The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery.

Background: The first version of The Society of Thoracic Surgeons National Adult Cardiac Surgery Database (STS NCD) was developed nearly 2 decades ago. Since its inception, the number of participants has grown dramatically, patient acuity has increased, and overall outcomes have consistently improved. To adjust for these and other changes, all STS risk models have undergone periodic revisions.

Ozonation in sequencing batch reactors for reduction of waste solids.

The objective of this research was to study a process modification for reducing the mass of waste sludge from sequencing batch reactors (SBRs) by promoting the use of intracellular products released by ozonation of the biomass. For this purpose, biomass generated in laboratory-scale SBRs was exposed to ozone (O3) as a cell-lysing agent to partially solubilize intracellular material. The results indicated that the application of low doses of ozone reduced the mass of waste sludge production by an average of 29%.

Urinary tract infection in women over the age of 65: is age alone a marker of complication?

Background: We were interested to know if our older female patients with urinary tract infections (UTIs) might have differing pathogens or rates of Escherichia coli antibiotic sensitivity and if our physicians managed them in a manner similar or dissimilar to the care provided to younger patients with no complications.

Methods: This was a secondary analysis from patients excluded from a previous retrospective study regarding uncomplicated UTIs.

Results: Twenty-six percent of total patients with UTIs were older than 65 and otherwise medically uncomplicated whereas 21% were older patients who did have complicating factors.

Corticosterone reduces dendritic complexity in developing hippocampal CA1 neurons.

Although prolonged stress and corticosteroid exposure induce morphological changes in the hippocampal CA3 area, the adult CA1 area is quite resistant to such changes. Here we addressed the question whether elevated corticosteroid hormone levels change dendritic complexity in young, developing CA1 cells. In organotypic cultures (prepared from P5 rats) that were 14-21 days cultured in vitro, two doses of corticosterone (30 and 100 nM) were tested.

Ecological networks--beyond food webs.

1. A fundamental goal of ecological network research is to understand how the complexity observed in nature can persist and how this affects ecosystem functioning. This is essential for us to be able to predict, and eventually mitigate, the consequences of increasing environmental perturbations such as habitat loss, climate change, and invasions of exotic species.

Nomenclature and databases for the surgical treatment of congenital cardiac disease--an updated primer and an analysis of opportunities for improvement.

This review discusses the historical aspects, current state of the art, and potential future advances in the areas of nomenclature and databases for the analysis of outcomes of treatments for patients with congenitally malformed hearts. We will consider the current state of analysis of outcomes, lay out some principles which might make it possible to achieve life-long monitoring and follow-up using our databases, and describe the next steps those involved in the care of these patients need to take in order to achieve these objectives. In order to perform meaningful multi-institutional analyses, we suggest that any database must incorporate the following six essential elements: use of a common language and nomenclature, use of an established uniform core dataset for collection of information, incorporation of a mechanism of evaluating case complexity, availability of a mechanism to assure and verify the completeness and accuracy of the data collected, collaboration between medical and surgical subspecialties, and standardised protocols for life-long follow-up.

The assessment of complexity in congenital cardiac surgery based on objective data.

When designed in 2000, the Aristotle Complexity Score was entirely based on subjective probability. This approach, based on the opinion of experts, was considered a good solution due to the limited amount of data available. In 2008, the next generation of the complexity score will be based on observed data available from over 100,000 congenital cardiac operations currently gathered in the congenital cardiac surgery databases of the Society of Thoracic Surgeons and the European Association for Cardio-Thoracic Surgery.

Impact of clopidogrel in patients with acute coronary syndromes requiring coronary artery bypass surgery: a multicenter analysis.

Objectives: The purpose of our multicenter study was to examine the impact of pre-operative administration of clopidogrel on reoperation rates, incidence of life-threatening bleeding, inpatient length of stay, and other bleeding-related outcomes in acute coronary syndrome (ACS) patients requiring cardiopulmonary bypass (coronary artery bypass graft surgery [CABG]) in a broad cross section of U.S. hospitals.

An ounce of prevention is worth a pound of cure: improving communication to reduce mortality during bioterrorism responses.

Objective: To identify communication needs and evaluate the effectiveness of alternative communication strategies for bioterrorism responses.

Methods: We provide a framework for evaluating communication needs during a bioterrorism response. Then, using a simulation model of a hypothetical response to anthrax bioterrorism in a large metropolitan area, we evaluate the costs and benefits of alternative strategies for communication during a response.

A model to begin to use clinical outcomes in medical education.

The latest phase of the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project challenges graduate medical education (GME) programs to select meaningful clinical quality indicators by which to measure trainee performance and progress, as well as to assess and improve educational effectiveness of programs. The authors describe efforts to measure educational quality, incorporating measurable patient-care outcomes to guide improvement. University of Florida College of Medicine-Jacksonville education leaders developed a tiered framework for selecting clinical indicators whose outcomes would illustrate integration of the ACGME competencies and their assessment with learning and clinical care.

Gender differences in mortality after mitral valve operation: evidence for higher mortality in perimenopausal women.

Background: Hormonal status is a potentially important cause for gender differences in outcomes after cardiovascular operations. Estrogen withdrawal states may potentiate ischemia-reperfusion injury by impairing endothelial cell function and increasing inflammatory cytokine levels. We hypothesized that gender influences mortality after mitral valve operations and that it varies with age, especially during periods of declining ovarian function.

GABA release by basket cells onto Purkinje cells, in rat cerebellar slices, is directly controlled by presynaptic purinergic receptors, modulating Ca2+ influx.

In many brain regions, Ca(2+) influx through presynaptic P2X receptors influences GABA release from interneurones. In patch-clamp recordings of Purkinje cells (PCs) in rat cerebellar slices, broad spectrum P2 receptor antagonists, PPADS (30microM) or suramin (12microM), result in a decreased amplitude and increased failure rate of minimal evoked GABAergic synaptic currents from basket cells. The effect is mimicked by desensitizing P2X1/3-containing receptors with alpha,beta-methylene ATP.

Diagnosis and treatment of Lyme disease.

Lyme disease is the most common tick-borne disease in the United States. This review details the risk factors, clinical presentation, treatment, and prophylaxis for the disease. Information was obtained from a search of the PubMed and MEDLINE databases (keyword: Lyme disease) for articles published from August 31, 1997, through September 1, 2007.

The risk of valve surgery for endocarditis in patients with dialysis-dependent renal failure.

Background And Aim Of The Study: Valvular endocarditis occurring in patients with dialysis-dependent renal failure increases the risk of mortality following valve surgery, but few specific data are available to guide surgical selection. The study aim was to develop a simple risk scoring system to identify high-risk dialysis patients undergoing valve surgery for endocarditis.

Methods: Using STS data from between January 1994 and December 2003, a total of 1,862 valvular procedures was recorded in dialysis patients with endocarditis.

Exploring the behavior of hospital composite performance measures: an example from coronary artery bypass surgery.

Background: Composite scores that combine several performance measures into a single ranking are becoming the accepted metric for assessing hospital performance. In particular, the Centers for Medicare & Medicaid Services Hospital Quality Incentive Demonstration (HQID) project bases financial rewards and penalties on these scores. Although the HQID composite calculation is straightforward and easily understood, its method of combining process and outcome measures has not been validated.

Off-pump techniques benefit men and women and narrow the disparity in mortality after coronary bypass grafting.

Background: Women have historically had greater morbidity and mortality than men after conventional coronary artery bypass grafting (CABG) on cardiopulmonary bypass (ONCAB). It is controversial whether off-pump CABG (OPCAB) alters this gender-based disparity.

Methods: The Society of Thoracic Surgeons National Cardiac Database was reviewed for risk factors and clinical outcomes of 42,477 consecutive, nonemergency, isolated, primary ONCAB or OPCAB cases performed at 63 North American centers that performed more than 100 OPCAB cases between January 1, 2004, and December 31, 2005.