The impact of post-operative sepsis on mortality after hospital discharge among elective surgical patients: a population-based cohort study

Our aim in the present study was to assess the mortality impact of hospital-acquired post-operative sepsis up to 1 year after hospital discharge among adult non-short-stay elective surgical patients.We conducted a population-based, retrospective cohort study of all elective surgical patients admitted to 82 public acute hospitals between 1 January 2007 and 31 December 2012 in New South Wales, Australia. All adult elective surgical admission patients who stayed in hospital for ≥4 days and survived to discharge after post-operative sepsis were identified using the Admitted Patient Data Collection records linked with the Registry of Births, Deaths, and Marriages. We assessed post-discharge mortality rates at 30 days, 60 days, 90 days and 1 year and compared them with those of patients without post-operative sepsis.We studied 144,503 survivors to discharge. Of these, 1857 (1.3%) had experienced post-operative sepsis. Their post-discharge mortality rates at 30 days, 60 days, 90 days and 1 year were 4.6%, 6.7%, 8.1% and 13.5% (vs 0.7%, 1.2%, 1.5% and 3.8% in the non-sepsis cohort), respectively (P < 0.0001 for all). After adjustment for patient and hospital characteristics, post-operative sepsis remained independently associated with a higher mortality risk (30-day mortality HR 2.75, 95% CI 2.14-3.53; 60-day mortality HR 2.45, 95% CI 1.94-3.10; 90-day mortality HR 2.31, 95% CI 1.85-2.87; 1-year mortality HR 1.71, 95% CI 1.46-2.00). Being older than 75 years of age (HR 3.50, 95% CI 1.56-7.87) and presence of severe/very severe co-morbidities as defined by Charlson co-morbidity index (severe vs normal HR 2.05, 95% CI 1.45-2.89; very severe vs normal HR 2.17, 95% CI 1.49-3.17) were the only other significant independent predictors of increased 1-year mortality.Among elective surgical patients, post-operative sepsis is independently associated with increased post-discharge mortality up to 1 year after hospital discharge. This risk is particularly high in the first month, in older age patients and in the presence of severe/very severe co-morbidities. This high-risk population can be targeted for interventions.Lixin Ou, Jack Chen, Ken Hillman, Arthas Flabouris, Michael Parr, Hassan Assareh and Rinaldo Bellom

Exploration and Explanation of the Rationale of Project-Based Curriculum

Background and Objective:Reflecting on different societies and despite the claim of progress in the fields of education, technology, society, etc., there are still many problems in human relations, civil relations and inefficiency of individuals. With this explanation, the question arises as to whether various advances have not been able to be used in practice. Has the development of education and technology not been in the public and real interests of human beings? Is education not adapted to the needs of society? Have various developments not found operational ground? And perhaps there are many other questions that can be asked about this. But with a little care it can be seen that each of these factors is rooted in a major cause, and that is the type of education and educational goals. The widespread objection of educational theorists is that learners in traditional systems seldom have the opportunity to learn something in-depth through the transfer of subject matter. At the present time, however, efforts should be made to lay the foundation for children's intellectual skills in the very early years of childhood and to shape their personalities so that they can look to their future with an open, independent and selective attitude. To this end, all available potentials and facilities such as teachers, students, parents, peers, learning environment and community around the school should be used to provide the desired indicators as much as possible. The goal of this article is about explain and analysis of project based curriculum. This study has considered rationale of project based learning in different aspects. Methods: In attention to the main goal of research and also rational of curriculum that is defined based on its basics, principles, and messages, so the fivefold questions of research include how defined the philosophical, psychological, and social basics of project based learning and the same time it considered its message and principles. In order to reach to analyze and explain of above aim applied research syntheses in which selected, contextualized, and categorized researches related to project based learning with a regular method. In the next step selected 101 researches which had objective criteria, then based on syntheses principles, rethinking, data rearrangement presented combination of their findings. Findings:Researcher with the help of research and with identifying of philosophical, psychological, and social basics of project based learning and drawing of message and principles of this kind of learning tried to analysis and explain rationale of project based curriculum. Conclusion: A study of previous research has shown that a direct study of project-based learning has not been conducted in the form of a curriculum. Most project-based research has been in the fields of agriculture, architecture, or project management. Although it has been considered in a few cases in formal education, it has been studied more as a teaching method and has dealt with only one element and not the whole curriculum   ===================================================================================== COPYRIGHTS  ©2019 The author(s). This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, as long as the original authors and source are cited. No permission is required from the authors or the publishers.  ====================================================================================

Change Point Estimation in Monitoring Survival Time

Precise identification of the time when a change in a hospital outcome has occurred enables clinical experts to search for a potential special cause more effectively. In this paper, we develop change point estimation methods for survival time of a clinical procedure in the presence of patient mix in a Bayesian framework. We apply Bayesian hierarchical models to formulate the change point where there exists a step change in the mean survival time of patients who underwent cardiac surgery. The data are right censored since the monitoring is conducted over a limited follow-up period. We capture the effect of risk factors prior to the surgery using a Weibull accelerated failure time regression model. Markov Chain Monte Carlo is used to obtain posterior distributions of the change point parameters including location and magnitude of changes and also corresponding probabilistic intervals and inferences. The performance of the Bayesian estimator is investigated through simulations and the result shows that precise estimates can be obtained when they are used in conjunction with the risk-adjusted survival time CUSUM control charts for different magnitude scenarios. The proposed estimator shows a better performance where a longer follow-up period, censoring time, is applied. In comparison with the alternative built-in CUSUM estimator, more accurate and precise estimates are obtained by the Bayesian estimator. These superiorities are enhanced when probability quantification, flexibility and generalizability of the Bayesian change point detection model are also considered

Comparison of Allelopathic Effect of Zataria Multiflora on the Germination and Growth Features of Cymbopogen Olivieri and Stipa Arabica Seedlings 1

Abstract: Application of native and genetically modified species is one of the main approaches to revival and modification of ranches. But in the mean time, it should be noted that those species that are compatible to each other should be used in vegetation expansion projects. Shiraz oregano (Zataria Multiflora) is from among those plants which could cause allelopathic effects due to their various chemical compositions. Hence, due to profusion of this plant throughout the Khalil Beig ranch of Arsanjan, and the considerable amount of Stipa Arabica and Cymbopogen Olivieri in the adjacent areas to this ranch that are consumed by the livestock, it was decided to study the possibility of applying the aforesaid species for expansion of vegetation throughout the Khalil Beig ranch. To this end, an investigation was conducted in the greenhouse environment using the soil taken from the habitat of Shiraz oregano. Underground and aerial parts of this plant were collected and extracts of 25, 50, 75 and 100 percent as well as 50 and 100 % densities were obtained from aerial and underground parts, respectively. Also, a bittern was considered as the prototype (distilled water). Seeds of Sarabica and C.olivieri were cultivated in flower pots containing the soils of oregano habitat and were irrigated using the abovementioned bitterns throughout the entire study. The investigations lasted for 5 weeks and the germination and growth rates of seedlings were recorded on a daily basis. In the end, characteristics of both species such as percentage of germination, length of stem, length of root, wet weight of stem, wet weight of root, dry weight of stem and dry weight of root affected by different density percentages of Shiraz oregano extract were analyzed through variance analysis. The Duncan test was applied for comparison of means. The results represented the preventive effect of compositions existing in Shiraz oregano on the studied features and the less vulnerability of S.arabica as compared with the C.olivieri

Risk-adjusted CUSUM control charts for shared frailty survival models with application to hip replacement outcomes: a study using the NJR dataset

Background:  Continuous monitoring of surgical outcomes after joint replacement is needed to detect which brands’ components have a higher than expected failure rate and are therefore no longer recommended to be used in surgical practice. We developed a monitoring method based on cumulative sum (CUSUM) chart specifically for this application.  Methods:  Our method entails the use of the competing risks model with the Weibull and the Gompertz hazard functions adjusted for observed covariates to approximate the baseline time-to-revision and time-to-death distributions, respectively. The correlated shared frailty terms for competing risks, corresponding to the operating unit, are also included in the model. A bootstrap-based boundary adjustment is then required for risk-adjusted CUSUM charts to guarantee a given probability of the false alarm rates. We propose a method to evaluate the CUSUM scores and the adjusted boundary for a survival model with the shared frailty terms. We also introduce a unit performance quality score based on the posterior frailty distribution. This method is illustrated using the 2003-2012 hip replacement data from the UK National Joint Registry (NJR). Results:  We found that the best model included the shared frailty for revision but not for death. This means that the competing risks of revision and death are independent in NJR data. Our method was superior to the standard NJR methodology. For one of the two monitored components, it produced alarms four years before the increased failure rate came to the attention of the UK regulatory authorities. The hazard ratios of revision across the units varied from 0.38 to 2.28. Conclusions:  An earlier detection of failure signal by our method in comparison to the standard method used by the NJR may be explained by proper risk-adjustment and the ability to accommodate time-dependent hazards. The continuous monitoring of hip replacement outcomes should include risk adjustment at both the individual and unit level

Power maximization of variable-speed variable-pitch wind turbines using passive adaptive neural fault tolerant control

Power maximization has always been a practical consideration in wind turbines. The question of how to address optimal power capture, especially when the system dynamics are nonlinear and the actuators are subject to unknown faults, is significant. This paper studies the control methodology for variable-speed variable-pitch wind turbines including the effects of uncertain nonlinear dynamics, system fault uncertainties, and unknown external disturbances. The nonlinear model of the wind turbine is presented, and the problem of maximizing extracted energy is formulated by designing the optimal desired states. With the known system, a model-based nonlinear controller is designed; then, to handle uncertainties, the unknown nonlinearities of the wind turbine are estimated by utilizing radial basis function neural networks. The adaptive neural fault tolerant control is designed passively to be robust on model uncertainties, disturbances including wind speed and model noises, and completely unknown actuator faults including generator torque and pitch actuator torque. The Lyapunov direct method is employed to prove that the closed-loop system is uniformly bounded. Simulation studies are performed to verify the effectiveness of the proposed method

Oak cynipid gall inquilines of Iran (Hym.: Cynipidae: Synergini), with description of new species

Ten known cynipid inquiline species associated with oak cynipid galls (Hymenoptera, Cynipidae: Synergini and Cynipini), their distribution and host associations are given for the first time for the Iranian cynipid fauna: Ceroptres cerri Mayr, C. clavicornis Hartig, Saphonecrus haimi (Mayr), Synergus gallaepomiformis (B. de Fonsc), S. pallidipennis Mayr, S. pallipes Hartig, S. reinhardi Mayr, S. thaumacerus (Dalman), S. umbraculus (Olivier) and S. variabilis Mayr. Five new species of cynipid inquilines, Saphonecrus irani Melika & Pujade-Villar sp. n., Synergus acsi Melika & Pujade-Villar sp. n., Synergus bechtoldae Melika & Pujade-Villar sp. n., Synergus palmirae Melika & Pujade-Villar sp. n. and Synergus mikoi Melika & Pujade-Villar sp. n. are described from Iran; the description and diagnosis of adults of these new species, their host associations and biology are given. Finally, galls that may induce by the inquiline Synophrus olivieri Kieffer have been collected

Fine Mapping of Genetic Variants in BIN1, CLU, CR1 and PICALM for Association with Cerebrospinal Fluid Biomarkers for Alzheimer's Disease

Recent genome-wide association studies of Alzheimer's disease (AD) have identified variants in BIN1, CLU, CR1 and PICALM that show replicable association with risk for disease. We have thoroughly sampled common variation in these genes, genotyping 355 variants in over 600 individuals for whom measurements of two AD biomarkers, cerebrospinal fluid (CSF) 42 amino acid amyloid beta fragments (Aβ42) and tau phosphorylated at threonine 181 (ptau181), have been obtained. Association analyses were performed to determine whether variants in BIN1, CLU, CR1 or PICALM are associated with changes in the CSF levels of these biomarkers. Despite adequate power to detect effects as small as a 1.05 fold difference, we have failed to detect evidence for association between SNPs in these genes and CSF Aβ42 or ptau181 levels in our sample. Our results suggest that these variants do not affect risk via a mechanism that results in a strong additive effect on CSF levels of Aβ42 or ptau181