Randolph L. Carter

Maternal and infant factors associated with excess kindergarten costs

Objective. To estimate the excess educational costs at kindergarten from infant and maternal factors that are reported routinely at birth. Methods. Birth and school records were analyzed for all children who were born in Florida between September 1, 1990, and August 31, 1991, and entered kindergarten from 1996 through 1999 (N = 120 554). Outcome measure was cost to state, derived from base allocation for students in regular classrooms plus multiplier weights for those who were assigned to 8 mutually exclusive special education categories or who repeated kindergarten. Results. More than one quarter of the study cohort was found to be assigned to special education classes at kindergarten. Regression model estimates indicated that children who were born at <1000 g (n = 380) generated 71% higher costs in kindergarten than children who were born at ≥2500 g. Children who were born at 1000 to 1499 g (n = 839) generated 49% higher costs. Other birth conditions, independent of birth weight, were associated with higher kindergarten costs: family poverty (31%), congenital anomalies (29%), maternal education less than high school (20%), and no prenatal care (14%). Because of their prevalence, family poverty and low maternal education accounted for >75% of excess kindergarten costs. If 9% of infants who weighed between 1500 and 2499 g (n = 1027) could be delivered at 2500 g, then the state of Florida potentially could save

Prevalence of various comorbidities among veterans with chronic kidney disease and its comparison with other datasets

1 million in kindergarten costs. Savings of a similar magnitude might be achieved if 3% of mothers who left school without a diploma (n = 1528) were to graduate. Conclusions. Any policy recommendation aimed at reducing education costs in kindergarten must take into consideration 3 factors: the prevalence of risk conditions whose amelioration is desired, the potential cost savings associated with reducing those conditions, and the costs of amelioration. Projecting these costs from information that is available at birth can assist school districts and state agencies in allocating resources.

Denervated Myocardium Is Preferentially Associated With Sudden Cardiac Arrest in Ischemic CardiomyopathyCLINICAL PERSPECTIVE: A Pilot Competing Risks Analysis of Cause-Specific Mortality

Abstract Chronic kidney disease (CKD) has a complicated interrelationship with various comorbidities. The purpose of this study was to describe the prevalence of various comorbidities among veterans with CKD and compare it with other datasets like Kidney Early Evaluation Program (KEEP), National Health and Nutrition Examination Survey (NHANES) and Medicare. Patients who had at least one outpatient visit in year 2007 (1 January 2007 to 31 December 2007) were included in the study (n =  75,787). Glomerular filtration rate (eGFR) was estimated by the Modification of Diet in Renal Disease (MDRD) study equation. CKD prevalence was calculated based on one or two serum creatinine values at least 3 months apart. Demographic data were obtained including age, gender, race, weight, height and body mass index (BMI). The prevalence of various comorbidities was also collected based on ICD 9 codes from the problem list. The prevalence of CKD among veterans was 47.3%, much higher than estimated in the US population. Patients with CKD were more likely to have any vascular disease (36.89% vs. 14.87%), diabetes (34.18% vs. 17.83%), hypertension (86.65% vs. 57.56%), and cancer (18.69% vs. 9.23%). Irrespective of age, the prevalence of vascular disease was much higher among veterans with CKD. The prevalence of coronary artery disease, peripheral vascular disease, and cancer was much higher among elderly veterans with CKD as compared to other datasets. CKD is a growing endemic associated with a high frequency of concomitant chronic illnesses. Public health resources should be applied for early recognition and risk modification of CKD.

Renin-Angiotensin-Aldosterone System Blockers in Elderly Adults with Chronic Kidney Disease without Diabetes Mellitus or Proteinuria

Background— Previous studies have identified multiple risk factors that are associated with total cardiac mortality. Nevertheless, identifying specific factors that distinguish patients at risk of arrhythmic death versus heart failure could better target patients likely to benefit from implantable cardiac defibrillators, which have no impact on nonsudden cardiac death. Methods and Results— We performed a pilot competing risks analysis of the National Institutes of Health–sponsored PAREPET trial (Prediction of Arrhythmic Events with Positron Emission Tomography). Death from cardiac causes was ascertained in subjects with ischemic cardiomyopathy (n=204) eligible for an implantable cardiac defibrillator for the primary prevention of sudden cardiac arrest after baseline clinical evaluation and imaging at enrollment (positron emission tomography and 2-dimensional echo). Mean age was 67±11 years with an ejection fraction of 27±9%, and 90% were men. During 4.1 years of follow-up, there were 33 sudden cardiac arrests (arrhythmic death or implantable cardiac defibrillator discharge for ventricular fibrillation or ventricular tachycardia >240 bpm) and 36 nonsudden cardiac deaths. Sudden cardiac arrest was correlated with a greater volume of denervated myocardium (defect of the positron emission tomography norepinephrine analog 11C-hydroxyephedrine), lack of angiotensin inhibition therapy, elevated B-type natriuretic peptide, and larger left ventricular end-diastolic volume index. In contrast, nonsudden cardiac death was associated with a higher resting heart rate, older age, elevated creatinine, larger left atrial volume index, and larger left ventricular end-diastolic volume index. Conclusions— Distinct clinical, laboratory, and imaging variables are associated with cause-specific cardiac mortality in primary-prevention candidates with ischemic cardiomyopathy. If prospectively validated, these multivariable associations may help target specific therapies to those at the greatest risk of sudden and nonsudden cardiac death. Clinical Trial Registration— URL: https://clinicaltrials.gov. Unique identifier: NCT01400334.

The Flipped Classroom in a Terminal College Mathematics Course for Liberal Arts Students

To compare the effect of renin‐angiotensin‐aldosterone system (RAAS) blockers with that of other antihypertensive agents on outcomes in a cohort of elderly veterans with incident chronic kidney disease (CKD) without diabetes mellitus or proteinuria.

Proton pump inhibitors are associated with increased risk of development of chronic kidney disease.

The purpose of this study was to assess the effect of flipping the classroom on final exam scores in a terminal general education college mathematics course for a diverse student population. We employed a quasiexperimental design. Seven instructors collectively taught 13 sections of each pedagogy (flipped/traditional). Six hundred thirty-two students participated. Common final exams were graded concurrently. Mixed-model analyses were performed. Students in flipped sections scored 5.1 percentage points higher on average than those in traditional sections (p = .02) when controlling for math SAT and financial aid status, an improvement of 7.8 points among Black students (p < .01) and 1.0 points among Whites (p = .67). The estimated average difference between White and Black students, conditional on covariates, was 5.2 percentage points in traditional sections (p < .01) and –1.6 in flipped sections (p = .39). The 6.8-point difference in achievement gap between pedagogies was statistically significant (p < .01). Flipping the classroom was associated with improved student performance, particularly among Black students.