Impact of an in-hospital endocarditis team and a state-wide endocarditis network on perioperative outcomes

Background: Infective endocarditis (IE) requires multidisciplinary management. We established an endocarditis team within our hospital in 2011 and a state-wide endocarditis network with referring hospitals in 2015. We aimed to investigate their impact on perioperative outcomes. Methods: We retrospectively analyzed data from patients operated on for IE in our center between 01/2007 and 03/2018. To investigate the impact of the endocarditis network on referral latency and pre-operative complications we divided patients into two eras: before ( n = 409) and after ( n = 221) 01/2015. To investigate the impact of the endocarditis team on post-operative outcomes we conducted multivariate binary logistic regression analyses for the whole population. Kaplan–Meier estimates of 5-year survival were reported. Results: In the second era, after establishing the endocarditis network, the median time from symptoms to referral was halved (7 days (interquartile range: 2–19) vs. 15 days (interquartile range: 6–35)), and pre-operative endocarditis-related complications were reduced, i.e., stroke (14% vs. 27%, p < 0.001), heart failure (45% vs. 69%, p < 0.001), cardiac abscesses (24% vs. 34%, p = 0.018), and acute requirement of hemodialysis (8% vs. 14%, p = 0.026). In both eras, a lack of recommendations from the endocarditis team was an independent predictor for in-hospital mortality (adjusted odds ratio: 2.12, 95% CI: 1.27–3.53, p = 0.004) and post-operative stroke (adjusted odds ratio: 2.23, 95% CI: 1.12–4.39, p = 0.02), and was associated with worse 5-year survival (59% vs. 40%, log-rank < 0.001). Conclusion: The establishment of an endocarditis network led to the earlier referral of patients with fewer pre-operative endocarditis-related complications. Adhering to endocarditis team recommendations was an independent predictor for lower post-operative stroke and in-hospital mortality, and was associated with better 5-year survival

Binary orbit, physical properties, and evolutionary state of Capella (alpha Aurigae)

We report extensive radial-velocity measurements of the two giant components of the detached, 104-day period binary system of Capella. Our highly accurate three-dimensional orbital solution based on all existing spectroscopic and astrometric observations including our own yields much improved masses of 2.466 +/- 0.018 M_Sun and 2.443 +/- 0.013 M_Sun for the primary and secondary (relative errors of 0.7% and 0.5%). Improved values are derived also for the radii (11.87 +/- 0.56 R_Sun and 8.75 +/- 0.32 R_Sun), effective temperatures (4920 +/- 70 K and 5680 +/- 70 K), and luminosities (79.5 +/- 4.8 L_Sun and 72.1 +/- 3.6 L_Sun). The distance is determined to be 13.042 +/- 0.028 pc. Capella is unique among evolved stars in that, in addition to all of the above, the chemical composition is known, including the overall metallicity [m/H], the carbon isotope ratio 12C/13C for the primary, and the lithium abundance and C/N ratios for both components. The latter three quantities are sensitive diagnostics of evolution, and change drastically for giants as a result of the deepening of the convective envelope during the first dredge-up. The secondary is crossing the Hertzprung gap, while the primary is believed to be in the longer-lived core-helium burning phase. However, we find that current stellar evolution models are unable to match all of the observations for both components at the same time, and at a single age, for any evolutionary state of the primary. Similar problems are found when testing the rotational synchronization, spin axis alignment, and orbital circularization of the system against tidal theory. We conclude that our understanding of the advanced stages of stellar evolution is still very incomplete. [Abridged]Comment: 42 pages in emulateapj format, including figures and tables. To appear in the 2009 August 10 issue of The Astrophysical Journa