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This study aimed to develop recommendations for acceptable physical and psychological clinical indicators of acute deterioration and strategies to support sustained adoption of an approach to detecting and responding to acute deterioration in long-term care. Previous studies have trialled programmes to reduce avoidable hospital transfers through early detection of acute deterioration in long-term care. However, variability in outcomes and implementation experiences highlights differences in the essential components of these approaches. Three-round Delphi process. The Delphi process conducted between September 2022 and January 2023 included a 22-member Australian expert panel to elicit consensus and to generate recommendations. Delphi participants were asked to rate the potential items on a 9-point scale for level of importance (Part A), level of priority of action (Part B) and level of acceptability (Part C). The mean, standard deviation (SD) and I-CVI of each item were calculated. Clinical indicators with mean ≥ 7, I-CVI ≥ 0.78 were considered to have a good degree of agreement, appropriateness and relevance and were deemed acceptable for inclusion. Participants completed a two-part online survey in Round 1, and three-part surveys in Rounds 2 and 3. Round 1, Part A included 44 clinical indicators. On completion of Round 3, 36 items remained. Care pathways in response to acute deterioration (n = 20) were included in Part B. After Round 3, 17 care pathways remained. There was agreement in Part C that communication aides, education and mentor programmes were necessary as viable strategies to support sustained adoption. Detecting the early warning signs of acute deterioration will have significant outcomes for residents, staff and health care services.

Clinical triage requires integrating multiple information sources to identify patients at risk of deterioration. Tools capturing global health assessments beyond disease-specific scores are being developed using either bottom-up aggregation of simple indicators or top-down machine learning from large datasets. Their alignment with expert clinical judgment remains poorly characterized. This study evaluates 2 latent health measurement approaches: Frailty Index-laboratory, a transparent bottom-up tool aggregating laboratory abnormalities via deficit accumulation theory, and ETHOS-ARES (Enhanced Transformer for Health Outcome Simulation-Adaptive Risk Estimation System), a transformer-based foundation model generating multidimensional patient representations from electronic health records. We assess whether each tool's severity rankings align with clinical consensus and whether they offer utility in triage decisions. In this 3-phase mixed methods study, at least 30 clinicians across hospital specialties reviewed 20 emergency department presentations derived from Medical Information Mart for Intensive Care IV-Emergency Department. Phase 1 compared unaided clinician severity and urgency judgments against model outputs using Spearman rank correlation, with a Turing-inspired indistinguishability test assessing whether model rankings fell within the distribution of clinician assessments. Phase 2 allocated clinicians to receive Frailty Index-laboratory or ETHOS-ARES outputs, measuring anchoring effects via within-person pre-post comparisons and exploring clinical utility through semistructured interviews analyzed using the Framework Method. Ethics approval was granted in June 2025 (KCL Research Ethics Office; MRSP-24/25-48707). Recruitment began in October 2025 (32 clinicians recruited as of manuscript submission), with data collection expected to be completed in January 2026 and analysis planned for March or April 2026. This study will quantify model-clinician agreement, measure anchoring effects, and generate qualitative insights on utility, trust, and adoption. The findings will inform the implementation of latent health measurement tools in clinical practice and provide a framework for the early-stage evaluation of artificial intelligence-based clinical decision support systems.

Lymphoedema assessment is central to diagnosis and management, but the optimal method remains uncertain. Tape measurement is widely used, although newer technologies may improve efficiency and patient experience. To compare five assessment methods for diagnostic accuracy, time-efficiency, cost and acceptability. Eighty-four adults with unilateral cancer-related lymphoedema underwent tape measurement, Perometer, L-Dex®, Bodystat Quadscan, and self-report. Analyses included reliability (Cronbach's alpha, Pearson's correlation), diagnostic accuracy and a health economic evaluation. Tape measurement at a 7.5% threshold achieved the highest accuracy (sensitivity 94%, specificity 95%). The Perometer was fastest and most favoured by participants, but was costly. Bio-impedance methods had moderate diagnostic value, particularly for early detection. The tape measure remains the most practical standard tool, while the Perometer offers efficiency and patient appeal where resources permit.

In 2026, the US Centers for Medicare & Medicaid Services implemented an update to the Physician Fee Schedule establishing a unified reimbursement rate for skin substitutes, also referred to as cellular, acellular and matrix-like products (CAMPs). This policy change introduced a fixed payment of [Formula: see text]127.14 per cm2, regardless of product type or regulatory classification. The aim of this work was to assess perceived impacts of the revised fee schedule that went into effect on 1 January 2026. The Wound and Hyperbaric Association conducted an online national survey of wound care practitioners and practices from 4 February 2026 to 14 April 2026. The Access Crisis Feedback Form consisted of 13 questions, including two open-ended items. Over the 69 days that the survey was open, 130 (~3%) responses were received from a comparative pool of 4551 National Provider Identifiers that had applied a CAMP in 2024. Collectively, respondents reported providing care to approximately 12,000 patients with wounds per week. Geographic representation included 36 of 50 (72%) states and Washington DC, and 8 of 12 (67%) Medicare Administrative Contractors. Most respondents (82%) practiced in non-facility settings; however, hospital-affiliated outpatient wound centres, and ambulatory surgery centres were also represented. The most severe concern identified was the 'Closure or planned closure of a wound care practice or service line', reported by just over 45% of responding settings. Only five (4%) respondents reported no significant impact, indicating that 96% perceived at least one operational impact following implementation of the revised payment policy. The most frequently cited concern (61%) was 'Authorisation delays for clinically eligible patients'. Analysis of the survey data suggests widespread impacts of the implemented CAMPs universal fee schedule across diverse wound care delivery settings in the US, including a substantial risk of service line closures. These findings raise concerns that a uniform CAMP product payment may not achieve site-of-care neutrality when hospital outpatient departments receive a separate application facility payment, while non-facility providers do not. Respondents reported that patients are already experiencing reduced access to advanced wound care, with associated complications such as: infection; sepsis; amputation; wound deterioration or enlargement; hospital readmission; the need for surgical debridement in the operating room setting; and flap- or graft-based salvage procedures. Responding wound care providers and practices, across diverse care settings and geographic regions, urge reevaluation of the current reimbursement framework to ensure the financial sustainability of wound care services, and to protect patient access and outcomes.

Neuronal activity is driven by the complex interplay between various membrane currents, often located in distinct domains of the spatially extended dendritic tree. How the effect of these currents propagates to the soma and contributes to neuronal output under in vivo conditions is not fully understood. Here, we develop a new method to measure and visualize the contributions of individual membrane currents to the somatic response in spatially extended biophysical model neurons. Our approach relies on the iterative decomposition of the axial current flowing between neighbouring compartments in proportion to the underlying membrane currents measured in the model. We apply this method to visualize the inputs driving hippocampal place cell activity. Our method provides a compact and intuitive description of the various dendritic events underlying subthreshold activity, spiking, or burst firing. By contrasting the dendritic input currents preceding spiking and bursting, we demonstrate that both could occur at highly variable input levels to proximal dendrites (basal and oblique), and that strong distal inputs facilitate, rather than control, the generation of complex spike bursts. Our method opens a novel window onto single-neuron computations that will help to design better models and to interpret the results of in vivo imaging experiments.

To describe the implementation of the Agency for Healthcare Research and Quality safety program for improving skin care and multidrug-resistant organism prevention in long-term care (LTC), a national program that emphasized skin care and bathing to prevent multidrug-resistant organism transmission in LTC facilities, which had a 97% (309/318 enrolled LTC facilities) retention rate. A quality improvement initiative that used a mixed-methods approach to assess process outcomes. Nursing leadership and direct-care staff at LTC facilities in the United States. The 18-month intervention (June 2023-November 2024) included educational webinars, office hours, and supporting materials. Implementation advisors (IAs) provided ongoing support to sites and assisted with data submission. Quantitative data on log-ins to webinars and office hours as well as resource downloads measured engagement. Qualitative analysis of reports and debriefing calls from the IAs provided perspective on implementation successes and challenges. Educational content comprised 19 webinars delivered over 18 months, office hours offered twice monthly, and supporting material that included 60 one-page "Teachable Moments" designed to promote practice change among direct-care staff. Although webinar log-ins and office hours decreased over time, participants claimed 1031 continuing education credits throughout the program. Of the 6104 downloads of supporting material, 4713 (77%) were for Teachable Moment documents. Qualitative analysis of the IA's reports and debriefing calls yielded 4 themes: program engagement, data collection and reporting, enhanced barrier precautions, and the role of IAs. The availability of continuing education credit, inclusion of flexible, high-interest educational content adaptable to each site's workflow, combined with robust implementation support, and low-burden data requirements likely contributed to sustaining high program retention. This approach can be adopted for future quality improvement programs, informing the strategy for public health agencies, quality improvement organizations, and LTC systems seeking to strengthen their infection prevention practices.

Mammalian mitochondrial ATP synthase typically organizes into rows of V-shaped dimers that impose significant membrane curvature essential for mitochondrial cristae formation. Using gentle, column-free purification combined with single-particle cryo-electron microscopy, we have identified a previously unrecognized planar dimeric form of bovine ATP synthase exhibiting minimal membrane bending. This planar dimer is characterized structurally by anti-parallel arrangement of two ATP synthase complexes linked by a straight conformation of inhibitory factor 1 (IF1), a sharp contrast to the kinked IF1 observed in tetrameric assemblies. Molecular dynamics simulations confirm that transitioning between straight and kinked IF1 conformations occurs without significant energetic barriers. The planar dimer also displays distinct peripheral stalk positioning relative to its adjacent α subunit. These structural divergences suggest a specialized function and a distinct localization for planar ATP synthase dimers, providing structural support for a division of labor within mitochondrial ATP synthase populations.

A wound is a prevalent clinical condition that requires a dressing to both prevent external damage and promote recovery. Herein, a novel wound dressing material was developed as an electrospun composite membrane based on cellulose acetate butyrate (CAB) to function as a drug carrier, with curcumin (Cur) as a model drug. The mechanical properties of the CAB-based membrane in the dry state were enhanced by a hybrid material composed of tungsten disulfide (WS2) and ZnAl layered double hydroxide (ZnAl-LDH), with improvements in tensile strength, Young's modulus, and toughness. The Cur-loaded CAB/WS2/ZnAl-LDH membrane (CAB/WL/Cur) also demonstrated antioxidant activity and exhibited modest antibacterial activity against Staphylococcus aureus. Additionally, the CAB/WL/Cur membrane was not toxic to L929 mouse fibroblast cells, with viability >100%. Importantly, the cumulative Cur release from the CAB/WL/Cur membrane, with the optimal WS2/ZnAl-LDH mixing ratio incorporated, was 83.56 ± 0.70%, which was higher than the Cur release from CAB/Cur and CAB/WS2/Cur membranes. Thus, this study demonstrates a novel approach to controlling the Cur release amount through the utilization of the optimized additive type and WS2/ZnAl-LDH mixing ratio for the CAB membrane. Based on its mechanical robustness, antibacterial and antioxidant activities, non-toxicity, and enhanced drug-release performance, the CAB/WL/Cur membrane shows potential for wound dressing applications and warrants further wound dressing-specific and in vivo evaluation. This work advances wound-care materials and controlled drug-delivery platforms, contributing to improved health outcomes and materials innovation.

Somatostatin receptor PET imaging is integral to the management of patients with neuroendocrine tumours (NETs), yet standardised criteria for therapy response assessment with the use of this modality are not available. This Policy Review reports the development of the European Neuroendocrine Tumor Society somatostatin receptor PET response assessment framework, established through a structured modified Delphi process coordinated by the European Neuroendocrine Tumor Society. 34 international experts from nuclear medicine, radiology, oncology, endocrinology, surgery, and related disciplines participated in four iterative rounds evaluating 76 statements, with consensus defined as at least 75% agreement. The framework proposes response categorisation based primarily on volumetric changes in somatostatin receptor-expressing target lesions, complemented by assessment of new lesions, rather than reliance on standardised uptake value-based metrics. Partial response is defined by at least 40% reduction in target lesion volume without new lesions, whereas progressive disease is defined by at least 40% volume increase of target lesions or the emergence of new lesions. Complete response requires absence of pathological tracer uptake, and a category of unconfirmed progressive disease is introduced for equivocal cases warranting short-interval reassessment. Although not yet validated against survival outcomes, this expert-derived framework (SSTR-PeRForm) provides a pragmatic foundation for harmonising somatostatin receptor PET-based response assessment in clinical trials and routine practice and represents a key step towards outcome-based validation.

Cervical cancer remains a leading cause of cancer-related mortality among women in low- and middle-income countries, with sub-Saharan Africa bearing a disproportionate burden. Although Human papillomavirus (HPV) vaccination is an effective preventive strategy, completion of the recommended two-dose schedule remains suboptimal in many rural settings in Uganda. This study assessed demographic and individual-level predictors of low HPV vaccine uptake among adolescent girls in Rukiga District. A cross-sectional mixed-methods study was conducted between September and November 2022 among 292 caregivers of adolescent girls aged 9-14 years in Rukiga District. Quantitative data were analyzed using multivariable logistic regression to identify factors associated with completion of the HPV vaccination series. Qualitative data were collected through in-depth interviews with 11 health workers and 10 Village Health Team members and analyzed thematically to explore contextual barriers to vaccine uptake. Completion of the two-dose HPV vaccination series was low (23.49%). Maternal caregiving was positively associated with vaccine completion (AOR = 1.70, 95% CI: 1.05-2.75, p = 0.030). In contrast, lack of formal education (AOR = 0.19, p = 0.033), primary education (AOR = 0.50, p = 0.007), and peasant occupation (AOR = 0.49, p = 0.013) among caregivers were associated with lower uptake. Individual factors such as residential mobility (AOR = 0.50, p = 0.001) and school absenteeism or dropout (AOR = 0.73, p = 0.037) significantly reduced the likelihood of completing vaccination. Qualitative findings revealed key barriers including misconceptions about vaccine safety, school-based delivery limitations, frequent mobility, health system constraints (e.g., stockouts, understaffing), and community mistrust. HPV vaccine uptake in Rukiga District remains low and is influenced by caregiver education, maternal involvement, socioeconomic status, and adolescent mobility and school attendance. Addressing these barriers requires targeted community health education, strengthening school and outreach vaccination strategies, and improving health system capacity. Tailored interventions focusing on less-educated caregivers and hard-to-reach adolescents are critical to improving vaccine completion and reducing the burden of cervical cancer.

The Nursing and Midwifery Council (NMC) updated the nursing and midwifery preregistration proficiencies in 2018 and 2019 respectively, and both contain requirements for safe staffing principles to be taught and assessed through academia and clinical placements of BSc degree programmes. To ascertain how higher educational institutions (HEIs) are preparing the 'future nurses' and 'future midwives' in terms of adequate knowledge on the principles of safer staffing, in line with four specific NMC proficiencies, ahead of entering the NMC register. A Freedom of Information request was made to 21 HEIs, complemented with an online survey of undergraduate preregistration students from five HEIs in England, to determine the level of safer staffing principles within the current curriculum. Reliance on clinical placements to support attainment of safer staffing knowledge was noted, with variation in curriculum content, acquisition of knowledge and assessment methods across HEIs; 86% of students declared that NMC proficiency 7.12, related to business case planning, was addressed the least. Implementing bespoke simulation learning, use of Chief Nursing Officer Safer Staffing Fellows, and integrating 'Fundamentals of Safer Staffing' e-learning will strengthen safer staffing knowledge related to four NMC proficiencies across HEIs and healthcare settings for future generations of nurses, midwives, practice and academic educators.

Coccolithophores produce 40-60% of marine calcium carbonate, largely through biomineralization of plates which encase cells in a 'coccosphere'. Despite the importance of coccolithophore calcification in ocean biogeochemistry, its function remains unresolved. A hypothesis suggesting it acts as a physical deterrent has been investigated in grazers and viruses, but not in bacteria. Here we show bacterial pathogenicity in heavily-calcified C. braarudii treated with Gephyrocapsa huxleyi bacterial-pathogen, Phaeobacter inhibens, is only observed with decalcified algae, leading to algal-cell death within as little as 15 hours. Decalcified algal cell mortality is P. inhibens-specific and likely requires close proximity, since treatment with bacterial supernatant or growth-inhibiting concentrations of indole-3-acetic acid shows no detrimental effect. Additionally, scanning electron microscopy shows visible bacterial attachment only on decalcified C. braarudii. These findings provide the first experimental evidence that the coccosphere can act as a barrier against specific bacteria, highlighting its defensive role in coccolithophores.

The vaccine and viral vector industry is growing at an accelerated rate. To improve harvest and purification processes, the development of continuous membrane-based operations, such as normal flow filtration (NFF) and single pass tangential flow filtration (SPTFF) for concentration were explored. This work was conducted using two model viruses, non-enveloped porcine parvovirus (PPV) and enveloped Suid herpesvirus (SuHV). The viruses are in the same family as the gene therapy vectors adeno associated virus and herpes simplex virus, respectively. SPTFF design started with batch TFF for membrane selection. Hollow fiber membranes with a 100 and 300 kDa molecular weight cut off were defined for PPV and SuHV SPTFF operations, respectively. The SPTFF runs for PPV did not provide any concentration of the virus and low protein and DNA removal, unlike batch TFF. Two hollow fiber membranes run at 10 mL/min and 2 psi were the best condition for SuHV concentration, with approximately 100-fold titer concentration and protein and DNA removal of 37% ± 5% and 32% ± 8%, respectively. This concentration was superior to the batch TFF and indicated a strong dependence on flow rate and transmembrane pressure. For NFF, filters selection and performance tests were carried out for NFF of PPV and SuHV, as well as cleaning protocols for hollow fiber membranes. The ultimate goal is to integrate this work into the continuous purification of viral vectors produced in mammalian cell cultures to reduce costs and increase throughput.

To evaluate the effect of staged interventions for vocal fold paresis and paralysis on objective and subjective laryngeal function to inform clinical decision-making. A retrospective chart review of approximately 1000 patients was performed at a quaternary care office to identify patients who had undergone type 1 thyroplasty between January 1990 and April 2024. Patients who had undergone all laryngeal surgeries by the senior author, had available operative reports, had vocal fold paresis and/or paralysis, and had high-quality pre- and postoperative strobovideolaryngoscopy (SVL) examinations were sorted into the thyroplasty-performed-first group or the other-intervention-performed-first group. Patient characteristics, voice quality, and laryngeal function measures were collected pre- and postoperatively. SVL examinations underwent blind review by three raters to assess glottic closure. Glottic gap measurements were performed using ImageJ, and statistical analyses were conducted using SPSS. Of the 177 patients who had undergone type 1 thyroplasty, 72 met inclusion criteria. The thyroplasty-performed-first group included 45 patients, and the other-intervention-performed-first group included 27 patients. Older age was more prevalent in the thyroplasty-performed-first group (t (72) = 2.287, P = 0.025). Patients in the thyroplasty-performed-first group had undergone a second medialization procedure 3.6 years (median) later (3.3 times longer) than those in the other group. However, there was no significant difference between the groups in glottic gap closure rating, glottic gap measurement, preoperative subjective voice quality, or objective voice quality measurements. Staged procedures may affect voice outcomes. In patients who had undergone thyroplasty, the time until a second medialization procedure increased if the thyroplasty was the first laryngeal intervention performed.

Surgical site infections (SSIs), infections at or near surgical incisions, represent 20-30% of nosocomial infections globally, with higher prevalence in low- and middle-income countries such as Syria. This study assessed SSI prevalence in two Syrian hospitals alongside a nationwide evaluation of surgical healthcare workers' knowledge, practices, compliance, and barriers to WHO/CDC SSI prevention guidelines. A cross-sectional survey was conducted among 375 healthcare workers in surgical settings across Syria. A structured questionnaire collected data on demographics, educational background, work experience, self-reported practices, knowledge of WHO guidelines, and perceived barriers to implementation. Composite knowledge and practice scores were calculated. Data were analyzed using descriptive statistics, Pearson correlation, and ANOVA. Adherence to basic preventive practices was high, including hand preparation (89.33%) and intraoperative sterilization (91.47%). However, gaps persisted in avoiding preoperative shaving, appropriate antibiotic prophylaxis timing and duration, and postoperative antibiotic discontinuation. Major barriers included lack of role models (68%), inadequate training (63%), and staff shortages. Pearson analysis revealed positive correlations between compliance and practice scores (r&#x2009;=&#x2009;0.5203, p&#x2009;<&#x2009;0.001) and compliance and knowledge scores (r&#x2009;=&#x2009;0.3372, p&#x2009;<&#x2009;0.001). Crucially, the weakest correlation was found between knowledge and practice scores (r&#x2009;=&#x2009;0.2662, p&#x2009;<&#x2009;0.001), highlighting a prominent know-do gap. Hospital-reported SSI prevalence was 9.5% in one hospital and 1.47% in the other. This study identified suboptimal knowledge and inconsistent implementation of high-impact SSI prevention practices among Syrian surgical healthcare workers despite strong adherence to basic aseptic measures. Targeted training, improved surveillance systems, and institutional support are needed to strengthen guideline adherence and reduce preventable SSIs.

To integrate screening for early type 1 diabetes (T1D) into well child care (WCC) at a diverse, urban FQHC using PRISM/RE-AIM to assess feasibility, reach, and implementation barriers in a population historically underrepresented in T1D screening research. We conducted an 8 month pragmatic implementation study embedding Autoimmunity Screening for Kids (ASK) early T1D screening into WCC for children aged 12-24 months. Implementation strategies included staff training, workflow integration, and culturally tailored educational materials. Outcomes were evaluated across RE-AIM dimensions. Of 359 eligible children, caregivers of 86 (24%) provided research consent and children completed laboratory draws. Screened participants reflected the clinic population: 77% Hispanic/Latino and 28% Spanish-speaking. One child, screened islet autoantibody-positive (1%) and was connected to follow-up care. All 13 clinicians completed training and ordered at least one screening test, but sustained adoption was concentrated among a subset of providers. Implementation challenges included limited visit time, competing priorities, difficulty conducting informed consent within WCC, and workflow disruptions related to research protocol requirements. Caregivers expressed strong support for early identification. Screening numbers remained stable but below targets, and research protocol deviations ultimately halted screening. Embedding research-based T1D screening into this FQHC was feasible but not sustainable due to structural, workflow, and research-specific demands. Findings highlight key barriers and contextual considerations necessary for future population-based islet cell autoantibody screening initiatives in primary care settings.

The study examines the relationship between human capital, including education and work experience, and the intention of Vietnamese workers to work extra hours. Working extra hours is common but poses risks to health and productivity, especially in developing economies with large informal sectors. We used data from the Vietnam Labor Force Survey with 200,242 observations. Because the dependent variable is a rare event, we applied Firth bias&#x2011;corrected logistic regression combined with the Karlson-Holm-Breen decomposition method to test the mediating role of income. Employees with higher education or longer work experience have significantly lower intention to work extra hours. Income statistically accounts for a small portion of this association for education, but a negligible portion for experience. People with short&#x2011;term or no contracts, those working in individual businesses, or heads of households tend to be more willing to work extra hours. In contrast, lower intention is associated with working in the public sector, medium- and large-sized enterprises, or having an indefinite-term contract. High human capital is associated with reduced need for working extra hours intentionally, mainly through non-financial channels rather than through income. Investing in education, vocational training, expanding formal contracts, and improving incomes may be associated with reduced pressure to work involuntary extra hours.

Throughout the 1950s, the Daily Mirror led a campaign by the popular press against petty, tyrannical discipline, commonly known as 'bull(shit)', within the British Army. Acting as moral entrepreneurs, tabloid newspapers positioned what they regarded to be the deviant behaviour exhibited by over-zealous non-commissioned officers towards national servicemen as a threat to the normative contours of British society. By doing so, the campaign against 'bull' sought to exploit latent fears about large standing armies in peacetime to pressure the Army to reform and modernize its methods of discipline. The article argues that the campaign against 'bull' was effective in that it elevated military discipline as an issue of public concern during a period in which the British Army was actively seeking to enhance its public image to improve soldier recruitment and retention as it prepared to revert back to being an all-volunteer force after the decision was made in 1957 to terminate National Service. By framing 'bull' as an archaic form of social control that was damaging to both morale and efficiency, the moral crusade compelled the Army to explain and justify its methods of discipline amidst increasing public and parliamentary concern.

Indication for visceral surgical procedures should be based on clinical reasoning only and independent of financial incentives. Yet, there is a lack of studies investigating whether insurance type (basic vs. supplementary private) is associated with surgical procedure rates. In this study we assessed whether incidence rates in adults with supplementary private insurance undergoing visceral surgical, non-emergency, in-patient procedures from 2012 to 2020 are higher compared to those with basic insurance only in Switzerland. We assessed incidence rates (IR) for basic only and supplementary private insurance stratified over time and by different age groups, and we fitted negative binomial regression models adjusted by inverse probability weights for specific visceral surgical procedures. We used primary or secondary discharge procedure codes for one of the following procedures: cholecystectomy, fundoplication, sigmoidectomy, rectopexy, haemorrhoidectomy, inguinal, femoral, and umbilical hernia repair. Of 1,954,119 surgical admissions (median age 63, 53.3% male, 15.3% non-Swiss nationality), 70.5% had basic insurance only. People with supplementary private insurance had a 7% higher probability (IRR, 1.07, 99% CI 1.06-1.07) to have a visceral surgical procedure done compared to people with basic insurance only-a result consistent across different types of procedures including cholecystectomy (IRR, 1.06, 99% CI 1.06-1.06), fundoplication (IRR, 1.09, 99% CI 1.09-1.10), sigmoidectomy (IRR, 1.10, 99% CI 1.10-1.10), rectopexy (IRR, 1.05, 99% CI 1.04-1.06), haemorrhoidectomy (IRR, 1.04, 99% CI 1.03-1.04), and hernia repair (IRR, 1.07, 99% CI 1.07-1.07). Sensitivity analyses, including side procedures, stratification by length of stay, and propensity score matching, suggested robustness of the results. In this cohort study, supplementary private insurance was independently associated with a higher probability of undergoing a visceral surgical procedure. The role of financial incentives in surgical procedures is still unclear.