2,539 research outputs found
External Validation of the Revised Cardiac Risk Index and the Geriatric-Sensitive Perioperative Cardiac Risk Index in Oldest Old Patients Following Surgery Under Spinal Anaesthesia; a Retrospective Cross-Sectional Cohort Study
No full textNirmeen Fayed,1,2 Sally Waheed Elkhadry,3 Andreas Garling,1 Richard K Ellerkmann1,4 1Anethesia and Critical Care Department, Klinikum Dortmund, Dortmund, Germany; 2Anesthesia and Critical Care Department, National Liver Institute Menoufia University, Shebin-Alkoom, Egypt; 3Epidemiology and Preventive Medicine Institute, National Liver Institute, Menoufia University, Shebin-Alkoom, Egypt; 4Anesthesia and Critical Care Department, Bonn University, Bonn, GermanyCorrespondence: Nirmeen Fayed, Anesthesia Department Klinikum Dortmund, Germany, Mollwitzer Straße 4, Dortmund, 44141, Germany, Tel +49 17647154842, Email [email protected]: The Revised Cardiac Risk Index (RCRI) and the Geriatric Sensitive Cardiac Risk Index (GSCRI) estimate the risk of postoperative major adverse cardiac events (MACE) regardless of the type of anesthesia and without specifying the oldest old patients. Since spinal anesthesia (SA) is a preferred technique in geriatrics, we aimed to test the external validity of these indices in patients ≥ 80 years old who underwent surgery under SA and tried to identify other potential risk factors for postoperative MACE.Methods: The performance of both indices to estimate postoperative in-hospital MACE risk was tested through discrimination, calibration, and clinical utility. We also investigated the correlation between both indices and postoperative ICU admission and length of hospital stay (LOS).Results: The MACE incidence was 7.5%. Both indices had limited discriminative (AUC for RCRI and GSCRI were 0.69 and 0.68, respectively) and predictive abilities. The regression analysis showed that patients with atrial fibrillation (AF) were 3.77 and those with trauma surgery were 2.03 times more likely to exhibit MACE, and the odds of MACE increased by 9% for each additional year above 80. Introducing these factors into both indices (multivariable models) increased the discriminative ability (AUC reached 0.798 and 0.777 for RCRI and GSCRI, respectively). Bootstrap analysis showed that the predictive ability of the multivariate GSCRI but not the multivariate RCRI improved. Decision curve analysis (DCA) showed that multivariate GSCRI had superior clinical utility when compared with multivariate RCRI. Both indices correlated poorly with postoperative ICU admission and LOS.Conclusion: Both indices had limited predictive and discriminative ability to estimate postoperative in-hospital MACE risk and correlated poorly with postoperative ICU admission and LOS, following surgery under SA in the oldest-old patients. Updated versions by introducing age, AF, and trauma surgery improved the GSCRI performance but not the RCRI.Keywords: geriatric, anesthetic techniques, subarachnoid, risk, major adverse cardiac even
G2 & G1 plants species of SW Colorado
No full textPresented at the 16th symposium held on September 27, 2019 in Grand Junction, Colorado.2019 G2 species of SW Colorado -- 2019 G1 species of SW Colorado
Dependence of unsaturated chloride diffusion on the pore structure in cementitious materials
No full textConceptual analysis is performed to examine the effects of pore features on the water continuity in unsaturated porous systems. The roles of pore features in relative chloride diffusion coefficient (Drc) of mortar specimens at various degrees of water saturation (Sw) were studied based on mercury intrusion porosimetry and resistivity tests. It is found that the role of pore structure in the Drc-Sw relationship is a result of its effect on the water continuity. Porosity and tortuosity are not relevant to the Drc-Sw relationship. A finer pore size distribution or lower pore connectivity tends to result in a lower Drc. The pore size effect on the Drc is pronounced primarily at high Sw, while the Drc is dominated by the pore connectivity at low Sw. Cement mortar with a higher water-to-binder ratio shows larger chloride diffusion at high relative humidity levels but smaller chloride diffusion at low relative humidity levels.Accepted Author ManuscriptMaterials and Environmen
Total Cost of Ownership for Application Replatform by Open-source SW
No full textAbstractIn intra-company IT environment, the use of open-source software (OSS) should be expanded to reduce IT costs and to establish SW governance. This requires the migration of systems from the existing commercial SW to open-source SW, but the attempt of application replatform is prevented by the expenses for application reprogramming and data migration. This study proposes a methodology for TCO calculation of application replatform using open-source SW. In practice, a five-year TCO shows a cost reduction effect of 78% - 83%. This TCO could be further reduced if the application size is increased due to data accumulation and the company gets open-source SW capabilities internally. In addition, it is possible to directly apply an application developed from open-source SW to a virtualized infrastructure environment, which enables to operate in a hybrid cloud environment. This enables a scalable, efficient and flexible IT operation and a sustainable TCO reduction in the futur
Review of previous meetings, Part 3: Montrose, SW Colorado, G2G3 species
No full textSymposium held on September 28, 2012 in Canyon City, Colorado.Title from website.2008 Montrose: SW Colorado G2G3 species -- 2009 Loveland: NW & central Colorado G2G3 species
Review of previous meetings, Part 3: SW Colorado G2, NW Colorado G2 species
No full textSymposium held on September 23, 2016 in Boulder, Colorado.Title page states Golden, Colorado, should be Boulder, Colorado.Title from website.2008/2016 SW Colorado G2G3 species -- 2009/2014 NW & central Colorado G2G3 species
Overdiagnosis in breast cancer screening: the importance of length of observation period and lead time
No full textPMCID: PMC3706885This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
Change management of the SW projects in the small and medium business
No full textThe bachelor thesis focuses on SW projects, ways of their management and mainly change management in the small and medium business. This thesis is devided into two parts. Author deals with SW projects and most common mistakes during their development in the theory part. The main aim of this part is to refer to these mistakes the reader, who is interested in SW projects. Next, there is a comparision of the two famous methodics, which are well-known in the SW development. These are ITIL and RUP. Author will choose the one, which will be more acceptable for the Cleverdecision. At this time, Cleverdecision has no change management and every change during the SW development is managed by contracting condition. That is why author formulates the ways of change management in the practical part. This will be based on the chosen methodics from the theory part. This formulation is the main aim of this thesis. The contribution of the thesis is in the definition of the change management workflow and in the proposition of the templates for setting the change requests. These templates are sufficient for unification concepts and easier specification of the change requests. Insertion of the change management into the contract is part of the thesis as well
Director, City Author Discuss Book Filming
No full textPhotograph used for a story in the Oklahoma Times newspaper. Caption: "The transition from novel to screen play was discussed here Friday by Bruce Cabot, left, Hollywood actor-producer, and Joseph E. Keller, 1301 SW 34 author of "Black Jack.
Seismic Tomography in Reykjanes , SW Iceland
No full textWe present tomographic results obtained around geothermal reservoirs using seismic data recorded both on-land Reykjanes, SW-Iceland and offshore along Reykjanes Ridge. We gathered records from a network of 83 seismic stations (including 21 Ocean Bottom Seismometers) deployed between April 2014 and August 2015. We obtain crustal velocity images from several tomography methods. First, we used local earthquakes to perform travel time tomography. The processing includes first arrival picking of P- and S-phases using an automatic detection and picking technique based on Akaike Information Criteria. We locate earthquakes by using a non-linear localization technique, as a priori information for deriving a 1D velocity model. We then computed a 3D velocity model by joint inversion of each earthquake’s location and velocity lateral anomalies with respect to the 1D model. Our results confirms previous models obtained in the area, with enhanced details. Second, we used ambient noise cross-correlation techniques which involve the computation of cross-correlation between seismic records. Empirical Green’s functions are estimated and analyzed to derive an S-wave velocity model by surface wave tomography. Third, noise correlation theory shows that zero-offset P-wave reflectivity at selected station locations can be approximated by auto-correlating and stacking station data. With few assumptions, single-station autocorrelations provide local 1D high-resolution structural acoustic-contrast versus depth information. We show that the application of ambient noise interferometry for reflection retrieval complement well the results from both classical and noise tomography methods
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