Quasi-experimental Analysis Research Articles

High-flow nasal cannulas versus standard oxygen therapy for moderate bronchiolitis: a quasi-experimental analysis.

In the last decades none of the medical therapies investigated have shown clear efficacy in the treatment of bronchiolitis, and literature agrees on a general de-implementation of pharmacological therapies, recognizing an effective role only to nutritional support and oxygen therapy. High-flow nasal cannulas (HFNC) has become increasingly popular in the last decade, despite its lack of clear efficacy. Recent randomized controlled trials (RCT) comparing standard oxygen therapy (SOT) and HFNC did not demonstrate significant benefit of HFNC. To acquire more clinical data on HFNC efficacy we performed a retrospective, quasi-experimental analysis of patients admitted for bronchiolitis in the epidemic seasons 2021-2022 and 2022-2023. To assess the efficacy of SOT and HFNC we used a pragmatic approach, a fuzzy regression discontinuity design, which is a quasi-experimental test. Unlike RCTs, this process is not a true randomization, but may be interpreted as quasi-randomization in an observational setting. HFNC did not reduce length of oxygen therapy (LOO) nor length of hospitalization (LOS) (respectively, p: 0.383 and p: 0.454). Treatment failure was not significantly different in the treatment groups (p: 0.354). It is crucial to perform additional RCTs with uniform protocols to determine the efficacy of HFNC more accurately in the treatment of bronchiolitis. HFNC does not reduce LOO, suggesting that early use of HFNC does not change the course of disease in moderate bronchiolitis. In view of the greater complexity and higher cost, HFNC should not be routinely used as first-line treatment in children with moderate respiratory distress and mild hypoxemia.

Planning policies to restrict fast food and inequalities in child weight in England: a quasi-experimental analysis.

England has one of the highest childhood obesity rates in Europe. To promote a healthier food environment in 2015, Gateshead Council in North East England introduced planning guidelines effectively banning any new fast-food outlets. Our aim was to investigate whether this policy led to any reductions in childhood overweight and obesity prevalence and the inequalities in these outcomes. We used data from the National Child Measurement Programme, the Food Standards Agency Food Hygiene Rating Scheme data, and the Office of National Statistics between 2012 and 2020. We estimated a difference-in-differences model employing propensity score matching to identify a control group. We found no significant change in population-level childhood overweight and obesity in Gateshead compared with control areas. In subgroup analysis by area-level deprivation, we found that the quintile of deprivation with the highest proportion of fast-food outlets had a statistically significant reduction of 4.8% in the prevalence of childhood overweight and obesity compared with control areas. Restricting fast-food outlets in areas with a high concentration of such outlets as part of a package of policies to reduce childhood obesity may help to reduce prevalence and inequalities in childhood overweight and obesity.

30-Month Impact of Medications for Opioid Use Disorder on Acute Care Utilization in Rural Communities.

To assess both the short- and longer-term impact of offering medications for opioid use disorder (MOUD, ie, methadone, buprenorphine, or naltrexone) on rates of all-cause emergency department (ED) visits and acute inpatient admissions (IP) over a 30-month period among Medicaid enrollees with opioid use disorder (OUD) residing in rural communities. A quasi-experimental retrospective analysis of longitudinal Medicaid claims data among continuously enrolled adult patients with OUD residing in 71 predominantly rural counties in the United States between 2018 and 2020. A cohort of patients receiving MOUD treatment was compared against a contemporaneous propensity score-matched comparison group consisting of those who received no MOUD during the period. The sample included 5370 patients with OUD in each group. At the index period (ie, the month in which any MOUD was used for the first time), buprenorphine was the most commonly used MOUD (82% of the MOUD treatment group). By the eighth month since the index period, MOUD use dropped below 60% among the MOUD treatment group. Over the 30-month post-MOUD period, MOUD treatment was associated with 24% (112 vs 148 per 1000 per month) and 52% (21 vs 44) lower rates of ED visit and IP admission rates, respectively (P < 0.001), relative to the comparison group. Moreover, the reductions persisted well after the 18th month period. Receipt of MOUD was associated with both immediate- and long-term lower rates in acute care utilization rates among adult Medicaid beneficiaries with OUD residing in rural communities despite significant treatment discontinuation.

A quasi-experimental evaluation of RADAR: response awareness, de-escalation, and referral for people with behavioral health issues

ABSTRACT This paper describes the implementation and evaluation of RADAR (Response Awareness, De-Escalation, and Referral), a hybrid CIT/co-response program for people with behavioral health issues (PBHI). RADAR emphasized information sharing between police, PBHI, and behavioral health professionals and targeted outreach to PBHI by a police officer and clinician working in partnership. We evaluated RADAR using a quasi-experimental analysis of calls for service and incident data, an officer survey, and interviews with key personnel. While RADAR did not significantly reduce calls, incidents, or physical contact and resistance relative to a comparison jurisdiction, the survey and interviews suggest that it did help to shift the department’s culture and organizational perceptions around collaborative responses to PBHI. The practical implications of our findings for police agencies seeking to implement co-responder programs include the need to focus on sustainability; relationship building between the police, PBHI, and clinicians; and technological solutions to improve data collection and evaluation efforts.

Benefits by Luck: A Study of Lotteries as a Selection Method for Government Programs

Lotteries could be a just and cost-effective procedure to distribute government benefits in contexts of oversubscription, with the added benefit of allowing assessments of the impact of government programs. However, little is known about whether there is public support for employing lotteries in this context. We examine support for a lottery that selects recipients of new government-built housing units in Brazil and find that neither lotteries participants nor the general public supports their use. We arrive at this result by employing a three-pronged multi-method approach. Quasi-experimental analysis of an original survey of lottery participants reveals that support not only is tepid, but substantially higher among winners than non-winners. In-depth interviews suggest that applicants believe lotteries miss the most deserving beneficiaries. A general population survey experiment reveals that lotteries are not perceived as just or efficient when compared to alternative beneficiary selection methods. While sometimes normatively desirable, the use of lotteries for government programs enjoys limited popular support.

Long-term health outcomes of young patients with low complexity coronary disease: A weighted analysis according to revascularization strategy.

Age is an important factor weighing on revascularization outcomes decisions. We analysed long-term health outcomes of young patients with low complexity coronary anatomy suitable for both CABG and PCI, according to revascularization strategy. Patients 60 year-old or less, undergoing invasive coronary angiography between Jan/2007 and Dec/2015, presenting with proximal LAD involvement, left main or multivessel disease and a SYNTAX Score (SS) ≤22 were retrospectively selected. An inverse probability of treatment weight methodology generated a pseudopopulation with well-balanced characteristics, which was used to estimate the average treatment effect between PCI (n = 374) and CABG (n = 173). Mean age was 53 ± 7 yo, 27% had DM and 48% presented with an ACS. Mean SYNTAX Score was 13.6 ± 4.9 and 68% underwent PCI as index revascularization strategy. In the weighed population, the adjusted hazard of the primary end-point of all-cause death at total follow-up (median 9.3 years [IQR: 6.9; 11.7]) was 0.40 (95% CI 0.19-0.7) for CABG vs PCI (incidence-rate 5.8 vs 14.0 deaths/1000-person-years). Accounting for death as competing-risk, the cumulative hazard of new revascularization (sub-distribution HR 0.72; 95% CI 0.32-1.25) and any cause hospital readmission (sub-distribution HR 0.70; 95% CI 0.41-1.07) were lower in CABG patients, as opposed to death/stroke rates at 30-days which were higher with CABG (0.3% vs 1.7%; risk ratio = 5.84). In this quasi-experimental analysis of young patients with CAD and an equivalent indication for both PCI or CABG, improved long-term health outcomes were favourably associated with CABG, as compared to PCI. These observations support the need for dedicated randomized trials with longer follow-up in order to better inform lifetime treatment options.

Enhancing Adult Literacy in Morocco: A Quasi-Experimental Analysis of Program Effectiveness and Skill Development

This article presents a quasi-experimental study evaluating Morocco's Agency for Adult Education “Literacy for Empowerment” program, using propensity score matching to compare data from participants and nonparticipants. Framed within a theory supporting an all-inclusive concept of literacy, the study was guided by two main questions, and data was collected through literacy-relevant test instruments and a questionnaire. The results suggest that individuals who participated in the program had better skills than those who did not (counterfactual). These skills include: (1) literacy skills, (2) personal life, (3) family sphere, (4) inclusive decision-making skills, (5) social skills, (6) community engagement, and (7) economic empowerment. The article concludes that only a comprehensive approach to literacy education would enhance both the quality and benefits derivable from adult literacy programs, advocating for its expansion throughout both rural and urban areas to ensure universal access to basic education and promote active citizen participation in development initiatives.

Impact of Regulatory Interventions on Ulipristal Acetate 5 mg (Esmya) Use in Spain: An Interrupted Time-Series Analysis.

Since late 2017, the use of ulipristal acetate 5 mg (UPA; Proprietary name: Esmya) has been under review in the European Union, due to an emerging hepatic risk. In February 2018 and in July 2018, the Spanish Agency of Medicines and Medical Devices and the marketing authorization holder put two risk minimization measures (RMM) in place, in order to inform about new safety information and to mitigate this risk. This study aims to assess RMM effectiveness in Spain, by performing an interrupted time-series (ITS) analyses, between 2014 and 2019. Two quasi-experimental ITS analyses to examine the use of UPA before and after the RMM release were performed: (a) an ecological study using aggregated data from a drug consumption database; and (b) a study using primary healthcare data gathered from electronic clinical records. Regulatory interventions were associated with an immediate and significant decrease level of DID (the number of DDD dispensed per 100 000 inhabitants and day) and incidence. The DID was 70% less than expected 12 months after the interventions. This value was 59% for the incidence. However, a change in the slope was not observed and the use started rising again in the last segment of the study period. Despite RMM had an immediate strong impact on UPA use, the last segment upward trend in the long-term might have been affected by the lack of comparable therapeutic alternatives. Further studies should be performed to confirm the increase trend observed and analyze subsequent measures and additional data.

Nudging Towards Sleep-Friendly Hospitalizations: A Multifaceted Approach on Reducing Unnecessary Overnight Interventions.

Choice architecture refers to the design of decision environments, which can influence healthcare decision-making. Nudges are subtle adjustments in these environments that guide decisions toward desired outcomes. For example, Computerized Provider Order Entry (CPOE) within Electronic Health Records (EHR) recommends frequencies for interventions such as nursing assessments and medication administrations, but these can link to around-the-clock schedules without clinical necessity. This study aimed to evaluate an intervention to promote sleep-friendly practices by optimizing choice architecture and employing targeted nudges on inpatient order frequencies. We employed a quasi-experimental interrupted time series analysis of a multifaceted, multiphase intervention to reduce overnight interventions in a hospital system. Our intervention featured EHR modifications to optimize the scheduling of vital sign checks, neurological checks, and medication administrations. Additionally, we used targeted secure messaging reminders and education on an inpatient neurology unit (INU) to supplement the initiative. Significant increases in sleep-friendly medication orders were observed at the academic medical center (AMC) and community hospital affiliate (CHA), particularly for acetaminophen and heparin at the AMC. This led to a reduction in overnight medication administrations, with the most substantial decrease observed with heparin at all locations (CHA: 18%, AMC: 10%, INU: 10%, p<0.05). Sleep-friendly vital sign orders increased significantly at all sites (AMC: 6.7%, CHA 4.3%, INU: 14%, p<0.05), and sleep-friendly neuro check orders increased significantly at the AMC (8.1%, p<0.05). There was also a significant reduction in overnight neurological checks at the AMC. Tailoring EHR modifications and employing multifaceted nudging strategies emerged as promising approaches for reducing unnecessary overnight interventions. The observed shifts in sleep-friendly ordering translated into decreases in overnight interventions. Multifaceted nudges can effectively influence clinician decision-making and patient care. The varied impacts across nudge types and settings emphasize the importance of thoughtful nudge design and understanding local workflows.

Evaluating the combination of in-person and electronic social networking services for family caregivers of stroke survivors: A quasi-experimental analysis.

The effectiveness of health interventions delivered via a combination of in-person and electronic social networking services for caregivers of stroke survivors remains uncertain. This study evaluates the feasibility of implementing educational and peer support programs for these caregivers through such platforms. Quasi-experimental design. This study included 105 caregiver-survivor dyads, with 54 dyads allocated to the intervention group and the remaining 51 to the control group. The LINE intervention comprised a combination of in-person and electronic social networking services including stroke and rehabilitation education, problem-solving skills training, long-term care information support, and 24-h peer and professional support for caregivers. The outcomes were assessed at baseline, after 1 month, and after 3 months, and encompassed caregivers' care burden, depressive symptoms, perceived social support, and quality of life, as well as the rehabilitation adherence and depressive symptoms of stroke survivors. Generalized estimating equations were used to examine group differences. The data were collected between August 2021 and October 2022. The average age of the caregivers was 48.3 years. Caregivers in the intervention group reported reduced care burdens and enhanced perceptions of social support and quality of life as compared to those in the control group. Additionally, stroke survivors in the intervention group were less likely to exhibit high-risk depressive symptoms. Delivering a stroke caregiver support intervention via in-person and electronic social networking services, such as LINE, effectively reduced the care burden for caregivers of stroke survivors. Additionally, it enhanced caregivers' perceived social support and quality of life. This study demonstrated that caregiver education and peer support programs administered through a combination of in-person and electronic social networking services can serve as an effective support system for the psychosocial health of stroke caregivers. These findings support the integration of such interventions into standard clinical practice by healthcare providers or governmental bodies.

The effects of Bolsa Família on human development: systematic review approach

Usually conditional cash transfer programmes (CCTs) are interpreted as passive policies dealing with income maintenance and needs fulfilment. However, recently some of the literature has suggested a more active role for them. The aim of this article is to investigate the inclusive role of human rights-based CCTs using the Bolsa Família (BF) policy as a case study. Specifically, I assess the effect of this programme on human development using a systematic review of results from natural, quasi-experimental, counterfactual and longitudinal analyses. The main findings suggest some positive effect of the BF on human development. However, the BF programme should be more integrated with the education and the health system to ameliorate the advancement of human rights. For example, when social workers visit recipient families they should enrol children in the education system. Also, healthcare teams should visit recipient families more frequently and provide healthcare advice as well as healthcare support to ameliorate the nutritional and health status of children.

Evaluation of cooperative learning in science education: A mixed-meta method study

The aim of this study is to reveal the effect of cooperative learning method in science education on academic achievement with mixed-meta method. For this purpose, various national and international databases were searched, and among 81 articles and 37 theses covering the period between 2001 and 2022, 46 articles and 31 theses that included pre-test-post-test data and included the statistical information required for experimental or quasi-experimental analysis were preferred for meta-analysis. The effect size of 77 studies included in the analysis was found to be &lt;i&gt;g &lt;/i&gt;= 1.070 and it was seen that the cooperative learning method in science education had a positive and large effect on academic achievement. On the other hand, as a result of the meta-thematic analysis, it was determined that the cooperative learning method increased academic achievement due to the meaningful and permanent realisation of learning. In addition, thanks to the activities in which the student plays a central role, it is understood that it develops positive attitudes towards the science course depending on the results such as making the course enjoyable and fun, making it popular and interesting; it is effective in gaining 21&lt;sup&gt;st&lt;/sup&gt; century skills such as creativity, communication and cooperation, productivity and entrepreneurship. It is thought that examining the effects of cooperative learning method in science education with mixed-meta method will contribute to the literature by providing comprehensive results on the subject.

Impact of the targeted poverty alleviation policy on older adults’ healthcare utilization: A quasi-experimental analysis from China

China implemented the Targeted Poverty Alleviation (TPA) policy in 2015 to fight against poverty. In order to assess the health performance of the TPA policy, this study aims to evaluate the impact of the TPA policy on healthcare utilization among older adults who normally have higher vulnerability to poverty and diseases. Drawing on data from four waves of the China Health and Retirement Longitudinal Study (CHARLS), we investigated the impact of the TPA policy on older individuals' outpatient and inpatient utilization using the difference-in-differences (DID) approach. In total, 5285 older respondents were incorporated into a final sample. The results indicated that the implementation of the TPA policy had a significantly positive impact on increasing inpatient care utilization for poor older adults. However, its impact on outpatient service utilization was not significant. To ensure that the increased level of inpatient care utilization was not caused by deteriorating health status, we further analyzed the impact of the TPA policy on poor older adults’ health outcomes. Results indicated that the TPA policy improved self-rated health and reduced the number of ADL limitations among older adults in registered poor households. The positive impact of the TPA policy on inpatient care utilization was found to be most beneficial for older adults in poor households who were female, coupled, and aged 70 years and above. The TPA policy in China improved healthcare access for economically disadvantaged older adults and contributed to the enhancement of their health outcomes. This evidence may have broad implications for other low- and middle-income countries aiming to reduce poverty and achieve health equity.

Health Care Costs After Genome-Wide Sequencing for Children With Rare Diseases in England and Canada

Etiologic diagnoses for rare diseases can involve a diagnostic odyssey, with repeated health care interactions and inconclusive diagnostics. Prior studies reported cost savings associated with genome-wide sequencing (GWS) compared with cytogenetic or molecular testing through rapid genetic diagnosis, but there is limited evidence on whether diagnosis from GWS is associated with reduced health care costs. To measure changes in health care costs after diagnosis from GWS for Canadian and English children with suspected rare diseases. This cohort study was a quasiexperimental retrospective analysis across 3 distinct English and Canadian cohorts, completed in 2023. Mixed-effects generalized linear regression was used to estimate associations between GWS and costs in the 2 years before and after GWS. Difference-in-differences regression was used to estimate associations of genetic diagnosis and costs. Costs are in 2019 US dollars. GWS was conducted in a research setting (Genomics England 100 000 Genomes Project [100KGP] and Clinical Assessment of the Utility of Sequencing and Evaluation as a Service [CAUSES] Research Clinic) or clinical outpatient setting (publicly reimbursed GWS in British Columbia [BC], Canada). Participants were children with developmental disorders, seizure disorders, or both undergoing GWS between 2014 and 2019. Data were analyzed from April 2021 to September 2023. GWS and genetic diagnosis. Annual health care costs and diagnostic costs per child. Study cohorts included 7775 patients in 100KGP, among whom 788 children had epilepsy (mean [SD] age at GWS, 11.6 [11.1] years; 400 female [50.8%]) and 6987 children had an intellectual disability (mean [SD] age at GWS, 8.2 [8.4] years; 2750 female [39.4%]); 77 patients in CAUSES (mean [SD] age at GWS, 8.5 [4.4] years; 33 female [42.9%]); and 118 publicly reimbursed GWS recipients from BC (mean [SD] age at GWS, 5.5 [5.2] years; 58 female [49.2%]). GWS diagnostic yield was 143 children (18.1%) for those with epilepsy and 1323 children (18.9%) for those with an intellectual disability in 100KGP, 47 children (39.8%) in the BC publicly reimbursed setting, and 42 children (54.5%) in CAUSES. Mean annual per-patient spending over the study period was $5283 (95% CI, $5121-$5427) for epilepsy and $3373 (95% CI, $3322-$3424) for intellectual disability in the 100KGP, $724 (95% CI, $563-$886) in CAUSES, and $1573 (95% CI, $1372-$1773) in the BC reimbursed setting. Receiving a genetic diagnosis from GWS was not associated with changed costs in any cohort. In this study, receiving a genetic diagnosis was not associated with cost savings. This finding suggests that patient benefit and cost-effectiveness should instead drive GWS implementation.

Profile update: the effects of identity disclosure on network connections and language

Our social identities determine how we interact and engage with the world surrounding us. In online settings, individuals can make these identities explicit by including them in their public biography, possibly signaling a change in what is important to them and how they should be viewed. While there is evidence suggesting the impact of intentional identity disclosure in online social platforms, its actual effect on engagement activities at the user level has yet to be explored. Here, we perform the first large-scale study on Twitter that examines behavioral changes following identity disclosure on Twitter profiles. Combining social networks with methods from natural language processing and quasi-experimental analyses, we discover that after disclosing an identity on their profiles, users (1) tweet and retweet more in a way that aligns with their respective identities, and (2) connect more with users that disclose similar identities. We also examine whether disclosing the identity increases the chance of being targeted for offensive comments and find that in fact (3) the combined effect of disclosing identity via both tweets and profiles is associated with a reduced number of offensive replies from others. Our findings highlight that the decision to disclose one’s identity in online spaces can lead to substantial changes in how they express themselves or forge connections, with a lesser degree of negative consequences than anticipated.

Impact of narcotics information management system on inappropriate benzodiazepine receptor agonist prescriptions: A quasi-experimental analysis in South Korea.

The South Korean government implemented the narcotics information management system (NIMS) on 18 May 2018 to manage benzodiazepine receptor agonists (BzRAs) and narcotics effectively and establish a reporting mechanism for these drugs. This study assessed the effects of NIMS on inappropriate use of BzRAs. Using national patient sample data from 2016 to 2020, we analysed adult outpatients who were prescribed oral BzRAs. We conducted a time series and segmented regression analysis using selected indicators to analyse the monthly variations related to the inappropriate use of these medications. The study revealed no significant changes in the indicators of inappropriate BzRA use following the NIMS implementation. Contrary to expectations, there was a significant increase in the proportion of patients exceeding defined daily dose (DDD) and in those receiving concurrent prescriptions of multiple BzRAs, following the implementation of NIMS. The immediate impact of the COVID-19 pandemic was an increase in DDD exceedance; however, overall, this did not significantly affect BzRA use. The introduction of NIMS did not significantly enhance the management of BzRA misuse. Additional measures, including continuous monitoring, system improvements and comprehensive education for prescribers and patients, are recommended to ensure the appropriate use of psychotropic medications.

Impacts of DRG-Based Prepayment Reform on the Cost and Quality of Patients with Neurologic Disorders: Evidence from a Quasi-Experimental Analysis in Beijing, China.

As one of the pioneering pilot cities in China's extensive Diagnosis Related Groups (DRG) -based prepayment reform, Beijing is leading a comprehensive overhaul of the prepayment system, encompassing hospitals of varying affiliations and tiers. This systematic transformation is rooted in extensive patient group data, with the commencement of actual payments on March 15, 2022. This study aims to evaluate the effectiveness of DRG payment reform by examining how it affects the cost, volume, and utilization of care for patients with neurological disorders. Utilizing the exogenous shock resulting from the implementation of the DRG-based prepayment system, we adopted the Difference-in-Differences (DID) approach to discern changes in outcome variables among DRG payment cases, in comparison to control cases, both before and following the enactment of the DRG policy. The analytical dataset was derived from patients diagnosed with neurological disorders across all hospitals in Beijing that underwent the DRG-based prepayment reform. Strict data inclusion and exclusion criteria, including reasonableness tests, were applied, defining the pre-reform timeframe as March 15th through October 31st, 2021, and the post-reform timeframe as the corresponding period in 2022. The extensive dataset encompassed 53 hospitals and encompassed hundreds of thousands of cases. The implementation of DRG-based prepayment resulted in a substantial 12.6% decrease in total costs per case and a reduction of 0.96 days in length of stay. Additionally, the reform was correlated with significant reductions in overall in-hospital mortality and readmission rates. Surprisingly, the study unearthed unintended consequences, including a significant reduction in the proportion of inpatient cases classified as surgical patients and the Case Mix Index (CMI), indicating potential strategic adjustments by providers in response to the introduction of DRG payments. The DRG payment reform demonstrates substantial effects in restraining cost escalation and enhancing quality. Nevertheless, caution must be exercised to mitigate potential issues such as patient selection bias and upcoding.

Percutaneous Microaxial Ventricular Assist Device Versus Intra-Aortic Balloon Pump for Nonacute Myocardial Infarction Cardiogenic Shock.

Evidence on the comparative outcomes following percutaneous microaxial ventricular assist devices (pVAD) versus intra-aortic balloon pump for nonacute myocardial infarction cardiogenic shock is limited. We included 704 and 2140 Medicare fee-for-service beneficiaries aged 65 to 99 years treated with pVAD and intra-aortic balloon pump, respectively, for nonacute myocardial infarction cardiogenic shock from 2016 to 2020. Patients treated using pVAD compared with those treated using intra-aortic balloon pump were more likely to be concurrently treated with mechanical ventilation, renal replacement therapy, and blood transfusions. We computed propensity scores for undergoing pVAD using patient- and hospital-level factors and performed a matching weight analysis. The use of pVAD was associated with higher 30-day mortality (adjusted odds ratio, 1.92 [95% CI, 1.59-2.33]) but not associated with in-hospital bleeding (adjusted odds ratio, 1.00 [95% CI, 0.81-1.24]), stroke (adjusted odds ratio, 0.91 [95% CI, 0.56-1.47]), sepsis (OR, 0.91 [95% CI, 0.64-1.28]), and length of hospital stay (adjusted mean difference, +0.4 days [95% CI, -1.4 to +2.3]). A quasi-experimental instrumental variable analysis using the cross-sectional institutional practice preferences showed similar patterns, though not statistically significant (adjusted odds ratio, 1.38; 95% CI, 0.28-6.89). Our investigation using the national sample of Medicare beneficiaries showed that the use of pVAD compared with intra-aortic balloon pump was associated with higher mortality in patients with nonacute myocardial infarction cardiogenic shock. Providers should be cautious about the use of pVAD for nonacute myocardial infarction cardiogenic shock, while adequately powered high-quality randomized controlled trials are warranted to determine the clinical effects of pVAD.

Pengaruh Strategi True Or False Terhadap Hasil Belajar Siswa pada Mata Pelajaran Fiqih di MTss Proyek Kandepag Medan

ln education, achieving learning goals with good Iearning outcomes is a driving force that motivates individuals to do it optimally, and it is one of the desires that must be fulfilled. ln order to achieve learning goals, teachers are also required to understand and choose strategies, methods, or media that are engaging for students to implement. This is because several research studies have shown a positive relationship between learning strategies and students' learning achievements, with the frequency of using learning strategies significantly predicting academic performance or student achievement. Therefore, this study aims to determine the influence of the true or false strategy on students' learning outcomes in the subject of Fiqh in class VIII of MTSS Proyek Kandepag Medan. The method used in this study is quantitative research with quasi-experimental research data analysis, using a non-equivalent controi group design. The sampling technique used as purposive sampling, with two research samples, namely class VIII A (Control Class) and VlIl B (Experimental Class), the research instrument used was a test instrument consisting of 20 true or false statements. The research results found an average with the control class of 55.32, while the experimental class obtained an average of 79.86, so in this case, the true or false strategy influences the learning outcomes of students in the Fiqh subject.

Incidence of environmental factors on travertine façade of heritage buildings in the historic center of Cuenca-Ecuador. A test scenario through Digital Imagen Processing

The problem of architectural heritage conservation in a consolidated historic urban context is of worldwide relevance. In Ecuador, and specifically in Cuenca, there are no specific approaches to evaluate the environmental impact on the heritage deterioration, therefore, an alternative diagnostic of travertine facades is proposed to define the levels of deterioration based on climatic factors through a case study. Two research stages are developed; 1) preliminary diagnosis of the architectural, environmental and anthropic components, using architectural cards and Leopold’s Multivariable Matrix; and 2) quasi-experimental analysis with a mixed approach (quantitative and qualitative) based on real-time data collection of potential environmental variables to generate deterioration, which focuses on image processing. This technique is gaining momentum because it offers the possibility of studying the characteristics of surfaces through a non-invasive procedure. This paper describes the application of the Normalized Difference Vegetation Index (NVDI) algorithm applied to RGB images known as False-NVDI in order to obtain the deterioration caused by the incidence of environmental factors on the travertine facades. In particular, images of two buildings belonging to the Historic Center of the City of Cuenca were used. The results indicate that this technique has a great potential to determine three levels of deterioration; good, fair and bad. At the same time, it is confirmed that the proposed methodology is an effective and low-cost tool with high potential for short-term application in previous studies and more extensive research prior to intervention.