Digital inclusive finance, green technological innovation, and carbon emissions from a spatial perspective.

Based on the panel data of 276 prefecture-level cities in China from 2011 to 2020, this study explores the impact of digital inclusive finance (DIF) on carbon emissions and the intrinsic mechanism of green technological innovation from a spatial perspective by constructing a spatial econometric model, a mediating effect model, and a threshold model. The results show that DIF significantly inhibits carbon emissions, exhibiting a spatial spillover effect. The transmission mechanism from a spatial perspective shows that green technological innovation plays a partial mediating role between DIF and carbon emissions, with the mediating effect accounting for approximately 59.47%. The heterogeneity analysis suggests that the impact of DIF on the reduction of carbon emissions is more pronounced in large and medium-sized cities and eastern regions. Further discussion reveals that the carbon reduction effect of DIF is also influenced by green technological innovation and industrial structure upgrading, showing threshold effects with marginal decreases and gradual increases, respectively.

A comparison of healthcare utilization and outcomes following skin vs. serum-specific IgE allergy testing.

OBJECTIVE: To compare the cost, healthcare utilization, and outcomes between skin and serum-specific IgE (sIgE) allergy testing. METHODS: This retrospective cohort study used IBM® MarketScan claims data, from which commercially insured individuals who initiated allergy testing between January 1 and December 31, 2018 with at least 12 months of enrollment data before and after index testing date were included. Cost of allergy testing per patient was estimated by testing pattern: skin only, sIgE only, or both. Multivariable linear regression was used to compare healthcare utilization and outcomes, including office visits, allergy and asthma-related prescriptions, and emergency department (ED) and urgent care (UC) visits between skin and sIgE testing at 1-year post testing (α = 0.05). RESULTS: The cohort included 168,862 patients, with a mean (SD) age of 30.8 (19.5) years; 100,666 (59.7%) were female. Over half of patients (56.4%, n = 95,179) had skin only testing, followed by 57,291 patients with sIgE only testing and 16,212 patients with both testing. The average cost of allergy testing per person in the first year was $430 (95% CI $426-433) in patients with skin only testing, $187 (95% CI $183-190) in patients with sIgE only testing, and $532 (95% CI $522-542) in patients with both testing. At 1-year follow-up post testing, there were slight increases in allergy and asthma-related prescriptions, and notable decreases in ED visits by 17.0-17.4% and in UC visits by 10.9-12.6% for all groups (all p < 0.01). Patients with sIgE-only testing had 3.2 fewer allergist/immunologist visits than patients with skin-only testing at 1-year follow-up (p < 0.001). Their healthcare utilization and outcomes were otherwise comparable. CONCLUSIONS: Allergy testing, regardless of the testing method used, is associated with decreases in ED and UC visits at 1-year follow-up. sIgE allergy testing is associated with lower testing cost and fewer allergist/immunologist visits, compared to skin testing.

A Fully Automated Mini-Mental State Examination Assessment Model Using Computer Algorithms for Cognitive Screening.

Background: Rapidly growing healthcare demand associated with global population aging has spurred the development of new digital tools for the assessment of cognitive performance in older adults. Objective: To develop a fully automated Mini-Mental State Examination (MMSE) assessment model and validate the model's rating consistency. Methods: The Automated Assessment Model for MMSE (AAM-MMSE) was an about 10-min computerized cognitive screening tool containing the same questions as the traditional paper-based Chinese MMSE. The validity of the AAM-MMSE was assessed in term of the consistency between the AAM-MMSE rating and physician rating. Results: A total of 427 participants were recruited for this study. The average age of these participants was 60.6 years old (ranging from 19 to 104 years old). According to the intraclass correlation coefficient (ICC), the interrater reliability between physicians and the AAM-MMSE for the full MMSE scale AAM-MMSE was high [ICC (2,1)=0.952; with its 95% CI of (0.883,0.974)]. According to the weighted kappa coefficients results the interrater agreement level for audio-related items showed high, but for items "Reading and obey", "Three-stage command", and "Writing complete sentence" were slight to fair. The AAM-MMSE rating accuracy was 87%. A Bland-Altman plot showed that the bias between the two total scores was 1.48 points with the upper and lower limits of agreement equal to 6.23 points and -3.26 points. Conclusions: Our work offers a promising fully automated MMSE assessment system for cognitive screening with pretty good accuracy.

Adaptability of water resources development and utilization to social-economy system in Hunan province, China.

The interplay of water resources with social-economy spheres involves a reciprocal feedback mechanism. With the acceleration of the construction process of modernized water networks in Hunan Province, investigating the adaptation status of the "Water-Social-Economy " composite system (WSE) is crucial for promoting sustainability. This study clarifies the connotation of the adaptability of WSE, and the quantitative analyses were conducted through coupling coordinative degree, harmonious development capacity, and the evolution of development lag types among the 14 cities of Hunan Province from 2005 to 2020. The results show that: (1) The development index of the water resources subsystem (WRS) showed a "downward-fluctuation-upward" trend, while the development index of the social-economy subsystem (SES) showed signs of great improvement, the former didn't catch up with the latter. (2) The coupling coordination degree of WSE developed well, and reached the coordinative development stage by 2020, but the unbalanced spatial pattern between north to south and east to west still exists and is further intensified. (3) The development ability of WSE improved while the harmony ability reduced, and the development rate of WRS and SES hasn't achieved dynamic synchronization. Finally, the policies and suggestions to improve the adaptability are put forward, which is of instructive significance for the sustainable development of water suitability.

Can digital economy improve employment structure?-Mediating effect based on a spatial Durbin model.

Based on the panel data of 283 prefecture-level cities in China from 2011 to 2019, this study constructed an index measurement system of digital economy, economic agglomeration, innovation and entrepreneurship, and employment structure. The index of digital economy was developed by entropy weight method, and the double-fixed spatial Durbin model was constructed based on the intermediary effect from the spatial perspective to determine the direct effect, indirect effect, and total effect of the digital economy, economic agglomeration degree, and innovation and entrepreneurship on employment structure. The results indicated a significant spatial correlation between the three aspects, i.e., digital economy can significantly optimize the employment structure, with an evident spillover effect. The mechanism analysis revealed that the level of innovation and entrepreneurship poses a stronger intermediary effect than the degree of economic agglomeration, and the digital economy in the eastern region directly impacts the urban employment structure; however, the influence of digital economy on the employment structure is significantly higher in small- and medium-sized cities than in large-sized cities.

Did regional coordinated development policy mitigate carbon emissions? Evidence from the Beijing-Tianjin-Hebei region in China.

In order to promote the balanced development of regional economy, governments at all levels are constantly introducing regional coordinated development policy (hereinafter referred to as "the Policy"). However, there is an important and interesting issue, namely, with the increasingly severe environmental problems resulted from rapid regional economic growth, what kind of impact will the Policy have on carbon emissions reduction? This is attracting wide attention from relevant stakeholders. Therefore, taking the Beijing-Tianjin-Hebei (BTH) region in China for example and through constructing the difference-in-differences (DID) model, this paper evaluated the effect of the implementation of the Policy on carbon emissions reduction. Results indicated that the Policy significantly reduced the level of regional carbon emissions in the BTH region. After carrying out a series of robustness tests, this paper still found that the above conclusions were reliable. Moreover, the mediation effect test shown that the Policy indirectly lessened carbon emissions by optimizing energy structure and reducing the intensity of carbon emissions, while the expanding of economic scale would lead to an increase in carbon emissions due to the effect from the Policy. Additionally, heterogeneity analysis revealed that the Policy had a more significant effect on carbon emissions reduction in underdeveloped regions with low environmental constraints. Overall, this paper would be beneficial to understanding the environmental effects of the Policy at the urban regional scale, thus providing an important basic theoretical basis for promoting the green and sustainable development of regional economy.

Cost of Serum Versus Skin Allergy Testing Among Medicare Fee-for-Service Beneficiaries in the United States.

Background: Testing for allergic sensitization can be achieved similarly via skin or serum specific immunoglobulin E (sIgE) testing, although the costs of each method differ. Objective: This study compared cost and utilization of allergy testing utilizing skin vs sIgE testing and whether equal access (parity) to both testing methods affects overall allergy testing costs among Medicare fee-for-service beneficiaries in the United States. Methods: Allergy test utilization and payment data were analyzed using 100% 2019 Medicare fee-for-service claims data. Beneficiaries with any sIgE test, skin prick test, or intradermal skin test associated with ICD-10 codes of allergic rhinitis, asthma, and food allergy were included. Aggregate and per-beneficiary testing cost, number of allergens tested, and number of allergy-related specialist visits incurred were estimated by the testing patterns of sIgE only, skin prick only, intradermal only, skin prick and intradermal, and sIgE plus prick and/or intradermal. Medicare Administrative Contractors (MACs) with parity for all allergy tests and those which restricted sIgE testing were compared. Multivariate linear regression was performed on the association between testing patterns and each cost and utilization measure, controlling for parity, age, sex, race/ethnicity, and dual-eligible status. Results: We analyzed 270 831 patients and 327 263 allergy-related claims. Total payment for all allergy tests was $71 380 866, including $15 903 954 for sIgE tests, $42 223 930 for skin prick tests, and $13 252 982 for intradermal tests. Beneficiaries receiving sIgE tests had only 1.8 fewer allergist visits than those with skin prick tests only (0.8 vs 2.6). Cost of testing per beneficiary was also lower in sIgE testing only compared with skin prick tests only ($161 vs $247). Multivariable regression results showed per-beneficiary payments for allergy testing were on average $22 lower in MACs with parity compared with MACs without parity. Discussion: Serum specific IgE testing is associated with lower costs and fewer allergy specialist visits compared with skin testing. Insurance coverage with parity toward sIgE and skin testing is associated with lower overall costs of allergy testing. Conclusion: Among Medicare fee-for-service beneficiaries in the United States, sIgE testing may be more cost effective compared with skin testing in the management of allergic disease.

Machine learning-enabled regional multi-hazards risk assessment considering social vulnerability.

The regional multi-hazards risk assessment poses difficulties due to data access challenges, and the potential interactions between multi-hazards and social vulnerability. For better natural hazards risk perception and preparedness, it is important to study the nature-hazards risk distribution in different areas, specifically a major priority in the areas of high hazards level and social vulnerability. We propose a multi-hazards risk assessment method which considers social vulnerability into the analyzing and utilize machine learning-enabled models to solve this issue. The proposed methodology integrates three aspects as follows: (1) characterization and mapping of multi-hazards (Flooding, Wildfires, and Seismic) using five machine learning methods including Naïve Bayes (NB), K-Nearest Neighbors (KNN), Logistic Regression (LR), Random Forest (RF), and K-Means (KM); (2) evaluation of social vulnerability with a composite index tailored for the case-study area and using machine learning models for classification; (3) risk-based quantification of spatial interaction mechanisms between multi-hazards and social vulnerability. The results indicate that RF model performs best in both hazard-related and social vulnerability datasets. The most cities at multi-hazards risk account for 34.12% of total studied cities (covering 20.80% land). Additionally, high multi-hazards level and socially vulnerable cities account for 15.88% (covering 4.92% land). This study generates a multi-hazards risk map which show a wide variety of spatial patterns and a corresponding understanding of where regional high hazards potential and vulnerable areas are. It emphasizes an urgent need to implement information-based prioritization when natural hazards coming, and effective policy measures for reducing natural-hazards risks in future.

Assessment of myocardial bridging and the pericoronary fat attenuation index on coronary computed tomography angiography: predicting coronary artery disease risk.

BACKGROUND: The fat attenuation index (FAI) is a radiological parameter that represents pericoronary adipose tissue (PCAT) inflammation, along with myocardial bridging (MB), which leads to pathological shear stress in the coronary vessels; both are associated with coronary atherosclerosis. In the present study, we assessed the predictive value of FAI values and MB parameters through coronary computed tomography angiography (CCTA) for predicting the risk of coronary atherosclerosis and vulnerable plaque in patients with MB. METHODS: We included 428 patients who underwent CCTA and were diagnosed with MB. FAI values, MB parameters, and high-risk coronary plaque (HRP) characteristics were recorded. The subjects were classified into two groups (A and B) according to the absence or presence of coronary plaque in the segment proximal to the MB. Group B was further divided into Groups B1 (HRP-positive) and B2 (HRP-negative) according to the HRP characteristic classification method. The differences among the groups were analysed. Multiple logistic regression analysis was performed to determine the independent correlation between FAI values and MB parameters and coronary atherosclerosis and vulnerable plaque risk. RESULTS: Compared to the subjects in Group A, those in Group B presented greater MB lengths, MB depths and muscle index values, more severe MB systolic stenosis and higher FAIlesion values (all P < 0.05). In multivariate logistic analysis, age (OR 1.076, P < 0.001), MB systolic stenosis (OR 1.102, P < 0.001) and FAIlesion values (OR 1.502, P < 0.001) were independent risk factors for the occurrence of coronary atherosclerosis. Compared to subjects in Group B2, those in Group B1 presented greater MB lengths and higher FAI values (both P < 0.05). However, only the FAIlesion value was an independent factor for predicting HRP (OR 1.641, P < 0.001). CONCLUSION: In patients with MB, MB systolic stenosis was associated with coronary plaque occurrence in the segment proximal to the MB. The FAI value was not only closely related to coronary atherosclerosis occurrence but also associated with plaque vulnerability. FAI values may provide more significant value in the prediction of coronary atherosclerosis than MB parameters in CCTA.

Digital economy, scientific and technological innovation, and high-quality economic development: A mediating effect model based on the spatial perspective.

Although the effect of the digital economy in promoting high-quality economic development is increasing day by day, research analysing this mechanism from the spatial perspective is very scarce. This study measures the level of the digital economy and high-quality economic development based on the panel data of 31 provinces in China from 2013 to 2020. On this basis, the direct, spillover, and mediating effects of the digital economy and scientific and technological innovation on high-quality economic development are further analysed through the spatial Durbin model and mediating effect model. The main conclusions are as follows: (1) the digital economy, scientific and technological innovation, and high-quality economic development all show significant spatial correlation; (2) the digital economy can directly drive high-quality economic development, the spillover effect of which is obvious; and (3) the mechanism analysis based on the spatial perspective shows that the mediating effect of scientific and technological innovation is significant. The conclusions still hold after robustness tests based on the use of lagged variables, replacement of the weight matrices, and changing of the measurement methods. This study provides theoretical support and empirical evidence for promoting the digital economy and high-quality economic development.

Distributed Economic Control of Dynamically Coupled Networks.

This article investigates the synthesis of distributed economic control algorithms under which dynamically coupled physical systems are regulated to a variational equilibrium of a constrained convex game. We study two complementary cases: 1) each subsystem is linear and controllable and 2) each subsystem is nonlinear and in the strict-feedback form. The convergence of the proposed algorithms is guaranteed using the Lyapunov analysis. Their performance is verified by two case studies on a multizone building temperature regulation problem and an optimal power flow problem, respectively.

Price Attractiveness and Price Complexity: Why People Prefer Level-Payment Loans.

The improving sequence effect suggests that in choices between a rising earning and any other sequences, participants prefer the rising earning. Recent studies show that the improving sequence effect also exists in a loan context. As consumers have a strong preference for falling loan profiles, banks may consider to offer loans in which the loan repayments concentrate at the beginning of the loan term. In this paper, we examined the improving sequence effect in context of a car loan with three repayment plans expressed in temporally reframed prices (TRP). By regressing the evaluation of loan profiles on the perceived price attractiveness, price complexity, TRP and the interaction terms, we find that (1) the perceived price attractiveness and price complexity significantly predict the loan evaluation, and they also explain a significant proportion of variance in loan evaluation; (2) the TRP effect interacts with the improving sequence effect. Specifically, with the introduction of TRP, respondents prefer constant profiles over falling profiles. TRP may explain why level-payment loans are still popular in real world, though the improving sequence effect suggests otherwise.

Optimal Time Point for 68Ga-PSMA-11 PET/CT Imaging in the Assessment of Suspected Metastatic Prostate Cancer in the Bladder of Postprostatectomy Patient.

ABSTRACT: A 77-year-old man with prostate cancer had prostatectomy and hormonal therapy and underwent pelvic MRI and 68Ga-PSMA-11 PET/CT during clinical follow-up. A pelvic MRI scan showed suspected metastasis along the posterior wall of urinary bladder. The 68Ga-PSMA-11 PET/CT was acquired in a dual-time point fashion, at 60 minutes and 110 minutes postinjection. At 60 minutes postinjection, the known bladder wall lesion showed lower than urine background uptake. On 110 minutes delayed images, the bladder wall lesion showed avid PSMA uptake, much higher than the urine background, increased PSMA uptake by the tumor over time, and improved contrast in the lesion.

Analysis of Early Job Market Experiences and Perceptions Among Bariatric Surgery Fellowship Graduates and Bariatric Surgery Program Directors.

PURPOSE: Over the past decade, an increasing number of bariatric surgeons are trained in fellowships annually despite only a modest increase in nationwide bariatric surgery volume. The study surveys the bariatric surgery job market trend in order to inform better career-choice decisions for trainees interested in this field. MATERIALS AND METHODS: A national retrospective cohort survey over an 11-year period was conducted. Bariatric surgery fellowship graduates from 2008 to 2019 and program directors (PDs) were surveyed electronically. Univariate analysis was performed comparing responses between earlier (2008-2016) and recent graduates (2017-2019). RESULTS: We identified a total of 996 graduates and 143 PDs. Response rates were 9% and 20% respectively (n = 88, 29). Sixty-eight percent of graduates felt there are not enough bariatric jobs for new graduates. Seventy-nine percent of PDs felt that it is more difficult to find a bariatric job for their fellows now than 5-10 years ago. Forty-eight percent of PDs felt that we are training too many bariatric fellows. Seventy-seven percent of all graduates want the majority of their practice to be comprised bariatric cases; however, only 42% of them reported achieving this. In the univariate analysis, recent graduates were less likely to be currently employed as a bariatric surgeon (64% vs. 86%, p = 0.02) and were less satisfied with their current case volume (42% vs. 66%, p = 0.01). CONCLUSIONS: The temporal increase in bariatric fellowship graduates over the past decade has resulted in a significant decline in the likelihood of employment in a full-time bariatric surgical practice and a decline in surgeons' bariatric case volumes.

Sensory assessment and block duration of transmuscular quadratus lumborum block at L2 versus L4 in volunteers: a randomized controlled trial.

BACKGROUND: The efficacy of an ultrasound guided transmuscular quadratus lumborum block (QLB) for perioperative analgesia of the upper and lower abdomen remain debatable. The purpose of this study was to compare the cutaneous sensory blocked area (CSBA) between QLB blocks performed at the L2 vs. L4 levels. METHODS: Twenty-two healthy volunteers were randomized 1:1 to receive an ultrasound guided right transmuscular QLB at the L2 level (group QL2) or L4 level (group QL4). A cold stimulus was applied for testing of the CSBA at 30 minutes after the blockade was performed. The CSBA was mapped and then calculated. Three hours after the QLB, a cold stimulus was applied once every hour until sensation returned normal and the effective block duration for each volunteer was determined and recorded. RESULTS: The maximum cephalad dermatome level reached was T7 in group QL2 vs. T11 in group QL4, respectively. Caudally, both groups reached the L2 dermatome level. The QL2 block primarily affected dermatomes T9 to L1, while the QL4 block affected T11 to L1. The total CSBA was larger in QL2 group than that in QL4 group (748 [171] cm2 vs. 501 [186] cm2, P=0.004). The effective duration of the QLB was significantly longer in group QL2 than in group QL4 (18.5 [2.0]h vs. 14.1 [4.7]h, P=0.012). The number of affected dermatomes assessed by cold test was significantly larger for the volunteers in groups QL2 (4.6 [0.81] vs. 2.1 [0.30], P<0.001). CONCLUSIONS: Ultrasound guided transmuscular QLB injection of 0.375% 20 mL ropivacaine at the L2 level produced a widespread cutaneous sensory blockade and a prolonged sensory block to cold sensation compared with the L4 level.

Role of provider encouragement on patient engagement via online portals.

OBJECTIVE: The study sought to examine whether provider encouragement is associated with improvements in engaging patients with their healthcare processes using online portals. MATERIALS AND METHODS: Using the Health Information National Trends Survey 2017 (N = 2, 670), we conducted an exploratory factor analysis with varimax orthogonal rotation and derived 3 outcome variables on patient engagement: (1) information access score, (2) care convenience score, and (3) patient engagement score. Multivariable linear regression on each outcome variable was conducted with provider encouragement as the main predictor, controlling for patient demographics. RESULTS: Women (60%), white participants (69%), and those with a college degree (49%) were more likely to report receiving provider encouragement. Those who were encouraged to use patient portals scored higher on all 3 outcome measures compared with those who were not encouraged (B = 0 .80 vs B = 0.11 for information access, B = 1.13 vs B = 0.13 for care convenience, and B = 0.44 vs B = 0.05 for patient engagement; all P < .001). For every additional 100 patients receiving encouragement, 65 more information access tasks, 94 more care convenience tasks, and 40 more patient engagement tasks would be performed. DISCUSSION: Provider encouragement was most influential concerning care convenience tasks and least influential on complex decision-making tasks. This may be due to portal design and the content available to patients, which merit consideration in future studies. CONCLUSIONS: Provider encouragement is associated with more patient engagement, as indicated by significantly higher utilization of patient portals for accessing information, participating in routine care processes, and making complex healthcare decisions.

The prevalence and clinical risk factors of insomnia in the Chinese elderly based on comprehensive geriatric assessment in Chongqing population.

BACKGROUND: Insomnia is a major public health problem affecting older people. This study aimed to investigate the prevalence and clinical risk factors of insomnia in a representative sample of Chinese elderly (≥ 60 years) in Chongqing. METHODS: A cross-sectional study based on comprehensive geriatric assessment was conducted from January 2013 to February 2014. A questionnaire on sleep status was provided to each patient and insomnia was assessed according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria. A multivariate logistic regression model was used to illustrate risk factors correlated with insomnia. RESULTS: Of the total 597 participants, 55.4% suffered from insomnia. The prevalence of insomnia in men and women was 48.2% and 63.2%, respectively. Coronary heart disease, dizziness, chronic pain, anorexia, malnutrition, depression and cognitive decline were identified as risk factors associated with insomnia. Hypertension, diabetes, hyperlipidaemia, headache, age and education level were not observed to be significantly associated with insomnia. CONCLUSIONS: Insomnia is highly prevalent among the elderly in Chongqing, and shows a positive correlation to coronary heart disease, dizziness, chronic pain, anorexia, malnutrition, depression, cognitive impairment. Moreover, women are more likely to experience insomnia than men.

Phototherapy for Neonatal Unconjugated Hyperbilirubinemia: Examining Outcomes by Level of Care.

OBJECTIVES: Newborns hospitalized with unconjugated hyperbilirubinemia without critical comorbidities may receive intensive phototherapy (IP) in non-ICU levels of care, such as a mother-newborn unit, or ICU levels of care. Our aim was to compare outcomes between each level. METHODS: Using hospital discharge data from 2005 to 2011 in New York's State Inpatient Database, we performed multivariate analyses to compare outcomes that included total cost of hospitalization, length of stay, 30-day readmission rate after IP, and the number of cases of death, exchange transfusion, and γ globulin infusion. We included term newborns treated with IP in their first 30 days of life and without diagnosis codes for other critical illnesses. Explanatory variables included level of care, sex, race, insurance type, presence or absence of hemolysis, hospital, volume of IP performed at each hospital, and year of hospitalization. RESULTS: Ninety-nine percent of IP was delivered in non-ICU levels of care. Incidence of major complications was rare (≤0.1%). After adjusting for confounders, ICU level of care was not associated with difference in length of stay (relative risk: 1.2; 95% confidence interval [CI]: 0.91 to 1.15) or 30-day readmission rate (odds ratio: 0.74; 95% CI: 0.50 to 1.09) but was associated with 1.51 (95% CI: 1.47 to 1.56) times higher costs. CONCLUSIONS: For otherwise healthy term newborns with jaundice requiring IP, most received treatment in a non-ICU level of care, and those in intensive care had no difference in outcomes but incurred higher costs. IP guideline authors may want to be more prescriptive about IP level of care to improve value.

$k$ -Times Markov Sampling for SVMC.

Support vector machine (SVM) is one of the most widely used learning algorithms for classification problems. Although SVM has good performance in practical applications, it has high algorithmic complexity as the size of training samples is large. In this paper, we introduce SVM classification (SVMC) algorithm based on -times Markov sampling and present the numerical studies on the learning performance of SVMC with -times Markov sampling for benchmark data sets. The experimental results show that the SVMC algorithm with -times Markov sampling not only have smaller misclassification rates, less time of sampling and training, but also the obtained classifier is more sparse compared with the classical SVMC and the previously known SVMC algorithm based on Markov sampling. We also give some discussions on the performance of SVMC with -times Markov sampling for the case of unbalanced training samples and large-scale training samples.

Clinical and socioeconomic factors associated with negative pediatric appendicitis.

BACKGROUND: Misdiagnosing appendicitis may lead to unnecessary surgery. The study evaluates the risk factors for negative appendectomies, as well as the clinical and socioeconomic consequences of negative appendectomy across three states. MATERIALS AND METHODS: Data were obtained from the California, New York, and Florida State Inpatient Databases 2005-2011. Patients (<18 years) who underwent nonincidental appendectomies (n = 156,660) were evaluated with hierarchical and multivariate negative binomial regression analyses on outcomes including hospital cost, length of stay (LOS), and associated morbidity. RESULTS: From 2005 to 2011, there was a decrease in the rate of negative appendicitis and perforated appendicitis, whereas the rate of true acute nonperforated appendicitis increased. Whites, females, and privately insured patients were associated with higher negative appendicitis rates, whereas those at an increased risk for perforated appendicitis were African-Americans, males, and those with public or no insurance. Compared to patients with acute nonperforated appendicitis, those with negative appendicitis have significantly higher morbidity (2.5% versus 1.3%), longer LOS (3.4 versus 1.8 d), and greater hospital costs averaged over time ($6926 versus $6492 per patient). CONCLUSIONS: Despite a low incidence, negative appendicitis is associated with greater morbidity, longer LOS, and higher cost than acute nonperforated appendicitis. Certain subpopulations are at higher risk for undergoing surgery for negative appendicitis, whereas others are at greater risk for presenting with perforated appendicitis. Further research is needed to understand what drives such disparities and to inform efforts to improve quality of hospital care across all groups of patients.