Study of length of stay in the cardiovascular intensive care unit

Coronary artery bypass graft (CABG) surgery is among the most common operations performed in the United States and accounts for more resources expended in cardiovascular medicine than any other single procedure. CABG surgery patients initially recover in the Cardiovascular Intensive Care Unit (CVICU). The post-procedure CVICU length of stay (LOS) goal is two days or less. A longer ICU LOS is associated with a prolonged hospital LOS, poor health outcomes, greater use of limited resources, and increased medical costs. ^ Research has shown that experienced clinicians can predict LOS no better than chance. Current CABG surgery LOS risk models differ greatly in generalizability and ease of use in the clinical setting. A predictive model that identified modifiable pre- and intra-operative risk factors for CVICU LOS greater than two days could have major public health implications as modification of these identified factors could decrease CVICU LOS and potentially minimize morbidity and mortality, optimize use of limited health care resources, and decrease medical costs. ^ The primary aim of this study was to identify modifiable pre-and intra-operative predictors of CVICU LOS greater than two days for CABG surgery patients with cardiopulmonary bypass (CPB). A secondary aim was to build a probability equation for CVICU LOS greater than two days. Data were extracted from 416 medical records of CABG surgery patients with CPB, 50 to 80 years of age, recovered in the CVICU of a large teaching, referral hospital in southeastern Texas, during the calendar year 2004 and the first quarter of 2005. Exclusion criteria included Diagnosis Related Group (DRG) 106, CABG surgery without CPB, CABG surgery with other procedures, and operative deaths. The data were analyzed using multivariate logistic regression for an alpha=0.05, power=0.80, and correlation=0.26. ^ This study found age, history of peripheral arterial disease, and total operative time equal to and greater than four hours to be independent predictors of CVICU LOS greater than two days. The probability of CVICU LOS greater than two days can be calculated by the following equation: -2.872941 +.0323081 (age in years) + .8177223 (history of peripheral arterial disease) + .70379 (operative time). ^

Puerperal Fever from Hippocrates to Pasteur

The death of a mother in childbirth leaving a newborn deserted is a sort of a desecration. This was a frequent event for early physicians. It was felt to be caused by miasmas or punishment from the gods. DaVinci felt the cause was milk stasis, Hippocrates - lochia, Virchow - weather. Then came Semmelweis, Pasteur and Lister. They started a battle with ignorance, hospital administration, budget and academic politics. Ending with the murder of Semmelweis!

Bayesian estimation of multilevel item response model with missing data

This study proposed a novel statistical method that modeled the multiple outcomes and missing data process jointly using item response theory. This method follows the "intent-to-treat" principle in clinical trials and accounts for the correlation between outcomes and missing data process. This method may provide a good solution to chronic mental disorder study. ^ The simulation study demonstrated that if the true model is the proposed model with moderate or strong correlation, ignoring the within correlation may lead to overestimate of the treatment effect and result in more type I error than specified level. Even if the within correlation is small, the performance of proposed model is as good as naïve response model. Thus, the proposed model is robust for different correlation settings if the data is generated by the proposed model.^

Risk factors for inflammatory breast cancer

Background: Inflammatory breast cancer (IBC) is rare and accounts for 2.5% of all invasive breast cancers. The 5-year survival rates are significantly lower than for other types of breast cancer, highlighting the significance of cancer prevention in IBC. The comprehensive multi-disciplinary team Morgan Welch Inflammatory Breast Cancer Research Program and Clinic at University of Texas MD Anderson Cancer Center treats the largest number of Inflammatory Breast patients in a single center. Because of this unique center, large patient resources, and good medical and epidemiological records, we were able to conduct the largest single center case-control and case-case study on IBC. Methods: We identified 246 patients diagnosed with IBC and 397 cancer free patients seen at the Dan L Duncan Cancer Prevention Clinic. Breast cancer reproductive risk factors and lifestyle risk factors were compared between tumor subtypes of IBC patients (Estrogen Receptor positive (ER+) and/or Progesterone Receptor positive (PR+), Human Epidermal Growth Factor 2 positive (HER2+)), and (ER -/PR-/HER2-)) and cancer free controls. Results: Breastfeeding was the only significant risk factor (p<0.01) between tumor subtypes in IBC patients. In the case-control study that included all IBC patients and cancer free patients the descriptive statistics indicate significant difference in BMI, history of smoking, number of children, age of first pregnancy, any breastfeeding and total time breastfeeding (p<0.05). No differences were found in the frequency of other breast cancer risk factors. Conclusion: The associations determined between cancer free controls and IBC patients have identified previously unknown risk factors for IBC. The risk factors identified by the case control study suggest BMI, history of smoking, and the protective effect of breastfeeding as potential modifiable risk factors that can be used to decrease the incidence of IBC. Impact: These results highlight the importance of evaluating epidemiologic risk factors of IBC, which could lead to the identification of distinct etiologic pathways that could be targeted for prevention.^

(Table 1) Geochemistry of ash layers at DSDP Leg 57 Holes

The study of the main characteristics of ash layers in Leg 57 cores shows that they are suitable for an analysis of the effect on eruptive activity of their distribution. We found (1) sediment recovery good and ash layers numerous; (2) sedimentary environment generally free from terrigenous clastic material; (3) reworking limited; (4) volcanic glass very acidic, ranging from rhyolitic to rhyodacitic composition; and (5) alteration and diagenesis negligible above the lower Miocene. The curves of explosive volcanic activity in Holes 438, 439, and 440 display two stages of high activity: an early one around 16 m.y. and a late one starting 5 m.y. B.P., both stages being separated by an upper Miocene quiescence. Detail in these results is limited by the chemical composition of the glass and accounts only for trends in explosive acid volcanism. Nevertheless, results are roughly in agreement with other data from the Northwest Pacific, although some discrepancies in the correlation of intensity of the episodes occur. The data from Leg 57 support the hypothesis of synchronous pulses in explosive volcanism.

Césped deportivo : comportamiento del cultivar AZ-1 de Pennisetum clandestinum Hochst. ex Chiov. (kikuyo). Paraná, Entre Ríos, Argentina

A fines de 2001 se incorporó al mercado argentino el cultivar AZ-1 de Pennisetum clandestinum Hochst. ex Chiov. (kikuyo) para ser utilizado en campos deportivos o con fines ornamentales. Con el propósito de caracterizar esta variedad comercial en el departamento Paraná (provincia de Entre Ríos, Argentina) se evaluó su comportamiento y aptitud para césped ornamental y/o deportivo en condiciones de mantenimiento para césped de calidad, bajo dos condiciones de drenaje. Se evaluaron cobertura, color, textura, distancia de entrenudos, grosor de estolones y período de dormición. El ensayo se realizó en Oro Verde, departamento Paraná, en un suelo Molisol y consistió en 2 tratamientos: con y sin drenaje, con 4 repeticiones cada uno. El tamaño de la parcela fue de 2,5 por 5,0 m. El diseño experimental utilizado fue parcelas apareadas y las mediciones se realizaron desde junio hasta noviembre de 2005. Las características climáticas locales son: temperatura media anual de 18,1°C y un régimen isohigro de 947,6 mm de precipitación anual. El cultivar se comportó como apto para césped en las características y condiciones de manejo evaluadas, sin diferencias entre los tratamientos con y sin drenaje. Presentó rápida implantación, niveles altos de cobertura, color claro y uniforme, textura media y estolones gruesos a medianos a través del tiempo. En invierno no perdió cobertura ni color. Se caracterizó como un césped no apto para campos deportivos de alta exigencia, pero recomendable para clubes de bajo presupuesto y mantenimiento.

Physical properties of sediment cores of the Bengal Fan

We examined geophysical data from a Multi-Sensor Core Logger (MSCL), a logging device providing continuous measurements of gamma-ray attenuation, p-wave travel time, and magnetic susceptibility on marine sediment cores. In the first part we focused on the gamma-ray system and compared two different calibration methods. From the gamma-ray attenuation, we calculated densities and porosities by incorporating mass weighted attenuation coefficients. The application of an iteration method reduces the error of the density and porosity estimates compared to GRAPE data. In addition, we derived equations to calculate water content and dry bulk density from gamma-ray attenuation measurements. Comparison with physical properties determined on discrete samples revealed a very good correlation of both data sets (r = 0.99). This correlation is valid for sediments from substantially different geological settings (e.g., turbidites, hemipelagic muds, and opal-rich sediments). In the second part we applied our data to marine geological questions. For sediments from the Antarctic Polar Frontal Zone, there is indication that the content of biogenic opal can be assessed using a correlation of density and p-wave velocity. For sediments from the Bengal Fan, the relationship between the MSCL acoustic impedance (the product of density and p-wave velocity) and the grain-size distribution in discrete samples can be used to predict clay and sand/silt ratios for sediment cores from the shelf and upper continental slope.