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This is a cross-sectional study aiming to understand the early characteristics and background of bone health impairment in clinically well children with Fontan circulation.
We enrolled 10 clinically well children with Fontan palliation (operated >5 years before study entrance, Tanner stage ≤3, age 12.1 ± 1.77 years, 7 males) and 11 healthy controls (age 12.0 ± 1.45 years, 9 males) at two children’s hospitals. All patients underwent peripheral quantitative CT. For the Fontan group, we obtained clinical characteristics, NYHA class, cardiac index by MRI, dual x-ray absorptiometry, and biochemical studies. Linear regression was used to compare radius and tibia peripheral quantitative CT measures between Fontan patients and controls.
All Fontan patients were clinically well (NYHA class 1 or 2, cardiac index 4.85 ± 1.51 L/min/m2) and without significant comorbidities. Adjusted trabecular bone mineral density, cortical thickness, and bone strength index at the radius were significantly decreased in Fontan patients compared to controls with mean differences −30.13 mg/cm3 (p = 0.041), −0.31 mm (p = 0.043), and −6.65 mg2/mm4 (p = 0.036), respectively. No differences were found for tibial measures. In Fontan patients, the mean height-adjusted lumbar bone mineral density and total body less head z scores were −0.46 ± 1.1 and −0.63 ± 1.1, respectively, which are below the average, but within normal range for age and sex.
In a clinically well Fontan cohort, we found significant bone deficits by peripheral quantitative CT in the radius but not the tibia, suggesting non-weight-bearing bones may be more vulnerable to the unique haemodynamics of the Fontan circulation.
Inpatient length of stay (LOS) has been used as a measure of hospital quality and efficiency. Patients with Clostridium difficile infections (CDI) have longer LOS.
To describe the relationship between hospital CDI incidence and the LOS of patients without CDI.
Retrospective cohort analysis.
We predicted average LOS for patients without CDI at both the hospital and patient level using hospital CDI incidence. We also controlled for hospital characteristics (eg, bed size) and patient characteristics (eg, comorbidities, age).
Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2009–2011.
The Nationwide Inpatient Sample includes patients from a 20% sample of all nonfederal US hospitals.
Inpatient LOS was significantly longer (P<.001) at hospitals with greater CDI incidence at both the hospital and individual level. At a hospital level, a percentage point increase in the CDI incidence rate was associated with more than an additional day’s stay (between 1.19 and 1.61 days). At the individual level, controlling for all observable variables, a percentage point increase in the CDI incidence rate at their hospital was also associated with longer LOS (between 0.6 and 1.05 additional days). Hospital CDI incidence had a larger impact on LOS than many other commonly used predictors of LOS.
CDI rates are a predictor of LOS in patients without CDI at an individual and institutional level. CDI rates are easy to measure and report and thus may provide an important marker for hospital efficiency and/or quality.
Infect. Control Hosp. Epidemiol. 2016;37(4):404–410
This chapter considers the role of experiments in regard to evaluation and action research in determining whether change in educational contexts can be attributed to the introduction of an intervention approach or programme. It explains the three classes of experimental design: 'true' experimental designs, such as randomised, controlled trials (RCTs), 'quasi-experimental' designs, and also 'small-n' experimental designs. True' and 'quasi-experiments' are 'studies of deliberate intervention. In the case of a 'true' experimental design such as an RCT, allocation to groups must be random. 'Small- n' experimental designs involve the manipulation of an independent (treatment) variable across a pre-intervention baseline phase, an intervention phase, and commonly a post-intervention phase. Most published studies of the effectiveness of school-based interventions use quasi-experimental designs. It is important for educational researchers to be aware of the beliefs and values of participants and stakeholders and indeed of underlying policy contexts and political realities.
Single photon emission computed tomography (SPECT) and positron emission tomography (PET) are among the earliest developed functional imaging techniques. SPECT images are acquired after administration of a radioactive compound that emits single photons that can be detected by gamma-cameras. Similar to SPECT, PET imaging also uses radioactive biotracers to monitor physiological processes. However, better localization is achieved in PET imaging. Functional magnetic resonance imaging (fMRI) can be used with several different experimental designs to answer distinct questions about brain function. Multiple sclerosis (MS) disease-related brain changes including the presence of focal lesions and atrophy can complicate functional neuroimaging studies. Functional imaging is utilized to study fatigue, depression, motor system, vision, cognition, and for interpretation of cortical reorganization. Functional imaging plays a much larger role in clinical trials for MS involving remyelination, cell grats, neuroprotective treatments, and in illuminating the mechanisms of progressive disease.
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