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To develop a risk score for deep sternal wound infection (DSWI) after isolated coronary artery bypass grafting (CABG).
Multicenter, prospective study.
Tertiary-care referral hospitals.
The study included 7,352 patients from the European multicenter coronary artery bypass grafting (E-CABG) registry.
An additive risk score (the E-CABG DSWI score) was estimated from the derivation data set (66.7% of patients), and its performance was assessed in the validation data set (33.3% of patients).
DSWI occurred in 181 (2.5%) patients and increased 1-year mortality (adjusted hazard ratio, 4.275; 95% confidence interval [CI], 2.804–6.517). Female gender (odds ratio [OR], 1.804; 95% CI, 1.161–2.802), body mass index ≥30 kg/m2 (OR, 1.729; 95% CI, 1.166–2.562), glomerular filtration rate <45 mL/min/1.73 m2 (OR, 2.410; 95% CI, 1.413–4.111), diabetes (OR, 1.741; 95% CI, 1.178–2.573), pulmonary disease (OR, 1.935; 95% CI, 1.178–3.180), atrial fibrillation (OR, 1.854; 95% CI, 1.096–3.138), critical preoperative state (OR, 2.196; 95% CI, 1.209–3.891), and bilateral internal mammary artery grafting (OR, 2.088; 95% CI, 1.422–3.066) were predictors of DSWI (derivation data set). An additive risk score was calculated by assigning 1 point to each of these independent risk factors for DSWI. In the validation data set, the rate of DSWI increased along with the E-CABG DSWI scores (score of 0, 1.0%; score of 1, 1.8%; score of 2, 2.2%; score of 3, 6.9%; score ≥4: 12.1%; P < .0001). Net reclassification improvement, integrated discrimination improvement, and decision curve analysis showed that the E-CABG DSWI score performed better than other risk scores.
DSWI is associated with poor outcome after CABG, and its risk can be stratified using the E-CABG DSWI score.
In this paper, we study weighted trust-networks (but also unweighted), where each edge is associated with either a positive or a negative score. Hence, we consider a distrust relationship as well, allowing a user to rate poor experiences with other individuals in his web of acquaintances. We propose an algorithm to compose two of such networks in a single one, in order to merge the knowledge obtained in two different communities of individuals (possibly partially-overlapping), through two different trust management-systems. Our algorithm is based on semiring algebraic-structures, in order to have a parametric computational-framework. Such composition can be adopted whenever two trust-based communities (with the same scope) need to be amalgamated: for instance, two competitor-companies that need to unify the trust-based knowledge on their (sub-) suppliers.
We propose a timed and soft extension of Concurrent Constraint Programming. The time extension is based on the hypothesis of bounded asynchrony: The computation takes a bounded period of time and is measured by a discrete global clock. Action prefixing is then considered as the syntactic marker that distinguishes a time instant from the next one. Supported by soft constraints instead of crisp ones, tell and ask agents are now equipped with a preference (or consistency) threshold, which is used to determine their success or suspension. In this paper, we provide a language to describe the agents' behavior, together with its operational and denotational semantics, for which we also prove the compositionality and correctness properties. After presenting a semantics using maximal parallelism of actions, we also describe a version for their interleaving on a single processor (with maximal parallelism for time elapsing). Coordinating agents that need to take decisions on both preference values and time events may benefit from this language.
The increase in life expectancy is leading to growing numbers of frail older people worldwide, while the potential availability of family and informal care resources – especially from older people's children – is dramatically declining in Europe, due to lower fertility rates, rising labour market participation by women and higher shares of lone-elderly households (OECD, 2005a). Providing appropriate longterm care to large numbers of disabled, very old people therefore represents an increasing challenge to all welfare states, particularly in the light of the preference granted by official policies, in Europe as elsewhere, to arrangements promoting ‘ageing in place’, by enhancing tailor-made home and community care services, and moving away from institutional care (European Commission, 2008). A solution that is increasingly being adopted to tackle this challenge is based on the employment of migrant care workers, a discreet and to a large extent invisible trend that is giving rise to a sort of ‘ethnic segmentation’ of the elder care sector across Europe (Lamura, 2013). Italy is one of the countries where this phenomenon has become most widespread. Due to the overlapping of increased female employment, generous cash-for-care schemes and a still ‘familistic’ approach to elder care, in the last decade an increasing number of Italian families have indeed opted to privately employ a migrant care worker, often on a live-in basis, in order to provide support to their frail older family members. In this chapter, after a short introduction on the global and European situation, a more in-depth overview of the main trends currently affecting the demand and supply of elder care in Italy is provided, including an outline of the motivations driving Italian families to employ migrant care workers as well as of the difficulties experienced by migrant workers themselves. The conclusion analyses the opportunities and challenges for receiving as well as sending countries, in an attempt to set an, albeit provisional, agenda for future research, policy and practice in this still largely neglected area.
Migrant care work in ageing societies: the phenomenon in a global and Mediterranean perspective
One of the major concerns resulting from population ageing is that expenditure to provide ‘formal’ long-term care services (services that are delivered by public, profit or non-profit organisations to dependent, mainly older, people requiring continuous assistance) are expected to increase worldwide (Oliveira Martins and de la Maisonneuve, 2006)
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