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Coronavirus disease 2019 (COVID-19) has migrated to regions that were initially spared, and it is likely that different populations are currently at risk for illness. Herein, we present our observations of the change in characteristics and resource use of COVID-19 patients over time in a national system of community hospitals to help inform those managing surge planning, operational management, and future policy decisions.
To determine risk factors for mortality among COVID-19 patients admitted to a system of community hospitals in the United States.
Retrospective analysis of patient data collected from the routine care of COVID-19 patients.
System of >180 acute-care facilities in the United States.
All admitted patients with positive identification of COVID-19 and a documented discharge as of May 12, 2020.
Determination of demographic characteristics, vital signs at admission, patient comorbidities and recorded discharge disposition in this population to construct a logistic regression estimating the odds of mortality, particular for those patients characterized as not being critically ill at admission.
In total, 6,180 COVID-19+ patients were identified as of May 12, 2020. Most COVID-19+ patients (4,808, 77.8%) were admitted directly to a medical-surgical unit with no documented critical care or mechanical ventilation within 8 hours of admission. After adjusting for demographic characteristics, comorbidities, and vital signs at admission in this subgroup, the largest driver of the odds of mortality was patient age (OR, 1.07; 95% CI, 1.06–1.08; P < .001). Decreased oxygen saturation at admission was associated with increased odds of mortality (OR, 1.09; 95% CI, 1.06–1.12; P < .001) as was diabetes (OR, 1.57; 95% CI, 1.21–2.03; P < .001).
The identification of factors observable at admission that are associated with mortality in COVID-19 patients who are initially admitted to non-critical care units may help care providers, hospital epidemiologists, and hospital safety experts better plan for the care of these patients.
The morphology and growth habits of Evactinopora species of the Evactinoporidae (new family) are documented. This distinctive family of free-living bryozoans has a radial colony form at all growth stages. During a brief attachment phase on a hard substrate, the colony morphology grew as an expanding cone with vertical folds. Following detachment of the nascent colony from this hard substrate, it settled on soft sediment and the free-living expanding colony acquired a star-like form by producing slender outrigger rays. Continued growth produced a radial array of vertical vanes containing feeding autozooecia. The colony maintained a vertical orientation on soft sediment by means of outrigger rays and secretion of solid skeleton on the colony base that provided ballast. The radial growth pattern, outrigger rays, and vertical vanes developed as adaptive characters suitable for free-living life on soft sediment. North American species of Evactinopora are redefined and described taxonomically on the basis of zoarial and zooecial characters and a new species, Evactinopora mangeri, erected. The new family Evactinoporidae is established on the basis of the novel characters of early colony detachment from a hard surface, radial growth pattern through life, generation of outrigger rays, and growth of vertical vanes from the top of rays.
The use of three-dimensional printing has been rapidly expanding over the last several decades. Virtual surgical three-dimensional simulation and planning has been shown to increase efficiency and accuracy in various clinical scenarios.
To report the feasibility of three-dimensional printing in paediatric laryngotracheal stenosis and discuss potential applications of three-dimensional printed models in airway surgery.
Retrospective case series in a tertiary care aerodigestive centre.
Three-dimensional printing was undertaken in two cases of paediatric laryngotracheal stenosis. One patient with grade 4 subglottic stenosis with posterior glottic involvement underwent an extended partial cricotracheal reconstruction. Another patient with grade 4 tracheal stenosis underwent tracheal resection and end-to-end anastomosis. Models of both tracheas were printed using PolyJet technology from a Stratasys Connex2 printer.
It is feasible to demonstrate stenosis in three-dimensional printed models, allowing for patient-specific pre-operative surgical simulation. The models serve as an educational tool for patients’ understanding of the surgery, and for teaching residents and fellows.
This carefully targeted and rigorous new textbook introduces engineering students to the fundamental principles of applied Earth science, highlighting how modern soil and rock mechanics, geomorphology, hydrogeology, seismology and environmental geochemistry affect geotechnical and environmental practice. Key geological topics of engineering relevance including soils and sediments, rocks, groundwater, and geologic hazards are presented in an accessible and engaging way. A broad range of international case studies add real-world context, and demonstrate practical applications in field and laboratory settings to guide site characterization. End-of-chapter problems are included for self-study and evaluation, and supplementary online materials include electronic figures, additional examples, solutions, and guidance on useful software. Featuring a detailed glossary introducing key terminology, this text requires no prior geological training and is essential reading for senior undergraduate or graduate students in civil, geological, geotechnical and geoenvironmental engineering. It is also a useful reference and bridge for Earth science graduates embarking on engineering geology courses.