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Transition of care refers to the continuity of health care during the movement from one healthcare setting to another as care needs change during a chronic illness. We sought to describe social, demographic, and clinical factors related to successful transition in a tertiary urban care facility in patients with CHD. Patients were identified utilising the electronic medical record. Inclusion criteria were patients with CHDs aged ≥15 years seen in the paediatric cardiology clinic between 2013 and 2014. Deceased patients were excluded. Clinical and demographic variables were collected. Patient charts were reviewed in 2015–2021 to determine if included patients were a) still in paediatric cardiology care, b) transitioned to adult cardiology/adult CHD, or were c) lost to follow-up. A total of 322 patients, 53% male (N:172), 46% female (N:149) were included. Majority had moderately complex lesions (N:132, 41%). Most patients had public insurance (N:172, 53%), followed by private insurance (N:67, 21%), while 15% of patients (N:47) were uninsured. Only 49% (N = 159) had successful transition, while 22% (N = 70) continued in care with paediatric cardiology, and 29% (N = 93) were lost to follow-up. Severity of CHD (p = 0.0002), having healthcare insurance (p < .0001), presence of a defibrillator (p = 0.0028), and frequency of paediatric cardiology visits (p = 0.0005) were significantly associated with successful transition. Most patients lost to follow-up (N:42,62%) were either uninsured or had public insurance. Lack of successful transition is multifactorial, and further efforts are needed to improve the process in patients with CHD.
While anecdotal evidence suggests that music may facilitate verbal memory, empirical evidence for this is less clear. Here, we examined whether learners’ characteristics such as age, working memory (WM), and musical training may influence the effect of music on word learning. Young and older adults learned novel word-referent mappings presented in three music conditions (spoken in the presence of background music, sung in-key, and sung out-of-key) and a control condition (spoken in quiet) and their performance was assessed immediately after learning. We found that whereas age and, to an extent, musical training had a general effect on word learning, WM modulated the effect of music: performance was worse in the music conditions relative to the control condition for learners with lower WM whereas the opposite pattern was observed for those with higher WM. Our results thus highlight the importance of considering individual characteristics in determining the effect of music on verbal memory.
We undertook a quality improvement project to address challenges with pulmonary artery catheter (PAC) line maintenance in a setting of low-baseline central-line infection rates. We observed a subsequent reduction in Staphylococcal PAC line infections and a trend toward a reduction in overall PAC infection rates over 1 year.
Timely morbidity surveillance of sheltered populations is crucial for identifying and addressing their immediate needs, and accurate surveillance allows us to better prepare for future disasters. However, disasters often create travel and communication challenges that complicate the collection and transmission of surveillance data. We describe a surveillance project conducted in New Jersey shelters after Hurricane Sandy, which occurred in November 2012, that successfully used cellular phones for remote real-time reporting. This project demonstrated that, when supported with just-in-time morbidity surveillance training, cellular phone reporting was a successful, sustainable, and less labor-intensive methodology than in-person shelter visits to capture morbidity data from multiple locations and opened a two-way communication channel with shelters. (Disaster Med Public Health Preparedness. 2015;10:525–528)
We develop quantile functions from regression models in order to derive risk margin and to evaluate capital in non-life insurance applications. By utilizing the entire range of conditional quantile functions, especially higher quantile levels, we detail how quantile regression is capable of providing an accurate estimation of risk margin and an overview of implied capital based on the historical volatility of a general insurers loss portfolio. Two modeling frameworks are considered based around parametric and non-parametric regression models which we develop specifically in this insurance setting. In the parametric framework, quantile functions are derived using several distributions including the flexible generalized beta (GB2) distribution family, asymmetric Laplace (AL) distribution and power-Pareto (PP) distribution. In these parametric model based quantile regressions, we detail two basic formulations. The first involves embedding the quantile regression loss function from the nonparameteric setting into the argument of the kernel of a parametric data likelihood model, this is well known to naturally lead to the AL parametric model case. The second formulation we utilize in the parametric setting adopts an alternative quantile regression formulation in which we assume a structural expression for the regression trend and volatility functions which act to modify a base quantile function in order to produce the conditional data quantile function. This second approach allows a range of flexible parametric models to be considered with different tail behaviors. We demonstrate how to perform estimation of the resulting parametric models under a Bayesian regression framework. To achieve this, we design Markov chain Monte Carlo (MCMC) sampling strategies for the resulting Bayesian posterior quantile regression models. In the non-parametric framework, we construct quantile functions by minimizing an asymmetrically weighted loss function and estimate the parameters under the AL proxy distribution to resemble the minimization process. This quantile regression model is contrasted to the parametric AL mean regression model and both are expressed as a scale mixture of uniform distributions to facilitate efficient implementation. The models are extended to adopt dynamic mean, variance and skewness and applied to analyze two real loss reserve data sets to perform inference and discuss interesting features of quantile regression for risk margin calculations.
To investigate the effect of public hospitals in Hong Kong not accepting free infant formula from manufacturers on in-hospital formula supplementation rates and breast-feeding duration.
Prospective cohort study.
In-patient postnatal units of four public hospitals in Hong Kong.
Two cohorts of breast-feeding mother–infant pairs (n 2560). Cohort 1 (n 1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n 1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding.
The mean number of formula supplements given to infants in the first 24 h was 2·70 (sd 3·11) in cohort 1 and 1·17 (sd 1·94) in cohort 2 (P<0·001). The proportion of infants who were exclusively breast-fed during the hospital stay increased from 17·7 % in cohort 1 to 41·3 % in cohort 2 (P<0·001) and the risk of breast-feeding cessation was significantly lower in cohort 2 (hazard ratio=0·81; 95 % CI 0·73, 0·90). Participants who non-exclusively breast-fed during the hospital stay had a significantly higher risk of stopping any or exclusive breast-feeding. Higher levels of formula supplementation also increased the risk of breast-feeding cessation in a dose–response pattern.
After implementation of a hospital policy to pay market price for infant formula, rates of in-hospital formula supplementation were reduced and the rates of in-hospital exclusive breast-feeding and breast-feeding duration increased.
To become lifelong learners is the ultimate goal of many if not most learners irrespective of their target of learning, and being able to self-learn is one major prerequisite of this goal. As far as the learning of a second language is concerned, dictionaries are among the most readily available and easily accessible self-learning tools available on the market, and are regarded as the most systematic and comprehensive lexical descriptions that users have access to (Jackson & Amvela, 2000). An increasing number of dictionaries are now available for learners at different levels and for different learning purposes, including general dictionaries, learners' dictionaries, translation dictionaries, pictorial dictionaries, collocation dictionaries, specialized dictionaries and encyclopaedic dictionaries (Jackson & Amvela, 2000). Of these, learners' dictionaries are among the most popular for second or foreign language learners, providing a range of information including word meanings, pronunciations, collocations, correct usage and syntactic behaviour.
This study investigates the acquisition of English word-final consonants by Hong Kong Cantonese learners of English as a second language and assesses the validity of the Markedness Differential Hypothesis for second language phonology acquisition by these learners. Twelve participants and three native speakers performed four speech tasks: reading a word list, reading three passages, describing pictures, and participating in a conversational interview. The results show that: (i) word-finally, more non-target laterals were produced than voiceless obstruents; and (ii) non-target productions of voiced obstruents were the highest. We argue that the Markedness Differential Hypothesis does not explain the acquisition of English word-final singleton consonants by Cantonese ESL learners in Hong Kong. We conclude that markedness alone cannot be used as a predictor for the relative difficulty of acquiring the target segments of a second language.
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