BackgroundResearchers and healthcare providers have paid little attention to morbidity and unplanned healthcare encounters for children following hospital discharge in low- and middle-income ...countries. Our objective was to compare symptoms and unplanned healthcare encounters among children aged <5 years who survived with those who died within 60 days of hospital discharge through follow-up phone calls.MethodsWe conducted a secondary analysis of a prospective observational cohort of children aged <5 years discharged from neonatal and paediatric wards of two national referral hospitals in Dar es Salaam, Tanzania and Monrovia, Liberia. Caregivers of enrolled participants received phone calls 7, 14, 30, 45, and 60 days after hospital discharge to record symptoms, unplanned healthcare encounters, and vital status. We used logistic regression to determine the association between reported symptoms and unplanned healthcare encounters with 60-day post-discharge mortality.ResultsA total of 4243 participants were enrolled and had 60-day vital status available; 138 (3.3%) died. For every additional symptom ever reported following discharge, there was a 35% greater likelihood of post-discharge mortality (adjusted odds ratio aOR 1.35, 95% confidence interval CI 1.10 to 1.66; p=0.004). The greatest survival difference was noted for children who had difficulty breathing (2.1% among those who survived vs 36.0% among those who died, p<0.001). Caregivers who took their child home from the hospital against medical advice during the initial hospitalisation had over eight times greater odds of post-discharge mortality (aOR 8.06, 95% CI 3.87 to 16.3; p<0.001) and those who were readmitted to a hospital had 3.42 greater odds (95% CI 1.55 to 8.47; p=0.004) of post-discharge mortality than those who did not seek care when adjusting for site, sociodemographic factors, and clinical variables.ConclusionSurveillance for symptoms and repeated admissions following hospital discharge by healthcare providers is crucial to identify children at risk for post-discharge mortality.
Informed Consent and SUPPORT Drazen, Jeffrey M; Solomon, Caren G; Greene, Michael F
The New England journal of medicine,
05/2013, Letnik:
368, Številka:
20
Journal Article
Recenzirano
In the summer of 1963, the nation watched in sadness as Patrick Bouvier Kennedy, the youngest child of President John F. Kennedy and First Lady Jacqueline Bouvier Kennedy, was born prematurely and ...then died of lung disease 2 days later at Children's Hospital in Boston. Even now, it is common knowledge that children born prematurely are at high risk for death.
So it is easy to imagine the stress when, in 2005, your new baby decides to come into the world after only 6 months of gestation, long before your pregnancy has reached term. You know that extremely premature babies . . .
The national objectives of general welfare, economic growth and stability, and security of the United States require the development of transportation policies and programs that contribute to ...providing fast, safe, efficient, and convenient transportation at the lowest cost consistent with those and other national objectives, including the efficient use and conservation of the resources of the United States.1 The above statement encapsulates the purpose and complexity of the federal government's transportation policy. Impediments to Ryan A. Payne, ryan@nkbattorneys.com, is a senior associate attorney with the law firm ofNetzer, Krautter & Brown P.C. He holds aBA in political science from the University of South Carolina, aJDfrom the University of Montana School of Law, and an MBA from the University of Montana. the successful deployment of a new generation of civil supersonic aircraft, therefore, include not only the regulations in 14 C.F.R. part 91 (applicable to all civil aircraft operations in US airspace), but also an outdated and mismatched intellectual property rights structure that rewards second, third, or fourth movers instead of protecting the trailblazer's investment in this technology. The sonic boom test program at Oklahoma City was designed to determine the public acceptability and the effect on ground structures on booms anticipated from future supersonic transport flights, inasmuch as the projected supersonic transport would travel at faster-than-sound speeds, carrying paying passengers, and fly over people and population centers.9 The results did not bode well for the possibility of overland supersonic travel and resulted in several rounds of lawsuits against the federal government, though they were ultimately unsuccessful.10 Concorde's Derivative Technology Due to the unique operational environment and mission objectives, Concorde was forced to be lighter, more powerful, more advanced, more luxurious, and faster than any civil aircraft of its time. For The law as it has developed is in tension with clearly stated federal policy goals, as well as commonsense and commercial goals. example, during an address to graduates of the US Air Force Academy delivered early on in the Jet Age, President John F. Kennedy remarked as follows: I am announcing today that the United States will commit itself to an important new program in civilian aviation.
BackgroundThere are no validated clinical decision aids to identify neonates and young children at risk of hospital readmission or postdischarge mortality in sub-Saharan Africa, leaving the decision ...to discharge a child to a clinician’s impression. Our objective was to determine the precision of clinician impression to identify neonates and young children at risk for readmission and postdischarge mortality.MethodsWe conducted a survey study nested in a prospective observational cohort of neonates and children aged 1–59 months followed 60 days after hospital discharge from Muhimbili National Hospital in Dar es Salaam, Tanzania or John F. Kennedy Medical Center in Monrovia, Liberia. Clinicians who discharged each enrolled patient were surveyed to determine their perceived probability of the patient’s risk of 60-day hospital readmission or postdischarge mortality. We calculated the area under the precision-recall curve (AUPRC) to determine the precision of clinician impression for both outcomes.ResultsOf 4247 discharged patients, 3896 (91.7%) had available clinician surveys and 3847 (98.7%) had 60-day outcomes available: 187 (4.8%) were readmitted and 120 (3.1%) died within 60 days of hospital discharge. Clinician impression had poor precision in identifying neonates and young children at risk of hospital readmission (AUPRC: 0.06, 95% CI: 0.04 to 0.08) and postdischarge mortality (AUPRC: 0.05, 95% CI: 0.03 to 0.08). Patients for whom clinicians attributed inability to pay for future medical treatment as the reason for risk for unplanned hospital readmission had 4.76 times the odds hospital readmission (95% CI: 1.31 to 17.25, p=0.02).ConclusionsGiven the poor precision of clinician impression alone to identify neonates and young children at risk of hospital readmission and postdischarge mortality, validated clinical decision aids are needed to aid in the identification of young children at risk for these outcomes.
Introduction
Women exposed to stressful events during pregnancy are thought to be at increased risk of adverse birth outcomes. However, studies investigating stressful events are often unable to ...control for important confounders, such as behavioral and genetic characteristics, or to isolate the impact of the stressor from other secondary effects. We used a discordant-sibling design, which provides stronger inferences about causality, to examine whether a widespread stressor with limited impact on day-to-day life (John F. Kennedy assassination) resulted in an increased risk of adverse birth outcomes.
Methods
Data were obtained from the Collaborative Perinatal Project, a prospective, multi-site cohort study conducted in the US from 1959 to 1965. Our analysis was restricted to singleton live births ≥24 weeks born before the assassination (
n
= 24,406) or in utero at the time (
n
= 5833). We also evaluated associations within siblings discordant for exposure (
n
= 1144). We used survival analysis to evaluate associations between exposure and preterm birth and marginal models to evaluate associations with birthweight and placental pathology.
Results
First trimester exposure was associated with preterm birth (hazard ratio (HR): 1.17; 95% CI: 1.05, 1.31). In the discordant-sibling model, the point estimate was similar (HR: 1.22; 95% CI: 0.36, 4.06). Third trimester exposure was associated with increased odds of fetal acute inflammation in the placenta (odds ratio (OR): 1.34, 95% CI: 1.05, 1.71).
Conclusions for Practice
First trimester exposure to an acute stressor was associated with preterm birth. We did not observe increased odds of placental pathology with first trimester exposure; however, stress may increase preterm birth risk through chronic placental inflammation, which was not evaluated in this sample.
Accepting the Democratic nomination for president in July 1960, John F. Kennedy exhorted his fellow Americans to join him in a mission of national sacrifice on the 'New Frontier'. This article will ...explore the influence of frontier mythology on the foreign policy rhetoric of the Kennedy administration. It will show how the prevalence of the Western in U.S. popular culture led Kennedy and his advisers to carefully construct a meaningful Cold War discourse, one which attempted to situate the administration's foreign policy within a heroic narrative of westward expansion. Yet this rhetorical strategy proved something of a double-edged sword; at key moments during his presidency, Kennedy found his 'New Frontier' rhetoric being turned against him by critics of his foreign policy. Led by Arizona Senator Barry Goldwater, these opponents accused the president of deviating from the mythic narratives he appealed to in his speeches, charging that the 'New Frontier' was but a pale imitation of the old. By exploring this contest over frontier mythology and its interaction with U.S. foreign policy, this article seeks to add a new dimension to the recent 'narrative turn' in international history.
"Southwest" was at the forefront of the region's identity when Moseley moseyed in back in 1975, carrying a reputation as an award-winning Dallas-area reporter who was one of the last to have ...interviewed President John F. Kennedy. Ed Sealover, who worked for Moseley fresh out of Northwestern University, is now a reporter at the Denver Business Journal. Pederson on DHS' Side In a less mournful goodbye, KATV is missing Jason Pederson, who left the Little Rock ABC affiliate after 24 years to create an ombudsman's office at the Arkansas Department of Human Services.
A Careerography of John F. Kennedy Jr Bigony, Cara; Alpers, Anne; Ponterotto, Joseph G.
Journal of Career Development,
02/2021, Letnik:
48, Številka:
1
Journal Article
Recenzirano
Odprti dostop
This article presents a careerography of John F. Kennedy Jr. (JFK Jr.), a late 20th-century iconic personality. Careerography adapts psychobiography by anchoring its interpretive lens in established ...theories of career development. In our longitudinal case study of JFK Jr., the theories of Donald Super and Mary Sue Richardson served as the career theories to frame and interpret his career development. The sequential model of careerography applied to JFK Jr. focused on (1) our selection of the historical subject, (2) ethical considerations and bracketing, (3) outlining initial research questions, (4) choosing anchoring career theories, (5) engaging the iterative research and theory application process, and (6) writing the careerography. The article concludes with a brief discussion of how careerography adds to the historical study of notable personalities, and how in turn career theory can be informed through the intensive case study method of careerography.
