6 research outputs found
Strategic Change and the Jazz Mindset: Exploring Practices that Enhance Dynamic Capabilities for Organizational Improvisation
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The oxidation of Type 310S stainless steel in mixed gases at elevated temperatures
Sheet specimens of Type 310S stainless steel were exposed to air as well as to lean'' and rich'' sulfidizing atmospheres at temperatures near 900{degrees}C to determine the relationships that exist between the scale structure, the rate of reaction, and the stresses generated during exposure. One goal of this experimental research program was to examine how these factors might be related to the breakdown of protective scales in sulfidizing atmospheres. It was found that the scales formed in air and the lean'' atmosphere are protective and non-spalling while those formed in the rich'' atmosphere spall, initially react at rates 1000 times greater than counterparts in less aggressive atmospheres, and later exhibit a breakaway''-type rapid reaction. Only those scales formed in air provide the cooperative, tractive interfacial forces required to produce uniform dilatation and deformation of the substrate. However, evidence exists for at least localized stresses in all of the scales examined
Chinese inpatients' subjective experiences of the helping process as viewed through examination of a nurses' focused, structured therapy group
The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications
Background:
The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.
Methods:
ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.
Results:
The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.
Conclusions:
This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.
© 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran