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To evaluate the impact of state-mandated policies for pulse oximetry screening on healthcare utilisation, with a focus on use of echocardiograms.
Data sources/study setting:
Healthcare Cost and Utilisation Project, Statewide Inpatient Databases from 2008 to 2014 from six states.
We defined pre- and post-mandate cohorts based on dates when pulse oximetry became mandated in each state. Linear segmented regression models for interrupted time series assessed associations between implementation of the screening and changes in rate of newborns with Critical CHD-negative echocardiogram results. We also evaluated the changes in rate of newborns who underwent echocardiogram but were not diagnosed with any health issues that could cause hypoxemia.
We identified 5967 critical CHD-negative echocardiograms (2847 and 3120 in the pre- and post-mandate periods, respectively). Our models detected a statistically significant increasing trend in rate of critical CHD-negative echocardiograms in the pre-mandate period (Incidence Rate Ratio: 1.08, p = 0.02), but did not detect any statistical differences in changes between pre- and post-mandate periods (Incidence Rate Ratio: 0.93, p = 0.14). Among non-Whites, an increasing trend of Critical CHD-negative echocardiogram during the pre-mandate period was detected (Incidence Rate Ratio 1.12, p < 0.01) and was attenuated during the post-mandate period (Incidence Rate Ratio 0.89, p = 0.02). Similar results were observed in the sensitivity analyses among both Whites and non-Whites.
Results suggest that mandatory state screening policies are associated with reductions in false-positive screening rates for hypoxemic conditions, with reductions primarily attributed to trends among non-Whites.
This study investigated patient characteristics in paediatric hospitalisations for hypertrophic cardiomyopathy. We used Nationwide Inpatient Sample, which is the largest all-payer inpatient database in the United States, yielding nationally representative estimates, from 2001 to 2014. ICD-9-CM diagnostic codes identified hospitalisations for patients with hypertrophic cardiomyopathy and <18 years. Outcomes included yearly rate of hospitalisation, death, admission via emergency department, and need for surgery. Predictors of interest were age groups (<1, 1–9, and ⩾10 y/o), sex, and race/ethnicity. Logistic regression modelled associations, adjusted by patient- and hospital-level variables. With 2302 weighted hospitalisations, hospitalisation rates were 0.22 per 100,000 children/year, with higher rates for <1 y/o (0.42) and ⩾10 y/o (0.31). Male-to-female ratios were more prominent in the oldest age group; 2.7:1 in ⩾10 y/o versus less than 1.7:1 for <10 y/o. In-hospital mortality was 1.5%, with highest mortality rates among the <1 y/o (6.3%). Children ⩾10 y/o had 5.59 times higher risk of admission from the emergency department than 1–9 y/o age group. Both ⩾10 and <1 y/o age groups had lower risk of surgical intervention compared to the 1–9 y/o group with odds ratio 0.56 and 0.26, respectively. Black children had higher risk of admission from the emergency department than White children with odds ratio 2.78. A relation between age group and sex was observed, with sex-based differences in prevalence and treatment of hypertrophic cardiomyopathy becoming more pronounced with age. Further studies are needed to clarify mechanisms behind age and racial disparity in hospitalisation, especially admission source.
The important aspects of human wellbeing outlined in human rights instruments and constitutional bills of rights can only be adequately secured as and when they are rendered the object of specific rights and corresponding duties. It is often assumed that the main responsibility for specifying the content of such genuine rights lies with courts. Legislated Rights: Securing Human Rights through Legislation argues against this assumption, by showing how legislatures can and should be at the centre of the practice of human rights. This jointly authored book explores how and why legislatures, being strategically placed within a system of positive law, can help realise human rights through modes of protection that courts cannot provide by way of judicial review.
Measurements made by an underwater glider deployed near the Ross Ice Shelf were used to identify the presence of Ice Shelf Water (ISW), which is defined as seawater with its potential temperature lower than its surface freezing point temperature. Properties logged by the glider included in situ temperature, electrical conductivity, pressure, GPS location at surfacings and time. For most of the first 30 recorded dives of its deployment, evidence suggests the glider was prevented from surfacing due to being under the ice shelf. For dives under the ice shelf, farthest from the ice shelf front, ISW layers of varying thicknesses and depth locations were observed; between 2 m thick (centred at 231 m depth) to >93 m thick (centred at >360 m). For dives under the ice shelf, close to the ice shelf front, either no ISW was observed or ISW layers were centred at shallower depths (116–127 m). Thicker ISW layers (e.g. up to 250 m thickness centred at 421 m) were observed for some glider dives in open water in front of the Ross Ice Shelf. No in situ supercooling (water colder than the pressure-dependent freezing point temperature) was observed.
This collection of essays by international specialists in the literature of Berlin provides a lively and stimulating account of writing in and about the city in the modern period. The first eight chapters chart key chronological developments from 1750 to the present day, while subsequent chapters focus on Berlin drama and poetry in the twentieth century and explore a set of key identity questions: ethnicity/migration, gender (writing by women), and sexuality (queer writing). Each chapter provides an informative overview along with closer readings of exemplary texts. The volume is designed to be accessible for readers seeking an introduction to the literature of Berlin, while also providing new perspectives for those already familiar with the topic. With a particular focus on the turbulent twentieth century, the account of Berlin's literary production is set against broader cultural and political developments in one of the most fascinating of global cities.
Parasite dynamics can be mediated by host behaviours such as sociality, and seasonal changes in aggregation may influence risk of parasite exposure. We used little brown bats (Myotis lucifugus) captured during the autumn mating/swarming period to test the hypothesis that seasonal and demographic-based variation in sociality affect ectoparasitism. We predicted that ectoparasitism would: (1) be higher for adult females and young of the year (YOY) than adult males because of female coloniality; (2) increase for adult males throughout swarming because of increasing contact with females; (3) decrease for adult females and YOY throughout swarming because of reduced coloniality and transmission of individual ectoparasites to males; (4) be similar for male and female YOY because vertical transmission from adult females should be similar. Ectoparasitism was lowest for adult males and increased for males during swarming, but some effects of demographic were unexpected. Contrary to our prediction, ectoparasitism increased for adult females throughout swarming and YOY males also hosted fewer ectoparasites compared with adult and YOY females. Interestingly, females in the best body condition had the highest parasite loads. Our results suggest that host energetic constraints associated with future reproduction affect pre-hibernation parasite dynamics in bats.