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Correction to: BMC Health Services Research (2025) 25:873 https://doi.org/10.1186/s12913-025-12969-2 In this article, the authors reported Errors in the Abstract and in the footnote of Table 5. Additional benefits for patients included increased access to specialist advice through the and reduced face-to-face contact due to use of a digital platforms minimising unnecessary hospital visits for patients. Additional benefits for patients included increased access to specialist advice through the Wound Care Command Centre™ and reduced face-to-face contact due to use of a digital platform minimising unnecessary hospital visits for patients. Anna Cohen4 Show authors BMC Health Services Research volume 25, Article number: 1206 (2025) Cite this article 175 Accesses Metrics details The Original Article was published on 01 July 2025 Correction to: BMC Health Services Research (2025) 25:873 https://doi.org/10.1186/s12913-025-12969-2 In this article, the authors reported Errors in the Abstract and in the footnote of Table 5. Additional benefits for patients included increased access to specialist advice through the and reduced face-to-face contact due to use of a digital platforms minimising unnecessary hospital visits for patients. Additional benefits for patients included increased access to specialist advice through the Wound Care Command Centre™ and reduced face-to-face contact due to use of a digital platform minimising unnecessary hospital visits for patients.

Background Chronic wounds pose considerable financial challenges for healthcare systems globally, with most cases requiring hospital care and extended lengths of stay, particularly due to delayed access to treatment. To address this, Sydney Local Health District (LHD) in Australia launched the Wound Care Command Centre™ in 2023, utilising a digital application for timely access to wound care and to reduce the burden on hospitals. This study evaluates the cost consequences of this Centre by comparing healthcare service use under this new model of care compared to service use under standard clinical practice after one year of operation to determine savings to the health system. Methods Admitted patient, non-admitted and emergency department patient records relating to chronic wounds between 2018 and 2024 were analysed to determine service use costs, number of chronic wound admissions, length of stay, non-admitted services and emergency department presentations. Regression was used to control for patient mix, and records from a neighbouring LHD utilising the standard clinical care model was used as a control for this study. Results We estimated that with the Wound Care Command Centre™, in 2023 there were up to 97 chronic wound admissions prevented, 943 hospital days averted due to earlier discharges, 308 more non-admitted service events and 208 more emergency department presentations in Sydney LHD, compared to expected levels under standard clinical practice models. This was consistent with reduced prevalence of complex cellulitis admissions in Sydney LHD and partial shifting of care from admitted to outpatient settings. Reduced hospital admissions and earlier discharges were estimated to total between $3.2 M to $4.8 M and costs of non-admitted and emergency department services were estimated to total $264k. After accounting for $1.3 M operational costs for the Command Centre over 2023, net savings were between $1.7 M to $3.3 M. Conclusions The Wound Care Command Centre™ reduced hospital admissions by 97 individuals and shortened hospital length of stays by 1.1 day, resulting in savings up to $3.3 M for Sydney LHD. Additional benefits for patients included increased access to specialist advice through the Wound Care Command Centre™ and reduced face-to-face contact due to use of a digital platform minimising unnecessary hospital visits for patients.

PurposeTransforaminal endoscopic discectomy has been found to have equivalent outcomes to traditional discectomy techniques. Controversy exists concerning whether this should be performed under general anesthetic with neuromonitoring or can be safely performed on awake patients without neuromonitoring. This study aimed to evaluate the safety and effectiveness of awake transforaminal endoscopic discectomy in an ambulatory setting.Methods100 consecutive patients with lumbar disc herniations treated with transforaminal endoscopic discectomy by a single surgeon were enrolled in the study. All procedures were performed under conscious sedation with local anesthetic. Preoperative and postoperative visual analog scale (VAS) scores were recorded and compared. Time spent in recovery prior to discharge home and complications were also recorded.ResultsAverage VAS score improved from a mean of 6.85 to 0.74 (median 7 to 0) immediately postoperatively. The average time spent in Post Anesthesia Care Unit (PACU) prior to discharge was 56.7 min. Average VAS score at 2 weeks was 3.07 (median 2.5). Complication rates were commensurate with published results in the literature. The most common complication was radiculitis, which appears to be more likely with foraminal/extraforaminal herniations at a rate of 20.7%, versus 2.6% for central/paracentral herniations. There were no cases that required conversion to general anesthetic or transfer to a hospital and no permanent nerve injuries in this cohort.ConclusionsEndoscopic discectomy can safely and successfully be performed in an ambulatory surgery center under conscious sedation and local anesthetic without neuromonitoring. This procedure leads to rapid recovery in the PACU and significantly improved VAS scores postoperatively.Level of evidenceLevel IV.

Background: Weightbearing computed tomography (WBCT) is becoming a valuable tool in the evaluation of foot and ankle pathology. Currently, cost analyses of WBCT scanners in private practice are lacking in the literature. This study evaluated the costs of acquisition, utilization, and reimbursements for a WBCT at a tertiary referral center, information of particular interest to practices considering obtaining such equipment. Methods: All WBCT scans performed at a tertiary referral center over the 55-month period (August 2016 to February 2021) were retrospectively evaluated. Patient demographics, pathology location, etiology, subspecialty of the ordering provider, and whether the study was unilateral or bilateral were collected. Reimbursement was calculated based on payor source as a percentage of Medicare reimbursement for lower extremity CT. The number of total scans performed per month was evaluated to determine revenue generated per month. Results: Over the study period, 1903 scans were performed. An average of 34.6 scans were performed each month. Forty-one providers ordered WBCT scans over the study period. Foot and ankle fellowship-trained orthopaedic surgeons ordered 75.5% of all scans. The most common location of pathology was the ankle, and the most common etiology was trauma. The device was cost neutral at 44.2 months, assuming reimbursement for each study was commensurate with Medicare rates. The device became cost neutral at approximately 29.9 months when calculating reimbursement according to mixed-payor source. Conclusion: As WBCT scan becomes more widely used for evaluation of foot and ankle pathology, practices may be interested in understanding the financial implications of such an investment. To the authors’ knowledge, this study is the only cost-effectiveness analysis of WBCT based in the United States. We found that in a large, multispecialty orthopaedic group, WBCT can be a financially viable asset and a valuable diagnostic tool for a variety of pathologies. Level of Evidence: Level III, diagnostic.

Category: Other Introduction/Purpose: Weightbearing Computed Tomography (WB CT) is becoming a valuable tool in the evaluation and understanding of foot and ankle pathology. With this, more practices may be interested in acquiring WB CT scanners and understanding cost effectiveness of acquisition. To date there are currently no US based reports of cost analysis of WB CT scanners. Our study is a cost analysis of WB CT at tertiary referral physician owned practice. Methods: Data was collected for all patients who underwent imaging utilizing a weight bearing CT scanner at our institution from the date of acquisition in 2016. For ease of analysis and applicability of information across orthopedic practices, Medicare reimbursement was used as a uniform estimation of reimbursement across all insurances at a rate of $163.50 per scan. We then compared the number of scans obtained per month to total costs related to acquiring and maintaining the WB CT machine. Secondary variables collected included patient demographic information, pathology location (forefoot, midfoot, hindfoot), and utilization of the device by subspecialty. Results: A WB CT scanner was acquired by a private group in 2016. A proforma analysis demonstrated $179,000 to acquire the machine, $30,000 for extended warranty, $995 for additional licenses. Between August 2016 and February 2021, 1702 unilateral studies and 100 bilateral studies were performed. Patients ranged in age from 6 to 92. Average age was 45 years with 45.9% male and 54.1% female. Forty-one staff utilized the CT scanner from various subspecialties with 5 Foot and Ankle (F&A) surgeons ordering 80% of scans. When dividing total costs by number of months since acquisition the monthly cost of the device is $3,318 which requires 20 scans per month when using Medicare reimbursement rates. Over a 55 month the average number of scans per month is 34. When dividing the cost of acquisition by reimbursement per scan, the breakeven point was 1,284 scans which occurred at approximately 3 years. Conclusion: As WB CT scans become a valuable tool for the analysis of foot and ankle pathology, groups may be interested in understanding the financial implications of such an investment. Our study is the only cost analysis based in the United States of WB CT. We found that WB CT is a cost-effective tool that can be used to evaluate a number or pathologies in the foot and ankle.

Microplastics (MPs) are an emerging pollutant with growing concern for their effect on human and wildlife health; however, songbirds remain understudied. Current MP research on songbirds relies on opportunistic sampling of deceased birds and examining the full gastrointestinal (GI) tract. As many songbirds are experiencing declines across the U.S., nonlethal methods of evaluating MP contamination warrant consideration. To better understand the presence of MPs within songbirds, I conducted a study on house sparrows (Passer domesticus) from established nest colonies in Texas (Stephenville, Earth Co.), North Dakota (Fargo, Cass Co.), and Pennsylvania (Easton, Northampton Co.) during 2023 and 2024. My first objective was to address assumptions of using fecal samples to quantify MP pollution in nestlings by determining variation in MPs across nestling development and variation within broods by examining nestling fecal sacs. My second objective was to validate the use of fecal sacs as a nonlethal method of MP detection by comparing it to analysis of the GI tract. I collected voluntarily excreted fecal samples from nestlings aged 4 days and 10 days. I euthanized a subset of 10-day old nestlings and collected their GI tracts immediately after collecting a fecal sample from them. After collection, I subjected both fecal and GI samples to chemical digestion using 30% H2O2 and vacuum filtration. I examined filtered samples under a stereomicroscope for MPs and I photographed and classified suspected MPs according to established methods. I found that 74.1% of fecal samples contained MPs (n = 321) and all GI tracts samples contained MPs (n = 14). I found little difference in contamination between day 4 and day 10 nestlings at all three of our sample sites. To assess within brood variation, I conducted an intra-class correlation test and determined that variation within brood is high (n = 42, R = 0.17, P = 0.021). Fecal MPs and GI MPs were not correlated. Since there is little difference across development, broods can be sampled at a single point in development. Due to the within brood variation being high, one nestling is not a representative sample, and the entire brood should be sampled. Given the lack of correlation between fecal and GI MPs, fecal samples may be better used as an indicator of MPs as opposed to a direct quantification. However, they still can be used for temporal and comparative studies exploring MP contamination in songbirds. By conducting this study on house sparrows, a model species, I inform future MP research and gain broader insight into the abundance of MPs in songbirds.

Insects are a rich source of bioactive compounds, and they also represent a potentially economical way to convert organic waste into high quality protein meal for use in animal feeds. However, these applications have rarely been considered simultaneously; that is, little attention has been paid to whether bioactive compounds present in insect meals from species such as black soldier fly (Hermetia illucens), yellow mealworm (Tenebrio molitor), or common housefly (Musca domestica) might affect their utility as a protein source. In this dissertation, I use enteric redmouth disease and its causative agent, Yersinia ruckeri, as a model to probe the effects of insect antimicrobial peptides on the microbiome and infection state in rainbow trout (Oncorhynchus mykiss). These studies contribute to our understanding of insect meal and fish health in the following areas: 1) development of a qPCR-based assay for detection of Y. ruckeri in the intestine of fish; 2) assessment of the effects of a purified insect AMP on the survival, microbiome, and carrier state of trout infected with Y. ruckeri; 3) comparison of diets made from insects with different levels of AMP transcription on survival, microbiome, and carrier state of trout infected with Y. ruckeri.The findings of these studies lead to several conclusions in addition to opening a number of new paths of inquiry. Y. ruckeri is capable of persisting in the tissues of infected fish for at least several months after exposure, and detection rates vary significantly depending on the assay and tissue used. A diet containing the insect AMP cecropin A not only altered the composition of the gut microbiome, but also appeared to increase the load of Y. ruckeri in fish that survived infection. This suggests that at least under certain conditions, the presence of insect AMPs in the diet could lead to undesirable effects. Finally, using a genetic model of immune regulation to vary the levels of AMPs between two insect meals did not result in significant differences in infection state. Potential applications of this approach to production insect species including black soldier flies (Hermetia illucens), yellow mealworms (Tenebrio molitor), and common houseflies (Musca domestica) are discussed.

Despite being a literary style for more than half a century, magical realism is an enigma that is difficult to define. While the term is seamlessly associated with Gabriel Garcia Marquez, magical realism’s loose definition has led critics to question its value to the progression of literary studies. To help remedy magical realism’s obscure definition, this thesis will be expanding on Kenneth Reed’s definition of magical realism, which he argues must use the neo-fantastic (the naturalization of magical elements in a text) to recast history. However, I argue magical realism must have a third characteristic, an identifiable deliberative purpose, inducing the audience to take social action.To support this claim, I will divide the thesis into five parts. The introduction will provide a brief outline detailing my definition for magical realism, as well as providing a detailed outline for the work as a whole. The first chapter will act as an overview of magical realism, detailing magical realism’s socio-political power, how that deliberative potential was lost, and the historical actors responsible. The second chapter will include a case study of Gabriel Garcia Marquez’s One Hundred Years of Solitude, which will cover how the Colombian journalist combined the deliberative function of testimonio literature with the neo-fantastic and recasting of history to restore magical realism to its original definition. The last chapter will focus on Toni Morrison’s last book God Help the Child, where the author used my definition of magical realism to bring attention to Tarana Burke’s “me too.” movement, which was marginalized by the social media #MeToo movement after the book’s publication. The conclusion will consider the implications of this new definition and examine where magical-realist studies should focus going forward.