Impact of prior hospital mortality versus surgical volume on mortality following surgery for congenital heart disease

ObjectiveOur objective was to assess the relationships of a hospital’s past adjusted in-hospital mortality and surgical volume with future in-hospital mortality after surgery for congenital heart disease.MethodsUsing the Pediatric Health Information Systems database, we (1) calculated hospital surgical volume and standardized mortality ratio (= observed number of deaths/expected number of deaths adjusted for surgery type) for January 2004 through June 2006 for children (0-18 years) after surgery for congenital heart disease at 38 hospitals and (2) assessed the relationship between these values and subsequent mortality during July 2006 through December 2008. We constructed Poisson regression models to estimate risk of mortality, adjusting for age, race, sex, genetic syndrome, insurance type, and surgery type (using the Risk Adjustment in Congenital Heart Surgery method).ResultsThere were 49,792 hospital encounters during 2004 through 2008 for pediatric patients having surgery for congenital heart disease, with an overall in-hospital mortality of 3.45%. For the 24,112 eligible encounters during July 2006 through December 2008, a hospital’s prior standardized mortality ratio was significantly associated with postoperative in-hospital mortality (P < .0001), and a hospital’s prior surgical volume had only borderline significance (P = .0792). On stratified analysis, past standardized mortality ratio was associated with mortality for both lower- and higher-risk surgical risk categories (P = .0105 and .0015, respectively). Hospital surgical volume was not significantly associated with mortality for lower-risk categories (P = .4122), but it was borderline significant for higher-risk categories (P = .0678).ConclusionsIn this data set, prior hospital surgical volume tended to be associated with improved mortality after higher-risk operations in pediatric patients with congenital heart disease, whereas prior hospital postoperative mortality was significantly associated with mortality across all risk strata of congenital heart surgery

Rebellion, resistance and restoration: strategies of limited violence in late Anglo-Saxon England, 1042–1066

A comparative analysis of the series of aristocratic rebellions which punctuated the reign of the penultimate Anglo-Saxon king Edward ‘the Confessor' (1042-1066), and in particular the better documented case study of the revolt of Earl Godwine in 1051-1052, reveals how violence might be limited and controlled in regard both to mechanisms of armed opposition against the king and to the ruler's reaction towards dissident nobles. It explores a pattern whereby an exiled noble sought refuge abroad, there raised a force of mercenaries or allies, then engaged in limited and indirect acts of hostility, usually on the peripheries of the kingdom, to exert pressure upon the king to negotiate whilst avoiding a direct attack on the monarch. Reconciliation was not inevitable, but in the majority of cases revolts succeeded in achieving a complete restoration to lands and position, with comparatively little bloodshed having occurred. It is argued that the period 1042-1066 marks a crucial transition between the more extreme violence of earlier rulers, who inflicted death or mutilation on dissidents, and the Normans’ introduction from 1066 of more restrained conduct towards political opponents

Quarkonium states in a complex-valued potential

We calculate quarkonium binding energies using a realistic complex-valued potential for both an isotropic and anisotropic quark-gluon plasma. We determine the disassociation temperatures of the ground and first excited states considering both the real and imaginary parts of the binding energy. We show that the effect of momentum-space anisotropy is smaller on the imaginary part of the binding energy than on the real part of the binding energy. In the case that one assumes an isotropic plasma, we find disassociation temperatures for the J/psi, Upsilon and chi_b of 1.6 T_c, 2.8 T_c, and 1.5 T_c, respectively. We find that a finite oblate momentum-space anisotropy increases the disassociation temperature for all states considered and results in a splitting of the p-wave states associated with the chi_b first excited state of bottomonium.Comment: 23 pages, 9 figures; v4: subtraction of V_infinity corrected to only subtract Re[V_infinity

From Faith To Faith: The Rise and Spread of Catholicism in Georgia, 1732-1832

Matthew Blake Strickland History Thesis 2012 for Valdosta State University.The research holes of other historians reside in the fact that the Catholic story has been neglected in discussions of Georgia religion. There have been many neglected points made about Catholics in Georgia during the era of the early republic when there is ample source material to appropriately discuss this group of Christians. In Colonial Georgia complete freedom of religion did not extend even to dissenters such as the Baptists, a group that became the dominant Christian denomination; however, they still retained some liberty. Because of various social issues along with outside circumstances, Catholics were completely banned from the colony in the beginning. However, the young state of Georgia in the emerging American republic was ripe for religious growth with the end of the American Revolution. Georgia provided the fertile ground and others provided the faith. The majority of Catholic believers in Georgia just after the American Revolution were foreign to the state. A group from Maryland traveled south to form the Church of the Purification of the Blessed Virgin Mary. Later in the 1790s, French émigrés settled along the coast eventually moving to Augusta and other inland places. Many Irish Catholics became the major leaders of the Catholic faith and journeyed there to minister in the American mission. Bishop John England was the most important figure in spreading the Roman Catholic faith in Georgia up to this time. Before he became the bishop of Charleston, the faith in Georgia was crumbling. Children were not learning their catechisms nor were marriages and deaths being blessed. A rift had formed between the laity and the clergy. Bishop England revived and helped further spread the Catholic Church in Georgia.John G. Crowley; Christopher C. Meyers; Sebastian P. Bartos; Carol M. Gle

Low cost current measurement of three phase cables

© 2018 IEEE. Recent growth in embedded generation alongside the anticipated consumer uptake of electric vehicles (EVs) and heat pumps present new challenges for distribution networks. This includes greater fluctuation in electricity demand. Data from existing maximum demand indicators in distribution substations is inadequate to understand the spread of demand over time. Retro-fit datalogging solutions are available for substation monitoring, but cost typically >£1200, which would be difficult to justify for all distribution substations. This paper looks at the development of a novel low cost alternative designed for measuring load on three phase cables

Overview of RS-25 Adaptation Hot-Fire Test Series for SLS, Status and Lessons Learned

This paper discusses the engine system design, hot-fire test history and analyses for the RS-25 Adaptation Engine test series, a major hot-fire test series supporting the Space Launch System (SLS) program. The RS-25 is an evolution of the Space Shuttle Main Engine (SSME). Since the SLS mission profile and engine operating conditions differ from that experienced by the SSME, a test program was needed to verify that SLS-unique requirements could be met by the adapted legacy engines. A series of 18 tests, including one engine acceptance test, was conducted from January 2015 to October 2017, to directly support Exploration Mission-1 (EM-1), the first flight of SLS. These tests were the first hot-firings of legacy SSME hardware since 2009. Major findings are described along with top level overview of the engine system

Partner Relationships and Injection Sharing Practices Among Rural Appalachian Women

Background—The role of relationships in initiating and maintaining women’s risk behaviors has been established. However, understanding factors that may underlie partner relationships and women’s risky drug use, particularly in rural contexts, is limited. This study is the first to examine the association between injecting partners and women’s risky injection practices as a function of relationship power perception. Methods—Female participants were recruited from three rural jails in the Appalachian region. Women were randomly selected, provided informed consent, and screened for study eligibility criteria. This cross-sectional analysis focuses on women who inject drugs (WWID) during the year before entering jail (n=199). Main findings—Approximately three-quarters (76%) reported having a recent main male sexual partner with a history of injection drug use (IDU). Although having a risky partner independently increased the likelihood of women reporting shared injection practices, perceptions of relationship power significantly moderated the effect on shared needle (AOR = 0.02 [0.003, 0.23]; p = .001) and shared works (AOR = 0.17 [0.03, 0.95]; p = .04) use. Conclusions—This interaction indicated that for WWID with a recent injecting male partner, greater perception of relationship power was associated with a decreased likelihood of shared injection practices. Implications for clinical assessment and intervention are discussed