Does interhospital transfer improve outcome of acute myocardial infarction? A propensity score analysis from the Cardiovascular Cooperative Project

<p>Abstract</p> <p>Background</p> <p>Many patients suffering acute myocardial infarction (AMI) are transferred from one hospital to another during their hospitalization. There is little information about the outcomes related to interhospital transfer. The purpose of this study was to compare processes and outcomes of AMI care among patients undergoing interhospital transfer with special attention to the impact on mortality in rural hospitals.</p> <p>Methods</p> <p>National sample of Medicare patients in the Cooperative Cardiovascular Study (n = 184,295). Retrospective structured medical record review of AMI hospitalizations. Descriptive study using a retrospective propensity score analysis of clinical and administrative data for 184,295 Medicare patients admitted with clinically confirmed AMI to 4,765 hospitals between February 1994 and July 1995. Main outcome measure included: 30-day mortality, administration of aspirin, beta-blockers, ACE-inhibitors, and thrombolytic therapy.</p> <p>Results</p> <p>Overall, 51,530 (28%) patients underwent interhospital transfer. Transferred patients were significantly younger, less critically ill, and had lower comorbidity than non-transferred patients. After propensity-matching, patients who underwent interhospital transfer had better quality of care anlower mortality than non-transferred patients. Patients cared for in a rural hospital had similar mortality as patients cared for in an urban hospital.</p> <p>Conclusion</p> <p>Transferred patients were vastly different than non-transferred patients. However, even after a rigorous propensity-score analysis, transferred patients had lower mortality than non-transferred patients. Mortality was similar in rural and urban hospitals. Identifying patients who derive the greatest benefit from transfer may help physicians faced with the complex decision of whether to transfer a patient suffering an acute MI.</p

The sovereignty of the royal portrait in revolutionary and Napoleonic Europe: five case studies surrounding Maria Carolina, Queen of Naples

This study demonstrates how royal portraiture functioned during the Revolutionary and Napoleonic wars as a vehicle for visualizing and processing the contemporary political upheavals. It does so by considering a notion of the 'sovereignty of the portrait', that is, the semiotic integrity (or precisely the lack thereof) and the material territory of royal portraiture at this historical juncture. Working from an assumption that the precariousness of sovereignty which delineated the Revolutionary and Napoleonic wars goes hand in hand with the precariousness of representation during the same period, it reframes prevailing readings of royal portraiture in the aftermath of the French Revolution by approaching the genre less as one defined by the oneway propagation of a message, and more as a highly unstable intermedial network of representation. This theoretical undertaking is refracted through the figure of Maria Carolina, Queen of Naples (1752-1814), close sister and foil to Queen Marie- Antoinette of France, and who, as de facto ruler of the Kingdom of Naples, physically survived revolution but was twice dethroned and thrice exiled. A diverse ecology of royal portraiture revolving around Maria Carolina is presented across five case studies. Close attention to the materiality of a hyperrealistic wax bust of Maria Carolina reveals how portraiture absorbed the trauma of the French Revolution; Maria Carolina’s correspondence in invisible ink is used as a tool to read a highly distinctive visual language of 'hidden' silhouettes of sovereigns and to explore the in/visibility of exile; a novel reading of Antonio Canova's work for the Neapolitan Bourbons through the lens of contemporary caricature problematizes the binary between ancien r&eacute;gime and parvenue monarchy; and a unique miniature of Maria Carolina offers itself as a material metaphor for post-revolutionary sovereignty. Finally, Maria Carolina’s death mask testifies to how Maria Carolina herself became a relic of the ancien régime.This thesis is not currently available in OR

The sovereignty of the royal portrait in revolutionary and Napoleonic Europe: five case studies surrounding Maria Carolina, Queen of Naples

This study demonstrates how royal portraiture functioned during the Revolutionary and Napoleonic wars as a vehicle for visualizing and processing the contemporary political upheavals. It does so by considering a notion of the 'sovereignty of the portrait', that is, the semiotic integrity (or precisely the lack thereof) and the material territory of royal portraiture at this historical juncture. Working from an assumption that the precariousness of sovereignty which delineated the Revolutionary and Napoleonic wars goes hand in hand with the precariousness of representation during the same period, it reframes prevailing readings of royal portraiture in the aftermath of the French Revolution by approaching the genre less as one defined by the oneway propagation of a message, and more as a highly unstable intermedial network of representation. This theoretical undertaking is refracted through the figure of Maria Carolina, Queen of Naples (1752-1814), close sister and foil to Queen Marie- Antoinette of France, and who, as de facto ruler of the Kingdom of Naples, physically survived revolution but was twice dethroned and thrice exiled. A diverse ecology of royal portraiture revolving around Maria Carolina is presented across five case studies. Close attention to the materiality of a hyperrealistic wax bust of Maria Carolina reveals how portraiture absorbed the trauma of the French Revolution; Maria Carolina’s correspondence in invisible ink is used as a tool to read a highly distinctive visual language of 'hidden' silhouettes of sovereigns and to explore the in/visibility of exile; a novel reading of Antonio Canova's work for the Neapolitan Bourbons through the lens of contemporary caricature problematizes the binary between ancien régime and parvenue monarchy; and a unique miniature of Maria Carolina offers itself as a material metaphor for post-revolutionary sovereignty. Finally, Maria Carolina’s death mask testifies to how Maria Carolina herself became a relic of the ancien régime

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease

The barrier coastline of North Norfolk, with particular reference to Scolt Head Island

Situated on the barrier coastline of north Norfolk, eastern England, Scolt Head Island is remarkable for the long period—almost one hundred years—of sustained geo- morphological research, allowing a proper, and rare, assessment of the relative importance of the role of ‘normal’ processes versus extreme events (storm surge impacts) in determining landform evolution. Drawing on an extensive literature, the chapter reports on studies of the Holocene history of the barrier island and the historical dynamics of barrier westward extension and landward retreat (and associated sand dune initiation, growth and decline). It considers contemporary tidal channel hydrodynamics and patterns of back-barrier saltmarsh sedimentation and accretion. It concludes by considering how the process environment may change, and Scolt may develop, in the near future and the implications for landward ecosystems and communities