Understanding Small Area Variation in Late Preterm Births in North Carolina

Late preterm (LPT) neonates are those who are born between 34 0/7th and 36 6/7th weeks' gestation. LPT neonates account for 70% of all premature births in the United States; these neonates have a higher morbidity and mortality risk than do term newborns. Variation in medical care that cannot be explained by population characteristics or common risk factors may be a result of differences in health system performance, including physician or health care setting practice variation. Identifying geographic variation in LPT birth rates might uncover health care delivery processes whose improvement could lower the rate of LPT births. The purpose of this study is to test the feasibility of identifying otherwise unexplained variation in the incidence of LPT births in the six perinatal care regions of North Carolina, as measured in a linked birth-death certificate database from the North Carolina State Center for Health Statistics. Exclusion of infants with major congenital anomalies, unknown GA, less than 34 weeks’ gestation, and out-of-state births leaves us with data on 884,304 singleton infants of whom 66,218 (7.5%) were LPT. Controlling for socio-demographic and medical/obstetrical risk factors leaves statistically significant (p< 0.001) variation in LPT across the perinatal regions. Regions 1, 2, 5, and 6 had the highest incidence of LPT births; regions 3 and 4 had the lowest. After controlling for risk factors, regions 2 and 6 had the highest adjusted probability of LPT birth (7.0% and 6.6%), but the adjusted rates of regions 1 and 5 approached those of 1 region 3 (6.2% for each, versus 5.9%). Even after adjustment for socio-demographic and medical risk factors, geographic variation persisted. It is possible that practice variation and health care system differences between regions explain some of the remaining variation. These are areas where policy changes and quality improvement efforts can help reduce variation, and therefore decrease LPT birth rates.Master of Public Healt

Center Variation in the Delivery of Indicated Late Preterm Births

Evidence for optimal timing of delivery for some pregnancy complications at late preterm gestation is limited. The purpose of this study was to identify center variation of indicated late preterm births

Diuretic Exposure in Premature Infants from 1997 to 2011

Diuretics are often prescribed off-label to premature infants, particularly to prevent or treat bronchopulmonary dysplasia (BPD). We examined their use and safety in this group

Perception of teaching performance in the virtual learning environment

This article aims to analyze the perception of the students of the professional school of business administration about the teaching performance in the virtual learning environment during the COVID-19 pandemic. When developing the research, it was determined that there is a good teaching performance, according to the perception of the students. However, it was identified that the factors of domain of the topic and class session management, present a better perception in this context of virtual learning; while the didactic strategies factor is the one that presents a not so favorable perception. In addition, through a comparative analysis, it was determined that the didactic strategies and planning factors have suffered a negative variation with respect to the perception per teacher, when moving from face-to-face to virtual learning, since, of the total of 17 specialty teachers, seven of them one negative variation. These results are validated by the linear regression test, where an R2 value of 0.965 is calculated, with respect to the didactic strategies factor. It means that this factor influences 96.5% on the perception of students with the global factor and an R2 value of 0.921 for the planning factor, which indicates an influence of 92.1%

Modelo de negocio para el desarrollo de una aplicación Financiera - FinTegra

En el presente trabajo se desarrollará la investigación para la validación del modelo de negocio de un aplicativo que ofrece herramientas y asesoramientos para incentivar el ahorro en las personas. La idea de negocio está orientada al segmento de clientes que ahorran, pero no saben administrarlo correctamente. Esta plataforma digital cuenta con diversas secciones de apoyo e información de cómo ahorrar su dinero e invertirlo en un futuro. Para la investigación del proyecto se realizaron experimentos que nos brindaron información sobre las necesidades y preferencias de los usuarios, asimismo se recolectaron datos reales que nos permitieron proyectar nuestras ventas y definir nuestros gastos. Dentro de estos experimentos se validaron cada parte del modelo de negocio planteado y la interacción entre el usuario y el prototipo del aplicativo a desarrollar. Con el objetivo de acercarnos más al segmento de los futuros clientes, además se desarrolló un plan de marketing para atraer al público objetivo a través de nuestras redes sociales y ello permitió generar las ventas de dicho aplicativo. Luego de ello, con los datos recopilados en los distintos experimentos y se elaboró un flujo de caja completo para nuestra idea de negocio proyectado a 3 años. Asimismo, se realizó el análisis y cálculo del financiamiento que el proyecto recibiría por parte del inversionista y de nosotros los fundadores. Finalmente, Fintegra demostró ser un proyecto innovador y de resultados positivos a un mediano plazo a pesar de la coyuntura.In this work, research will be developed to validate the business model of an application that offers tools and advice to encourage savings in people. The business idea is aimed at the segment of customers who save, but do not know how to manage it correctly. This digital platform has various support and information sections on how to save your money and invest it in the future. For the research of the project, experiments were carried out that gave us information about the needs and preferences of the users, as well as real data that allowed us to project our sales and define our expenses. Within these experiments, each part of the proposed business model and the interaction between the user and the prototype of the application to be developed were validated. In order to get closer to the segment of future customers, a marketing plan was also developed to attract the target audience through our social media, and that allowed us start selling our project of mobile app. After that, with the data collected in the different experiments and a complete cash flow was elaborated for our business idea projected to 3 years. Likewise, the analysis and calculation of the financing that the project would receive from the investor and us the founders was carried out. Finally, Fintegra proved to be an innovative project with positive results in the medium term despite the situation.Trabajo de investigació

Risk factors associated with prolonged neonatal intensive care unit stay after threatened late preterm birth*

Objective: To identify risk factors associated with neonatal intermediate or intensive care unit (NICU) stay ≥ 3 days among women with threatened late preterm birth (PTB). Study design: Secondary analysis of women with nonanomalous, singleton gestations enrolled in multicenter trial of betamethasone versus placebo for late PTB. Maternal and obstetric characteristics at time of presentation with threatened PTB were compared between those with and without NICU stay ≥3 days. Multivariable logistic regression identified risk factors for NICU stay ≥ 3 days. Result: Of 2795 eligible mother-neonate dyads, 962 (34%) had NICU stay ≥3 days. Gestational age and fetal growth restriction as the reason for threatened PTB had the strongest association with NICU stay ≥3 days in the final model (AUC 0.76). Conclusion: Maternal and obstetric characteristics at the time of admission for threatened late PTB should be considered when counseling patients about the probability of NICU stay ≥3 days

Regional Variation in Late Preterm Births in North Carolina

Late preterm (LPT) neonates (34 0/7th to 36 6/7th weeks' gestation) account for 70% of all premature births in the United States. LPT neonates have a higher morbidity and mortality risk than term neonates. LPT birth rates vary across geographic regions. Unwarranted variation is variation in medical care that cannot be explained by sociodemographic or medical risk factors; it represents differences in health system performance, including provider practice variation. The purpose of this study is to identify regional variation in LPT births in North Carolina that cannot be explained by sociodemographic or medical/obstetric risk factors

Association between Sarcopenia and Community-Acquired Pneumonia in elderly people of a hospital in Callao, Peru between 2010 and 2015.

Introducción: Sarcopenia es un síndrome geriátrico con una prevalencia de hasta el 50% en dicha población, la cual incrementa el riesgo de mortalidad e infecciones como la neumonía adquirida en la comunidad que es la primera causa infecciosa de mortalidad en adultos mayores. El objetivo del estudio es determinar la incidencia y los factores de riesgo para neumonía adquirida en la comunidad y sarcopenia en un hospital del Perú Métodos: Se realizó una cohorte retrospectiva en el servicio de Geriatría del Centro Médico Naval “Cirujano Mayor Santiago Tavara”. Se definió sarcopenia por los criterios de “Conceso Europeo de Sarcopenia” y neumonía adquirida en la comunidad por el diagnóstico consignado en la historia clínica en Clasificación Internacional de Enfermedades (CIE-10). Se utilizó como medida de asociación el riesgo relativo (RR) para las variables. Por último, la asociación entre sarcopenia y neumonía fue estimada mediante regresión de Poisson bivariado y multivariado. Resultados: Se incluyó 1598 sujetos, 59.0% hombres con una edad media de 78.3 ± 8.6 años. La prevalencia de sarcopenia fue 15.1% (IC95%: 13.3-16.8) y la incidencia de neumonía adquirida en la comunidad en pacientes con sarcopenia fue 44%; en comparación, con la población sin sarcopenia fue 10%. En el modelo multivariado, se halló mayor incidencia de neumonía en personas con sarcopenia comparado con no sarcopenia, RR(a) 3.88 (IC95% 2.82-5.33) Conclusión: Nuestro estudio demuestra mayor riesgo de neumonía adquirida en la comunidad en una población geriátrica del Perú.Introduction: Sarcopenia is a geriatric syndrome with a prevalence of up to 50% which increases the risk of mortality and nosocomial infections like community-acquired pneumonia, the first infectious-related cause of death in elderly people. The aim of our study was to determine the incidence and risk factors of community-acquired pneumonia in older adults with sarcopenia in a Peruvian hospital. Methods: A retrospective cohort study was conducted in the geriatrics service of Centro Medico Naval “Cirujano Mayor Santiago Tavara”. Sarcopenia was defined by “European Consensus of Sarcopenia” criteria and community-acquired pneumonia was defined by the diagnosis in the medical record with International Classification of Diseases 10th) ICD-10. The relative risk (RR) for the variables was used as a measure of association. Finally, the association between sarcopenia and pneumonia was estimated by bivariate and multivariate Poisson regression. Results: A total of 1598 subjects were enrolled, 59.0% were male; with a mean age of 78.3 ± 8.6 years. The prevalence of sarcopenia was 15.1% (95% CI: 13.3-16.8) and the incidence of community-acquired pneumonia in sarcopenic was 44%; instead in no sarcopenic was 10%. In the multivariate model, we found a higher incidence of pneumonia in sarcopenic compared to non-sarcopenic, RR(a) 3.88 (95% CI: 2.82-5.33). Conclusion: Our study showed a more risk of community-acquired pneumonia in a group of sarcopenics in Peru.Tesi

La importancia del índice de masa corporal en la fuerza muscular

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.Carta al EditorRevisión por pare

Diuretic Exposure in Premature Infants from 1997 to 2011

Diuretics are often prescribed off-label to premature infants, particularly to prevent or treat bronchopulmonary dysplasia (BPD). We examined their use and safety in this group