Factors Associated with the Need for Hospitalization, Length of Hospital Stay, and Parental Consent to Participate in Research among Children with Community Acquired Pneumonia

Community-acquired pneumonia (CAP) is the third leading cause of hospitalization among children in the U.S. This research is comprised of three studies of children with CAP. The data were collected for the CDCs Etiology of Pneumonia in the Community (EPIC) study. Study one aimed to examine the association of clinical factors with potentially unnecessary hospitalizations, as defined by a length of stay (LOS) in the hospital ≤ 24 hours. Study two aimed to validate the Canadian Acute Respiratory Illness and Flu Scale (CARIFS) questionnaire among an inpatient pediatric population with CAP. This study also examined the utility of the CARIFS questionnaire in predicting LOS in the hospital. Study three examined factors that could influence parental consent for their child to participate in research. Participants were children, 0-18 years old, classified into five age categories, who were hospitalized with CAP at one of three sites: Le Bonheur Children\u27s Hospital, Monroe Carell Jr. Children\u27s Hospital at Vanderbilt and Primary Children\u27sHospital.A short length of stay, ≤ 24 hours, was associated across all ages with higher oxygen saturation level at admission. Study two, the CARIFS survey, had high internal reliability among this population (Cronbach\u27s alpha = 0.89). The 18 CARIFS questions loaded onto four domains (physical function, parental impact, subjective symptoms and objective symptoms). Except for infants, the more severe the symptoms of physical function, the longer the LOS. In study three, households with less education were more likely to give consent for their child to participate than those with a college degree (OR = 4.78, 95% CI = 1.75, 13.05). Desire to learn more about their child\u27s illness (OR = 1.59, 95% CI = 1.06, 2.39) and altruism (OR = 3.64, 95% CI =2.20, 6.02) was also associated with higher participation, while concern about the nose and throat swab (OR = 0.48, 95% CI = 0.36, 0.65) was associated with lower participation. These findings show clinical presentation of CAP does not adequately predict LOS, while parent-reported markers of a child\u27s physical function may predict LOS. Detailed explanation of potential benefits and reducing invasive procedures could improve participation in research

Impact and Cost-Effectiveness of Point-Of-Care CD4 Testing on the HIV Epidemic in South Africa.

Rapid diagnostic tools have been shown to improve linkage of patients to care. In the context of infectious diseases, assessing the impact and cost-effectiveness of such tools at the population level, accounting for both direct and indirect effects, is key to informing adoption of these tools. Point-of-care (POC) CD4 testing has been shown to be highly effective in increasing the proportion of HIV positive patients who initiate ART. We assess the impact and cost-effectiveness of introducing POC CD4 testing at the population level in South Africa in a range of care contexts, using a dynamic compartmental model of HIV transmission, calibrated to the South African HIV epidemic. We performed a meta-analysis to quantify the differences between POC and laboratory CD4 testing on the proportion linking to care following CD4 testing. Cumulative infections averted and incremental cost-effectiveness ratios (ICERs) were estimated over one and three years. We estimated that POC CD4 testing introduced in the current South African care context can prevent 1.7% (95% CI: 0.4% - 4.3%) of new HIV infections over 1 year. In that context, POC CD4 testing was cost-effective 99.8% of the time after 1 year with a median estimated ICER of US$4,468/DALY averted. In healthcare contexts with expanded HIV testing and improved retention in care, POC CD4 testing only became cost-effective after 3 years. The results were similar when, in addition, ART was offered irrespective of CD4 count, and CD4 testing was used for clinical assessment. Our findings suggest that even if ART is expanded to all HIV positive individuals and HIV testing efforts are increased in the near future, POC CD4 testing is a cost-effective tool, even within a short time horizon. Our study also illustrates the importance of evaluating the potential impact of such diagnostic technologies at the population level, so that indirect benefits and costs can be incorporated into estimations of cost-effectiveness

How Can Viral Dynamics Models Inform Endpoint Measures in Clinical Trials of Therapies for Acute Viral Infections?

Acute viral infections pose many practical challenges for the accurate assessment of the impact of novel therapies on viral growth and decay. Using the example of influenza A, we illustrate how the measurement of infection-related quantities that determine the dynamics of viral load within the human host, can inform investigators on the course and severity of infection and the efficacy of a novel treatment. We estimated the values of key infection-related quantities that determine the course of natural infection from viral load data, using Markov Chain Monte Carlo methods. The data were placebo group viral load measurements collected during volunteer challenge studies, conducted by Roche, as part of the oseltamivir trials. We calculated the values of the quantities for each patient and the correlations between the quantities, symptom severity and body temperature. The greatest variation among individuals occurred in the viral load peak and area under the viral load curve. Total symptom severity correlated positively with the basic reproductive number. The most sensitive endpoint for therapeutic trials with the goal to cure patients is the duration of infection. We suggest laboratory experiments to obtain more precise estimates of virological quantities that can supplement clinical endpoint measurements

The Use of Top-Down Approach in Teaching Listening Through Short Stories

Listening comprehension is the first skill that students should master, because before someone understands and starts to speak, lie or she has to hear sounds, words, or speech pattern. Listening is considered as a difficult language skill since it involves some aspects of the language, for example, vocabulary, understanding the sound, grammar, getting, the mainL_ understandingidea, specific information and reference. The teaching of listening in formal schools is still considered unsuccessful for that it tends to make students boring. Therefore, English teachers should provide more challenging and interesting listening activities. Teaching listening withZ7short stories is said to be one of the way to reduce students boredom and to increase students listening comprehension.For the above reasons, this research was intended to find out whether there was significant improvement of students listening comprehension in short stories after being taught through top - down approach. This research was done in a group pretest posttest design. The population of this research was the eleventh grade in SMA YP UN ILA Bandar Lampung. The sample of this research was XI IPA I and was selected by using random sampling technique. In collecting the data, the researcher administered the pretest, the treatments and posttest. The data was analyzed by using repeated measure t-test. In which the significance was determined by p<0.05. The result of t-test computation showed that (-ratio was higher than t-table (t,>t,.J, that is, (29.330>2.021), it can be concluded that there was a significant improvement of students listening comprehension after being taught short stories through top - down approach. This means that teaching listening through short stories in a top-down approach was applicable to improve sttideiitslistening omprehension ability

Implementasi Perda No. 12 Tahun 2001 Tentang Pemakaian Busana Melayu di Lingkungan Pendidikan, Pegawai Negeri Sipil, Swasta / Badan USAha Milik Daerah di Kantor Dinas Pendapatan Daerah Kota Pekanbaru Tahun 2014

All associated with social norms, religion, customs, so clothing developed with the meaning of varied. Riau especially the City of Pekanbaru, ranging from the building to the street name indentik with malay, especially government buildings and museum. Malay clothes must be used by all levels of the start of the level of education from kindergarten to Senior High School private and state that is clothed in the Malays that the model is determined by the school and used on Friday. Malay clothes using some unique motifs malay, until the Malay batik. The purpose of this research is to know the implementation of Perda No. 12 2001 at the office of Regional Income City of Pekanbaru.Research method that will be used is a research survey. The location of this research is in the office of Regional Income City of Pekanbaru located in the way the Lotus, because they see government officials have not maximum of implementing Perda No. 12 The year 2001 about malay fashion consumption in the educational environment, Civil Servants, Private/Enterprises area. The reason for the taking of research in this location is because there is no scientific research reveals the problem as noted in this research.The results of research on the implementation of the Perda No. 12 2001 at the office of Regional Income City of Pekanbaru Years 2014, including the category of good, this shows that the policy of Malay fashion consumption in the City of Pekanbaru still needs to be repaired and improved again. Should the leaders of increasing positive influence to the officials with how to give an example of an example or a good example, has authority in front of civil servants in order to grow their sense of withheld or respect

The Use Of Top-Down Approach In Teaching Listening Through Short Stories

Listening comprehension is the first skill that students should master, because before someone understands and starts to speak, lie or she has to hear sounds, words, or speech pattern. Listening is considered as a difficult language skill since it involves some aspects of the language, for example, vocabulary, understanding the sound, grammar, getting, the mainL_ understandingidea, specific information and reference. The teaching of listening in formal schools is still considered unsuccessful for that it tends to make students boring. Therefore, English teachers should provide more challenging and interesting listening activities. Teaching listening withZ7short stories is said to be one of the way to reduce students boredom and to increase students listening comprehension.For the above reasons, this research was intended to find out whether there was significant improvement of students listening comprehension in short stories after being taught through top - down approach. This research was done in a group pretest posttest design. The population of this research was the eleventh grade in SMA YP UN ILA Bandar Lampung. The sample of this research was XI IPA I and was selected by using random sampling technique. In collecting the data, the researcher administered the pretest, the treatments and posttest. The data was analyzed by using repeated measure t-test. In which the significance was determined by p<0.05. The result of t-test computation showed that (-ratio was higher than t-table (t,>t,.J, that is, (29.330>2.021), it can be concluded that there was a significant improvement of students listening comprehension after being taught short stories through top - down approach. This means that teaching listening through short stories in a top-down approach was applicable to improve sttideiitslistening omprehension ability

Analisis Penyerapan Tenaga Kerja Sektor Pariwisata ( Sektor Perdagangan, Hotel dan Restoran ) di Kota Batu

Target of this research is to analyse impact change of commercial sector added value, restaurant and hotel in absorbtion of labour in Batu City year 2002-2011. This research use method research of analysis of regressi doubled linear. Result of research indicate that there is positive influence between PDRB commercial sector, restaurant and hotel (X) to Labour in commercial sector, restaurant and hotel (Y) equal to 43%. Becoming if PDRB commercial sector, restaurant and hotel (X) mount equal to 1 % of hence Labour in commercial sector, restaurant and hotel (Y) will go up equal to 43% conversely if commercial sector, restaurant and hotel (X) equal to 1 % of hence Labour in commercial sector, restaurant and hotel ( Y) will go down equal to 43% with other variable assumption remain to

Risk factors for the development of hepatocellular carcinoma (HCC) in chronic hepatitis B virus (HBV) infection:a systematic review and meta-analysis

Hepatocellular carcinoma (HCC) is one of the leading contributors to cancer mortality worldwide and is a leading cause of death in individuals with chronic hepatitis B virus (HBV) infection. It is uncertain how the presence of other metabolic factors and comorbidities influences HCC risk in HBV. Therefore, we performed a systematic literature review and meta‐analysis to seek evidence for significant associations. MEDLINE, EMBASE and Web of Science databases were searched from 1 January 2000 to 24 June 2020 for studies investigating associations of metabolic factors and comorbidities with HCC risk in individuals with chronic HBV infection, written in English. We extracted data for meta‐analysis and generated pooled effect estimates from a fixed‐effects model. Pooled estimates from a random‐effects model were also generated if significant heterogeneity was present. We identified 40 observational studies reporting on associations of diabetes mellitus (DM), hypertension, dyslipidaemia and obesity with HCC risk. Only DM had a sufficient number of studies for meta‐analysis. DM was associated with >25% increase in hazards of HCC (fixed‐effects hazards ratio [HR] 1.26, 95% confidence interval (CI) 1.20–1.32, random‐effects HR 1.36, 95% CI 1.23–1.49). This association was attenuated towards the null in a sensitivity analysis restricted to studies adjusted for metformin use. In conclusion, in adults with chronic HBV infection, DM is a significant risk factor for HCC, but further investigation of the influence of antidiabetic drug use and glycaemic control on this association is needed. Enhanced screening of individuals with HBV and diabetes may be warranted