Increased Rates of Prolonged Length of Stay, Readmissions, and Discharge to Care Facilities among Postoperative Patients with Disseminated Malignancy: Implications for Clinical Practice.

BackgroundThe impact of surgery on end of life care for patients with disseminated malignancy (DMa) is incompletely characterized. The purpose of this study was to evaluate postoperative outcomes impacting quality of care among DMa patients, specifically prolonged length of hospital stay, readmission, and disposition.MethodsThe American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for years 2011-2012. DMa patients were matched to non-DMa patients with comparable clinical characteristics and operation types. Primary hepatic operations were excluded, leaving a final cohort of 17,972 DMa patients. The primary outcomes were analyzed using multivariate Cox regression models.ResultsDMa patients represented 2.1% of all ACS-NSQIP procedures during the study period. The most frequent operations were bowel resections (25.3%). Compared to non-DMa matched controls, DMa patients had higher rates of postoperative overall morbidity (24.4% vs. 18.7%, p<0.001), serious morbidity (14.9% vs. 12.0%, p<0.001), mortality (7.6% vs. 2.5%, p<0.001), prolonged length of stay (32.2% vs. 19.8%, p<0.001), readmission (15.7% vs. 9.6%, p<0.001), and discharges to facilities (16.2% vs. 12.9%, p<0.001). Subgroup analyses of patients by procedure type showed similar results. Importantly, DMa patients who did not experience any postoperative complication experienced significantly higher rates of prolonged length of stay (23.0% vs. 11.8%, p<0.001), readmissions (10.0% vs. 5.2%, p<0.001), discharges to a facility (13.2% vs. 9.5%, p<0.001), and 30-day mortality (4.7% vs. 0.8%, p<0.001) compared to matched non-DMa patients.ConclusionSurgical interventions among DMa patients are associated with poorer postoperative outcomes including greater postoperative complications, prolonged length of hospital stay, readmissions, disposition to facilities, and death compared to non-DMa patients. These data reinforce the importance of clarifying goals of care for DMa patients, especially when acute changes in health status potentially requiring surgery occur

Driver hand positions on the steering wheel while merging into motorway traffic

It has been suggested that a driver's hand position on the steering wheel can reflect the perceived risk of the road context (Walton, D., & Thomas, J. A. (2005). Naturalistic observations of driver hand positions. Transportation Research Part F, 8. 229-238, Thomas, J. A., & Walton, D. (2007). Measuring perceived risk: Self-reported and actual hand positions of SUV and car drivers. Transportation Research Part F, 10, 201-207). These original studies were based on field observations where only a part of the steering wheel could be viewed. In the present study hand positions were observed in a driving simulator during the performance of a demanding task: merging into motorway traffic. In the current study the whole steering wheel could be observed and hand positions were classified in three categories: high control, medium control, and low control. Differences in hand position between different traffic conditions were limited, and hand position did not correlate with self-reported risk or self-reported mental effort, but changes in hand positions do seem to be associated with changes in workload demand. It is therefore concluded that hand position can give some information about mental workload. (C) 2010 Elsevier Ltd. All rights reserved

Investigation of the mechanical behavior of electrodes after calendering and its influence on singulation and cell performance

Battery cell production is a complex process chain with interlinked manufacturing processes. Calendering in particular has an enormous influence on the subsequent manufacturing steps and final cell performance. However, the effects on the mechanical properties of the electrode, in particular, have been insufficiently investigated. For this reason, the impact of different densification rates during calendering on the electrochemical cell performance of NMC811 (LiNi$_{0.8}$Mn$_{0.1}$Co$_{0.1}$O$_{2}$) half-cells are investigated to identify the relevant calendering parameters. Based on this investigation, an experimental design has been derived. Electrode elongations after calendering in and orthogonal to the running direction of the NMC811 cathode are investigated in comparison with a hard carbon anode after calendering. Elongations orthogonal to the machine direction are observed to have no major dependencies on the compaction rate during calendering. In the machine direction, however, significant elongation occurs as a dependency of the compaction rate for both the hard carbon anode and the NMC811. In addition, the geometric shape of the NMC811 electrodes after separation into individual sheets is investigated with regard to different compaction rates during calendering. It is shown that the corrugations that occur during calendering are propagated into the single electrode, depending on the compaction rate

Would You Buy a Used Car from this Priest? An Economic Theory of Religion and the Church

This paper uses the theory of the firm to explain a variety of characteristics of religious doctrine and behavior. The paper analyzes doctrine about the afterlife, altering events, temporal happiness, and various social goods including property rights enforcement.http://deepblue.lib.umich.edu/bitstream/2027.42/61263/1/Hull_B_1985_Working_Paper_33_Economic_Theory_of_Church.pd

Product Variety in Religious Markets

This is an electronic version of an article published in the Review of Social Economy.(c)1998 Copyright Taylor & Francis. Review of Social Economy is available online at http://www.informaworld.com/openurl?genre=article&issn=0034%2d6764&volum e=56&issue=1&spage=1This paper analyzes the relationship between religious market product variety and church membership. We find that denominational variety is negatively associated with the total level of church membership in U.S. counties. This result appears to contradict the standard religious product variety model. Our data are consistent with a more general view of markets that incorporates the cost to consumers of product variety. Where product variety has significant costs, an increase in variety may reduce total market penetration. The paper suggests market characteristics that might give rise to this situation, characteristics present in the religion market.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61246/1/Hull B - 1998 - Religion Product Variety - RSE.pd

Religion, Warrior Elites, and Property Rights

In 1119 C.E., King Baldwin II of Jerusalem granted nine French knights space in the Al Aqsa Mosque on the Temple Mount over the ruins of Solomon’s Temple to create the headquarters of a new monastic order: The Poor Fellow-Soldiers of Christ and of the Temple of Solomon (Pauperes commilitones Christi Templique Solomonici). The Knights Templar, or Templars, as they have become known, grew in wealth and power after that modest beginning to become an influential and pervasive organization throughout Western Europe until the years before their suppression by King Philip of France in 1307. The Templars were only one of a number of Christian holy orders of “warrior monks” founded after the First Crusade. The Knights Hospitaller (Order of Saint John) and the Teutonic Knights are the most well-known, but at least fourteen other orders were founded in Syria, in Central and Eastern Europe, and in the Iberian Peninsula. More importantly for this paper, the Templars are one example of what we label “warrior elites.” Our definition of warrior elites is not precise, but is intended to include pre-industrial full-time specialized soldiers that represent a relatively small part of a region’s military forces but possess disproportionate military strength. In addition, warrior elites often possess significant political and social power. This paper explores the extent to which warrior elites have two characteristics: they adopt a special religion, either different from the mainstream religion or a unique adaptation of the mainstream religion, and the special religion has doctrinal provisions which enforce property rights. To the extent warrior elites have these two characteristics, we hypothesize they are an example of a social institution that evolves as a low-cost alternative to government and to ordinary religion as a method of property rights enforcement. Our preliminary analysis yields mixed results. Certainly there are examples of warrior elites who have the two aforementioned characteristics: the Templars and at least some of the other post Crusades warrior monks being examples. By contrast, the loyalty to leaders by Japan's samurai the Ottoman Empire’s Janissaries likely eroded a well-defined system of property rights is not consistent with our hoped-for results.http://deepblue.lib.umich.edu/bitstream/2027.42/96847/1/Hull_B_-_2013_-_Working_Paper_Warrior_Elites.pd

Towards an Economic Theory of the Church

This paper employs the theory of the firm to explain behavior of the church. Churches produce a set of products including entertainment, a variety of socially valuable public goods, eternal life, and alteration of otherwise fated events. Most importantly, the church reduces transactions costs by enforcing a system of property rights. Enforcement is enhanced by the promise of heaven and threat of hell, two innovations uniquely available to the church. We test some implications of the model using the Standard Cross-Cultural Sample of the Human Relations Area Files.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57295/1/Hull B - 1989 - Econ Theory of Church - IJSE.pd

Hell, Religion, and Cultural Change

This paper's key conclusion is that church doctrine about the afterlife is a function of factors predictable with economic theory. Religion, like government, family, and community can enforce property rights and encourage socially valuable behavior. Religious doctrines about hell as punishment for breaking rules that arguably benefit society will occur in religions in cultures where the church is relatively more influential than the family, community, and government. Statistical material from the Human Relations Area Files tends to support the model's implications as does informal analysis of New England colonial Puritan doctrine about hell.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57427/1/Hull B - 1994 - Hell and Culture - JITE.pd

Investigating light-induced processes in covalent dye-catalyst assemblies for hydrogen production

The light-induced processes occurring in two dye-catalyst assemblies for light-driven hydrogen production were investigated by ultrafast transient absorption spectroscopy. These dyads consist of a push-pull organic dye based on a cyclopenta[1,2-b:5,4-b’]dithiophene (CPDT) bridge, covalently linked to two different H2-evolving cobalt catalysts. Whatever the nature of the latter, photoinduced intramolecular electron transfer from the excited state of the dye to the catalytic center was never observed. Instead, and in sharp contrast to the reference dye, a fast intersystem crossing (ISC) populates a long-lived triplet excited state, which in turn non-radiatively decays to the ground state. This study thus shows how the interplay of different structures in a dye-catalyst assembly can lead to unexpected excited state behavior and might open up new possibilities in the area of organic triplet sensitizers. More importantly, a reductive quenching mechanism with an external electron donor must be considered to drive hydrogen production with these dye-catalyst assemblies. © 2020 by the authors. Licensee MDPI, Basel, Switzerland