Option Plans Research Articles

Robot-Assisted Spine Surgery: The Pearls and Pitfalls.

Robot-assisted spine surgery has gained notable popularity among surgeons because of recent advancements in technology. These innovations provide several key benefits, including high screw accuracy rates, reduced radiation exposure, customized preoperative and intraoperative planning options, and improved ergonomics for surgeons. Despite the promising outcomes reported in literature, potential technical challenges remain across various robotic platforms. It is crucial for surgeons to remember that robotic platforms are shared-control systems, requiring the surgeon to maintain primary control throughout the procedure. To ensure patient safety, surgeons should be well versed in common technical pitfalls and strategies to mitigate these limitations.

Utilization of Immediate Postpartum Contraception and Its Association with Interpregnancy Interval: 10-Year Experience at a Single Center.

Increasing availability of immediate postpartum long-acting reversible contraception (LARC) has added contraceptive alternatives to bilateral tubal ligation (BTL) in the immediate postpartum period. The resultant access to long-term contraception has provided patients with improved control over the timing of pregnancies. Our objective is to evaluate changes in the utilization of immediate postpartum contraceptive methods over a 10-year period and its association with interpregnancy interval (IPI). Retrospective cohort study of 36,445 patients delivered at a single academic hospital center from 2012 to 2020. Deliveries <23 weeks gestation and patients who underwent a cesarean hysterectomy or postpartum hysterectomy for obstetric indications were excluded. The primary outcome was the utilization of postpartum BTL, intrauterine devices, contraceptive implants, and Depo-Provera over the study time period. The secondary outcomes were IPI and interdelivery interval (IDI). Outcomes were compared using appropriate tests of trend. We adjusted for significant covariates as assessed in baseline characteristics. A total of 35,281 patients were included in our study. Groups were different in baseline characteristics including age, race/ethnicity, parity, BMI, insurance status, comorbidity risk, and attendance at postpartum exam. Over the study period, there was a significant difference in utilization of Depo-Provera, LARC, intrauterine device (IUD), and implant (p < 0.001). There was a significant increase in IPI (p < 0.001) and IDI (p < 0.001). We observed a significant increase in utilization of immediate postpartum LARC over the study period which corresponded to a significant increase in IPI and IDI. Our findings emphasize the importance of the availability of immediate postpartum contraception as well as its effectiveness in improving family planning options for reproductive-aged patients. We found significantly increased IPI and IDI associated with increased utilization of long-acting reversible contraceptives immediately postpartum. Our findings emphasize the importance of providers offering these options to patients as well as being comfortable initiating immediate postpartum contraception. · Immediate postpartum LARC access has increased over the past 10 years.. · Access to more methods of contraception allows patients more options for family planning.. · Increased utilization of LARC led to increased IPI and IDI..

The Continuing Quest To Integrate Care For Dual-Eligible Enrollees.

For people dually eligible for Medicare and Medicaid, one integrated care plan option is coming to an end. States are planning what to offer next.

LMIC-25. EXPANDING THE PEDIATRIC NEURO-ONCOLOGY TELECONFERENCE EXPERIENCES, A LUXURY, OR A NECESSITY?

Abstract INTRODUCTION Videoteleconference in neurooncology is feasible and sustainable. The well-established 20 years’ Sickkids/KHCC teleconferencing is an example. Since 2018, several regional centers joined these meetings to discuss their patients’ management plans. We aimed to evaluate the impact of this experience. METHODS We retrospectively reviewed the 56 meetings’ minutes (9/2018-12/2023) and compared the pre-conference suggested plans with the post-conference recommendations. We recorded if the recommendations were implemented and the impact perceived. RESULTS In total, 251 patients were discussed: KHCC (137) and non-KHCC (114). Four of the regional participating oncologists had dedicated pediatric neuro-oncology training. Patients were selected for discussion due to challenges in their management (i.e. with relapsed tumors, rare diagnoses, unexpected tumor behavior). Main diagnoses were: Low-grade-glioma (28%), High-grade-glioma (21%), and Medulloblastoma (17%). Of the 227 patients where the local team suggested a care plan, the teleconference recommendations concurred with the proposed plan in 50% of the cases, agreed on but provided an alternative plan option in 18% and disagreed on in 32% of the cases. The difference in recommendations mostly affected the proposed treatment modality (15%). In 64% of the discordant plans and 50% of the alternative plans, the treating team applied the recommendations. Challenges to apply the recommendations were mainly linked to patients’ factors (53%, plan refusal, traveling abroad, clinical deterioration), local multidisciplinary team consensus on a different plan (29%) or logistic difficulties (18%, e.g. drug access). CONCLUSIONS Improvement in patients’ care was likely achieved with the continuous effort of the local teams to implement the recommendations. Participating oncologists valued the shared educational experience learned from each other’s case discussions, especially those related to molecular-testing and implications on treatment. Joining such regional teleconferences is of particular importance to small-volume centers or those lacking a pediatric neurooncologist. Regional and international collaborations are a necessity when it comes to improving the care of children with CNS tumors.

Family planning preferences in transgender youth in an urban multi-disciplinary gender clinic

BackgroundKnown barriers to family planning in the transgender population include low utilization of cryopreservation and decisional regret. There is growing data on the risk of infertility with GAHT, and on to what degree transgender adolescents feel informed about fertility and family planning options. ObjectiveAssess preferences regarding options for family planning and fertility preservation in transgender adolescents treated with GAHT in a pediatric endocrinology gender clinic. The goal is to enhance patient education about potential effects of GAHT on fertility and options for family planning. MethodsForty one adolescents aged 10 years and older treated with GAHT in an urban outpatient pediatric endocrinology clinic were surveyed over a 6-month period from January to June 2022. Survey questions were multiple choice, Likert scale, and open-ended. Participants were at least 10 years of age, actively followed in the clinic, and receiving GAHT at time of enrollment. ResultsForty one participants completed the survey. Four (10 %) expressed interest in discussing family planning with their provider. Eighteen (45 %) were open to discussion in the future; 16 (39 %) were not interested at all. 12 (30 %) participants were planning for future parenthood, and 16 (40 %) participants were undecided. Of those interested in parenthood 7 (53.8 %) planned to adopt or foster. Barriers to family planning expressed included financial concerns, potential need to pause GAHT, and social stigma of transgender parenthood. Twenty (50 %) participants recalled prior family planning discussion with their endocrinologist. ConclusionFamily planning discussions may not be optimally impactful given that 50 % of participants did not recall the conversations. Family planning is a lower priority in this population as most desired to postpone discussion with their provider despite choosing treatment that could influence fertility. It is essential to identify methods to engage transgender youth in discussions related to family planning during GAHT.

Early Lessons From State-Based Public Option Plans

This JAMA Forum discusses the early lessons from state-run public option–style health insurance plans in Colorado and Washington State that can be used by Minnesota and Nevada for their plans that are still under development.

Treatment plan for maxillary third molars based on radiological findings varies among oral surgeons: a web-based “paper” clinic study

ObjectivesTo evaluate variation in treatment plans and pathological findings related to maxillary second and third molars based on PAN images and CBCT among Danish and Dutch oral and maxillofacial surgeons. Study designThis web-based “paper” clinic contained 10 cases of impacted maxillary third molars comprising clinical information, PAN, and CBCT. Treatment plan and pathological findings were established based on clinical information and PAN, thereafter, based on CBCT by 28 surgeons. Options for treatment plan for third molars were no treatment, or tooth removal. Options for treatment plan for second molars were no treatment, tooth removal, or endodontic and/or filling therapy. The surgeons assessed external root resorption, marginal bone loss, and follicular space. ResultsA change in treatment plan between PAN and CBCT was registered between 0% and 43% of the surgeons among the cases. The surgeons did not agree completely on the treatment plan in any of the cases. Variation was present among the surgeons evaluating pathological findings. In several cases, severity of root resorption was rated worse in CBCT than in PAN. ConclusionsVariation in treatment plan and pathological findings was observed among surgeons. No correlation between change in pathological findings and change in treatment plan was found. Statement of Clinical RelevanceVariation exists among oral surgeons regarding treatment planning and pathological findings related to maxillary second and third molars seen in panoramic images and CBCT. In several cases external root resorption was more severe seen in CBCT compared to panoramic imaging.

Domestic violence as a risk factor of maternal filicide.

This paper will investigate precursors to maternal filicide, focusing on domestic violence. While psychosis is often well described, less frequently explored are the connections between prior trauma, domestic violence, depression, and filicide. We will discuss reasons why a woman may not disclose domestic violence and suggest possible areas for intervention. We present a case involving domestic violence, its impact on mental health, and eventual filicide. We then present an alternative scenario of the same case where filicide is considered, but is avoided. The case of the mother who experienced domestic violenceand was accused and sentenced for filicide is seen in greater relief by presenting the case in an alternative scenario with effective interventions. It is clear the availability and the ability to access community supports, such as obstetric and pediatric screening, psychiatric treatment, domestic violence shelters, intimate partner violence outreach services, parenting support groups, and hospital social work case management, tragedies such as filicide can be prevented. Traumatic early childhood experiences predispose people to a stress-response system that is more prone to inactivity and impulsivity. This can cause women in domestic violence relationships to stay, limit their options for family planning, become increasingly depressed, not seek community support, and risk impulsive action of harming their child. This risk can be mitigated by building stable relationships with their medical team, treating depression, connecting with home visitation programs, and being empowered to access contraception.

Association of Client and Provider Race with Approaches Pursued by Social Workers for Reducing Firearm Access.

Social workers assess and intervene to prevent harm among clients at risk of harm to self (HTS) and harm to others (HTO) with a firearm. This study sought to assess the impact of client race on social workers' approaches to reduce firearm access when they weighed voluntary (e.g., store out-of-home) and involuntary (e.g., extreme risk protection order) removal methods. We considered the role of social workers' self-identified race as a moderator of this relationship, comparing white (single race) and Black, Indigenous, and People of Color (BIPOC) social workers. A survey was distributed to Washington state social workers (n = 9073) who were presented with two case vignettes, each randomized to view the client's race as Black or white. Logistic regression was used to assess the association between the client's race and the pursuit of voluntary or involuntary methods, stratified by social workers' race. Among the participants (n = 1306), 26% pursued at least one involuntary care plan option for the HTS client, and 59% for the HTO client. The Black client at risk of HTS had lower odds of an involuntary care plan option compared to the white client (OR = 0.69, 95% CI 0.54-0.88), while the Black client at risk of HTO had higher odds of an involuntary care plan options (OR = 1.13, 95% CI 1.07-1.66). These associations were not statistically significantly different between white (single race selected) and BIPOC social workers. This study contributes to the growing understanding of potential racial disparities in social workers' decision-making regarding firearm access reduction strategies.

Architectural and planning solutions for multistorey residential buildings with safety capsules

The purpose of this study is to develop an architectural and construction solution for protecting the civilian population in a multi-story residential building by creating a safe space with instant accessibility. The paper analyzes the past and present experience of designing and constructing civil defense facilities. An architectural and structural solution of the “safety capsule” − a form of protection of the civilian population of instant accessibility in multi-storey residential buildings has been developed based on the best practices. The safety capsule is a dual-purpose protective structure of instant accessibility, that can be used as a shelter during emergencies and as an auxiliary room in peacetime by the residents of the house. The options for detailed planning of the internal space of the “safety capsule” were designed. The proposed solution is integrated into the architectural and planning structure of multi-storey residential buildings by the example of 12-storey and 16-storey residential buildings.

The practice of multi-criteria decision analysis modeling in decision support for landscape planning

Abstract In this paper, after constructing the index system of garden landscape planning, the entropy weight method and hierarchical analysis method are used to combine and assign weights to each index. Using a multi-criterion decision analysis model to establish the decision matrix of landscape planning alternatives, the weighted normative value of each indicator is obtained to obtain the weighted normalization matrix for landscape planning. According to the matrix analysis to get the positive and negative ideal solution of each index, calculate the utility function value between each alternative and the perfect solution, and get the optimal decision-making scheme of landscape planning. The analysis of the three options for landscape planning found that Scheme S2 has the largest utility function value of 0.642, which is considered the optimal scheme. The analysis of the application effect of this scheme found that the proportion of garden green space in the Xinghua garden landscape area increased by 16.23 % compared with 2010, and the proportion of enterprise and institutional land decreased by 5.04 %. The analysis results of this paper show that the multi-criteria decision analysis model plays a highly supportive role in the decision-making of landscape planning, and lays a foundation for the decision-making of the optimal scheme in future landscape planning.

ПРОГНОЗУВАННЯ ФІНАНСОВИХ ПОКАЗНИКІВ СУБ’ЄКТА ПІДПРИЄМНИЦЬКОЇ ДІЯЛЬНОСТІ: ВИБІР ОПТИМАЛЬНОГО МЕТОДУ

The use of economic and mathematical methods for solving financial problems is an integral part of effective management of enterprise resources and making sound economic decisions. This approach is becoming increasingly important in today’s world, as the dynamism of the financial environment and the variety of factors influencing the economy require complex analysis and precise calculations. The use of mathematical tools also allows to reduce the risks of making wrong decisions and improve the quality of forecasts. The article considers the necessity of forecasting financial indicators of a business entity as a process of predicting future financial results and the state of the enterprise for effective management and strategic decision-making, which gives an opportunity to ensure better resource planning, timely response to changes and reduce financial risks, contributing to the business sustainability and success. An analytical straight-line alignment of the dynamics of the amount of net revenue from sales was carried out on the basis of the financial statements of a real enterprise; a straight line equation characterising the amount of revenue from sales was derived and its forecast value for 2024 was calculated. The equation of the second-order parabola, which characterizes the trend in the value of sales revenue, was also derived and its forecast value for 2024 was found. For each method, the value of the standard square deviation of the actual levels of the dynamic series from the adjusted ones, i.e. the relative error of calculations, was calculated, and the optimal forecasting option was chosen – the one with the smaller relative error. It was found that the straight line more accurately reflects the main trend of a series of dynamics, which characterises the amount of revenue from sales of a business entity. On the basis of this conclusion and the obtained forecast data for 2024, the lower and upper limits of the projected value of sales revenue were calculated. It is concluded that forecasting of the financial performance of an enterprise allows to find optimal options for further development and planning of business activities and is a promising and relevant direction of predicting trends in the development of an enterprise, contributes to effective management and making sound strategic decisions.

Preimplantation Genetic Testing within the Public Healthcare System in Slovenia.

Preimplantation genetic testing (PGT) is the earliest form of prenatal diagnosis that has become an established procedure for couples at risk of passing a severe genetic disease to their offspring. At UMC Ljubljana, we conducted a retrospective register-based study to present 15 years of PGT service within the public healthcare system in Slovenia. We collected the data of the PGT cycles from 2004 to 2019 and compared clinical outcomes for chromosomal and monogenic diseases using different embryo biopsy and testing approaches. In addition, we assessed the extent to which PGT has become the preferred option compared to classic prenatal diagnostics. We treated 211 couples, 110 with single gene disorder, 88 with structural chromosome rearrangement and 13 for numerical chromosome aberration. There were 375 PGT cycles with oocyte retrieval, while embryo transfer was possible in 263 cases resulting in 78 deliveries and 84 children. Altogether, the clinical pregnancy rate per embryo transfer was 31% in 2004-2016 (blastomere biopsy) and 43% in 2017-19 (blastocyst biopsy), respectively. We assessed that approximately a third of couples would opt for PGT, while the rest preferred natural conception with prenatal diagnosis. Our results show that providing a PGT service within the public healthcare system has become a considerable option in pregnancy planning for couples at risk of transmitting a severe genetic disease to their offspring. In Slovenia, approximately a third of couples would opt for PGT. Although the number of cycles is small, our clinical results are comparable to larger centres.

Unilateral gemination: A case report

Introduction: Dental gemination is an uncommon developmental anomaly characterized by an enlarged bifid tooth crown. Case Report: This case report presents clinical and radiographic findings of gemination affecting a mandibular left lateral incisor in a 20-year-old female patient. The patient presented for a routine dental examination, which revealed an abnormal crown morphology of the mandibular left lateral incisor. There was no associated symptomology. Radiographic analysis confirmed the presence of a single root and root canal beneath the bifid tooth crown. Based on the clinical and radiographic features, a diagnosis of gemination was made. The treatment plan options were discussed with the patient, who opted not to restore the anomalous tooth. Instead, the geminated tooth will be kept under observation with regular monitoring and preventive care. Conclusion: This case provides an example of the importance of proper diagnosis of developmental dental anomalies. It also underscores the role of patient preferences in determining appropriate management of incidental findings like asymptomatic geminated teeth.

SAT408 Assessment Of Family Planning Readiness In Transgender Youth

Abstract Disclosure: R.S. Conard: None. L.J. Folsom: None. Background: Transgender individuals identify with a gender incongruent with the sex assigned at birth. Some seek medical care in the form of gender affirming hormone therapy (GAHT) or gender affirming surgery (GAS). GAHT initiated in adolescence may include GnRH analogues and cross-sex hormones. Barriers to family planning in this population include low utilization of cryopreservation and decisional regret. There is a paucity of data on the risk of infertility with GAHT, and on to what degree transgender adolescents feel informed about fertility and family planning options. Objective: To assess knowledge regarding options for family planning and fertility preservation in transgender adolescents treated with GAHT in a pediatric endocrinology gender clinic. The goal is to enhance patient education about potential effects of GAHT on fertility and options for family planning. Methods: 41 adolescent patients aged 10 years and older treated with GAHT in an urban outpatient pediatric endocrinology clinic were surveyed from January to June 2022. Survey questions were multiple choice, Likert scale, and open-ended. To be included participants were at least 10 years of age, actively followed in the clinic, and receiving GAHT at time of enrollment. Results: 41 participants completed the survey. Four (10%) expressed interest in discussing family planning with their provider at the time of survey completion. 18 (45%) were open to discussion in the future; 16 (39%) were not interested at all. 13 (32.5%) participants were planning for future parenthood, and 16 (40%) participants were undecided. Of those interested in parenthood 7 (53.8%) planned to adopt or foster. Barriers to family planning expressed included financial concerns, potential need to pause GAHT, and social stigma of transgender parenthood. 20 (50%) participants reported prior family planning discussion with their endocrinologist. Conclusion: Despite routine family planning discussions documented during visits, these may not be optimally impactful given that 50% of participants did not recall the conversations. Family planning appears to be of lower priority in this population as most desired to postpone discussions with their provider despite undergoing treatment that could influence fertility. Our findings indicate it is essential to actively identify methods to engage transgender youth in discussions related to family planning during GAHT. Presentation: Saturday, June 17, 2023

Chance-constrained multi-stage stochastic energy system expansion planning with demand satisfaction flexibility

A classic multi-period stochastic energy system expansion planning (ESEP) model aims to address demand uncertainty by requiring immediate demand satisfaction for all scenarios. However, this approach may result in an expensive system that deviates from the planner’s long-term goals, especially when facing unexpectedly high demand scenarios. To address this issue, we propose a chance-constrained stochastic multi-stage ESEP model that allows for a portion of demand to remain unmet in specific periods while still ensuring complete demand satisfaction during most of the planning horizon, including the final period. This approach provides more time flexibility to build infrastructure and assess needs, ultimately reducing costs and allowing for a broader view of infrastructure planning options. To solve the chance-constrained stochastic model, we introduce a binary-search-based progressive hedging algorithm heuristic, which is particularly useful for large-scale models. We demonstrate the effectiveness and benefits of implementing the chance-constrained model through a case study of Rwanda using real-world data.

Adult-onset Alexander disease among patients of Jewish Syrian descent.

Alexander disease (AxD) is a rare autosomal dominant leukodystrophy caused by heterozygous mutations in the glial fibrillary acid protein (GFAP) gene. The age of symptoms onset ranges from infancy to adulthood, with variable clinical and radiological manifestations. Adult-onset AxD manifests as a chronic and progressive condition, characterized by bulbar, motor, cerebellar, and other clinical signs and symptoms. Neuroradiological findings typically involve the brainstem and cervical spinal cord. Adult-onset AxD has been described in diverse populations but is rare in Israel. We present a series of patients diagnosed with adult-onset AxD from three families, all of Jewish Syrian descent. Five patients (4 females) were diagnosed with adult-onset AxD due to the heterozygous mutationc.219G > A, p.Met73Ile in GFAP. Age at symptoms onset ranged from 48 to 61 years. Clinical characteristics were typical and involved progressive bulbar and gait disturbance, followed by pyramidal and cerebellar impairment, dysautonomia, and cognitive decline. Imaging findings included medullary and cervical spinal atrophy and mostly infratentorial white matter hyperintensities. A newly recognized cluster of adult-onset AxD in Jews of Syrian origin is presented. This disorder should be considered in differential diagnosis in appropriate circumstances. Genetic counselling for family members is required in order to discuss options for future family planning.

Opportunities and limitations of integrating computational and collaborative approaches to scenario planning

In the context of changing global trends and growing uncertainties, creating and evaluating alternative future scenarios is crucial for urban and regional planning. Computational and collaborative approaches are two contemporary options for scenario planning. They have distinct roles and are often applied independently. This study investigates the integration of these two approaches, addressing a knowledge gap by explicitly integrating a Cellular Automata-based model within the collaborative geodesign framework. It assesses the integration process and scenario planning outcomes through a resilience planning case study. The key finding from this experiment is that integrating the information generated by a computational approach with the transparency and reliability inherent in a collaborative approach can enhance the end-user's scenario planning experience. The integration is also perceived to have positive effects on scenario outcomes, which is particularly relevant for joint evidence-based and collaborative resilience planning in cities and regions. However, the study also highlights the need for further investigation into the options for integrating computational methods into collaborative approaches and into the utility of integration in real-world planning with practitioners and the community.

IMPLEMENTASI MANAJEMEN KURIKULUM DARURAT PADA MASA PANDEMI COVID 19 DI MAN I CIREBON

The Covid 19 Pandemic outbreak that hit Indonesia has paralyzed all sectors of life including education. Education managers are required to be creative and innovative to adapt to the changing environment. The objectives of this study are to: (1) Know the emergency curriculum management planning during the Covid-19 pandemic at MAN 1 Cirebon, (2) Know the implementation of emergency curriculum management during the Covid-19 pandemic at MAN 1 Cirebon (3) Know the evaluation of emergency curriculum management during the Covid-19 pandemic at MAN 1 Cirebon. The scope of curriculum management includes curriculum planning, implementation, and evaluation. This research is qualitative research. Data collection was done through interviews, observation, and documentation. The subjects of this study were the head of the madrasah and educators. The data analysis technique uses the Miles and Huberman model which consists of data reduction, data presentation, and conclusions. Researchers used three management scopes as a tool to analyze curriculum implementation. The results of the study found that: First, Emergency Curriculum Planning at MAN 1 Cirebon has been running well, involving existing elements, coordinating with the deputy head of the institution, and making options in planning. However, it is still necessary to increase the competence of IT-related teachers in the form of training so that it supports the implementation of KBM well, on target, and not monotonous in learning. Second. Implementation of the emergency curriculum at MAN 1 Cirebon presents the learning process from the material, media, strategies, and evaluation of learning. Third. evaluation of the emergency curriculum at MAN 1 Cirebon conducts an evaluation by collecting data and finding solutions to problems.

Swab pooling enables rapid expansion of high-throughput capacity for SARS-CoV-2 community testing

BackgroundThe challenges of rapid upscaling of testing capacity were a major lesson from the COVID-19 pandemic response. The need for process adjustments in high-throughput testing laboratories made sample pooling a challenging option to implement. ObjectiveThis study aimed to evaluate whether pooling samples at source (swab pooling) was as effective as qRT-PCR testing of individuals in identifying cases of SARS-CoV-2 in real-world community testing conditions using the same high-throughput pipeline. MethodsTwo cohorts of 10 (Pool10: 1,030 participants and 103 pools) and 6 (Pool6: 1,284 participants and 214 pools) samples per pool were tested for concordance, sensitivity, specificity, and Ct value differences with individual testing as reference. ResultsSwab pooling allowed unmodified application of an existing high-throughput SARS-Cov-2 testing pipeline with only marginal loss of accuracy. For Pool10, concordance was 98.1% (95% Confidence interval: 93.3–99.8%), sensitivity was 95.7% (85.5–99.5%), and specificity was 100.0% (93.6–100.0%). For Pool6, concordance was 97.2% (94.0–99.0%), sensitivity was 97.5% (93.7–99.3%), and specificity was 96.4% (87.7–99.6%). Differences of outcomes measure between pool size were not significant. Most positive individual samples, which were not detected in pools, had very low viral concentration. If only individual samples with a viral concentration > 400 copies/ml (i.e. Ct value < 30) were considered positive, the overall sensitivity of pooling increased to 99.5%. ConclusionThe study demonstrated high sensitivity and specificity by swab pooling and the immediate capability of high-throughput laboratories to implement this method making it an option in planning of rapid upscaling of laboratory capacity for future pandemics.