In-hospital mortality after stomach cancer surgery in Spain and relationship with hospital volume of interventions

<p>Abstract</p> <p>Background</p> <p>There is no consensus about the possible relation between in-hospital mortality in surgery for gastric cancer and the hospital annual volume of interventions. The objectives were to identify factors associated to greater in-hospital mortality for surgery in gastric cancer and to analyze the possible independent relation between hospital annual volume and in-hospital mortality.</p> <p>Methods</p> <p>We performed a retrospective cohort study of all patients discharged after surgery for stomach cancer during 2001–2002 in four regions of Spain using the Minimum Basic Data Set for Hospital Discharges. The overall and specific in-hospital mortality rates were estimated according to patient and hospital characteristics. We adjusted a logistic regression model in order to calculate the in-hospital mortality according to hospital volume.</p> <p>Results</p> <p>There were 3241 discharges in 144 hospitals. In-hospital mortality was 10.3% (95% CI 9.3–11.4). A statistically significant relation was observed among age, type of admission, volume, and mortality, as well as diverse secondary diagnoses or the type of intervention. Hospital annual volume was associated to Charlson score, type of admission, region, length of stay and number of secondary diagnoses registered at discharge. In the adjusted model, increased age and urgent admission were associated to increased in-hospital mortality. Likewise, partial gastrectomy (Billroth I and II) and simple excision of lymphatic structure were associated with a lower probability of in-hospital mortality. No independent association was found between hospital volume and in-hospital mortality</p> <p>Conclusion</p> <p>Despite the limitations of our study, our results corroborate the existence of patient, clinical, and intervention factors associated to greater hospital mortality, although we found no clear association between the volume of cases treated at a centre and hospital mortality.</p

A Playful Evolution: The Transformation of Game Theory* in the United States from the 1970s through the 2000s

The trajectory of Game Studies has been atypical of a traditional academic field. Notions of theory and practice have been co-dependent on one another in the formation of the field. Because of its unusual development, understanding how Game Studies conceptualizes itself as a field remains a point of contention. Similar to the objectivity question in Novick\u27s That Noble Dream, issues of disciplinarity and knowledge production center on the interactivity question in Game Studies. This research creates a historical lineage in order to better understand how Game Studies practitioners think of themselves as a field. By deconstructing the work of theorists from the early 1970s, when games emerged more fully in the public consciousness, to the 2000s, when Game Studies moved more fully into the academic consciousness, it becomes possible to understand where Game Studies fits within higher education and industry as well as conceptualize its future trajectory

Examining Brain and Body Correlates of Cerebrovascular Reactivity Among Adolescents with and without Bipolar Disorder

Cardiovascular disease (CVD) is excessive and premature among individuals with bipolar disorder (BD). Cerebrovascular reactivity (CVR), a marker of cerebrovascular health, is the capacity of the brainâ s blood vessels to vasodilate when induced by vasoactive substances. We examined this topic for the first time in BD. CVR was measured in 25 adolescents with BD and 25 age and sex-matched psychiatrically healthy controls (HCs). Whole-brain analyses showed that BDs have lower CVR in the posterior cingulate gyrus and periventricular white matter. When controlling for differences in body mass index (BMI), additional between group CVR differences were observed in the temporal poles, supramarginal gyrus and lingual gyrus. There were no significant clusters of the brain that were BD>HC. Our results suggest that CVR may be a proxy for future risk of CVD and/or cerebrovascular disease, given the location of anomalous CVR within regions where cerebrovascular pathology occurs in mid-life.M.Sc