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Approximately, 1.7 million individuals in the United States have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). This has disproportionately impacted adults, but many children have been infected and hospitalised as well. To date, there is not much information published addressing the cardiac workup and monitoring of children with COVID-19. Here, we share the approach to the cardiac workup and monitoring utilised at a large congenital heart centre in New York City, the epicentre of the COVID-19 pandemic in the United States.
Registry-based trials have emerged as a potentially cost-saving study methodology. Early estimates of cost savings, however, conflated the benefits associated with registry utilisation and those associated with other aspects of pragmatic trial designs, which might not all be as broadly applicable. In this study, we sought to build a practical tool that investigators could use across disciplines to estimate the ranges of potential cost differences associated with implementing registry-based trials versus standard clinical trials.
We built simulation Markov models to compare unique costs associated with data acquisition, cleaning, and linkage under a registry-based trial design versus a standard clinical trial. We conducted one-way, two-way, and probabilistic sensitivity analyses, varying study characteristics over broad ranges, to determine thresholds at which investigators might optimally select each trial design.
Registry-based trials were more cost effective than standard clinical trials 98.6% of the time. Data-related cost savings ranged from $4300 to $600,000 with variation in study characteristics. Cost differences were most reactive to the number of patients in a study, the number of data elements per patient available in a registry, and the speed with which research coordinators could manually abstract data. Registry incorporation resulted in cost savings when as few as 3768 independent data elements were available and when manual data abstraction took as little as 3.4 seconds per data field.
Registries offer important resources for investigators. When available, their broad incorporation may help the scientific community reduce the costs of clinical investigation. We offer here a practical tool for investigators to assess potential costs savings.
The effective management of chronic asthma requires long-term adherence to both pharmacotherapy and optimal self-management practices. The use of mobile applications (apps) offer a promising and cost-effective platform to support the self-management of asthma. However, students as consumers may not always be sufficiently knowledgeable to select the best app to link with the management of their condition. If school psychologists become familiar with apps, they may be better positioned to provide guidance to students about app selection and how to identify apps that include appropriate behaviour change techniques (BCT). Accordingly, the overall aim of this study was to present a method by which school psychologists could identify quality apps for the purpose of supporting students who need to self-manage chronic asthma. A directed content analysis was used to evaluate asthma apps, based on behaviour change content and app quality. A systematic selection process yielded a total of 36 apps (26 from iTunes, 12 from Google Play) that were evaluated using two published rating measures. Overall, apps contained limited BCTs and a low level of quality health information. Conversely, apps with higher quality health information utilised a larger range of BCTs than lower quality apps. It was concluded that while apps designed to support the management of asthma appear to be a potentially valuable addition to traditional interventions, the technology is still in its infancy, and school psychologists should be aware of the limited behaviour change content, age appropriateness of apps, and whether the health information provided is evidence-based.
Recent years have seen an exponential increase in the variety of healthcare data captured across numerous sources. However, mechanisms to leverage these data sources to support scientific investigation have remained limited. In 2013 the Pediatric Heart Network (PHN), funded by the National Heart, Lung, and Blood Institute, developed the Integrated CARdiac Data and Outcomes (iCARD) Collaborative with the goals of leveraging available data sources to aid in efficiently planning and conducting PHN studies; supporting integration of PHN data with other sources to foster novel research otherwise not possible; and mentoring young investigators in these areas. This review describes lessons learned through the development of iCARD, initial efforts and scientific output, challenges, and future directions. This information can aid in the use and optimisation of data integration methodologies across other research networks and organisations.
Using existing data from clinical registries to support clinical trials and other prospective studies has the potential to improve research efficiency. However, little has been reported about staff experiences and lessons learned from implementation of this method in pediatric cardiology.
We describe the process of using existing registry data in the Pediatric Heart Network Residual Lesion Score Study, report stakeholders’ perspectives, and provide recommendations to guide future studies using this methodology.
The Residual Lesion Score Study, a 17-site prospective, observational study, piloted the use of existing local surgical registry data (collected for submission to the Society of Thoracic Surgeons-Congenital Heart Surgery Database) to supplement manual data collection. A survey regarding processes and perceptions was administered to study site and data coordinating center staff.
Survey response rate was 98% (54/55). Overall, 57% perceived that using registry data saved research staff time in the current study, and 74% perceived that it would save time in future studies; 55% noted significant upfront time in developing a methodology for extracting registry data. Survey recommendations included simplifying data extraction processes and tailoring to the needs of the study, understanding registry characteristics to maximise data quality and security, and involving all stakeholders in design and implementation processes.
Use of existing registry data was perceived to save time and promote efficiency. Consideration must be given to the upfront investment of time and resources needed. Ongoing efforts focussed on automating and centralising data management may aid in further optimising this methodology for future studies.
Starting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P < .05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.
A framework was examined to assist school psychologists and counsellors in recommending quality apps for supporting diabetes self-management. A content analysis was undertaken to assess behaviour change strategies in Apple and Android smartphone apps for the self-management of type 2 diabetes. The Behaviour Change Technique Taxonomy was used to assess the presence of behaviour change strategies, while the Mobile App Rating Scale was used to assess overall app quality. Raters found, on average, 7.13 behaviour change techniques out of a possible 93, indicating few behaviour change techniques in apps for the self-management of Type 2 diabetes. Analysis indicated that apps of a higher overall quality tended to incorporate more behaviour change strategies. It was concluded that mental-health professionals are advantaged if they are able to assess and refine selection tools for matching apps with the needs of students with diabetes.
Hypoplastic left heart syndrome is the most expensive birth defect managed in the United States, with a 5-year survival rate below 70%. Increasing evidence suggests that hospital volumes are inversely associated with mortality for infants with single ventricles undergoing stage 1 surgical palliation. Our aim was to examine the relative effects of surgeon and institutional volumes on outcomes and resource utilisation for these children.
A retrospective study was conducted using the Pediatric Health Information System database to examine the effects of the number of procedures performed per surgeon and per centre on mortality, costs, and post-operative length of stay for infants undergoing Risk Adjustment for Congenital Heart Surgery risk category six operations at tertiary-care paediatric hospitals, from 1 January, 2004 to 31 December, 2013. Multivariable modelling was used, adjusting for patient and institutional characteristics. Gaussian kernel densities were constructed to show the relative distributions of the effects of individual institutions and surgeons, before and after adjusting for the number of cases performed.
A total of 2880 infants from 35 institutions met the inclusion criteria. Mortality was 15.0%. Median post-operative length of stay was 24 days (IQR 14–41). Median standardized inpatient hospital costs were $156,000 (IQR $108,000–$248,000) in 2013 dollars. In the multivariable analyses, higher institutional volume was inversely associated with mortality (p=0.001), post-operative length of stay (p=0.004), and costs (p=0.001). Surgeon volume was associated with none of the measured outcomes. Neither institutional nor surgeon volumes explained much of the wide variation in outcomes and resource utilization observed between institutions and between surgeons.
Increased institutional – but not surgeon – volumes are associated with reduced mortality, post-operative length of stay, and costs for infants undergoing stage 1 palliation.
We present the case of a newborn with tetralogy of Fallot and pulmonary atresia, with a right pulmonary artery from the ascending aorta, and a left pulmonary artery arising from the right coronary artery via an indirect aortopulmonary collateral. The embryogenesis of this unusual combination of pulmonary blood supply has significant implications when considering normal migration of the aortopulmonary septum.
Although function-based interventions have been shown to be effective, the methods utilised to carry out functional behaviour assessments (FBA) have practical limitations. This study explored the relative utility and feasibility of three FBA methods in a school setting to inform a function-based intervention to reduce problem behaviour in a boy with autism. The study consisted of (1) indirect and direct assessments, (2) a modified functional analysis, and (3) the intervention. New video technology, Behavior Capture, was trialled to facilitate data collection in the classroom. All methods contributed to identifying the function of the problematic behaviour, though only the functional analysis provided conclusive results. A peer-mediated intervention based on these findings conducted in the school playground reduced the problem behaviours. All FBA methods could be applied in the school setting and provided useful information. Novel technology was helpful in facilitating data collection. A naturalistic intervention was successful in reducing problem behaviours and increasing play skills.
Perspectives from 22 countries on aspects of the legal environment for selection are presented in this article. Issues addressed include (a) whether there are racial/ethnic/religious subgroups viewed as “disadvantaged,” (b) whether research documents mean differences between groups on individual difference measures relevant to job performance, (c) whether there are laws prohibiting discrimination against specific groups, (d) the evidence required to make and refute a claim of discrimination, (e) the consequences of violation of the laws, (f) whether particular selection methods are limited or banned, (g) whether preferential treatment of members of disadvantaged groups is permitted, and (h) whether the practice of industrial and organizational psychology has been affected by the legal environment.
The effects of several microstructural parameters on the mechanical
behaviour of a helically perforated thin film structure, or inverse
microspring, were investigated using a finite element model. The
parameters investigated were the helical pitch angle, the cross-section
radius, and the coil spacing. The elastic modulus was found to depend most
strongly on the helical pitch angle (changing by a factor of 1.3 as the
pitch angle went from 35° to 70°). Variations in the coil radius and the
film thickness had a minor effect on the modulus. It was also found that
using a finite size model (as opposed to an infinite model using periodic
boundary conditions) produced better conditioned results. A preliminary
confirmation of the model's validity was performed by comparison to
nanoindentation results of a nickel helically perforated thin film.
In most contaminated soils and mine tailings, mercury (Hg) is not readily available for plant uptake. A strategy for inducing Hg mobilization in soils to increase accumulation potential in plants was investigated to enhance Hg phytoremediation. Accumulation of Hg in the nickel hyperaccumulator Berkheya coddii, the salt-tolerant Atriplex canescens, and the nonaccumulators Brassica juncea and Lupinus sp. was studied by pot trials containing mine tailings treated with either soluble Hg or sulfur-containing ligands. Accumulation of Hg in shoots of B. coddii and A. canescens after addition of soluble Hg was lower than 10 mg/kg dry weight. The addition of ammonium thiosulfate (NH4S2O3) to tailings mobilized Hg in substrates, as indicated by the elevated Hg concentrations in leachates from the pots of both species. Ammonium thiosulfate caused a significant increase in the Hg concentration in shoots of B. juncea. Conversely, Hg translocation to Lupinus sp. shoots was significantly reduced in the presence of this ligand. Mass balance calculations revealed a significant fraction of Hg was lost from the system. This unaccounted-for Hg may indicate Hg volatilization. The results suggest that there is potential for induced plant Hg accumulation for phytoremediation of Hg-contaminated sites. Issues of Hg leaching and volatilization, however, need to be addressed before this technology can be implemented in the field.
In order to promote research using data from NASA’s Extreme Ultraviolet Explorer (EUVE) satellite, the Center for EUV Astrophysics has implemented a Guest Investigator (GI) Science Program. The purpose of the GI Program is to provide researchers with information, services, and training in the use of public EUVE data sets; in effect, it offers to the research community the technical experience and intricate knowledge of the EUVE data sets resident at CEA. All interested researchers are encouraged to participate as GIs.
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