In this study we used national data to determine changes in the prevalence of hospital admissions for medically complex children over a 15-year period.
Data from the Nationwide Inpatient Sample, a ...component of the Healthcare Cost and Utilization Project, was analyzed in 3-year increments from 1991 to 2005 to determine national trends in rates of hospitalization of children aged 8 days to 4 years with chronic conditions. Discharge diagnoses from the Nationwide Inpatient Sample were grouped into 9 categories of complex chronic conditions (CCCs). Hospitalization rates for each of the 9 CCC categories were studied both individually and in combination. Trends of children hospitalized with 2 specific disorders, cerebral palsy (CP) and bronchopulmonary dysplasia, with additional diagnoses in more than 1 CCC category were also examined.
Hospitalization rates of children with diagnoses in more than 1 CCC category increased from 83.7 per 100,000 (1991-1993) to 166 per 100 000 (2003-2005) (Pr<.001). The hospitalization rate of children with CP plus more than 1 CCC diagnosis increased from 7.1 to 10.4 per 100 000 (P=.002), whereas the hospitalization rates of children with bronchopulmonary dysplasia plus more than 1 CCC diagnosis increased from 9.8 to 23.9 per 100,000 (P<.001).
Consistent increases in hospitalization rates were noted among children with diagnoses in multiple CCC categories, whereas hospitalization rates of children with CP alone have remained stable. The relative medical complexity of hospitalized pediatric patients has increased over the past 15 years.
Low birth weight and preterm birth are associated with adverse consequences including increased risk of infant mortality and chronic health conditions. Black infants are more likely than white ...infants to be born prematurely, which has been associated with disparities in infant mortality and other chronic conditions.
To evaluate whether Medicaid expansion was associated with changes in rates of low birth weight and preterm birth outcomes, both overall and by race/ethnicity.
Using US population-based data from the National Center for Health Statistics Birth Data Files (2011-2016), difference-in-differences (DID) and difference-in-difference-in-differences (DDD) models were estimated using multivariable linear probability regressions to compare birth outcomes among infants in Medicaid expansion states relative to non-Medicaid expansion states and changes in relative disparities among racial/ethnic minorities for singleton live births to women aged 19 years and older.
State Medicaid expansion status and racial/ethnic category.
Preterm birth (<37 weeks' gestation), very preterm birth (<32 weeks' gestation), low birth weight (<2500 g), and very low birth weight (<1500 g).
The final sample of 15 631 174 births (white infants: 8 244 924, black infants: 2 201 658, and Hispanic infants: 3 944 665) came from the District of Columbia and 18 states that expanded Medicaid (n = 8 530 751) and 17 states that did not (n = 7 100 423). In the DID analyses, there were no significant changes in preterm birth in expansion relative to nonexpansion states (preexpansion to postexpansion period, 6.80% to 6.67% difference: -0.12 vs 7.86% to 7.78% difference: -0.08; adjusted DID: 0.00 percentage points 95% CI, -0.14 to 0.15, P = .98), very preterm birth (0.87% to 0.83% difference: -0.04 vs 1.02% to 1.03% difference: 0.01; adjusted DID: -0.02 percentage points 95% CI, -0.05 to 0.02, P = .37), low birth weight (5.41% to 5.36% difference: -0.05 vs 6.06% to 6.18% difference: 0.11; adjusted DID: -0.08 percentage points 95% CI, -0.20 to 0.04, P = .20), or very low birth weight (0.76% to 0.72% difference: -0.03 vs 0.88% to 0.90% difference: 0.02; adjusted DID: -0.03 percentage points 95% CI, -0.06 to 0.01, P = .14). Disparities for black infants relative to white infants in Medicaid expansion states compared with nonexpansion states declined for all 4 outcomes, indicated by a negative DDD coefficient for preterm birth (-0.43 percentage points 95% CI, -0.84 to -0.02, P = .05), very preterm birth (-0.14 percentage points 95% CI, -0.26 to -0.02, P = .03), low birth weight (-0.53 percentage points 95% CI, -0.96 to -0.10, P = .02), and very low birth weight (-0.13 percentage points 95% CI, -0.25 to -0.01, P = .04). There were no changes in relative disparities for Hispanic infants.
Based on data from 2011-2016, state Medicaid expansion was not significantly associated with differences in rates of low birth weight or preterm birth outcomes overall, although there were significant improvements in relative disparities for black infants compared with white infants in states that expanded Medicaid vs those that did not.
Population numbers at local levels are fundamental data for many applications, including the delivery and planning of services, election preparation, and response to disasters. In resource-poor ...settings, recent and reliable demographic data at subnational scales can often be lacking. National population and housing census data can be outdated, inaccurate, or missing key groups or areas, while registry data are generally lacking or incomplete. Moreover, at local scales accurate boundary data are often limited, and high rates of migration and urban growth make existing data quickly outdated. Here we review past and ongoing work aimed at producing spatially disaggregated local-scale population estimates, and discuss how new technologies are now enabling robust and cost-effective solutions. Recent advances in the availability of detailed satellite imagery, geopositioning tools for field surveys, statistical methods, and computational power are enabling the development and application of approaches that can estimate population distributions at fine spatial scales across entire countries in the absence of census data. We outline the potential of such approaches as well as their limitations, emphasizing the political and operational hurdles for acceptance and sustainable implementation of new approaches, and the continued importance of traditional sources of national statistical data.
A frequency reconfigurable printed Yagi-Uda antenna is presented for cognitive radio applications. A 46% continuous frequency tuning bandwidth is obtained by loading the driver dipole arms and four ...directors with varactor diodes. This configuration allows a high-gain and an almost constant end-fire pattern to be maintained while the antenna operating frequency is tuned. A parametric study was undertaken considering the inter-director spacing, director length tapering, and reflector geometry. It was found possible over the band that the front-to-back ratio is >; 16 dB, the sidelobe level is <; -14 dB and the cross polarization levels in the principal planes are <; - 15.5 dB. From 1-dB compression point measurements, the maximum input power of the antenna with the present diodes is limited to 17.6 dBm at 700 MHz. This suggests that reconfigurable antennas which use active components should have an IIP3 specification placed on them. The frequency selective feature of the antenna makes it as an attractive user terminal antenna for fixed point-to-multipoint cognitive radio enabled broadband wireless access.
The US Department of Defense (DoD) realizes the many uses of additive manufacturing (AM) as it has become a common fabrication technique for an extensive range of engineering components in several ...industrial sectors. 3D Printed (3DP) sensor technology offers high-performance features as a way to track individual warfighters on the battlefield, offering protection from threats such as weaponized toxins, bacteria or virus, with real-time monitoring of physiological events, advanced diagnostics, and connected feedback. Maximum protection of the warfighter gives a distinct advantage over adversaries by providing an enhanced awareness of situational threats on the battle field. There is a need to further explore aspects of AM such as higher printing resolution and efficiency, with faster print times and higher performance, sensitivity and optimized fabrication to ensure that soldiers are more safe and lethal to win our nation's wars and come home safely. A review and comparison of various 3DP techniques for sensor fabrication is presented.
Objectives:
The high concentration of smokers among subgroups targeted by the Affordable Care Act and the historically worse health and lower access to health care among smokers warrants an ...evaluation of how Medicaid expansion affects smokers. We evaluated the impact of Medicaid expansion on smoking behavior, access to health care, and health of low-income adults, and we compared outcomes of all low-income people with outcomes of low-income current smokers by states’ Medicaid expansion status.
Methods:
We obtained data from the Behavioral Risk Factor Surveillance System (2011-2016) for low-income adults aged 18-64. We estimated multivariable linear ordinary least squares probability models using a quasi-experimental difference-in-difference approach to compare smoking behavior, access to health care, and health between people in expansion states and nonexpansion states and, specifically, on low-income adults and the subgroup of low-income current smokers.
Results:
Compared with low-income smokers in nonexpansion states, low-income smokers in expansion states were 7.6 percentage points (95% confidence interval CI, 5.7-9.6; P < .001) more likely to have health insurance, 3.2 percentage points (95% CI, 1.3-5.2; P = .001) more likely to report good or better health, and 2.0 percentage points (95% CI, –3.9 to –0.1; P = .044) less likely to have cost-related barriers to care. Health and insurance gains among current smokers in expansion states were larger relative to health gains (1.6 percentage points; 95% CI, 0.5-2.7; P = .003) and insurance gains (4.6 percentage points; 95% CI, 3.5-5.8; P < .001) of all low-income adults in these states.
Conclusions:
Greater improvements among low-income smokers in Medicaid expansion states compared with nonexpansion states could influence future smoking behaviors and warrant longer-term monitoring. Additionally, health and insurance gains among low-income smokers in expansion states suggest the potential for Medicaid expansion to improve health among smokers compared with nonsmokers.
Long-held assumptions of poor prognoses for patients with haematological malignancies (HM) have meant that clinicians have been reluctant to admit them to the intensive care unit (ICU). We aimed to ...evaluate ICU, in-hospital, and 6 month mortality and to identify predictors for in-hospital mortality.
A cohort study in a specialist cancer ICU of adult HM patients admitted over 5 yr. Data acquired included: patient characteristics, haematological diagnosis, haematopoietic stem cell transplant (HSCT), reason for ICU admission, and APACHE II scores. Laboratory values, organ failures, and level of organ support were recorded on ICU admission. Predictors for in-hospital mortality were evaluated using uni- and multivariate analysis.
Of 199 patients, median age was 58 yr inter-quartile range (IQR) 46–66, 51.7% were emergency admissions, 42.2% post-HSCT, 51.9% required mechanical ventilation, median APACHE II was 21 (IQR 16–25), and median organ failure numbered 2 (IQR 1–4). ICU, in-hospital, and 6 month mortalities were 33.7%, 45.7%, and 59.3%, respectively. Univariate analysis revealed bilirubin >32 µmol litre−1, mechanical ventilation, ≥2 organ failures, renal replacement therapy, vasopressor support (all P<0.001), graft-vs-host disease (P=0.007), APACHE II score (P=0.02), platelets ≤20×109 litre−1 (P=0.03), and proven invasive fungal infection (P=0.04) were associated with in-hospital mortality. Multivariate analysis revealed that ≥2 organ failures odds ratio (OR) 5.62; 95% confidence interval (95% CI), 2.30–13.70 and mechanical ventilation (OR 3.03; 95% CI, 1.33–6.90) were independently associated with in-hospital mortality.
Mortality was lower than in previous studies. Mechanical ventilation and ≥2 organ failures were independently associated with in-hospital mortality. ‘Traditional' variables such as neutropenia, transplantation status, and APACHE II score no longer appear to be predictive.
Abstract Objectives The hybrid approach for the initial management of hypoplastic left heart syndrome shifts the risks of major open surgery from the vulnerable neonatal period to an older age. This ...study determined differences between the hybrid and the standard Norwood procedures in postoperative in-hospital mortality, renal failure, and survival to at least 2 years of age. Methods Data from the Pediatric Health Information System, a detailed hospital discharge database of 43 freestanding children's hospitals, were analyzed. The Pediatric Health Information System includes demographic information, diagnosis, and procedure and clinical service data. Instrumental variable regression techniques were used to estimate the predicted probability of in-hospital mortality, renal failure, and survival to 24 months of age for infants with hypoplastic left heart syndrome who received a hybrid or Norwood procedure. The statistical models controlled for demographics and comorbid chromosomal anomalies. Results A total of 3654 infants with hypoplastic left heart syndrome underwent intervention from 1998 to 2012. Of these, 242 underwent the hybrid approach and the remainder underwent the Norwood procedure. Instrumental variable models showed significantly reduced odds of patients who underwent the hybrid approach being diagnosed with renal failure (adjusted risk ratio ARR, 0.48; 95% confidence interval CI, 0.26-0.89); increased odds of surviving initial hospitalization (ARR, 1.28; 95% CI, 1.06-1.55); increased odds of survival, indicated by readmissions more than 6 months after initial hospitalization (ARR, 1.53; 95% CI, 1.05-2.22); and a decrease in length of stay by 20 days for the initial surgical hospitalization (95% CI, −27.4 to −13.9). Conclusions The short term hospital-based outcomes and longer-term survival outcomes of the hybrid approach for hypoplastic left heart syndrome may be better than those of the Norwood procedure.
To distinguish the effects of late preterm birth from the complications associated with the causes of delivery timing, this study used propensity score-matching methods on a statewide database that ...contains information on both mothers and infants.
Data for this study came from Arkansas Medicaid claims data linked to state birth certificate data for the years 2001 through 2005. We excluded all multiple births, infants with birth defects, and infants at <33 weeks of gestation. Late preterm infants (LPIs) (34 to 36 weeks of gestation) were matched with term infants (37-42 weeks of gestation) according to propensity scores, on the basis of infant, maternal, and clinical characteristics.
A total of 5188 LPIs were matched successfully with 15303 term infants. LPIs had increased odds of poor outcomes during their birth hospitalization, including a need for mechanical ventilation (adjusted odds ratio aOR: 1.31 95% confidence interval CI: 1.01-1.68), respiratory distress syndrome (aOR: 2.84 95% CI: 2.33-3.45), and hypoglycemia (aOR: 1.60 95% CI: 1.26-2.03). Outpatient and inpatient Medicaid expenditures in the first year were both modestly higher (outpatient, adjusted marginal effect: $108 95% CI: $58-$158; inpatient, $597 95% CI: $528-$666) for LPIs.
LPIs are at increased risk of poor health-related outcomes during their birth hospitalization and of increased health care utilization during their first year.
The U.S. Army is entering a period of modernization, phasing out older, limited and costlier weapon designs for new, more efficient, and effective weapon technologies. The emphasis has shifted to ...optimizing lethality and accuracy at extended ranges to reduce cost per kill via the use of mechanization and automation to provide more coverage with fewer systems while reducing crew burden, size, and training requirements. The improved overall system performance via integration of technology enablers such as additive manufacturing is prepositioned for future capability growth. Additive manufacturing, or 3D printing, has been postulated to allow the rate of energy release from gun propellant to be highly optimized by controlling the surface area of the grain, thus resulting in a high generation of gas to maintain pressure later in the ballistic cycle. Consequentially, higher efficiency is achieved with more energy delivered to the projectile, and faster launch velocities are achieved, providing an enhanced capability for maneuvering forces on the battlefield.
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