Bacterial Infections Change Natural History of Cirrhosis Irrespective of Liver Disease Severity

OBJECTIVES: We assessed the prognostic significance of infections in relation to current prognostic scores and explored if infection could be considered per se a distinct clinical stage in the natural history of cirrhosis. METHODS: We included consecutive patients with cirrhosis admitted to a tertiary referral liver unit for at least 48 h over a 2-year period. Diagnosis of infection was based on positive cultures or strict established criteria. We used competing risk analysis and propensity score matching for data analysis. RESULTS: 501 patients (63% male, 48% alcoholic liver disease, median Model of End-stage Liver Disease (MELD)=17) underwent 781 admissions over the study period. Portal hypertensive bleeding and complicated ascites were the commonest reasons of admission. The incidence of proven bacterial infection was 25.6% (60% community acquired and 40% nosocomial). Survival rates at 3, 6, 12, and 30 months were 83%, 77%, 71%, and 62% in patients without diagnosis of infection, vs. 50%, 46%, 41%, and 34% in patients with diagnosis of infection. Overall survival was independently associated with MELD score (hazards ratio (HR) 1.099), intensive care (ITU) stay (HR 1.967) and bacterial infection (HR 2.226). Bacterial infection was an independent predictor of survival even when patients who died within the first 30 days were excluded from the analysis in Cox regression (HR 2.013) and competing risk Cox models in all patients (HR 1.46) and propensity risk score-matched infected and non-infected patients (HR 1.67). CONCLUSIONS: Infection most likely represents a distinct prognostic stage of cirrhosis, which affects survival irrespective of disease severity, even after recovery from the infective episode

Gender Impact on Transit Quality of Service Importance and Performance Assessment

This paper examines the impact of gender on transit travelers’ quality assessment considering 26 indicators’ importance and performance ratings. Through an online survey and using a 5 point Likert scale, transit travelers were asked to rate both the importance and the performance they recognize for the examined quality indicators. The online survey was distributed to a list of contacts, organizations, businesses, universities and operations’ websites in three Greek cities (Athens, Thessaloniki and Volos), aiming to cover all modes and quality conditions someone may face in Greek transit operations. In total, 211 PT users (96 male and 116 female transit travelers) provided their feedback that was further analyzed, aiming to underline the impact of their gender on transit quality importance and performance assessments. Research results, showed that women attribute a higher importance than men on route and service related characteristics, cleanliness and safety and security related indicators, along with the availability of shelter and benches at stops, the ease of purchasing ticket and the use of ecological vehicles. Similarly, women recognize a higher performance for the ease of purchasing ticket. Research results explicitly analyze the gender impact on transit quality assessment, providing useful knowledge and insights for decision makers planning and operations. © 2021, The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG

Guidance Provision for Increasing Quality of Service of Public Transport

Travellers formulate their optimal strategyto follow for their trip, every time they may shift to another mode. Trip generalized cost is perceived based on quality of service aspects and type of traveller. One of the most known models to assess service quality is the GAP model, proposed by Parasuramanet al. (1985), which considersboth consumer and provider beliefs, expectations, perceptions and standards. The present paper deals with the fifth GAP of the model, known as the quality GAP, thus expected versus perceived quality of service, for the assessment of the transit service quality. This GAP has been estimated for the case of the transit system in Greece. An internet based questionnaire was used to collect user expectations and perceptions of 26 selected transit quality indicators, based on a 5 point likert scale. Then, a decision tree was developed, using the J48 algorithm, which linked user perceptions and expectations with the overall service quality assessment. The decision tree analysis depicts the importance of various quality components in the generalized cost estimation. Findings showed that the performance indicator "Availability of information by phone, mail", was the most crucial parameter for the overall assessment of the service, while both performance and importance variables participated in the tree formulation. Tree paths provide guidance for transit operators and/or decision makers for increasing the quality of their services and at the same time enhance performance efficiency and operation profitability. © 2017 The Authors