UNASSIGNED: Unmet needs for ancillary services are substantial among people with human immunodeficiency virus (PWH), and provider type could influence the prevalence of unmet needs for these services.
UNASSIGNED: Data from a national probability sample of PWH were analyzed from the Centers for Disease Control and Prevention\'s Medical Monitoring Project. We analyzed 2019 data on people who had ≥1 encounter with a human immunodeficiency virus (HIV) care provider (N = 3413) and their care facilities. We assessed the proportion of needs that were unmet for individual ancillary services, overall and by HIV care provider type, including infectious disease (ID) physicians, non-ID physicians, nurse practitioners, and physician assistants. We calculated prevalence differences (PDs) with predicted marginal means to assess differences between groups.
UNASSIGNED: An estimated 98.2% of patients reported ≥1 need for an ancillary service, and of those 46% had ≥1 unmet need. Compared with patients of ID physicians, needs for many ancillary services were higher among patients of other provider types. However, even after adjustment, patients of non-ID physicians had lower unmet needs for dental care (adjusted PD, -5.6 [95% confidence interval {CI}, -9.9 to -1.3]), and patients of nurse practitioners had lower unmet needs for HIV case management services (adjusted PD, -5.4 [95% CI, -9.4 to -1.4]), compared with patients of ID physicians.
UNASSIGNED: Although needs were greater among patients of providers other than ID physicians, many of these needs may be met by existing support systems at HIV care facilities. However, additional resources may be needed to address unmet needs for dental care and HIV case management among patients of ID physicians.

The provision of ancillary services (AS) is subject to changes associated with the energy transition. Due to new requirements, the power supply quality, reliability, and safety must be achieved by simultaneously complying with technological, economic, and environmental constraints. To mitigate these challenges, we derive factors responsible for a successful venture of all stakeholders, referred to as critical success factors (CSFs). In a Design Science Research (DSR)-based approach, twelve specific CSFs are deduced from expert interviews with transmission-, plant-, and distribution system operators. These CSFs are evaluated in a focus group discussion with academic experts afterward. We summarize practical results and findings from failed and successful projects concerning energy trading strategies, asset portfolios, grid expansion, and communication technologies. We contribute to AS knowledge and derive recommendations for further research and practice.

Purpose: Access to ancillary services-including HIV support services, non-HIV clinical services, and subsistence services-can support care engagement and viral suppression and reduce disparities among people with HIV (PWH). We used representative U.S. data to assess differences in unmet needs for ancillary services between transgender women with HIV and other PWH. In addition, we examined associations between unmet needs and clinical outcomes among transgender women. Methods: We analyzed 2015-2020 Medical Monitoring Project data among transgender women (N = 362), cisgender men (N = 17,319), and cisgender women (N = 6016) with HIV. We reported weighted percentages for characteristics, and reported adjusted prevalence ratios (aPRs) controlling for race/ethnicity and age, and 95% confidence intervals (CI) using logistic regression with predicted marginal means to assess differences between groups. Results: Among transgender women, unmet needs were highest for dental care (24.9%), shelter or housing (13.9%), and transportation assistance (12.6%). Transgender women were more likely than cisgender men to have unmet subsistence needs. Among transgender women, unmet needs for ancillary services were negatively associated with many clinical outcomes after adjusting for age and race/ethnicity. Unmet needs for subsistence services were associated with higher levels of antiretroviral therapy nonadherence (aPR: 1.39; 95% CI: 1.13-1.70) and detectable viral loads (aPR: 1.47; 1.09-1.98), emergency room visits (aPR: 1.42; 1.06-1.90), and depression (aPR: 2.74; 1.83-4.10) or anxiety (aPR: 3.20; 2.05-5.00) symptoms. Conclusions: Transgender women with HIV were more likely than cisgender men with HIV to experience unmet needs for subsistence services-likely a reflection of substantial socioeconomic disadvantage. Addressing unmet needs is an essential step for improving care outcomes among transgender women with HIV.

BACKGROUND: There are concerns that the availability of in-office ancillary services may lower thresholds for evaluation, leading to the overuse of testing without clear benefit. Motivated by this issue, we analyzed nationally representative survey data, and examined for associations between the availability of in-office laboratory services and the use of prostate specific antigen testing.
METHODS: Using restricted data from the 2006-2008 NAMCS, we determined the prevalence of physician practices offering on-site laboratory services. We then characterized differences between practices with and without these capabilities as well as among the physicians working in them. Finally, we fitted multivariable logistic regression models to estimate the odds of prostate specific antigen testing given a man\'s mortality risk and the availability of in-office laboratory services at the practice where he received care.
RESULTS: Approximately half of all primary care and urology practices offered in-office laboratory services. Practice characteristics associated with these capabilities included practice size (p <0.001) and breadth of specialization (p = 0.021). Employed physicians were more likely to work in practices with in-office laboratory services than self-employed physicians (p <0.001). On multivariable regression the availability of on-site laboratory services was not associated with the use of prostate specific antigen testing (OR 0.86, 95% CI 0.62-1.20, p = 0.362). In fact, the probability of prostate specific antigen testing among patients with the highest mortality risk was lower if they were seen at a practice with in-office laboratory services.
CONCLUSIONS: These findings provide some reassurance that in-office ancillaries do not lead to overuse of prostate specific antigen testing.

The high tertiary healthcare utilisation in Singapore due to an ageing population and increasing chronic disease load has resulted in the establishment of primary care networks (PCNs) for private general practitioners (GPs) to provide team-based, community care for chronic diseases. A total of 22 PCN leaders and programme managers from 10 PCNs participated in online group discussions and a survey. Outcome harvesting was used to retrospectively link the intended and unintended outcomes to the programme initiatives and intermediate results (IRs). The outcomes were generated, refined and verified before shortlisting for analysis. About 134 positive and 22 negative PCN outcomes were observed since inception in 2018. By establishing PCN headquarters and entrusting PCN leaders with the autonomy to run these, as well as focusing policy direction on GP onboarding, GP engagements and clinical governance, the programme successfully harnessed the collective capabilities of GPs. Developments in the organisation (IR1) and monitoring and evaluation (IR4) were the top two contributors for positive and negative outcomes. Sustainable practice and policy changes represented 46% and 20% of the positive outcomes respectively. Sustainable positive outcomes were predominantly contributed by funding, clear programme policy direction and oversight. Conversely, most negative outcomes were due to the limited programme oversight especially in areas not covered by the programme policy.

The COVID-19 pandemic led to partial or total lockdowns in several countries during the first half of 2020, which in turn caused a depressed electricity demand. In Great Britain (GB), this low demand combined with large renewable output at times, created conditions that were not expected until renewable capacity increases to meet emissions targets in coming years. The GB system experienced periods of very high instantaneous penetration of non-synchronous renewables, compromising system stability due to the lack of inertia in the grid. In this paper, a detailed analysis of the consequences of the lockdown on the GB electricity system is provided, focusing on the ancillary services procured to guarantee stability. Ancillary-services costs increased by £200m in the months of May to July 2020 compared to the same period in 2019 (a threefold increase), highlighting the importance of ancillary services in low-carbon systems. Furthermore, a frequency-secured scheduling model is used in the present paper to showcase the future trends that GB is expected to experience, as penetration of renewables increases on the road to net-zero emissions by 2050. Several sensitivities are considered, demonstrating that the share of total operating costs represented by ancillary services could reach 35%.

In energy-only electricity markets, such as Australia\'s National Electricity Market (NEM), it has been argued that an increasing penetration of variable renewable energy (VRE) generation is likely to have two effects: (i) more extreme spot prices, with greater instances of both very high and very low prices and (ii) a need to increase the market price cap (MPC) and related price signals for reliability. This article examines the validity of both these effects using spot pricing outcomes in South Australia (SA), which has one of the highest VRE penetrations worldwide. We find partial support for these two effects. While extremely low prices have become more frequent over time, extremely high prices have become less frequent. Spot price volatility has risen, consistent with the hypothesis, but not because prices have become more extreme. Furthermore, these findings are observed for prices in all NEM regions, not just SA. Also, reliability has remained high over the past decade despite the MPC remaining constant in real terms. We provide four reasons why higher VRE penetration need not result in more extreme prices and higher MPCs: (i) greater investment in volatility-dampening, reliability-enhancing technologies like storage and interconnectors; (ii) increased contract cover; (iii) more price-responsive demand; and (iv) emergence of additional ancillary service revenues. These findings have implications for the durability of the NEM\'s energy-only design given expected further increases in VRE penetration rates across the NEM.

Prior Huntington\'s disease (HD) studies suggest ancillary services improve motor symptoms, cognition, mood, and quality of life but frequency of use and clinicalcharacteristics are unclear.
Describe ancillary service utilization in a cohort of individuals with HD and determine which participant characteristics are associated with ancillary service utilization.
Retrospective cross-sectional analysis of Enroll-HD database. Participants were grouped by therapy: physical and/or occupational (PT/OT), psychotherapy and/or counseling (PC), speech and/or swallowing (ST). We performed bivariate comparisons analysis of demographic and disease characteristics between those with/without each therapy and to analyze one-year mean change in assessment scores.
Of 4751 participants, 1537 (32.35%) utilized therapies (11.82% PT/OT, 5.33% PC, 3.01% ST, 1.98% all three, 10.21% two therapies). PT/OT participants had worse motor and functional scores: mean UHDRS motor score (41.17 vs. 38.05, p = 0.002), median total functional capacity score (TFC) (8.00 vs. 9.00, p < 0.001). PC participants had worse mood but better cognitive and functional scores: median depression score (7.00 vs. 2.00, p < 0.001), median MMSE (28.00 vs. 26.00, p < 0.001), median TFC (10.00 vs. 8.00, p < 0.001). ST participants had more dysarthria, and worse cognitive and functional scores: dysarthria (32.2% vs. 20.1% p < 0.001), mean correct Symbol Digit Modality Test (16.79 vs. 23.27, p < 0.001), median TFC (6.00 vs. 9.00, p < 0.001). Over one year, PC participants\' depression scores improved compared to untreated (- 1.24 vs. - 0.11, p = 0.040). ST participants\' depression scores worsened (1.14 vs. - 0.23, p = 0.044). Mean change in TFC was not significant for any therapies.
Only 32% of Enroll-HD site participants received ancillary services. Use correlated with expected clinical characteristics, though impact of use remains unclear.

OBJECTIVE: Neurodevelopmental impairment is common after surgery for congenital heart disease (CHD) in infancy. While neurodevelopmental follow-up of high-risk patients has increased, the referral patterns for ancillary services following initial evaluation have not been reported. The aim of this study is to describe the rates and patterns of referral at the initial visit to our outcomes clinic of patients who underwent surgery for CHD during infancy.
METHODS: The Cardiac Developmental Outcomes Program clinic at Texas Children\'s Hospital provides routine longitudinal follow-up with developmental pediatricians and child psychologists for children who required surgery for CHD within the first 3 months of life. Demographic, diagnostic, and clinical data, including prior receipt of intervention and referral patterns at initial presentation, were abstracted from our database.
RESULTS: Between April 2013 and May 2017, 244 infants under 12 months of age presented for initial evaluation at a mean age of 7 ± 1.3 months. At presentation, 31% (76/244) were referred for either therapeutic intervention (early intervention or private therapies), ancillary medical services, or both. Referral rates for low-risk (STAT 1-3) and high-risk (STAT 4-5) infants were similar (28 vs. 33%, P = .48). Referrals were more common in: Hispanic white infants (P = .012), infants with non-cardiac congenital anomalies (P = .001), history of gastrostomy tube placement (P < .001), and infants with prior therapy (P = .043). Infants of non-English speaking parents were three times more likely to be referred (95% CI = 1.5, 6.4; P = .002).
CONCLUSIONS: At the time of presentation, nearly 1 in 3 infants required referral. Referral patterns did not vary by traditional risk stratification. Sociodemographic factors and co-morbid medical conditions increased the likelihood of referral. This supports the need for routine follow-up for all post-surgical infants regardless of level of surgical complexity. Further research into the completion of referrals and long-term referral patterns is needed.

To investigate contemporary issues facing practicing otolaryngologists including workforce dynamics, ancillary service modeling, otolaryngic allergy integration, ambulatory surgery center utilization, and relevant certificate of need legislation.
A cross-sectional survey analysis of academic and private practicing otolaryngologists in North and South Carolina in 2016.
A cross-sectional survey was e-mailed to 510 practicing otolaryngologists in North and South Carolina.
A 21.3% survey response rate was achieved. Otolaryngology workforce was defined by horizontal aggregation of otolaryngologists into larger group models, with fewer solo practitioners being replaced by younger otolaryngologists or employing otolaryngology extenders. Excluding academic practice, few otolaryngologists have chosen direct hospital employment as a career option, although otolaryngologists with fewer years of practice are pursuing that option with greater frequency. Ancillary services showed audiology and hearing aid services being the most common, followed by otolaryngic allergy, point-of-service computed tomography, and ultrasound. Although otolaryngologists tend to avoid vertical integration, ambulatory surgery center (ASC) ownership trends favor a joint venture model with a hospital system partner. Most otolaryngologists favor changes to certificate of need legislation to improve patient access to these lower-cost facilities, regardless of whether they currently utilize or have access to an ASC.
Otolaryngology is uniquely positioned to adapt and respond to current paradigm shifts within ambulatory medicine. Further analysis is needed to prepare current and future otolaryngologists for the demands and opportunities these challenges pose as patient-centered care models and consumer dynamics shape future patient expectations and utilization of healthcare.
5. Laryngoscope, 2490-2499, 2018.