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Background: The number of liver transplant recipients (LTR) is worldwide increasing and, as the survival is improving as well, there is an increasing number of patients needing total hip arthroplasty (THA). There might be increased risks for this specific group of patients and due to their comorbidities costs might be higher too. Using a big national database outcome and cost of THA should be compared between liver transplant recipients and the general population. Methods: The study was performed using a collection of Medicare, Medicaid, and private insurance claims. Length of stay (LOS), 30-day readmissions, complications rates up to 5 years, and 90-day total cost of care between liver transplant recipients and matched non-transplant patients should be compared. All primary THAs from 2010 to 2019 were identified. 513 patients with a liver transplant before their THA were matched to 10,759 patients without a history of solid organ transplant at a 1:20 ratio based on age, sex, Charlson Comorbidity Index, obesity, and diabetes status. Results: LTR had a longer average LOS (4.2 vs. 3.4 days, p Conclusions: These findings suggest that complications and costs are no major point of concern in patients with liver transplant that are operated with THA.

The purpose of this article was to reassess patterns previously identified in the Federal Bureau of Investigation’s Law Enforcement Officers Killed and Assaulted (LEOKA) data, expanding the time frame from 5 years to 20 years, for application within law enforcement when considering training needs over the life cycle of an officer's career. Consistent with the findings of the earlier analysis, this study identifies two prevalent patterns: the age range with the highest frequency of death was 30–39, and the years of experience with the highest frequency of death was 0–4. In fact, the analysis indicates an even stronger pattern of the deadly combination of age and tenure. Implications of the study include the need for larger scale data collection on the national population of officers, detailed information on transfers and time of service overall (as opposed to time in service at current department), and evaluations of current training programs and practices regarding de-escalation and the use of force as well as self-defense and situational awareness.

Objective: Advancements have been made in the care of patients with Treacher Collins syndrome (TCS), but epidemiological data are lacking given its rarity. A national database provides a valuable opportunity for studying the incidence of rare craniofacial conditions. We sought to evaluate disease incidence of phenotypically severe cases and the frequency of the most common associated diagnoses and interventions. Design: The 2016 Kids’ Inpatient Database (KID), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality was the first version to include updated International Classification of Diseases-Tenth Edition (ICD-10) coding encompassing a unique code for TCS. The 2016 KID was queried for the unique code. Incidence was calculated using national estimates. Diagnosis and procedure codes were pooled and analyzed. Patients: A total of 266 discharge cases with a diagnosis code for TCS (Q75.4). Main Outcomes: Disease incidence and the most frequent diagnosis and procedure codes. Results: The estimated incidence of children born with a diagnosis of TCS was approximately 1 in 80,000. Two of the three most common ICD-10 diagnosis codes were tracheostomy status and obstructive sleep apnea. The most common procedures performed were airway examination procedures. Conclusions: Treacher Collins syndrome is a rare craniofacial disorder requiring complex multidisciplinary management. Phenotypically severe cases requiring inpatient management may be rarer than previous estimates suggest. Inpatient airway interventions are very common, and multidisciplinary team members should anticipate the degree of potential airway risk these patients pose.

Study Design: Observational cohort study. Objective: To compare 1-year perioperative complications between structural allograft (SA) and synthetic cage (SC) for anterior cervical discectomy and fusion (ACDF) using a national database. Methods: The TriNetX Research Network was retrospectively queried. Patients undergoing initial single or multilevel ACDF surgery between October 1, 2015 and April 30, 2019 were propensity score matched based on age and comorbidities. The rates of 1-year revision ACDF surgery and reported diagnoses of pseudoarthrosis, surgical site infection (SSI), and dysphagia were compared between structural allograft and synthetic cage techniques. Results: A comparison of 1-year outcomes between propensity score matched cohorts was conducted on 3056 patients undergoing single-level ACDF and 3510 patients undergoing multilevel ACDF. In single-level ACDF patients, there was no difference in 1-year revision ACDF surgery ( P = .573), reported diagnoses of pseudoarthrosis ( P = .413), SSI ( P = .620), or dysphagia ( P = .529) between SA and SC groups. In multilevel ACDF patients, there was a higher rate of revision surgery (SA 3.8% vs SC 7.3%, odds ratio = 1.982, P < .001) in the SC group, and a higher rate of dysphagia in the SA group (SA 15.9% vs SC 12.9%). Conclusion: While the overall revision and complication rate for single-level ACDF remains low despite interbody graft selection, SC implant selection may result in higher rates of revision surgery in multilevel procedures despite yielding lower rates of dysphagia. Further prospective study is warranted.

Background and objective: Pancreatic and periampullary cancers are sometimes found to have a too advanced disease during surgery to allow resection. The aim was to describe characteristics, treatment, outcome, and time trends for patients that were planned for pancreatic surgery but found unresectable during surgery. Methods: Data from the Swedish National Pancreatic and Periampullary Cancer Registry were used. All patients registered between January 2010 and August 2018 were included. The patient cohort was divided in two halves based on year of diagnosis. Results: In total, 12,377 patients were included in the registry and finally 4568 patients were scheduled for surgery. During surgical exploration, 3879 (84.9%) patients underwent pancreatic resection, 658 (14.4%) patients were found unresectable, and 31 (0.7%) had no pancreatic resection due to other reasons (e.g. benign lesion, comorbidity). More patients underwent surgical exploration and resection during the second time period, but exploration without resection was unchanged (15.7% vs 13.7%; p = 0.062). Survival rates were lower among the unresectable patients with pancreatic and periampullary tumors compared to the resectable patients, including 30-day mortality (n = 17 (3.5%) vs n = 39 (1.6%), p = 0.004) and 90-day mortality (n = 72 (15.0%) vs n = 70 (2.8%), p Conclusions: Unresectability is associated with an unfavorable prognosis. The frequency did not decrease during the study period, but palliative surgical procedures became less common.

Objective: To assess the timing, type, and associated adjunct procedures for secondary cleft rhinoplasty nationally. Design: Data were extracted from a national database of all secondary cleft rhinoplasty procedures (Current Procedural Terminology [CPT] codes 30460 and 30462). Frequency statistics were utilized to analyze demographics, comorbidities, surgical procedures, and timing. Chi-squared analysis and Fisher exact test were used for analysis. Setting: National Surgical Quality Improvement Program-Pediatric Database. Participants: A total of 1720 patients met inclusion criteria for secondary cleft rhinoplasty repair. Interventions: No relevant intervention. Main Outcomes and Measures: Age, demographics, comorbidities, and associated procedures. Results: Over 5 consecutive years, 1720 patients underwent secondary cleft lip rhinoplasty nationally. Mean patient age was 9.3 ± 5.3 years. Unilateral cleft rhinoplasty patients were older (9.0 years) than bilateral patients (7.8 years; P = .001). Rib grafting was performed in 6.3% of patients at a mean age of 10.6 years with a higher proportion of Asian and female patients. Auricular grafts were more commonly performed by otolaryngology than plastic surgery. The most common adjunct procedures included secondary cleft lip revision (33.1%) and tympanostomy tube placement (10.2%). When subdividing by type of cleft rhinoplasty, tip rhinoplasty was performed at a mean age of 7.3 years compared to rhinoplasty with osteotomies and a major septal component at 12.1 years ( P < .001). Conclusions: This study reveals that a large proportion of cleft rhinoplasties are performed in skeletally immature patients. Although patients undergoing rib grafting, nasal osteotomies, and a major septal component were older, these procedures are still performed in a large proportion of patients who are younger than expected.

Using a national database of state education policies related to the Every Student Succeeds Act (ESSA), as well as data from surveys, interviews, and site visits, Adam Edgerton describes how ESSA has shifted relationships among state education agencies (SEAs) and school districts. Some states have not changed their policies much despite the flexibility afforded under the law, although some states have adjusted what measures are included in their accountability systems. States also expressed concern about how to meet requirements for English language learners and students with disabilities. Overall, SEAs are designing more targeted interventions for underperforming districts, and they are focusing on providing supports rather than punishments. But in this era of increased flexibility, it is possible for states to move from one extreme — punitive test-based accountability — to another — laissez-faire leadership.

Objectives: The goal of this study is to describe the 30-day postoperative sequelae of pediatric choanal atresia repair and identify predictive factors for adverse events. Study Design: The American College of Surgeons’ National Surgery Quality Improvement Program-Pediatric (NSQIP-P) database was searched between January 2012 and December 2015 to identify pediatric patients status post choanal atresia repair. Postoperative outcomes included surgical site complications, readmissions, and total length of stay. Results: A total of 178 children underwent choanal atresia repair. The overall complication rate was 6.2%, while the 30-day readmission rate was 15%. Patients with CHARGE had a longer mean duration of hospitalization (26.91 days vs 8.05 days, P = .013). Additionally, patients ≤10 days of age had longer duration of hospitalization (17.84 days vs 9.24 days, P ≤ .001) and higher readmission rates (33.30% vs 10.1%, P = .001). Among the nonsyndromic cohort, ventilator dependence was a predictor of postoperative complications (odds ratio [OR] = 16.08, P < .001), higher readmission rates (OR = 5.46, P = .002), and a longer hospital stay (OR = 18.69, P < .001). Conclusion: Analysis of the 2012-2015 NSQIP-P data set reveals that patients with a diagnosis of CHARGE and those ≤10 days of age have a longer duration of hospitalization. Increased risk of postoperative complications and longer duration of hospitalization were both influenced by chronic steroid use and ventilator dependence.

Objectives: Eight years of panel data are used to investigate the association between three dimensions of religiosity and total and disability-free life expectancy (TLE/DFLE) in Taiwan. Method: Data come from the 1999 “Taiwan Longitudinal Study on Aging” (TLSA; N = 4,440; Age 55+). Dimensions of religiosity are public, private, belief, and coping. Mortality is linked to a national database. Disability is activities of daily living (ADLs). TLE/DFLE estimates use the Stochastic Population Analysis for Complex Events (SPACE) software. Results: Those who engage in public and private religiosity live longer and more years disability-free than others, but proportion of life disability-free does not differ across levels of religiosity. Coping is less associated with TLE and DFLE. Coping however associates with more years disabled among men. Findings are robust to model specifications. Discussion: The way in which religiosity associates with health depends upon the definition. When it does associate, religiosity increases TLE and DFLE proportionately.

A systematic review was conducted with the aim of describing the demographical data, features and outcomes of patients with Lyme disease (LD), reported from Turkey. Three international database (electronic PubMed, Web of Science and Scopus) and two national database (Ulakbim and Turkmedline) searches were performed using the following keywords ([‘Lyme’ or ‘Borrelia burgdorferi’ or ‘Borrelia’ or ‘Borreliosis’] and ‘Turkey [and/country]’). National Notifiable Diseases Surveillance System (NNNDS) of Centers for Disease Control and Prevention (CDC) criteria were used for classification. A PRISMA-based algorithm was used for systematic review. There were a total of 75 LD cases in 36 different reports. Studies related to LD are confined to case reports. We believe that LD is an important healthcare problem in Turkey and to our knowledge this is the first systematic review from this country.

Objectives: The extensor mechanism of the knee is composed of the quadriceps tendon, the patellar tendon, and the patella. These injuries are associated with several comorbidities including diabetes mellitus, rheumatoid arthritis, gout, hyperparathyroidism, chronic renal failure and corticosteroid or anabolic steroid use. Cigarette smoking is also a known risk factor for extensor mechanism rupture, with increased number of pack years associated with decreased tendon thickness and increased incidence of rupture. Smoking has also been shown to have deleterious effects on tendon repair, with a higher frequency of post-surgical complications involving soft-tissue infection, failure of wound healing, and worse functional outcomes in smokers relative to non-smokers. Using a large national data set of extensor mechanism repair patients, risk factors for extensor tendon injury, and the effects of smoking on the risk of postoperative complication were analyzed. We hypothesized that patients who smoke would have higher rates of post-surgical complications relative to non-smokers. Methods: This retrospective study utilized the Humana insurance data set within the PearlDiver Patient Records Database (PearlDiver Inc, Fort Wayne, Indiana), a large private/commercial and Medicare medical record database. Patients who underwent extensor mechanism repair using Current Procedural Terminology (CPT) codes CPT-27380, CPT-27524, and CPT-27385 were identified. These patients were partitioned into two cohorts, one coding for tobacco use or nicotine dependence before their repair and another who did not. Gender, age, obesity, morbid obesity, diabetes, hypertension, chronic obstructive pulmonary disease (COPD), steroid use, renal dialysis, thyroid disease, end stage renal disease, hyperlipidemia, and systemic inflammation rates were assessed in each population. Postoperative complications, including 30-day readmission rate, 1-year revision rate (defined as a repeat procedure within 1 year post-index surgery), urinary tract infection (UTI), surgical site complication, deep vein thrombosis (DVT), sepsis, pneumonia, myocardial complications, respiratory complications, cardiac complications, cardiac arrest, coagulation, and death were investigated for the two groups. Multivariate logistic regression was used to calculate odds ratios, controlling for age, gender, race, Charlson Comorbidity Index (CCI), and all risk factors that were found to have significantly different risks between smoking and non-smoking patients. Statistical analysis was performed using the PearlDiver software, which runs R, Version 1.1.442. An α value of .05 was set as the level of significance. Results: Among extensor mechanism repair patients, 1559 (22.5%) smoking patients and 5376 (77.5%) non-smoking patients were included in the analysis. The age distribution of both cohorts of patients was similar, with most patients being between 65 and 74 years of age (Table 1). Pre-operative comorbidities associated with extensor mechanism injury were found to be significantly different between the smoking and non-smoking cohorts, specifically with regards to smokers 11.2% vs. 5.9% (p

Introduction: The optimal treatment of patients with a displaced intracapsular femoral neck fracture remains controversial. We utilised a national database of Medicare patients to determine if there was any difference in complications and reoperation rate of patients undergoing total hip arthroplasty (THA) or hemiarthroplasty (HA) for femoral neck fractures. Methods: This study utilised the PearlDiver Patient Records Database, a national for-fee database of Medicare patient procedure and diagnosis records from 2005 to 2012. Outcome procedures and diagnoses including revision, dislocation, infection, and cardiovascular events that occurred during the study time period were also identified over the entire study period as well as 90 days and 2 years. Results: We identified 275,439 patients with femoral neck fractures who underwent HA and 26,017 patients who underwent THA, respectively. Patients undergoing HA had significantly lower rates ( p < 0.0001) of revision 2.48% versus 3.85% (OR = 0.633; 95% CI, 0.592–0.678), dislocation 1.76% versus 3.39% (0.512; 0.476–0.551), infection 3.44% versus 4.87% (0.694; 0.657–0.737). There was no statistical significant difference in 2-year cardiac morbidity ( p = 0.252). However, when controlling for age, patients 65–69 years showed no significant difference in infection or revision over the study period or at 2 years. Conclusions: In this study, patients who underwent THA for femoral neck fractures had a higher rate of dislocations, infections and increased rates of repeat surgery than those who underwent HA but this difference was not significant in patients 65–69 years. Hemiarthroplasty may result in fewer complications in older Medicare patients although this difference may not be present in younger Medicare patients.

Patients with end stage renal disease (ESRD) represent a growing subset of surgical candidates and ESRD status has been associated with increased morbidity and mortality in other operations. Using a national database, we examined outcomes and risk factors for patients presenting with perforated gastroduodenal ulcers undergoing omentopexy. We identified adult and emergent patients with perforated duodenal and gastroduodenal ulcers that underwent omentopexy using the 2005 to 2012 Nationwide Inpatient Sample. We identified patients with ESRD status and assessed comorbidity status using the Elixhauser–van Walraven score. Univariate and multivariable logistic regression analyses were performed. Inpatient mortality was the primary outcome. Six thousand five hundred and twenty-one patients were identified. Median age was 59.0 years, majority were male (55.56%), 79 (1.21%) patients had ESRD, 367 (5.63%) patients died during admission. Multivariable logistic regression showed age (OR 2.71, P < 0.0001), Elixhauser–van Walraven score (OR 2.69, P < 0.0001), and ESRD status (OR 3.88, P < 0.0001) as independent risk factors for mortality. ESRD was associated with increased mortality in patients undergoing omentopexy for perforated gastroduodenal ulcers. Future studies are necessary to identify methods to increase perioperative survival.

Objective: Health registries and discharge-level databases are powerful tools. Commonly used data sets include the Nationwide Inpatient Sample (NIS); Surveillance, Epidemiology, and End Results Program (SEER); National Cancer Database (NCDB); and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). This study investigated the frequency with which these resources are being used and categorized their contributions to literature. Design: A literature review from 2005 to 2016 for papers utilizing the aforementioned databases and publishing in The Laryngoscope, JAMA-Otolaryngology, Head and Neck, Otolaryngology-Head and Neck Surgery, and International Forum of Allergy and Rhinology was conducted. Results were categorized based on the contribution(s) of the paper. The incidence rate of database publications was calculated for each year along with the 95% confidence intervals using a Poisson distribution. Results: Three hundred ten studies were identified. Seventy percent report descriptive findings, and 65% report outcomes/survival. Approximately 18% made clinical recommendations. In 2005, the incidence rate of database publications was 3 per 1000 journal publications (95% CI, 1-9) and remained relatively stable until 2008. From 2010 onward, there was a persistent increase in publications, culminating in the highest incidence rate in 2016 of 26 database publications per 1000 journal publications (95% CI, 20-32). Conclusions: There was a nearly 10-fold increase in database publications in 2016 compared to 2005. The majority provide descriptive data and outcomes measures. The role of these studies warrants further investigation.

Study Design: Retrospective cohort study. Objectives: Diabetes mellitus is a highly prevalent disease in the United States. Adult spinal deformity (ASD) surgery encompasses a wide variety of spinal disorders and is associated with a morbidity rate between 20% and 80%. Considering utilization of spinal surgery will continue to increase, this study investigates the influence of diabetes mellitus on acute postoperative outcomes following elective ASD surgery. Methods: The 2010-2014 American College of Surgeon’s National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases (9th Revision) diagnosis codes relevant to ASD surgery. Patients were divided into cohorts based on their diabetic status. Bivariate and multivariate logistic regression analyses were employed to identify which 30-day postoperative outcomes patients are at risk for. Results: A total of 5809 patients met the inclusion criteria for the study of which 4553 (84.2%) patients were nondiabetic, 578 (10.7%) patients had non–insulin-dependent diabetes mellitus (NIDDM), and 275 (5.1%) patients had insulin-dependent diabetes mellitus (IDDM). Diabetes status was significantly associated with length of stay ≥5 days (NIDDM: odds ratio [OR] = 1.27, 95% confidence interval [CI] = 1.02-1.58, P = .034; IDDM: OR = 1.55, 95% CI = 1.15-2.09, P = .004), any complication (NIDDM: OR = 1.26, 95% CI = 1.01-1.58, P = .037), urinary tract infection (NIDDM: OR = 1.87, 95% CI = 1.14-3.05, P = .012), and cardiac complications (IDDM: OR = 4.05, 95% CI = 1.72-9.51, P = .001). Conclusions: Given the prevalence of diabetes, surgeons will invariably encounter these patients for ASD surgery. The present study identifies the increased risk NIDDM and IDDM patients experience following ASD surgery. Quantification of this increased risk may improve the selection of appropriate surgical candidates, patient risk stratification, and patient postoperative safety.

For decades, dental schools in the United States have endured a significant faculty shortage. Studies have determined that the top 2 sources of dental faculty are advanced education programs and private practice. Those who have completed both DDS and PhD training are considered prime candidates for dental faculty positions. However, there is no national database to track those trainees and no evidence to indicate that they entered academia upon graduation. The objective of this study was to assess outcomes of dental school–affiliated oral sciences PhD program enrollment, graduates, and placement between 1994 and 2016. Using the American Dental Association annual survey of advanced dental education programs not accredited by the Commission on Dental Accreditation and data obtained from 22 oral sciences PhD programs, we assessed student demographics, enrollment, graduation, and placement. Based on the data provided by program directors, the average new enrollment was 33, and graduation was 26 per year. A total of 605 graduated; 39 did not complete; and 168 were still in training. Among those 605 graduates, 211 were faculty in U.S. academic institutions, and 77 were faculty in foreign institutions. Given that vacant budgeted full-time faculty positions averaged 257 per year during this period, graduates from those oral sciences PhD programs who entered academia in the United States would have filled 9 (3.6%) vacant faculty positions per year. Therefore, PhD programs have consistently generated only a small pipeline of dental school faculty. Better mentoring to retain talent in academia is necessary. Stronger support and creative funding plans are essential to sustain the PhD program. Furthermore, the oral sciences PhD program database should be established and maintained by dental professional organizations to allow assessments of training models, trends of enrollment, graduation, and placement outcomes.

Background: Nationwide epidemiologic studies in Scandinavian countries have shown that the incidence of Achilles tendon ruptures (ATRs) has increased, and the rate of surgical treatment has declined markedly in the past decade. However, there is a lack of national-level data on the trend of ATRs and surgical procedures in other regions. Purpose: To clarify the trend in the incidence of ATRs and the proportion of surgery using the nationwide health care database in Japan. Study Design: Descriptive epidemiology study. Methods: Age- and sex-stratified data on the annual number of ATRs and surgical procedures between 2010 and 2017 were obtained from the Japanese national health care database, which includes almost all inpatient and outpatient medical claims nationwide. The Japanese population data were also obtained from the population census. The change in the annual incidence of ATRs per 100,000 people was assessed using a Poisson regression analysis. The trend in the annual proportion of surgeries relative to the occurrence of tendon ruptures was determined using a linear regression analysis. Results: A total of 112,601 ATRs, with men accounting for 67%, were identified over 8 years. Patients aged ≥60 years accounted for 27,106 (24%), while those aged 20 to 39 years and 40 to 59 years accounted for 36,164 (32%) and 49,331 (44%), respectively. The annual incidence of ATR ranged from 12.8/100,000 to 13.9/100,000 (women, 8.2-8.9/100,000; men, 17.2-19.5/100,000), which did not change over the study period ( P = .82). Moreover, the annual incidences did not change across sexes and age categories. The annual proportion of surgery increased significantly, from 67% in 2010 to 72% in 2017 ( P = .003). The annual proportions increased across sexes and age categories except for women aged 40 to 59 years. Conclusion: The incidence of ATR did not change between 2010 and 2017, according to the Japanese nationwide health care database. Furthermore, the proportion of surgical treatment increased during the study period. Overall, 70% of patients underwent surgical treatment. This study suggested that the trend in ATR and surgery differed across regions.

Study Design: Retrospective cohort study. Objective: The purpose was to compare rates of postoperative ED visits, readmission, and reoperation between patients with and without preexisting mental illness undergoing outpatient anterior cervical discectomy and fusion (ACDF). Methods: A retrospective review of the Mariner Database was conducted on patients who underwent ACDF between 2010 and 2017. Exclusion criteria included same day revision surgery and patients with a history of spine infection, trauma, or neoplasm. Patients were grouped into 3 categories: those with existing history of anxiety and/or depression, those with severe mental illness, and those without any history of mental illness. Severe mental illness was defined as a combination of diagnosis including schizophrenia, bipolar disorder, and/or psychotic disorder. Outcome measures were analyzed by comparing groups using multivariate logistic regression. Significance was set at P < 0.05. Results: Patients with anxiety/depression and patients with severe mental illness both had significantly increased risk of ED visits and readmission at 30-day and 90-day intervals. Compared to patients without mental illness, patients with severe mental illness (OR 1.93, P < 0.001) had significantly increased rates of reoperation at 90-days and 1-years postoperatively. Patients with anxiety/depression did not have increased rates of reoperation relative to patients without anxiety/depression at any time interval ( P > 0.05). Conclusion: Anxiety/depression as well as more severe psychiatric disease such as Schizophrenia and Bipolar disorder were significantly associated with increased healthcare utilization following outpatient ACDF. Patients with preexisting mental illness undergoing outpatient ACDF should be carefully evaluated preoperatively and closely followed postoperatively to reduce risk of adverse events.

Objectives To describe serious incidents occurring in the management of patient remains after their death. Design Incidents occurring after patient deaths were analysed using content analysis to determine what happened, why it happened and the outcome. Setting The Strategic Executive Information System database of serious incidents requiring investigation occurring in the National Health Service in England. Participants All cases describing an incident that occurred following death, regardless of the age of the patient. Main outcome measures The nature of the incident, the underlying cause or causes of the incident and the outcome of the incident. Results One hundred and thirty-two incidents were analysed; these related to the storage, management or disposal of deceased patient remains. Fifty-four incidents concerned problems with the storage of bodies or body parts. Forty-three incidents concerned problems with the management of bodies, including 25 errors in postmortem examination, or postmortems on the wrong body. Thirty-one incidents related to the disposal of bodies, 25 bodies were released from the mortuary to undertakers in error; of these, nine were buried or cremated by the wrong family. The reported underlying causes were similar to those known to be associated with safety incidents occurring before death and included weaknesses in or failures to follow protocol and procedure, poor communication and informal working practices. Conclusions Serious incidents in the management of deceased patient remains have significant implications for families, hospitals and the health service more broadly. Safe mortuary care may be improved by applying lessons learned from existing patient safety work.

Study Design: Retrospective analysis of prospectively collected data. Objectives: Few studies have investigated the role of preoperative anemia on postoperative outcomes of posterior cervical fusion. This study looked to investigate the potential relationship between preoperative anemia and postoperative outcomes following posterior cervical spine fusion. Methods: Data from patients undergoing elective posterior cervical fusions between 2005 and 2012 was collected from the American College of Surgeons National Surgical Quality Improvement Program database using inclusion/exclusion criteria. Multivariate analyses were used to identify the predictive power of anemia for postoperative outcomes. Results: A total of 473 adult patients undergoing elective posterior cervical fusions were identified with 106 (22.4%) diagnosed with anemia preoperatively. Anemic patients had higher rates of diabetes ( P = .0001), American Society of Anesthesiologists scores ≥3 ( P < .0001), and higher dependent functional status prior to surgery ( P < .0001). Intraoperatively, anemic patients also had higher rates of neuromuscular injuries ( P = .0303), stroke ( P = .013), bleeding disorders ( P = .0056), lower albumin ( P < .0001), lower hematocrit ( P < .0001), and higher international normalized ratio ( P = .002). Postoperatively, anemic patients had higher rates of complications ( P < .0001), death ( P = .008), blood transfusion ( P = .001), reoperation ( P = .012), unplanned readmission ( P = .022), and extended length of stay (>5 days; P < .0001). Conclusions: Preoperative anemia is linked to a number of postoperative complications, which can increase length of hospital stay and increase the likelihood of reoperation. Identifying preoperative anemia may play a role in optimizing and minimizing the complication rates and severity of comorbidities following posterior cervical fusion.

Purpose Forearm fractures are one of the most commonly sustained injuries in children and are often treated non-operatively. The purpose of this study was to estimate the rate of inpatient surgical treatment of paediatric forearm fractures over time using a large, publicly available, national database. Methods The Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) was evaluated between 2000 and 2012. Forearm fractures and surgeries were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis and procedure codes. Univariable and multivariable logistic regression were used to determine variables associated with greater proportion of surgical treatment. All statistical analyses were performed using SAS statistical software v.9.4 (SAS Institute Inc., Cary, NC, USA). Statistical significance was set at p < 0.05. Results The database identified 30 936 forearm fracture admissions. Overall, 19 837 of these patients were treated surgically (64.12%). The percentage of patients treated with surgery increased from 59.3% in 2000 to 70.0% in 2012 (p < 0.001). Multivariable regression analysis found increased age (p < 0.001), more recent year (p < 0.001), male gender (p = 0.003) and admission to a children's hospital (p < 0.001) were associated with an increased proportion of patients receiving surgical treatment. Medicaid payer status was associated with a lower proportion of surgical treatment (p < 0.001). Conclusions The rate of operative treatment for paediatric forearm fractures admitted to the hospital increased over time. Increased surgical rates were associated with older age, male gender, treatment at a children's hospital and non-Medicaid insurance status.

Spinal cord injury service delivery in the UK has improved over the years. The modern concept of Spinal Cord Injury care commenced after the Second World War. Patients started to live longer after the improvement in the medical and nursing care which was delivered in Spinal Cord Injury Centres across the country. In the last five years, spinal cord injury care has seen major advances. The Spinal Cord Injury Strategy Board was established in 2010 which led to the development of the Spinal Injury Pathway, the Spinal Injury National database and the creation of the clinical reference group for Spinal Cord Injury. This led to improvement in the care of evidence-based management.

Objective The association between comorbidities and inpatient mortality with sudden sensorineural hearing loss (SSNHL) has not been investigated. Therefore, this study aimed to provide a 14-year nationwide incidence, and identify risk factors and comorbidities of SSNHL inpatient mortality. Methods Data were obtained from the Taiwan National Health Insurance Research Database for 2000 to 2013. Inpatient mortality of 31,258 patients hospitalized with a diagnosis of SSNHL was recorded and analyzed. Results Sixteen patients with SSNHL exhibited mortality with a percentage of 0.05% and an incidence of less than 0.01 per 100,000 people per year. The risk of variables among inpatient mortality was associated with older age (adjusted odds ratio [OR]: 1.042, 95% confidence interval [CI]: 1.009–1.077) and the presence of catastrophic illness (adjusted OR: 4.949, 95% CI: 1.290–18.996). Potential comorbidities included hematologic diseases, cancers, chronic hepatitis, gastrointestinal bleeding, chronic obstructive pulmonary disease, seizures or convulsions, coronary artery disease, diabetes mellitus, and varicose veins and their associated complications. Conclusions This 14-year nationwide study shows that inpatient mortality rate for SSNHL is relatively rare, but suggests we should still be aware of the potential for such underlying conditions to cause SSNHL as well as the mortality associated with these conditions.

Objectives: There is concern that the number of youth sports injuries are increasing in the United States. The purpose of our study was to utilize a large national database to characterize the incidence of surgical procedures for various pediatric sports orthopedic injuries as well as trends amongst certain patient populations. Methods: A search of the Truven Health MarketScan Database (over 39 million patients per year) was conducted to identify the incidence of various orthopaedic conditions as well as associated surgical procedures from 2008 through 2014 amongst patients 10-19 years of age. The database was searched for patients who had International Classification of Disease (ICD-9) codes and Current Procedure Terminology (CPT) codes for operative treatment for the following conditions: anterior cruciate ligament (ACL) injuries, knee collateral ligament injuries, chondral injuries, Osgood-Schlatter syndrome, and elbow ulnar collateral ligament (UCL) injury. Patients identified were characterized by gender, age, and year of injury as well as surgery. Regression analysis was used to evaluate differences in surgery trends between individual patient groups delineated by age, and gender. The Cochran-Armitage trend test was used to identify significant differences in surgery trends seen yearly. Results: A total of 660,982 patients sustained an injury with 165,590 (25%) having related surgery during the study period. Surgery was performed for 65,224 (54.4%) patients for ACL injury, 3,839 (3.7%) patients for knee collateral ligament injury, 91,217 (30.6%) patients for chondral injury, 211 (0.2%) patients for Osgood-Schlatter syndrome, and 5,099 (22.71%) patients for UCL injury. Only knee collateral ligament injuries demonstrated an increase in the rate of surgical intervention over time, from 2% in 2008 to 5.3% in 2014 (p < .0001). Age greater than 15 yrs was associated with a higher likelihood for surgical intervention for all diagnoses (p < .001). Average age of surgical intervention ranged from 15.9 yrs for Osgood-Schlatter syndrome to 16.8 yrs for a UCL injury and did not change for any diagnosis over time. Females were more likely to undergo surgery for ACL injuries (OR = 1.5, p < .0001), knee collateral ligament injury (OR = 1.7, p < .0001), and Osgood-Schlatter syndrome (OR = 1.8, p < .0001) while males were more likely to undergo surgery for chondral injuries (OR = 1.6, p < .0001) and UCL injuries (OR = 1.1, p < .0005). Both male and female patients demonstrated a sustained increase in surgery for knee collateral ligament injuries over the study period, with no other diagnosis showing trend changes secondary to gender. Conclusion: Our study found the incidence of surgical treatment of five common sports injuries remained stable over time with only knee collateral ligament injuries demonstrating an increase in surgical incidence over the study period. There was no significant change over time in the average age of surgical intervention for all diagnosis. Females were more likely to undergo surgery for ACL injuries, knee collateral ligament injuries, and Osgood-Schlatter syndrome while males were more likely to undergo surgery for chondral and UCL injuries. Despite concern that incidence of youth sports injuries and surgeries are increasing over time and that average age of these injuries is decreasing, our data using a large US National Database does not support this.

Objectives: The aim was to compare prostate cancer and all-cause mortality in patients diagnosed with prostate cancer following a transurethral resection of the prostate (TURP) (incidental prostate cancer, IPC), to men diagnosed with localised non-incidental prostate cancer (NIPC). Patients and methods: Men diagnosed with localised prostate cancer between 2000 and 2008 were identified from the English national cancer registry. Their records were linked to the Hospital Episode Statistics (HES) database of hospital admissions in England to identify men who had a TURP. Men were considered to have IPC if prostate cancer was diagnosed less than 60 days after TURP. Mortality rates were calculated using the Kaplan–Meier method. Mortality rate ratios (RR) comparing IPC and NIPC were calculated with multivariable Poisson regression adjusting for age group, co-morbidities, year of diagnosis and radical treatment. Results: A total of 192,960 men were included. Of these, 6666 (3.5%) had IPC and 186,294 (96.5%) NIPC. Median follow-up was 4.7 years (0.5–11.0). Ten-year prostate cancer mortality was 17.1% in IPC, 19.0% in NIPC. With adjustment, the prostate cancer-specific mortality in IPC was 30% lower than NIPC (RR 0.70, 95% CI 0.65–0.75, pConclusion: Ten-year prostate cancer mortality in IPC was 17%. Men with IPC had lower prostate cancer-specific mortality than other prostate cancer patients.

Objective. The objective of the present study is to utilize a national database to examine the association between obesity and postoperative complications after primary Achilles tendon repair. Methods. The PearlDiver database was queried for patients undergoing primary Achilles repair using CPT 27650. Excision of a Haglund’s deformity or tendon transfer were exclusion criteria. Patients were then divided into obese (body mass index [BMI] > 30 kg/m2) and nonobese (BMI < 30 kg/m2) cohorts using ICD-9 codes. Complications within 90 days postoperatively were assessed using ICD-9 and CPT codes. Results. In all, 18 948 patients who underwent primary Achilles tendon repair were identified from 2005 to 2012. Overall, 2962 patients (15.6%) were coded as obese or morbidly obese. Obese patients had significantly higher rates of postoperative wound complications (odds ratio [OR] = 2.1; P < .0001), infection (OR = 1.8; P < .0001), venous thromboembolism (VTE; OR = 1.8; P = .001), and medical complications (OR = 3.9; P < .0001) compared with nonobese patients after primary Achilles tendon repair. Additionally, obese patients had a significantly lower rate of ankle stiffnesassociated with a significantly higher risk of s (OR = 0.4; P < .0001) compared with nonobese patients. Conclusion. Obesity is associated with a significantly higher risk of wound complications, infection, VTE, and medical complications after primary Achilles tendon repair. Levels of Evidence: Prognostic, Level II: Retrospective study

India has the distinction of having one of the most ancient, richest and largest collections of manuscripts in the world. These manuscripts which are available in different forms, languages, scripts and cover a wide range of subjects are a powerful medium for the preservation of Indian cultural heritage. But the preservation of these manuscripts is a serious problem for the custodians of manuscripts because of the hot and humid climate of the country. In this context the present paper gives an account of the commendable efforts rendered by the National Mission for Manuscripts since its inception in 2003 by establishing and strengthening 57 manuscript resource centres, 50 manuscript conservation centres and developing a National Database of Manuscripts. It also presents the current status of digitization of Indian cultural heritage in the form of manuscripts starting from its collection to the development of a Digital Manuscript Library for global access.

Objectives: To determine UK national trends and results of the Ross operation in relation to all aortic valve interventions. Methods: Examination of the UK Congenital Central Cardiac Audit Database for all aortic valve procedures performed between 2000 and 2011 in children (0-16 years) and young adults (16-30 years). Results: A total of 2,206 aortic valve procedures were performed in children and 1,824 in young adults, the proportions in the two groups being: Ross operation (19% vs 15%, respectively), surgical valvoplasty (9.5% vs 4%), surgical valvotomy (9.5% vs 1%), aortic valve replacement (AVR; 11% vs 55%), aortic root replacement (4% vs 18%), and balloon valvoplasty (47% vs 7%). The 30-day and 1-year survival after Ross is 99.3% and 98.7%, respectively, in the last four years achieving 100%. In children, the proportion of balloon valvoplasty increased from an average of 43% in 2000 to 2006 to 53% in 2007 to 2011, whereas the Ross operation decreased from 22% to 16% ( P < .001). In young adults, the figures are an increase from 49% to 58% for AVR compared to a decrease from 23% to 9% for Ross ( P < .001). Our own single-center series of 91 patients also shows standard results for early- and long-term survival and freedom from reoperation, but gradually fewer Ross operations performed. The year-on-year changes show a significant decreasing trend locally and nationally. Conclusions: Despite an excellent track record, the Ross operation is performed less frequently in the United Kingdom. This report is a first step in comparing treatment modalities at national level.

In Ireland funding for research, especially in the social sciences, has declined considerably. Consequently some data collection methods, particularly faceto-face interviews, have become financially impractical. Postal surveys offer a less expensive alternative but the use of postal methods is hampered in Ireland by restrictions on the use of the electoral register – the only national database which matches citizens’ names and addresses. The electoral register was the most common sampling frame used by researchers to generate representative samples of the Irish population until the Electoral (Amendment) Act 2001 (Section 32) prohibited its use for general research purposes. Basing a sample on addresses only is problematic in the absence of a national postcode system and the fact that a large percentage of Irish houses have non-unique addresses (i.e. lack numbers). The following note addresses these issues and describes the development of a national representative sample.

This article addresses the issue of peer effects on a swimmer’s performance. The National Database of Student Athletes in Taiwan from 2008 to 2010 is employed. The results show that a swimmer performs better when his or her competitors are faster. The evidence shows that peer effects are positive. As to the relative quality of swimmers in a competition, dispersed-quality competitors make a swimmer faster. The evidence also shows that older and taller boys swim faster. The regressions of the Heckman selection model support these conclusions.

Background: Patellar instability refers to subluxation or dislocation of the patella out of the trochlear groove of the femur. Patellar instability is classically thought to be most common in adolescent girls. Risk factors for patellar instability described in the literature include female sex, race, sports participation, personal or family history of patellar instability, ligamentous laxity, trochlear dysplasia, and other anatomic factors. However, the epidemiology of patellar instability is not fully characterized, as some studies have produced conflicting information or been drawn from limited populations. In this study, we used the Pediatric Health Information System (PHIS) database to examine trends in admissions for patellar instability throughout the United States. We believe that a national pediatric hospital database will help to illustrate trends in the epidemiology of patellar instability. We hypothesized that there would be an increasing rate of patellar instability admissions in recent years. Secondarily, we examined how demographic factors and insurance status relate to admissions for patellar instability. Methods: This study used Pediatric Health Information System (PHIS) which is a comprehensive administrative database in which more than 45 pediatric hospitals participate, including not-for-profit, freestanding, and tertiary care pediatric centers associated with the Children’s Hospital Association. Patients with ICD 9 & 10 codes 8363, 8364, 71785, M221.0, S83.001, S83.002, S83.003, S83.004, S83.005, and S83.006, were abstracted from PHIS. We abstracted patient characteristics such as age, sex, race, primary source of payment, and discharge year, as well as hospital characteristics such as hospital city. We included all patients admitted with patellofemoral dislocations that were reported in the PHIS database between January 1, 2004 and April 30, 2017. A Shapiro-Wilk test was conducted to determine normality of the dataset, along with a subsequent Pearson correlation to examine the relationship between number of patellar dislocation admissions over the years studied, adjusted for number of hospitals in the study. The relationship between age at admission and sex was examined using a two sample T-test and a linear regression analysis. All statistical analyses were performed using IBM SPSS Statistics Software Version 23.0 (IBM Corp, Armonk, NY, USA). Statistical significance was set at p < 0.05. Results: An estimated total of 25,413 admissions for patellar instability were identified by the search of the PHIS database; 15,444 (60.8%) were female patients and 9,966 (39.2%) were male. The adjusted number of admissions per reporting hospital significantly increased over the years studied (r=0.775, pConclusions/Significance: Based on a PHIS database search, pediatric hospital admissions for patellar instability are steadily increasing. The majority of patients admitted for patellar instability are female, white, and have insurance other than Medicaid. Males admitted for patellar instability tended to be older than females admitted for the same. [Table: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text]

Drawing on a corpus of eight task-based interactions involving a map task (Australian National Database of Spoken Language (ANDOSL)), this article seeks to focus on how speakers orient to directional terms in an interactional context, and in so doing, to add to features that can be deemed to characterize this speech exchange system. Analysis of the data using conversation analysis showed that features of the talk were confirmation and clarification checks, which provided an opportunity to check understanding and the accuracy of the instruction leading to a correction, acknowledgement or further information; modulated repair and mitigated criticism, resulting in the maintenance of an affiliative stance towards the other speaker; and avoidance of problems that viewpoints or directional terms might cause. Problems with the directional terms in this corpus confirm prior research that the confusion between east and west, and left and right are the terms that cause problems for speakers.

The database developed under NCHRP Project 9-23A, Development of a National Catalog of Subgrade Soil–Water Characteristic Curves (SWCC) Default Inputs to Use in the MEPDG, included not only measured soil index properties needed in all hierarchical levels of the enhanced integrated climatic model but also SWCC parameters, which are key in the implementation of Level 1 analyses. A set of maps in portable document format displaying the location of every soil unit identified within the continental United States, Hawaii, Alaska, and Puerto Rico and a simple interface in MS Excel to aid in querying of data were also developed for the project. Under NCHRP Project 9-23B, Integrating the National Database of Subgrade Soil–Water Characteristic Curves and Soil Index Properties with the MEPDG, a second research effort was directed to integrate an enhanced version of the geographic information system–enabled database with the Mechanistic–Empirical Pavement Design Guide. Specifically, NCHRP Project 9-23B aimed at the implementation of an interactive tool that allows the design guide users (currently DarWin-ME users) to retrieve both appropriate soil unit maps and soil properties relevant to a particular user-specified location by entering either state milepost information or geographical coordinates. The final product was integrated into a public website that can be accessed by design guide users, agencies, industry, and academicians through a simple link. Details of the development of this useful search tool and its main features are presented.

With ever-present budget cuts, teachers often use within-class achievement grouping to meet the needs of students of all ability levels but particularly high-ability students. Using a national database, this study examined the relationship between achievement grouping and the size of achievement groups on kindergarten reading growth. Additionally, it examined whether those relationships differed for kindergarteners in a gifted program. Findings suggest that achievement grouping is related to higher reading achievement, particularly when the average group size is small. Furthermore, although students provided gifted programming at the early grade of kindergarten generally experienced less kindergarten reading growth than their peers, this study suggests the use of achievement grouping provided them the opportunity and instruction to improve their reading achievement during the kindergarten year.

Objective: This study aims to identify the combination of substances with high potential for drug interactions in a palliative care setting and to provide concise recommendations for physicians. Methods: We used a retrospective systematic chart analysis of 200 consecutive inpatients. The recently developed and internationally advocated classification system OpeRational ClAssification of Drug Interactions was applied using the national database of the Federal Union of German Associations of Pharmacists. Charts of patients with potential for severe DDIs were examined manually for clinical relevance. Results: In 151 patients (75%) a total of 631 potential drug interactions were identified. Opioids (exception: methadone), non-opioids (exception: non-steroidal anti-inflammatory drugs), benzodiazepines, proton-pump inhibitors, laxatives, co-analgesics (exception: carbamazepine) and butylscopolamine were generally safe. High potential for drug interactions included combinations of scopolamine, neuroleptics, metoclopramide, antihistamines, non-steroidal anti-inflammatory drugs, (levo-) methadone, amitriptyline, carbamazepine and diuretics. The manual analyses of records from eight patients with risk for severe drug interactions provided no indicator for clinical relevance in these specific patients. Drug interactions attributed to the cytochrome pathway played a minor role (exception: carbamazepine). Conclusion: Most relevant drug interactions can be expected with: (i) drugs (inter-) acting via histamine, acetylcholine or dopamine receptors; and (ii) Non-steroidal anti-inflammatory drugs. Even in last hours of life the combination of substances (e.g. anticholinergics) may produce relevant drug interactions (e.g. delirium). Perspective: Data on the potential for drug–drug interactions in palliative case is extremely scarce, but drug interactions can be limited if a few facts are considered. A synopsis of the findings of these studies is presented as concise recommendation to minimize drug interactions.

Analyses of National Highway Traffic Safety Administration's Fatality Analysis Reporting System (FARS) and National Automotive Sampling System (NASS)/General Estimates System (GES) data from 2002–2006 revealed specific performance errors and combinations of driver, vehicle, and roadway/environmental characteristics associated with older drivers' crashes at intersections. For subsets of the two-vehicle crash data within each national database, crash involvement ratios based on comparisons of at-fault to not-at-fault drivers within groups of drivers aged

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis is a relatively common ailment that affects many people. The method of surgical management of this disease process is usually an ankle arthrodesis (AA) or a total ankle replacement (TAR). Traditionally, AA was viewed as the “gold standard”, however TAR has grown in popularity. Numerous studies have evaluated the risks and benefits of each of these treatments including satisfaction, biomechanics, and cost. The purpose of this study was to compare the cost and rate of complications for patients who underwent either an AA or TAR using a large database. Methods: Using the PearlDiver Technologies, Inc. database, Medicare patients who were diagnosed with ankle arthritis based on ICD-9 codes from 2005 to 2014 were analyzed. Patients were identified who underwent either AA or TAR utilizing ICD-9 procedure and CPT codes. These patient groups were evaluated for postoperative complications and reoperation rates. Subjects and associated costs were followed after the initial procedure. A cost analysis based on diagnosis and procedural codes was then performed on the separate groups, using a t-test to determine statistical significance. Data was analyzed with regards to standard demographic information as well as a metric of overall patient health status, the Charlson Comorbidity Index (CCI). Results: During the study period, 673,789 patients were identified with the diagnosis of ankle arthritis. Of those, 19,120(2.8%) underwent AA and 9,059 (1.3%) underwent TAR. While the yearly rate of AA performed remained stable, TAR was performed at increasing rates. The overall complication rate in the AA group was 24.9% with a 16.5% revision rate compared to 15.1% and 11.2% respectively in the TAR group (PConclusion: While TAR was found to be a more expensive treatment option than AA in this large-scale database study, patients in this group had significantly lower complication rates. The reoperation rates were also lower in the TAR group. The CCI was noted to be slightly lower in the arthroplasty group, meaning these patients may have been healthier, representing a selection bias. Also, the patients that had complications were found to have a higher CCI on average. When choosing surgical intervention for end-stage ankle arthritis, patients should be counseled on cost differences and potential complications for TAR and AA.

Studies have shown conflicting data with regard to the volume and outcome relationship for gastrectomy. Using the University HealthSystem Consortium national database, we examined the influence of the hospital's volume of gastrectomy on outcomes at academic centers between 2004 and 2008. Outcome measures, including length of stay, 30-day readmission, morbidity, and in-hospital mortality, were compared among high- (13 or greater), medium- (6 to 12), and low-volume (five or less) hospitals. There were 10 high- (n = 593 cases), 36 medium- (n = 1076 cases), and 75 low-volume (n = 500 cases) hospitals. There were no significant differences between high- and low-volume hospitals with regard to length of stay, overall complications, 30-day readmission rate, and in-hospital mortality (2.4 vs 4.4%, respectively, P = 0.06). Despite the small number of gastrectomies performed at the low-volume hospitals, these same hospitals performed a large number of other types of gastric surgery such as gastric bypass for the treatment of morbid obesity (102 cases/year). Within the context of academic medical centers, lower annual volume of gastrectomy for neoplasm is not a predictor of poor outcomes which may be explained by the gastric operative experience derived from other types of gastric surgery.

Studies have shown that esophagectomies performed at high-volume centers have lower in-hospital mortality. However, the volume-outcome relationship for esophagectomy performed at academic centers is unknown. Using the University HealthSystem Consortium national database, we examined the influence of the hospital's volume of esophagectomy on outcome at academic centers between January 2003 and October 2007. Outcomes including length of stay, 30-day re-admission, morbidity, and observed and expected mortality were compared between high (>12), medium (6–12), and low-volume centers’ (≤5) annual cases. There were 30 high (n = 3984), 23 medium (n = 822), and 54 low-volume (n = 430) hospitals. Compared with low-volume counterparts, high-volume hospitals had shorter lengths of stay (14.1 vs 17.2 days, P < 0.01), fewer overall complications (51.1% vs 56.5%, P = 0.03), fewer cardiac complications (1.1% vs 2.5%, P = 0.01), fewer pulmonary complications (18.5% vs 29.8%, P < 0.01), fewer hemorrhagic complications (3.2% vs 6.7%, P < 0.01), fewer patients requiring skilled nursing facility care (9.5% vs 19.7% P < 0.01), and lower in-hospital mortality (2.5% vs 5.6%, P < 0.01). The observed-to-expected mortality ratio was 0.6 for high-volume and 1.0 for low-volume centers. Within the context of academic centers, there is a threshold of >12 esophagectomies annually whereby there is a lower mortality and improved outcome.

This research revisits, updates, and expands the research on undergraduate education from the 1996 Berkeley Conference as reported in O'Neill and Fletcher's edited book titled Nonprofit Management Education: U.S. and World Perspectives. First, the nature and types of undergraduate programs in the United States are examined from a national database developed by Mirabella that answers these questions: How many colleges and universities offer undergraduate nonprofit studies? What colleges and departments offer these? Do they award degrees or certificates? What types of courses are offered? Where do their graduates get jobs? Then, four curricular models used by American Humanics (AH) campuses for nonprofit education are examined: certificate programs, academic minors, academic majors, and programs combining the previous three. The relationships of AH programs to higher education trends are identified and undergraduate nonprofit education programs beyond AH are examined.

This study describes special education alternative route (AR) teacher preparation programs. The authors developed a national database of programs and collected information on program sponsorship, length and intensity, features, and participant demographics. Most of the 235 programs in the database were in states that had significant shortages of special education teachers, and the authors received 101 responses to the survey. Active collaboration and use of professional standards in program development were commonplace. Most programs required full-time teaching, although the length of preteaching preparation varied dramatically, as did overall program length. Although many participants were general education teachers or recent degree recipients, the largest subgroup consisted of midcareer changers. This article discusses these findings and provides recommendations for additional research.

Using a longitudinal national database, the authors conducted a path analysis of girls’ school delinquency to determine the indirect and direct effects of socioeconomic status, parental involvement, bonding to school, and girls’ self-perception of reputation on school delinquency during middle school and high school. Self-perception of reputation was the most influential factor in girls’ school delinquency, followed by bond to school and socioeconomic status. Implications for school counselors are presented.

Several distinct definitions of postoperative death have been used in various quality reporting programs. Some have defined postoperative mortality as the occurrence of death after a surgical procedure when the patient dies while still in the hospital, while others have considered all deaths occurring within a predetermined, standardized time interval after surgery to be postoperative mortality. While mortality data are still collected and reported using both these individual definitions, the Society of Thoracic Surgeons (STS) believes that either approach alone may be inadequate. Accordingly, the STS prefers a more encompassing metric, Operative Mortality. Operative Mortality is defined in all STS databases as (1) all deaths, regardless of cause, occurring during the hospitalization in which the operation was performed, even if after 30 days (including patients transferred to other acute care facilities); and (2) all deaths, regardless of cause, occurring after discharge from the hospital, but before the end of the 30th postoperative day. This article provides clarification for some uncommon but important scenarios in which the correct application of this definition may be challenging.

The goal of transition services is to improve the postschool outcomes for students with disabilities, but more than 10 years after the Individuals with Disabilities Act (IDEA) mandated transition services, students with disabilities are still exiting high school with significantly different postschool outcomes than their peers. Community-based instruction, work experience, family involvement, interagency collaboration, and postsecondary training have been highlighted as methods to improve student outcomes. This article identifies 101 community-based transition programs that incorporate community-based instruction, work experience, and postsecondary education especially designed for students aged 18-21 years old. Findings regarding disability populations, ages served, community locations, funding sources, interagency collaboration, and staffing of these programs are discussed.

This is a confirmatory factor analysis (CFA) of deficiencies in nursing homes obtained from the On-line Survey Certification and Reporting system (OSCAR), a national database on nursing home quality maintained by the U.S. Health Care Financing Administration (HCFA). A major goal was to identify a core set of items that would reliably reflect a meaningful set of dimensions of problems in quality of care. The analysis suggests that it is reasonable to posit a model of eight underlying factors to which state surveyors are responding as they assign deficiencies to nursing homes. Forty items are robust indicators of the eight dimensions of problems in quality of care. The data contain considerable random and probably systematic error worth understanding. Establishing that the data contain systematic variability is crucial because OSCAR data are a potentially valuable source of quality of care information for researchers, policymakers, and consumers.

Background. To promote informed decision making about mammography, clinicians are urged to present women with complete, relevant information about breast cancer and screening. Understanding women’s current beliefs may help guide such efforts by uncovering misunderstandings, conceptual gaps, and areas of concern. Objective. The authors sought to learn how women view breast cancer, their personal risk of breast cancer, and how screening mammography affects that risk. Methods. Forty-one open-ended semistructured telephone interviews with women selected from a national database by quota sampling to ensure a wide range in demographics of the participants. Results. Almost all respondents viewed breast cancer as a uniformly progressive disease that begins in a silent curable form (typically found by mammograms) and, unless treated early, invariably grows, spreads, and kills. Some women felt that any abnormality found must be treated, even if it was not malignant. None had heard of potentially nonprogressive cancers, and when informed, most felt that the uncertain prognosis of such lesions reinforced the need to find and treat disease as soon as possible. Women expressed a wide range of views about their personal risk of breast cancer. Although some saw breast cancer as a central threat to their health, many others cited heart disease, other cancers, violence, and trauma as greater concerns. Most recognized the importance of “uncontrollable” factors for breast cancer such as age, sex, family history, and genetics. However, other “controllable” factors with little or no demonstrated link to breast cancer (e.g., smoking, diet, toxic exposures, “bad attitudes”) were given equal or greater prominence, suggesting that many women feel considerable personal responsibility for their level of breast cancer risk. Similarly, although women recognized that mammography was not perfect, almost all believed that failure to have mammograms put one at risk for premature and preventable death. When asked how mammography worked, almost all repeated the message that “early detection saves lives,” suggesting that advanced cancer (and perhaps most cancer deaths) reflected a failure of early detection. The belief in the benefit of early detection was so strong that some women advocated scaring other women into getting mammograms because it is “better to be safe than sorry.” Conclusions. Women view breast cancer as a uniformly progressive disease rarely curable unless caught early. The exaggerated importance many attribute to a variety of controllable factors in modifying personal risk and the “danger” seen in failing to have mammograms may lead women diagnosed with breast cancer to blame themselves.

Objective: To report the distribution and results of laparoscopic repair of perforated ulcer surgery in surgical departments in a major region in Denmark and compare it with the results from the national database regarding mortality and morbidity. Method: Case charts from all patients who underwent laparoscopic repair of perforated ulcer in Western Denmark in the period 1 January 2003–1 July 2007 were collected. Demographical data, surgical details, morbidity, 30-day mortality, and length of stay were recorded. For comparison, data from the National Health Registry (NIP) describing all patients who had an operation due to perforated ulcer in this period was obtained. Results: No more than 51 out of 818 patients undergoing operation for perforated ulcer in the region had a laparoscopic operation. Mortality in the laparoscopic group was 4% compared to 26% reported from the national database (NIP). The laparoscopic group had a higher reperforation rate but length of stay was equal. No formal criteria concerning surgeon or patients selection for laparoscopic surgery were met. Conclusion: Laparoscopic repair of perforated ulcer was done without any selection criteria in few surgical departments in Western Denmark and was associated with a low mortality but a higher risk of reperforation.

Entrepreneurial leaders are key to economic success in postmodern society. This paper indicates that Gestalt graphologists, using handwriting alone, are able to identify successful entrepreneurs. Handwritings of entrepreneurs with proven success in business were paired with handwritings of a random sample from a national database of American households with telephones. The graphologists were asked to identify the handwriting of the successful entrepreneurs in each of the 40 pairs. The observed frequencies of success for the three graphologists were 31, 34, and 34 out of 40, respectively.