Since the introduction of the visual abstract in 2016, more than 100 journals have adopted its use to disseminate scientific research. To date, 7 randomized cross-over trials have consistently ...reproduced its ability to disseminate research effectively. During the adoption of the visual abstract, there has also been a learning curve that has moved journals to dedicate more resources to it and create more formal guidelines. In parallel, the visual abstract has also had secondary gains of promoting clear communication and diversifying our editorial boards. Moving forward, the visual abstract is now ready to go beyond research dissemination to more directly influence patient care by adapting the tool for patient education, procedural teaching, research trial enrollment, or practice guideline nudges. Taken together, the visual abstract has come of age, and it is time to move beyond simply disseminating research.
Water scarcity issues around the world have renewed interest in the use of solar water evaporation as a means of providing fresh water. Advances in photothermal materials and thermal management, ...together with new interfacial system designs, have considerably improved the overall efficiency of solar steam generation (SSG) for desalination and wastewater treatment. Several classes of rationally-designed photothermal materials (PTMs) and nanostructures have enabled effective absorption of broad solar spectrum resulting in improved solar evaporation efficiency. Among several classes of PTMs, semiconductor-based PTMs have demonstrated great potential for SSG. In this review, we highlight the progress and prospects in SSG with emphasis on the use and evolution of advanced semiconductor materials for PTMs and their various designs and engineered architectures. Applications and future prospects for desalination and wastewater treatment are also discussed.
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•Semiconductor-based photothermal materials are desirable for solar steam generation.•This review highlights their mechanisms, designs and application in desalination.•Knowledge gaps and further research needed are laid out.
Background Surgical wound classification has been the foundation for infectious risk assessment, perioperative protocol development, and surgical decision-making. The wound classification system ...categorizes all surgeries into: clean, clean/contaminated, contaminated, and dirty, with estimated postoperative rates of surgical site infection (SSI) being 1%–5%, 3%–11%, 10%–17%, and over 27%, respectively. The present study evaluates the associated rates of the SSI by wound classification using a large risk adjusted surgical patient database. Methods A cross-sectional study was performed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset between 2005 and 2008. All surgical cases that specified a wound class were included in our analysis. Patient demographics, hospital length of stay, preoperative risk factors, co-morbidities, and complication rates were compared across the different wound class categories. Surgical site infection rates for superficial, deep incisional, and organ/space infections were analyzed among the four wound classifications using multivariate logistic regression. Results A total of 634,426 cases were analyzed. From this sample, 49.7% were classified as clean, 35.0% clean/contaminated, 8.56% contaminated, and 6.7% dirty. When stratifying by wound classification, the clean, clean/contaminated, contaminated, and dirty wound classifications had superficial SSI rates of 1.76%, 3.94%, 4.75%, and 5.16%, respectively. The rates of deep incisional infections were 0.54%, 0.86%, 1.31%, and 2.1%. The rates for organ/space infection were 0.28%, 1.87%, 2.55%, and 4.54%. Conclusion Using ACS-NSQIP data, the present study demonstrates substantially lower rates of surgical site infections in the contaminated and dirty wound classifications than previously reported in the literature.
The aim of this study was to evaluate whether hospital network participation is associated with improvement in surgical outcomes and spending compared to control hospitals not participating in a ...network.
Hospitals face significant financial and organizational pressures to integrate into networks. It remains unclear whether these business arrangements impact clinical quality or healthcare expenditures.
We conducted a longitudinal, quasi-experimental study of 1,981,095 national Medicare beneficiaries (2007-2014) undergoing general, vascular, cardiac, or orthopedic surgery at a network (n = 1868) or non-network (n = 2734) hospital. We tested whether joining a network was associated with improvement in the study outcomes after accounting for overall trends toward better outcomes. We used hierarchical multivariable logistical and linear regression to adjust for patient factors, procedural characteristics, type of admission, and hospital factors.
After accounting for patient factors and existing trends toward better outcomes, there was no association between network participation and surgical outcomes. For example, the rates of serious complications were similar between network 11.4%, 95% confidence interval (CI) 11.1%-11.5% and non-network hospitals (11.2%; 95% CI 11.0%-11.3%; odds ratio 1.00, 95% CI 0.97-1.03, P = 0.92). There was no association between time-in-network and improvement in rates of serious complications during the 8-year study period. For example, after 7 years of network participation, the rate of serious complications in 2014 was 9.6% (95% CI 8.8%-10.4%) in network hospitals versus 9.2% (95% CI 8.5%-9.9%, P = 0.11) in non-network hospitals.
Hospital network participation was not associated with improvements in patient outcomes or lower episode payments among Medicare beneficiaries undergoing inpatient surgery.
In the United States, reports about perioperative complications associated with bariatric surgery led to the establishment of accreditation criteria for bariatric centers of excellence and many ...bariatric centers obtaining accreditation. Currently, most bariatric procedures occur at these centers, but to what extent they uniformly provide high-quality care remains unknown.
To describe the variation in surgical outcomes across bariatric centers of excellence and the geographic availability of high-quality centers.
This retrospective review analyzed the claims data of 145 527 patients who underwent bariatric surgery at bariatric centers of excellence between January 1, 2010, and December 31, 2013. Data were obtained from the Healthcare Cost and Utilization Project's State Inpatient Database. This database included unique hospital identification numbers in 12 states (Arkansas, Arizona, Florida, Iowa, Massachusetts, Maryland, North Carolina, Nebraska, New Jersey, New York, Washington, and Wisconsin), allowing comparisons among 165 centers of excellence located in those states. Participants were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Those included in the study cohort were patients with a primary diagnosis of morbid obesity and who underwent laparoscopic Roux-en-Y gastric bypass, open Roux-en-Y gastric bypass, laparoscopic gastric band placement, or laparoscopic sleeve gastrectomy. Excluded from the cohort were patients younger than 18 years or who had an abdominal malignant neoplasm. Data were analyzed July 1, 2016, through January 10, 2017.
Risk-adjusted and reliability-adjusted serious complication rates within 30 days of the index operation were calculated for each center. Centers were stratified by geographic location and operative volume.
In this analysis of claims data from 145 527 patients, wide variation in quality was found across 165 bariatric centers of excellence, both nationwide and statewide. At the national level, the risk-adjusted and reliability-adjusted serious complication rates at each center varied 17-fold, ranging from 0.6% to 10.3%. At the state level, variation ranged from 2.1-fold (Wisconsin decile range, 1.5%-3.3%) to 9.5-fold (Nebraska decile range, 1.0%-10.3%). After dividing hospitals into quintiles of quality on the basis of their adjusted complication rates, 38 of 132 (28.8%) had a center in a higher quintile of quality located within the same hospital service area. Variation in rates of complications existed at centers with low volume (annual mean SD procedure volume, 156 20 patients; complication range, 0.6%-6.4%; 9.8-fold variation), medium volume (annual mean SD procedure volume, 239 27 patients; complication range, 0.6%-10.3%; 17.5-fold variation), and high volume (annual mean SD procedure volume, 448 131 patients; complication range, 0.6%-4.9%; 7.5-fold variation).
Even among accredited bariatric surgery centers, wide variation exists in rates of postoperative serious complications across geographic location and operative volumes. Given that a large proportion of centers are geographically located near higher-performing centers, opportunities for improvement through regional collaboratives or selective referral should be considered.
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