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We study the indexing systems that correspond to equivariant Steiner and linear isometries operads. When G is a finite abelian group, we prove that a G-indexing system is realized by a Steiner operad if and only if it is generated by cyclic G-orbits. When G is a finite cyclic group, whose order is either a prime power or a product of two distinct primes greater than 3, we prove that a G-indexing system is realized by a linear isometries operad if and only if it satisfies Blumberg and Hill’s horn-filling condition. We also repackage the data in an indexing system as a certain kind of partial order. We call these posets transfer systems, and develop basic tools for computing with them.
To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.
Retrospective cohort study.
Eight tertiary-care referral general hospitals in California.
We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.
For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15–1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, −25%; IQR, −20% to −29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%–105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, −15%; IQR, −14% to −21%) and decreased the SIR at all hospitals (median, −8%; IQR, −4% to −11%).
For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.
Did the Crusades trigger significant intellectual activity? To what extent and in what ways did the Latin residents of the Crusader States acquire knowledge from Muslims and Eastern Christians? And how were the Crusader states influenced by the intellectual developments which characterized the West in the twelfth and thirteenth centuries? This book is the first to examine these questions systematically using the complete body of evidence from one major urban centre: Acre. This reveals that Acre contained a significant number of people who engaged in learned activities, as well as the existence of study centres housed within the city. This volume also seeks to reconstruct the discourse that flowed across four major fields of learning: language and translation, jurisprudence, the study of Islam, and theological exchanges with Eastern Christians. The result is an unprecedentedly rich portrait of a hitherto neglected intellectual centre on the Eastern shores of the medieval Mediterranean.
Libman–Sacks endocarditis is rare in children and adolescents, more so as a first manifestation of systemic lupus erythematosus. Currently, sterile verrucous lesions of Libman–Sacks endocarditis are recognised as a cardiac manifestation of both systemic lupus erythematosus and antiphospholipid syndrome. They are clinically silent in a majority of the cases. The presence of antiphospholipid antibodies in systemic lupus erythematosus is associated with three times higher prevalence of mitral valve nodules and significant mitral regurgitation. We present the case of isolated mitral regurgitation with abnormal looking mitral valve, detected in early childhood, which deteriorated to a severe degree in the next decade and was diagnosed as Libman–Sacks endocarditis after surgical repair from histopathology. The full-blown clinical spectrum of systemic lupus erythematosus with antiphospholipid antibodies was observed several weeks after cardiac surgery. We discuss the atypical course of Libman–Sacks endocarditis with follow-up for 10 years, along with a review of the literature.
The endothelium serves barrier, synthetic and catalytic functions and is a site of complex interacting processes involving a large number of biological components. Mathematical modeling might provide valuable insight into the global integration of those interactions into tissue function. The purpose of this chapter is to provide a nontechnical review of a well-established modeling platform, namely differential equations, that harnesses the powerful tools of calculus to analyze the time-dependent behavior of dynamical systems. Differential equations have been abundantly used by modelers. Yet, this framework is largely unknown to basic and clinical scientists. We will briefly describe this framework, provide examples that relate to endothelium modeling, and discuss its strengths and weaknesses (Figure 191.1).
A dynamical system is an amalgam of interacting components together with a set of rules for how the states of the components evolve in time, and so the notion of time evolution is key when thinking about such a system. Many primary or calculated useful physiological quantities, such as cardiac output and vascular resistance, are related in a static fashion. In other words, one can relate these quantities by means of algebraic equations of varying complexity. The equations resulting from drawing an analogy between electrical circuits and the circulation have led to additional appealing concepts, such as peripheral vascular resistance and vascular capacitance. However, the clinician is clearly aware that these quantities change over time as the “system” adapts to changing external and internal conditions such as fluid administration, local concentration of effectors, or drug dose.