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BackgroundCRS-HIPEC provides oncologic benefit in well-selected patients with peritoneal carcinomatosis; however, it is a morbid procedure. Decision tools for preoperative patient selection are limited. We developed a risk score to predict severity of 90 day complications for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).Patients and MethodsAdults who underwent CRS-HIPEC at the University of Pittsburgh Medical Center (March 2001–April 2020) were analyzed as part of this study. Primary endpoint was severe complications within 90 days following CRS-HIPEC, defined using Comprehensive Complication Index (CCI) scores as a dichotomous (determined using restricted cubic splines) and continuous variable. Data were divided into training and test sets. Several machine learning and traditional algorithms were considered.ResultsFor the 1959 CRS-HIPEC procedures included, CCI ranged from 0 to 100 (median 32.0). Adjusted restricted cubic splines model defined severe complications as CCI > 61. A minimum of 20 variables achieved optimal performance of any of the models. Linear regression achieved the highest area under the receiving operator characteristic curve (AUC, 0.74) and outperformed the NSQIP Surgical Risk calculator (AUC 0.80 vs. 0.66). Factors most positively associated with severe complications included peritoneal carcinomatosis index score, symptomatic status, and undergoing pancreatectomy, while American Society of Anesthesiologists 2 class, appendiceal diagnosis, and preoperative albumin were most negatively associated with severe complications.ConclusionsThis study refines our ability to predict severe complications within 90 days of discharge from a hospitalization in which CRS-HIPEC was performed. This advancement is timely and relevant given the growing interest in this procedure and may have implications for patient selection, patient and referring provider comfort, and survival.

The artist discusses the work in Silly Trip Wires, 2020 his Master of Fine Arts exhibition. The exhibition includes an installation, Silly Trips Wires, and documentation of a smaller site-specific version of the work. The Artist discusses the process of transition from military to civilian, and the potential effects that mental trauma from combat deployments can have on this process. This is tied to an analysis of how communicating the experience of veterans to civilians, through artwork, functions to bring about understanding.

Meaningful improvement in schools and districts is just small shifts away. How can administrators and teachers work together in ways that lead to significant—and sustained—improvement over time? How can schools accomplish this goal without adding to the work of overstretched educators? This practical guide answers these questions with recommendations for small, practical, powerful shifts that educators can make to their daily practice. In Small Shifts, Meaningful Improvement, P. Ann Byrd, Alesha Daughtrey, Jonathan Eckert, and Lori Nazareno define collective leadership, a set of practices through which teachers and administrators work together to improve teaching, learning, and innovation. They explore the seven conditions of collective leadership and their corresponding shifts that, when effectively implemented, make a difference: * Adapting, not adopting, a shared vision and strategy * Building co-ownership, not buy-in, through supportive administration, * Mindfully aligning resources and capacity, * Developing supportive social norms and working relationships to build culture and continuity, * Growing shared influence authentically and organically, * Creating an orientation toward improvement, and * Structuring an intentional work design to support sustainability. The authors share stories of real schools and districts that have implemented the shifts and provide useful tools that educators can use as they begin their own efforts. Both informative and inspiring, Small Shifts, Meaningful Improvement supports leadership work that will advance how administrators and teachers collaborate, learn together, generate solutions to longstanding challenges, and make those solutions stick over time.

Background: Although hypertension (HTN) is a major modifiable risk factor for arterial damage, blood pressure (BP) remains poorly controlled in the hypertensive population. Telemedicine is a promising adjunct intervention that may complement traditional therapies and improve adherence rates; however, current approaches have multiple barriers to entry, including the use of relatively expensive Bluetooth devices or the dependence on smart phone utilization, which tend to exclude low-income and more elderly populations. Objective: The aim of this study was to design and implement a new phone call- and short message service text messaging-based intervention, Epharmix’s EpxHypertension, in a quality improvement project that demonstrates the feasibility of this system for BP control in a family medicine setting. Methods: We recruited 174 patients from a community clinic in St Louis from a database of patients diagnosed with HTN. An automated call or text messaging system was used to monitor patient-reported BPs. If determined to be elevated, physicians were notified by an email, text, or electronic medical record alert. Mean systolic BPs (SBPs) and diastolic BPs (DBPs) were compared at the beginning and end of 12 weeks. Results: After 12 weeks on the system, patients with a baseline SBP of 140 mm Hg or higher reduced SBP by 10.8 mm Hg (95% CI −14.5 to −7.2, P<.001) and DBP by 6.6 mm Hg (95% CI −9.9 to −3.4, P=.002), but no significant changes were observed in overall BPs and BPs in the group with baseline SBP less than 140 mm Hg. Conclusions: EpxHypertension provides a viable means to control HTN in patients with high baseline BPs despite previous therapy. This community implementation study demonstrates the feasibility of implementing EpxHypertension across a primary care setting without the need for smartphones or Bluetooth-linked BP cuffs. Future studies should evaluate its effectiveness in a randomized control trial compared with standard of care.

The increasing availability of multi-core and multi-processor architectures provides new opportunities for improving the performance of many computer simulations. Markov Chain Monte Carlo (MCMC) simulations are widely used for approximate counting problems, Bayesian inference and as a means for estimating very highdimensional integrals. As such MCMC has found a wide variety of applications in fields including computational biology and physics,financial econometrics, machine learning and image processing. This thesis presents a number of new method for reducing the runtime of Markov Chain Monte Carlo simulations by using SMP machines and/or clusters. Two of the methods speculatively perform iterations in parallel, reducing the runtime of MCMC programs whilst producing statistically identical results to conventional sequential implementations. The other methods apply only to problem domains that can be presented as an image, and involve using various means of dividing the image into subimages that can be proceed with some degree of independence. Where possible the thesis includes a theoretical analysis of the reduction in runtime that may be achieved using our technique under perfect conditions, and in all cases the methods are tested and compared on selection of multi-core and multi-processor architectures. A framework is provided to allow easy construction of MCMC application that implement these parallelisation methods.

  Prominent among them were Bush's meeting with the Muslim community at a time when Al Gore canceled a meeting; Bush's advocating repeal of a law that allows law enforcement officers to arrest suspected terrorists based on secret evidence; and Bush's moderate stand on the control of holy places in Jerusalem.

The sheet music and lyrics for Jonathan Byrd's \"Jacks\" are presented.