Resource Burden Research Articles

Water footprint assessment and its importance in Indian context: a meta-review

Abstract With the increasing population and per capita demand for freshwater, the burden of natural resources has increased many folds. Indian agriculture is still largely dependent on conventional methods of crop production that are mainly inefficient. Water security is essential for social and economic development, having an indispensable role in enhancing health, well-being, and economic progress, particularly in a developing country like India. Water footprint (WF) is an important indicator that helps ascertain the direct and indirect use of water in any process. WF modeling in agriculture enables us to pinpoint the impacts and limitations of the current crop production system. Assessing vulnerabilities across various regions and time helps us prepare actions to improve water productivity and promote sustainable water use. There is considerable spatial variability in blue, green, and gray WF among the different states of India due to their varied climate, soil, and topographic characteristics. WF assessment is critical for developing water allocation strategies, planning water trade, making policies, and implementing remedial measures. This paper describes the significance of WF and its proper management for sustainable crop production in India.

The false prosperity and promising future: Effects of data resources on bank efficiency

This study investigates the impact of data resources on bank efficiency. Based on data management theory, we measure bank data resources and find that higher data resources are associated with lower cost efficiency using data on Chinese banks over the period 2013 to 2019. However, data resources have no significant impact on profit efficiency. We discover that data resources reduce cost efficiency possibly due to increased overheads and decreased capital adequacy ratio. Furthermore, we conclude that emerging data technologies can reduce the cost burden of data resources on commercial banks, resulting in synergistic technical benefits. The findings are of timely policy importance and practical relevance for regulators, policy-makers, and bank managers. Our main results hold for a battery of endogeneity and robustness tests.

Exploring healthcare professionals' perspective of the process of obtaining consent for adult patient's having planned surgery: A scoping review.

The aim of this scoping review was to provide an overview of the literature about the process of obtaining consent from adult patients undergoing planned surgery from the healthcare professionals' perspective and analyse knowledge gaps. The process of obtaining consent for planned elective surgery manifests an individual's fundamental right to decide what happens to their body. The process is often suboptimal and problematic, placing a significant resource burden on health systems globally. Deficiencies in the documentation on consent forms have also been shown to increase the risk of operating room error. Scoping review. Arksey and O'Malley's (International Journal of Social Research Methodology, 8, 2005 and 19) five-step scoping review methodology was used. Fifty-three articles were included; 39 primary and 14 secondary research publications. Three key findings were identified; there is currently low-level evidence about surgical consent processes to inform clinical practice; junior doctors obtain surgical consent frequently, yet this process was likely undertaken sub-optimally; and current knowledge gaps include capacity assessment, decision-making and pre-procedural consent checks. Planned surgical consent processes are complex, and both surgeons and perioperative nurses are essential during the process. While surgeons have responsibility to obtain consent, perioperative nurses provide a safety net in the surgical consent process checking the surgical consent information is correct and has been understood by the patient. Such actions may influence consent validity and patient safety in the operating room. Knowledge gaps about capacity assessment, decision-making, pre-procedural checks and the impact of junior doctors obtaining consent on patient understanding, safety and legal claims are evident. This review highlights the importance of the surgical nurse's role in the planned surgical consent process. While the responsibility for obtaining surgical consent lies with the surgeon, the nurse's role verifying consent information is crucial as they act as a safety net and can reduce error in the operating room. The authors declare that no patient or public contribution was made to this review in accordance with the aim to map existing literature from the healthcare professionals' perspective.

Spatio-temporal pattern, matching level and prediction of ageing and medical resources in China

ObjectivePopulation ageing, as a hot issue in global development, increases the burden of medical resources in society. This study aims to assess the current spatiotemporal evolution and interaction between population ageing and medical resources in mainland China; evaluate the matching level of medical resources to population ageing; and forecast future trends of ageing, medical resources, and the indicator of ageing-resources (IAR).MethodsData on ageing (EPR) and medical resources (NHI, NBHI, and NHTP) were obtained from China Health Statistics Yearbook and China Statistical Yearbook (2011–2020). We employed spatial autocorrelation to examine the spatial–temporal distribution trends and analyzed the spatio-temporal interaction using a Bayesian spatio-temporal effect model. The IAR, an improved evaluation indicator, was used to measure the matching level of medical resources to population ageing with kernel density analysis for visualization. Finally, an ETS-DNN model was used to forecast the trends in population ageing, medical resources, and their matching level over the next decade.ResultsThe study found that China's ageing population and medical resources are growing annually, yet distribution is uneven across districts. There is a spatio-temporal interaction effect between ageing and medical resources, with higher levels of both in Eastern China and lower levels in Western China. The IAR is relatively high in Northwest, North China, and the Yangtze River Delta, but showed a declining trend in North China and the Yangtze River Delta. The hybrid model (ETS-DNN) gained an R2 of 0.9719, and the predicted median IAR for 2030 (0.99) across 31 regions was higher than the median IAR for 2020 (0.93).ConclusionThis study analyzes the relationship between population ageing and medical resources, revealing a spatio-temporal interaction between them. The IAR evaluation indicator highlights the need to address ageing population challenges and cultivate a competent health workforce. The ETS-DNN forecasts indicate higher concentrations of both medical resources and ageing populations in eastern China, emphasizing the need for region-specific ageing security systems and health service industries. The findings provide valuable policy insights for addressing a hyper-aged society in the future.

Point-of-care ultrasound: The new district focus.

Point-of-care ultrasound (POCUS) improves patient outcomes. The current POCUS curriculum of the Emergency Medicine Society of South Africa is based on guidelines from the United Kingdom with a different burden of disease (BoD) and available resources than encountered locally. To determine which modules of the POCUS curriculum should be implemented to better equip doctors working at a district hospital in the West Coast District (WCD), South Africa. Six district hospitals within the WCD. A descriptive cross-sectional survey with questionnaires for medical managers (MMs) and medical practitioners (MPs). A response rate of 78.9% for MPs and 100% for MMs was obtained. MPs rated the following modules of POCUS most relevant to their daily practice: (1) first trimester pregnancy; (2) deep vein thrombosis; (3) extended focused assessment with sonography in trauma; (4) central vascular access; and (5) focused assessment with sonography for human immunodeficiency virus (HIV) and tuberculosis (TB) (FASH). There is a need for a POCUS curriculum informed by the local pattern of disease. Priority modules were identified based on the local BoD and reported relevance to practice. Despite the availability of ultrasound machines within the WCD, few MPs were accredited and able to perform POCUS independently. There is a need to implement training programmes for medical interns, MPs, family medicine registrars and family physicians working in district hospitals. A relevant curriculum for POCUS training based on the local needs within communities has to be developed.Contribution: This study emphasises the need for a locally informed POCUS curriculum and training programmes.

HIV Late Presenters in Asia: Management and Public Health Challenges.

Many individuals are diagnosed with human immunodeficiency virus (HIV) infection at an advanced stage of illness and are considered late presenters. We define late presentation as a CD4 cell count below 350 cells/mm3 at the time of HIV diagnosis, or presenting with an AIDS-defining illness regardless of CD4 count. Across Asia, an estimated 34-72% of people diagnosed with HIV are late presenters. HIV late presenters generally have a higher disease burden and higher comorbidity such as opportunistic infections than those who are diagnosed earlier. They also have a higher mortality rate and generally exhibit poorer immune recovery following combined antiretroviral therapy (cART). As such, late HIV presentation leads to increased resource burden and costs to healthcare systems. HIV late presentation also poses an increased risk of community transmission since the transmission rate from people unaware of their HIV status is approximately 3.5 times higher than that of early presenters. There are several factors which contribute to HIV late presentation. Fear of stigmatisation and discrimination are significant barriers to both testing and accessing treatment. A lack of perceived risk and a lack of knowledge by individuals also contribute to late presentation. Lack of referral for testing by healthcare providers is another identified barrier in China and may extend to other regions across Asia. Effective strategies are still needed to reduce the incidence of late presentation across Asia. Key areas of focus should be increasing community awareness of the risk of HIV, reducing stigma and discrimination in testing, and educating healthcare professionals on the need for early testing and on the most effective ways to engage with people living with HIV. Recent initiatives such as intensified patient adherence support programs and HIV self-testing also have the potential to improve access to testing and reduce late diagnosis.

#5409 FACTORS ASSOCIATED WITH THE CIRCUIT LIFESPAN OF CONTINUOUS KIDNEY REPLACEMENT THERAPY (CKRT)

Abstract Background and Aims Approximately half of patients in intensive care unit (ICU) experienced acute kidney injury (AKI). ICU patients with severe AKI and hemodynamic instability sometimes require continuous kidney replacement therapy (CKRT). Termination of CKRT circuits leads to blood loss, attenuation of therapeutic effects of CKRT, and a heavy workload and resource burden for medical staff. Identification of the factors which can prolong the lifespan of CKRT circuits is clinically essential. We aimed to elucidate the factors affecting the lifespan of CKRT circuits in ICU patients. Method We evaluated the lifespans of 559 CKRT circuits used for 63 ICU patients at the Okinawa Prefectural Nanbu Medical Center and Children's Medical Center from April 1st, 2021 to March 31st, 2022. We enrolled all ICU patients who required CKRT. Our research team prospectively collected information on the patients' basal characteristics, CKRT prescription, activated clotting time (ACT) after the hemofilter, CKRT circuit lifespan, and causes of termination of circuits prospectively. Effects of ACT were examined by grouping patients into three with their ACT values: <140, 140≦ and <180, and ≧180 seconds. The primary outcome of this study was a termination of the CKRT circuit within 24 hours after the initiation of the CKRT circuit. The secondary outcome was the cause of terminating CKRT circuits. Primarily, we examined the impacts of factors associated with CKRT circuit lifespan using multivariable Cox-proportional hazards regression. Results Our cohort's median follow-up period of CKRT hemofilter was 18.5 hours. The total number of participants was 63, and 63.5% were male. In the multivariate Cox regression analysis, targeting ACT between 140 to 180 seconds was associated with a longer circuit lifespan (HR = 2.11(1.43-3.11), p<0.0001) than the group of CKRT circuits with ACT<140 seconds. Based on our results, targeting ACT between 140 to 180 seconds extended the median survival time of the circuit lifespan to 1.4 times longer than the group of circuits with ACT less than 140 (Fig. 1). There were no differences in the causes of hemofilter occlusion among the three ACT groups. Notably, COVID-19 was not significantly associated with a reduction in circuit lifespans (HR = 0.63(0.35-1.11), p = 0.110). Conclusion Appropriate monitoring of ACT during CKRT may help prolong circuit lifespan, and the optimal ACT range was 140 to 180 seconds. In contrast, COVID-19 was not a risk factor for an early occlusion of CKRT circuits.

Statistical simulations show that scientists need not increase overall sample size by default when including both sexes in in vivo studies.

In recent years, there has been a strong drive to improve the inclusion of animals of both sexes in the design of in vivo research studies, driven by a need to increase sex representation in fundamental biology and drug development. This has resulted in inclusion mandates by funding bodies and journals, alongside numerous published manuscripts highlighting the issue and providing guidance to scientists. However, progress is slow and barriers to the routine use of both sexes remain. A frequent, major concern is the perceived need for a higher overall sample size to achieve an equivalent level of statistical power, which would result in an increased ethical and resource burden. This perception arises from either the belief that sex inclusion will increase variability in the data (either through a baseline difference or a treatment effect that depends on sex), thus reducing the sensitivity of statistical tests, or from misapprehensions about the correct way to analyse the data, including disaggregation or pooling by sex. Here, we conduct an in-depth examination of the consequences of including both sexes on statistical power. We performed simulations by constructing artificial datasets that encompass a range of outcomes that may occur in studies studying a treatment effect in the context of both sexes. This includes both baseline sex differences and situations in which the size of the treatment effect depends on sex in both the same and opposite directions. The data were then analysed using either a factorial analysis approach, which is appropriate for the design, or a t test approach following pooling or disaggregation of the data, which are common but erroneous strategies. The results demonstrate that there is no loss of power to detect treatment effects when splitting the sample size across sexes in most scenarios, providing that the data are analysed using an appropriate factorial analysis method (e.g., two-way ANOVA). In the rare situations where power is lost, the benefit of understanding the role of sex outweighs the power considerations. Additionally, use of the inappropriate analysis pipelines results in a loss of statistical power. Therefore, we recommend analysing data collected from both sexes using factorial analysis and splitting the sample size across male and female mice as a standard strategy.

Impact of COVID-19 on Public Interest in Breast Cancer Screening and Related Symptoms: A Google Trends Analysis.

The COVID-19 Pandemic has led to a decrease in cancer screening due to redeployment of healthcare resources and public avoidance of healthcare facilities. Breast Cancer is the most common cancer diagnosed in women, with improved survival rates with early detection. An avoidance of screening, resulting in late detection, greatly affects survival and increases healthcare resource burden and costs. To evaluate if a sustained decrease in public interest in screening occurred, and to evaluate other search terms, and hence interest, associated with that. This study utilized Google Trends to analyze public interest in breast cancer screening and symptoms. We queried search data for four keyword terms ("mammogram", "breast pain", "breast lump", and "nipple discharge") from 2019-01-01 to 2022-01-01. The relative search frequency (RSF) metric was used to assess interest in these terms, and related queries were retrieved for each keyword to evaluate trends in search patterns. Despite an initial drastic drop in interest in mammography from March-April 2020, this quickly recovered by July 2020. After this period, alongside recovery of interest in screening there was a rapid increase in interest for arranging for mammography. Relative search frequencies of perceived Breast Cancer related symptoms such as Breast Lump, Nipple Discharge and Breast Pain remained stable. There was increase public interest in natural and alternative therapy of breast lumps despite recovery of interest in mammography and breast biopsy. There was a significant correlation between search activity and Breast Cancer Awareness Month (BCAM) in October. Online search interest in breast cancer screening experienced a sharp decline at the beginning of the COVID-19 pandemic, with a subsequent return to baseline interest in arranging mammography followed this short period of decreased interest.

Ultrasound vs. clinical diagnosis-which is better in diagnosing acute appendicitis?: a cohort study.

A retrospective cohort study was conducted in a district general hospital which 1046 cases of laparoscopic appendicectomy were included and examined for the use of USS or clinical diagnosis. The sensitivity, specificity, negative and positive predictive value in USS and data in clinical evaluation were analysed for their accuracy in the diagnosis of acute appendicitis based on the histology results post appendicectomy. Clinical diagnosis without preoperative imaging was found to have a significantly lower negative appendicectomy rate of 27.20% compared with 42.67% in those who underwent ultrasound. 44.64% of the patients were misdiagnosed with a normal USS result who had a subsequent positive histology of appendicitis. USS has been shown to be less sensitive for diagnosing acute appendicitis which results in high negative appendicectomy and misdiagnosis rate. With an increasing burden of health budget and resources, cautious and appropriate use of USS would avoid the misdiagnosis and prevent further complications. Thorough clinical evaluation remains an important first step and role in the diagnosis of acute appendicitis.

EPH40 A Retrospective Cohort Study of Veteran′s Affairs Data: Epidemiology, Treatments, Clinical Outcomes, and Burden of Immunoglobulin a Nephropathy

Immunoglobulin A nephropathy (IgAN), the glomerular accumulation of IgA-containing immune complexes in the kidneys, may lead to damage of the glomerular filtration barrier which results in proteinuria, hematuria, and often kidney failure (KF). This study describes the epidemiology, treatments, clinical outcomes, and resource burden of patients with IgAN using United States Veteran’s Affairs (VA) data.

Genitourinary Radiation Injury Following Prostate Cancer Treatment: Assessment of Cost and Health Care System Burden

To evaluate the healthcare resource impact of radiation injury following prostate cancer treatment. Using IBM MarketScan, we performed a retrospective study of men with prostate cancer who were treated with radiotherapy and subsequently developed low-grade (LGRI) and high-grade radiation injury (HGRI). Radiation injury diagnoses includedbladder neck stenosis, hematuria/cystitis, fistula, ureteral stricture, and incontinence. LGRI and HGRI included injury diagnosis without intervention and with intervention, respectively. Health care visits and costs were measured over 5 time periods including2 years before radiation, 1 year before radiation, radiation to injury diagnosis, injury diagnosis to first intervention (LGRI), and following first intervention (HGRI). Negative binomial regression modeling was used to assess the effect of radiation injury on average cost adjusting for demographics and comorbidities. Between 2008 and 2017, we identified 121,027 men who received radiotherapy following prostate cancer diagnosis of which 10,057 (8.3%) experienced aHGRI. The frequency of urologic visits and average costs were similar in those without injury and LGRI. However, men with HGRI experienced higher visit frequency and monthly costs. Amongst high-grade injuries, urinary fistula had the highest frequency of visit utilization at 378 visits before first intervention and 245 visits after first intervention. Following radiation injury diagnosis, the average monthly cost was twice as high in those with HGRI ($85.78) compared to LGRI ($38.66). HGRI was associated with increased urologic health care use and average monthly cost when compared to those who experienced LGRI or no injury. Urinary fistula was associated with the largest resource burden.

Metabolic biomarkers in lung cancer screening and early diagnosis (Review).

Late diagnosis is one of the major contributing factors to the high mortality rate of lung cancer, which is now the leading cause of cancer-associated mortality worldwide. At present, low-dose CT (LDCT) screening in the high-risk population, in which lung cancer incidence is higher than that of the low-risk population is the predominant diagnostic strategy. Although this has efficiently reduced lung cancer mortality in large randomized trials, LDCT screening has high false-positive rates, resulting in excessive subsequent follow-up procedures and radiation exposure. Complementation of LDCT examination with biofluid-based biomarkers has been documented to increase efficacy, and this type of preliminary screening can potentially reduce potential radioactive damage to low-risk populations and the burden of hospital resources. Several molecular signatures based on components of the biofluid metabolome that can possibly discriminate patients with lung cancer from healthy individuals have been proposed over the past two decades. In the present review, advancements in currently available technologies in metabolomics were reviewed, with particular focus on their possible application in lung cancer screening and early detection.

PO-03-054 OPTIMIZING REMOTE MONITORING ALERTS FOR CIED PATIENTS TO REDUCE RESOURCE UTILIZATION WITHOUT COMPROMISING CLINICAL CARE

The benefits of remote monitoring (RM) have been demonstrated in multiple clinical studies and have become the standard of care for patients with cardiovascular implantable electronic devices (CIEDs). Benefits include fewer hospitalizations, reduction in mortality and improved clinical workflow by reducing in-office visits. As RM utilization increases, the amount of transmitted data can become a resource burden for responsible caregivers. To evaluate RM alert burden from actively monitored CIED patients within US-based integrated healthcare system to identify opportunities to optimize RM and a reduction of provider workload. We conducted an epidemiologic descriptive study using data from 9,781 CIED Patients from 7 healthcare centers within Kaiser Permanent who were monitored using BIOTRONIK Home Monitoring® (HM) from 1/1/22 through 7/31/22. Frequencies and proportions were used to describe alerts during the study period, as well as occurrence by device type. Patterns were identified that suggest specific alert programming differences leading to unnecessary alerts from a given healthcare centers or device type. In total, 9,781 active CIED patients enrolled in HM were analyzed. A total of 8,519 (87%) patients had ≥1 alert in the given timeframe. The distribution of device types in the patient population with an alert was: 5,725 (67%) implantable pulse generator (IPG), 132 (2%) cardiac resynchronization therapy pacemaker (CRT-P), 1,718 (20%) implantable cardioverter-defibrillator (ICD), 715 (8%) cardiac resynchronization therapy defibrillator (CRT-D) and 229 (3%) implantable cardiac monitors (ICM). A breakdown of alerts per patient per month shows that the majority (65%) of all alerts are generated by a minority of patients (20%). In conjunction with this finding, the alert per patient rate in this timeframe was the highest for ICM (15/patient) and CRT-D (13/patient) which represents 10% of all patients. Alert optimization is essential to reduce the work burden associated with RM. As shown in this analysis a limited number of patients (20%) are responsible for a significant portion of the overall alert burden (65%). We plan to target those high-volume alert sites as well as the specific alerts and specific patients to create server-based alert “templates” to optimize patient care and decrease alert burden for clinicians. A subsequent analysis will determine impact on patient outcomes and reduction in the burden of work.

Legal obstacles and possibilities for environmental bargaining in Australia

Informed by an emerging discourse in environmental labour studies, this article investigates the legality of environmental bargaining in Australia. It demonstrates that existing enterprise bargaining law mostly prevents meaningful and enforceable bargaining regarding environmental issues. Proposed here instead is that more impactful possibilities for environmental bargaining exist under state Work Health and Safety (WHS) laws. In this respect, the article engages with some of the latest legal developments within the field of WHS that may enable environmental bargaining on the terms recommended by the environmental labour studies literature. It nevertheless acknowledges that such proposals may generate additional regulatory and resource burdens on regulators and workers alike. Accordingly, it concludes by canvasing a range of alternative regulatory arrangements rendering environmental bargaining more fair and effective.

Changes in the pathogen spectrum of hospitalized adults with community-acquired pneumonia in Fujian Province: A multicenter, retrospective study from 2012 to 2018.

Changes in the pathogen spectrum of hospitalized adults with community-acquired pneumonia in Fujian Province: A multicenter, retrospective study from 2012 to 2018.

Privacy vs. Efficiency: Achieving Both Through Adaptive Hierarchical Federated Learning

As a decentralized training paradigm, Federated learning (FL) promises data privacy by exchanging model parameters instead of raw local data. However, it is still impeded by the resource limitations of end devices and privacy risks from the ‘curious’ cloud. Yet, existing work predominately ignores that these two issues are non-orthogonal in nature. In this article, we propose a joint design (i.e., AHFL) that accommodates both the efficiency expectation and privacy protection of clients towards high inference accuracy. Based on a cloud-edge-end hierarchical FL framework, we carefully offload the training burden of devices to one proximate edge for enhanced efficiency and apply a two-level differential privacy mechanism for privacy protection. To resolve the conflicts of dynamical resource consumption and privacy risk accumulation, we formulate an optimization problem for choosing configurations under correlated learning parameters (e.g., iterations) and privacy control factors (e.g., noise intensity). An adaptive algorithmic solution is presented based on performance-oriented resource scheduling, budget-aware device selection, and adaptive local noise injection. Extensive evaluations are performed on three different data distribution cases of two real-world datasets, using both a networked prototype and large-scale simulations. Experimental results show that AHFL relieves the end's resource burden (w.r.t. computation time 8.58% <inline-formula><tex-math notation="LaTeX">$\downarrow$</tex-math></inline-formula> , communication time 59.35% <inline-formula><tex-math notation="LaTeX">$\downarrow$</tex-math></inline-formula> and memory consumption 43.61% <inline-formula><tex-math notation="LaTeX">$\downarrow$</tex-math></inline-formula> ) and has better accuracy (6.34% <inline-formula><tex-math notation="LaTeX">$\uparrow$</tex-math></inline-formula> ) than 3 typical baselines under the limited resource and privacy budgets. The code for our implementation is available at <uri>https://github.com/Guoyeting/AHFL</uri> .

Services Management and Distributed Multihop Requests Routing in Mobile Edge Networks

Multi-access Edge Computing (MEC) is an emerging computing architecture to release the resource burden of the centralized cloud and reduce the mobile application latency. Services management and MEC requests routing is a major problem in MEC systems. Existing works mainly focus on the one-hop centralized request routing strategies. However, the centralized one-hop routing method is not suitable enough since the MEC network is a distributed system, and the number of MEC requests increases dramatically. In this paper, we have proposed an online problem. In such problem, we jointly consider the mobile edge service management and the distributed multi-hop requests routing in an MEC network in which the MEC requests randomly generate. We prove that such problem is NP-Hard even in the off-line scenario. Furthermore, we propose an approximation algorithm to manage the MEC services and two distributed online algorithms to route MEC requests. The approximation ratio and competitive ratio of these algorithms have been analyzed. Experiments are carried out to evaluate the performance of the algorithms and simulation results imply that these algorithms are effective and efficient.

Up and over: Consequences of raising the United States-Mexico border wall height.

San Diego County's geographic location lends a unique demographic of migrant patients injured by falls at the United States-Mexico border. To prevent migrant crossings, a 2017 Executive Order allocated funds to increase the southern California border wall height from 10 ft to 30 ft, which was completed in December 2019. We hypothesized that the elevated border wall height is associated with increased major trauma, resource utilization, and health care costs. Retrospective trauma registry review of border wall falls was performed by the two Level I trauma centers that admit border fall patients from the southern California border from January 2016 to June 2022. Patients were assigned to either "pre-2020" or "post-2020" subgroups based upon timing of completion of the heightened border wall. Total number of admissions, operating room utilization, hospital charges, and hospital costs were compared. Injuries from border wall falls grew 967% from 2016 to 2021 (39 vs. 377 admissions); this percentage is expected to be supplanted in 2022. When comparing the two subgroups, operating room utilization (175 vs. 734 total operations) and median hospital charges per patient ($95,229 vs. $168,795) have risen dramatically over the same time period. Hospital costs increased 636% in the post-2020 subgroup ($11,351,216 versus $72,172,123). The majority (97%) of these patients are uninsured at admission, with costs largely subsidized by federal government entities (57%) or through state Medicaid enrollment postadmission (31%). The increased height of the United States-Mexico border wall has resulted in record numbers of injured migrant patients, placing novel financial and resource burdens on already stressed trauma systems. To address this public health crisis, legislators and health care providers must conduct collaborative, apolitical discussions regarding the border wall's efficacy as a means of deterrence and its impact on traumatic injury and disability. Prognostic and Epidemiological; Level IV.

Management of acute open flexor tendon injuries of the hand and wrist: basic sciences, surgical factors and rehabilitation pertinent to optimizing outcome

Flexor tendon injuries to the hand and wrist represent a significant resource burden to the UK NHS. A good understanding of tendon basic science and repair techniques is crucial for the surgeon undertaking their repair and rehabilitation. Furthermore, this is a common topic assessed in the FRCS(Orth) examination. This article will summarize the basic science relating to tendon structure, physiology and injury. Additionally, it will present key surgical and rehabilitation factors relevant to clinical outcomes.