2019. The instrument depended in the study was 28-GHQ self- administered technique . The GHQ-28 is divided into four categories: somatic symptoms, anxiety/insomnia, social dysfunction and depression. This questionnaire includes information about the operated child such as gender, age, date of birth, and also information about the parents, such as their age, job and family background .Data were analyzed in several steps. First descriptive statistics, which include frequency and percentages. The second step, which include inferential statistics Chi-Square test) ,the probability level depend in the present study was p

This commentary discusses the impact of geography in asymmetric warfare to analyze how an inferior side acting from a geographical advantage can cast a challenge to the superior party in the conflict. As such, the paper focuses on the context of narrow seas, the opportunities and challenges that the geographical configuration of the seas create for adversaries, its impact on their capabilities and influence on their choices. Subsequently, it attempts to illustrate the role of geography in enhancing the efficiency of small arms tactics and unconventional warfare at seas, henceforth, realizing the spatial factor behind the rise of non-state actors as a major threat in maritime security. The commentary then discusses the case of the Houthi insurgency in Yemen to empirically explore their utilization of the geographical location of the country at the southern entrance of the Red Sea, near Bab el-Mandeb Strait to execute sporadic military operations against the more superior coalition led by Saudi Arabia.

Abstract Background Health state utility values (HSUVs) are an important input to economic evaluations and the choice of HSUV can affect the estimate of relative cost-effectiveness between interventions. This systematic review identified utility scores for patients with metastatic non-small cell lung cancer (mNSCLC), as well as disutilities or utility decrements relevant to the experience of patients with mNSCLC, by treatment line and health state. Methods The MEDLINE®, Embase and Cochrane Library databases were systematically searched (September 2016) for publications describing HSUVs in mNSCLC in any treatment line. The EQ-5D website, the School of Health and Related Research Health Utilities Database (ScHARRHUD) and major pharmacoeconomic and clinical conferences in 2015–2016 were also queried. Studies in adults with previously treated mNSCLC were selected for further analysis. The information extracted included study design, description of treatment and health state, respondent details, instrument and tariff, HSUV or (dis) utility decrement estimates, quality of study, and appropriateness for use in economic evaluations. Results Of 1883 references identified, 36 publications of 34 studies were included: 19 reported EQ-5D scores; eight reported HSUVs from valuations of vignettes made by members of the public using standard gamble (SG) or time trade-off (TTO); two reported SG or TTO directly elicited from patients; two reported EQ-5D visual analogue scale scores only; one reported Assessment of Quality of Life instrument scores; one reported HSUVs for caregivers to patients with mNSCLC using the 12-item Short-Form Health Survey; and one estimated HSUVs based on expert opinion. The range of HSUVs identified for comparable health states showed how differences in study type, tariff, health state and the measures used can drive variation in HSUV estimates. Conclusions This systematic review provides a set of published HSUVs that are relevant to the experience of adult patients previously treated for mNSCLC. Our review begins to address the challenge of identifying reliable estimates of utility values in mNSCLC that are suitable for use in economic evaluations, and also highlights how varying estimates result from differences in methodology.

The nurses have an important and effective role in the evaluation of the type of nursing care , which are providing to patient with cardiogenic shock , via their contribution in the quality of nursing care, which are provided to cardiogenic shock patients. The present study aims at assessment of knowledge and practices of nurses that they working in the coronary care unit and emergency department. A Correlation study was performed in the coronary care unit and emergency department in Ibn Sena teaching hospital , Almousl general hospital and aljmhori teaching hospital in mousl city for the period from 8 january 2005 to 12 may 2005. The sample of the study included (50 subject) of nurses who work in he above units. The results of the study showed that there was significant difference between the knowledge and practice of nurses in regard to theoretical mean.. The level of education . and duration of employment had appositive impact on the knowledge and practices. While the gender and the training session had no significant impact on knowledge and practice . Based on the above results , the study recommends that the nurses in these units should haven sufficient practice and the knowledge update about critical care , especially about cardiogenic shock, nursing staff who work in the coronary care unit and emergency department units should be assessing after tanning; and larger study to elaborate the effects of different variables on the knowledge and practice of nurses.

Background and objectives: Use of over the counter (OTC) medications is an important area for research within different health care systems. It is also associated with increased risk of abuse and medication addiction. The need to avoid unnecessary exposure to medication is a concern among the health-care community, in which pharmacy staff plays first line of response and their knowledge is critical. In Kurdistan region of Iraq, other medical and to some extend non-medical staff also works in pharmacies which may affect their scientific understanding of medication. The current study aims to determine the knowledge of pharmacies staff regarding OTC medication use in Erbil city. Methods: A cross-sectional study was conducted from 15th- October 2018 to 15th -October 2019. A sample of 187 pharmacies in Erbil city Centre was recruited through a systematic random sampling technique. Data were collected through direct interview with participants, A questionnaire was used for interviewing the pharmacy staff about socio-demographic characteristics and knowledge regarding OTC medications. The validity and reliability of the instrument was checked. Data were analyzed by using the software system of Statistical Package for Social Science (SPSS version 23). Results: The total number of the studied sample was 187 medical and para-medical staff working in Erbil pharmacies. Their mean age + SD were 28.56 + 5.33 years, ranging from 18 to 45 years. Generally only quarter (25%) of the whole sample had good level of knowledge. less than one third (29.4%) of the sample knew the correct definition of the OTC. Only 28.3% of the sample thinks that the OTC medications mostly cause side effects. Good level of knowledge was significantly associated with being female, and being a graduate and with being a specialized pharmacist. Conclusion: There is a limited knowledge about OTC medications among staff working in pharmacies.