Maternal Death before Admission to the Sylvanus Olympio University Hospital Center (CHU SO): Epidemiological and Etiological Aspects

Background: In Togo, the maternal mortality rate in 2017 was estimated at 396/100,000 live births. Maternal death before admission is an increasingly growing phenomenon in the gynecology-obstetrics clinic of the CHU SO. No epidemiological data is available on the subject. Objective: Determine the epidemiological and etiological profiles of a pregnant, parturient, or woman who has given birth dead before or within 10 minutes of her admission. Methods: This was a descriptive cross-sectional study from January 1, 2014, to December 31, 2021. All maternal deaths occurring before admission and within 10 minutes of admission to the clinic were included in the study of gynecology and obstetrics at CHU SO. The data were processed by Epi info version 7 software. Results: In total, 654 maternal deaths, including 153 maternal deaths before admission, were recorded, corresponding to 23.4% of all maternal deaths. The median age was 30.2 years. 37.2% of women were uneducated. 41.2% were resellers. 79.1% of women were cohabiting. 47.1% of women had performed less than 3 ANC. 43.8% of the women who died had completed their ANC in a medical center. 54.3% by a midwife, 37.3% by unqualified personnel. 62.7% of deaths occurred postpartum and 36.3% during pregnancy. 79.1% were referrals. 88.9% of the women who died arrived in a non-medical taxi car. Among the 57 patients who died during their pregnancy, 40.3% were carrying a pregnancy of 28 to 36 weeks, and 36.3% were full-term pregnancies. Among the 96 women who died postpartum, 93.3% had given birth vaginally. Among the 121 referrals, 34.7% came from a birthing center, 56.2% were referred by a state midwife and 30.6% by unqualified personnel;46.3% were referred without a reference form, 94.3% were referred without venous access. In 10.7%, the reason for evacuation was bleeding from the delivery, with an average evacuation time of one-hour 5minutes. 60.3% of women who died had an evacuation delay of more than one hour. 94.8% of patients died of direct obstetric causes, including immediate postpartum hemorrhage in 60.1% of cases. Conclusion: Deaths before admission constitute an increasingly growing problem at CHU SO. A late referral is a determining factor in maternal deaths before admission.

Unplanned intensive care admission leading to an adverse event:Incidence,preventability and feature analysis

Objective:To compare the characteristics of patients between adverse event(AE)group and non-AE group,and to assess the causes,preventability,and severity of AE.Methods:A retrospective triple-phase medical record study was conducted at a Spanish tertiary hospital.Data was collected over a 6-month period,including all patients with an unplanned intensive care admission.Demographic characteristics,APACHEⅡ,length of ICU stay,mortality were compare between AE and non-AE group causes,preventability and severity were analyzed in AE cases.Results:597 Patients were included in the study.The overall incidence of AEs was 17.3%(n=103),of which 83.5%were considered preventable.Mortality within the AE group was higher than in the non-AE group(23.3%vs.13.6%),making it 1.7 times more frequent in the AE group(95%CI:1.143-2.071).The primary cause of AE was associated with surgical procedures(43.7%).Of the AEs,18.4%were classified as mild,58.3%as moderate,and 23.3%as severe.Conclusions:The incidence of unplanned intensive care admissions due to AE is high and potentially preventable.This is concerning given the high mortality observed in patients admitted to the intensive care unit because of an AE,although direct causality cannot always be established.The findings emphasize the importance of patient safety and underscore the need for improved quality and management of care resources.They also indicate where efforts should be directed to enhance care risk management.

Admission Control Based on QoS for Third Generation Broadband Mobile Communication Systems

In this paper, a novel admission scheme is proposed which provides high degrees of quality of service (QoS) guarantees for multimedia traffic carried in mobile networks. The proposed scheme combines the admission control and bandwidth reservation to guarantee QoS requirements. It considers both local information and remote information to determine whether to accept or reject a connection. In order to embody the characteristics of the algorithms proposed in the article, two traditional algorithms of admission control are used for comparison. In the end of the paper the simulation analyses are given and the results show that the proposed algorithm can adjust the bandwidth according to the current status of networks and decrease the probability of connections forcibly dropped. The most important thing is that the algorithm is based on the multimedia communications and can guarantee the QoS of real time connections through decreasing the bandwidth of non real time connections.

A Contrastive Genre Analysis of Chinese and American University Admission Brochures

This study mainly uses the move and step analysis to conduct a contrastive genre analysis on the selected 20 Chinese ad-mission brochures(CABs) and 20 American admission brochures(AABs).Differences in moves,move sequences and step arrange-ments have revealed themselves in this comparison.Firstly,Chinese university admission brochures cast more focus on basic infor-mation about the university,the application procedure and admission criteria,while American universities,besides offering such in-formation,also emphasize the promotional function of the admission brochures.They use appealing and creative moves to commer-cially‘sell'advantages of the university to the potential applicants.Secondly,based on Kress & van Leeuwen's visual grammarsymbolic meaning,images and colors in admission brochures are also explored and analyzed as language.For one thing,after count-ing the frequency of the four categories of images,namely portrait,campus scenery,campus life pictures and graphs,it is foundthat,compared with CABs,AABs have a highly more obvious tendency in using images.The images are used as an effective tool toincrease the sense of credibility,identity-recognition,attract reader's attention,and help understanding,making the facts and in-formation more intuitive.For another thing,the main colors used in the brochures are yet another noticeable feature.Especially inAmerican brochures,universities tend to use their‘traditional colors' in the brochure to achieve a sense of consistency.Some Chi-nese brochures also follow this promotional strategy,yet a large percentage of them do not use any recognizable colors other thanthe printed black and white.Based on these differences,suggestions are put forward from perspectives including choice of movesand steps to improve the quality of CABs,hopefully raising their acceptance in the international level.

Admission delay is associated with worse surgical outcomes for elderly hip fracture patients:A retrospective observational study

BACKGROUND:The influence of surgical delay on mortality and morbidity has been studied extensively among elderly hip fracture patients.However,most studies only focus on the timing of surgery when patients have already been hospitalized,without considering pre-admission waiting time.Therefore,the present study aims to explore the infl uence of admission delay on surgical outcomes.METHODS:In this retrospective study,we recorded admission timing and interval from admission to surgery for included patient.Other covariates were also collected to control confounding.The primary outcome was 1-year mortality.The secondary outcomes were 1-month mortality,3-month mortality,ICU admission and postoperative pneumonia.We mainly used multivariate logistic regression to determine the effect of admission timing on postoperative outcomes.An additional survival analysis was also performed to assess the impact of admission delay on survival status in the fi rst year after operation.RESULTS:The proportion of patients hospitalized on day 0,day 1,day 2 after injury was 25.4%,54.7%and 66.3%,respectively.And 12.6%patients visited hospital one week later after injury.Mean time from admission to surgery was 5.2 days(standard deviation 2.8 days).Hospitalization at one week after injury was a risk factor for 1-year mortality(OR 1.762,95%CI 1.026–3.379,P=0.041).CONCLUSION:Admission delay of more than one week is signifi cantly associated with higher 1-year mortality.As a supplement to the current guidelines which emphasizes early surgery after admission,we also advocate early admission once patients get injured.

Association between Ambient Air Pollution and Hospital Emergency Admissions for Respiratory and Cardiovascular Diseases in Beijing: a Time Series Study

Objective To investigate the association between ambient air pollution and hospital emergency admissions in Beijing. Methods In this study, a semi-parametric generalized additive model （GAM） was used to evaluate the specific influences of air pollutants （PM10, SO2, and NO2） on hospital emergency admissions with different lag structures from 2009 to 2011, the sex and age specific influences of air pollution and the modifying effect of seasons on air pollution to analyze the possible interaction. Results It was found that a 10μg/m3 increase in concentration of PMlo at lag 03 day, SO2 and NO2 at lag 0 day were associated with an increase of 0.88%, 0.76%, and 1.82% respectively in overall emergency admissions. A 10 lag/m3 increase in concentration of PM10, SO2 and NO2 at lag 5 day were associated with an increase of 1.39%, 1.56%, and 1.18% respectively in cardiovascular disease emergency admissions. For lag 02, a 10 μg/m3 increase in concentration of PM10, SO2 and NO2 were associated with 1.72%, 1.34%, and 2.57% increases respectively in respiratory disease emergency admissions. Conclusion This study further confirmed that short-term exposure to ambient air pollution was associated with increased risk of hospital emergency admissions in Beijing.

Daily Visibility and Hospital Admission in Shanghai, China

Objective The study is to investigate the associations between visibility, major air pollutants and daily counts of hospital admission in Shanghai, China. Methods Daily data on hospital admission, visibility, and air pollution during 2005‐2008 were obtained from the Shanghai Insurance Bureau （SHIB）, Shanghai Meteorological Bureau, and Shanghai Environmental Monitoring Center, respectively. The generalized additive model （GAM） with penalized splines was used to examine the associations between daily visibility and hospital admission. Results Among various pollutants, PM 2.5 showed strongest correlation with visibility. Decreased visibility was significantly associated with increased risk of hospital admission in Shanghai. An inter‐quartile range decrease in the 2‐day （L01） moving average of visibility corresponded to 3.66% （95%CI： 1.02%, 6.31%）, 4.06% （95%CI： 0.84%, 7.27%）, and 4.32% （95%CI： 1.67%, 6.97%） increase of total, cardiovascular, and respiratory hospitalizations, respectively. Conclusion Our analyses provide the first piece of evidence in China, demonstrating that decreased visibility has an effect on hospital admission, and this finding strengthens the rationale for further limiting air pollution levels in Shanghai.

New degradation call admission control for increasing WCDMA system capacity

Propose a new degradation call admission control（DCAC）scheme, which can be used in wideband code division multiple access communication system. So-called degradation is that non-real time call has the characteristic of variable bit rate, so decreasing its bit rate can reduce the load of the system, consequently the system can admit new call which should be blocked when the system is close to full load, therefore new call＇s access probability increases. This paper brings forward design project and does system simulation, simulation proves that DCAC can effectively decrease calls＇ blocking probability and increase the total number of the on-line users.

Game-theoretic approach to power and admission control in hierarchical wireless sensor networks

Power efficiency and link reliability are of great impor- tance in hierarchical wireless sensor networks （HWSNs）, espe- cially at the key level, which consists of sensor nodes located only one hop away from the sink node called OHS. The power and admission control problem in HWSNs is comsidered to improve its power efficiency and link reliability. This problem is modeled as a non-cooperative game in which the active OHSs are con- sidered as players. By applying a double-pricing scheme in the definition of OHSs＇ utility function, a Nash Equilibrium solution with network properties is derived. Besides, a distributed algorithm is also proposed to show the dynamic processes to achieve Nash Equilibrium. Finally, the simulation results demonstrate the effec- tiveness of the proposed algorithm.

A Combining Call Admission Control and Power Control Scheme for D2D Communications Underlaying Cellular Networks

As device-to-device(D2D) communications usually reuses the resource of cellular networks, call admission control(CAC) and power control are crucial problems. However in most power control schemes, total data rates or throughput are regarded as optimization criterion. In this paper, a combining call admission control(CAC) and power control scheme under guaranteeing QoS of every user equipment(UE) is proposed. First, a simple CAC scheme is introduced. Then based on the CAC scheme, a combining call admission control and power control scheme is proposed. Next, the performance of the proposed scheme is evaluated. Finally, maximum DUE pair number and average transmitting power is calculated. Simulation results show that D2 D communications with the proposed combining call admission control and power control scheme can effectively improve the maximum DUE pair number under the premise of meeting necessary QoS.

Impact of admission blood glucose levels on prognosis of elderly patients with ST elevation myocardial infarction treated by primary percutaneous coronary intervention

OBJECTIVE:Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events。 We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients >65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction。 METHODS:We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ±5.4)。 Patients were divided into two groups according to admission blood glucose levels。 Group : low glucose group (LLG), glucose < 168 mg/dL; and Group 2: high glucose group (HGG), glucose >168 mg/dL。 RESULTS:In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P <0.001)。 Multivariate regression analysis showed: Killip > 1, post-thrombolysis in MI <3 and admission blood glucose levels were independent predictors of in-hospital adverse cardiac events (P <0.001)。 CONCLUSIONS:Admission hyperglycemia in elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality。

Interdialytic Weight Gain in Hemodialysis Patients: Worse Hospital Admissions and Intradialytic Hypotension

Introduction: Interdialytic weight-gain (IDWG) has been linked to various complications in hemodialysis (HD) patients. Method: Prospective clinical-observational study to evaluate the effect of IDWG in HD patients on the rate of hospital admissions over a 12-month period, and the impact of high IDWG on the frequency of IDH. Results: Of the 240 patients, those who had IDWG ≥ 4%, 81% had at least one hospital admission due to volume-overload or the need for extra HD-session(s). On the other hand, only 19% of those having IDWG < 4% had been admitted or got extra HD sessions (p < 0.001). Of those who were admitted (over 12 months) due to volume overload;74.1% had IDWG ≥ 4%, while 25.9% had IDWG < 4% (p < 0.001). Regarding IDH, 87% of patients having IDWG ≥ 4% had at least one episode of IDH/week. On the other hand, only 22.5% of those with IDWG < 4% had one episode of IDH/week (p < 0.001). When analyzing those who had at least one IDH episode/week;72.9% of them had IDWG ≥ 4%, while only 27.1% had IDWG < 4% (p < 0.001). Conclusion: In HD patients, the frequency of hospital admission due to volume-overload and the need for extra HD-sessions is strongly related to the amount of IDWG (>4% in our patients), the same stands for the frequency of IDH. Thus, control of IDWG in HD patients is of great importance, keeping in mind the importance of the nutrition status of HD patients that may also impact IDWG.

Monthly admissions for heart failure (HF)— Environmental links

In recent years the role of HF in the outcomes, cost of treatment in cardiology is raising. Concomitantly a number of studies were published demonstrating connections of many cardiac events with Space Weather Activity-Solar, Geomagnetic, Cosmic Ray (Neutron) activity levels. The aim of this study was to study links of timing of hospital admissions for HF with season and space weather components. Patients and Methods: monthly admissions of male and female patients for HF in two hospitals of Rabin Medical Center for years 2000-2012 were the subject of the study. 76,601 patient were included, 42,293 men, 34,308 woman. The cosmophysical data from USA, Russia and Finland were used. Results: Monthly average number of admissions for HF: 491.0 ± 82.4, 271.1 ± 46.75 for men and 219.9 ± 39.8 for woman. Gender admissions strongly correlated. Monthly admission for HF number differed by 2.2 - 2.5 times. Minimal admissions were in August, September;maximal—in January, February, December and March (according to numbers). It was a significant inverse correlation of monthly HF admissions with monthly solar activity and GMA indices and correlation with CRA (neutron) activity. Conclusion: Monthly admissions number for HF is fluctuated by season of the year, depending on gender and related to monthly solar and Cosmic Ray (Neutron) activity level. Gender differences in HF exacerbation may be a component explaining gender differences in longevity.

Total ischemic time and outcomes for patients with ST-elevation myocardial infarction： does time of admission make a difference？

Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.

SERVICE-AWARE BASED FUZZY ADMISSION CONTROL SCHEME IN MULTI-SERVICE NETWORKS

Multi-service aggregated transmission is the direction of IP network. Providing different Quality of Service (QoS) assurance for different services has become a crucial problem in future network. Admission control is a vital function for multi-service IP network. This paper proposes a novel fuzzy admission control scheme based on coarse granularity service-aware technique. Different service has discriminative sensitivity to the same QoS characteristic parameter in general. The traffic class can be perceived by the service request parameter and the proposed QoS function. And requirements of dif- ferent applications can be met by maintaining the life parameter. From simulation results, the proposed scheme shows a better QoS provisioning than those traditional fuzzy logic based methods under the same admission probability.

Joint Resource Allocation and Admission Control in Sliced Fog Radio Access Networks

Network slicing based fog radio access network(F-RAN) has emerged as a promising architecture to support various novel applications in 5 G-and-beyond wireless networks. However, the co-existence of multiple network slices in F-RANs may lead to significant performance degradation due to the resource competitions among different network slices. In this paper, the downlink F-RANs with a hotspot slice and an Internet of Things(Io T) slice are considered, in which the user equipments(UEs) of different slices share the same spectrum. A novel joint resource allocation and admission control scheme is developed to maximize the number of UEs in the hotspot slice that can be supported with desired quality-of-service, while satisfying the interference constraint of the UEs in the Io T slice. Specifically, the admission control and beamforming vector optimization are performed in the hotspot slice to maximize the number of admitted UEs, while the joint sub-channel and power allocation is performed in the Io T slice to maximize the capability of the UEs in the Io T slice tolerating the interference from the hotspot slice. Numerical results show that our proposed scheme can effectively boost the number of UEs in the hotspot slice compared to the existing baselines.

Terminal-Modality-Based Joint Call Admission Control Algorithm for Fair Radio Resource Allocation in Heterogeneous Cellular Networks

There is a problem of unfairness in allocation of radio resources among heterogeneous mobile terminals in heterogeneous wireless networks. Low-capability mobile terminals (such as single-mode terminals) suffer high call blocking probability whereas high-capability mobile terminals (such as quad-mode terminals) experience very low call blocking probability, in the same heterogeneous wireless network. This paper proposes a Terminal-Modality-Based Joint Call Admission Control (TJCAC) algorithm to reduce this problem of unfairness. The proposed TJCAC algorithm makes call admission decisions based on mobile terminal modality (capability), network load, and radio access technology (RAT) terminal support index. The objectives of the proposed TJCAC algorithm are to reduce call blocking/dropping probability, and ensure fairness in allocation of radio resources among heterogeneous mobile terminals in heterogeneous networks. An analytical model is developed to evaluate the performance of the proposed TJCAC scheme in terms of call blocking/dropping probability in a heterogeneous wireless network. The performance of the proposed TJCAC algorithm is compared with that of other JCAC algorithms. Results show that the proposed algorithm reduces call blocking/dropping probability in the networks, and ensure fairness in allocation of radio resources among heterogeneous terminals.

Adaptive Terminal-Modality-Based Joint Call Admission Control for Heterogeneous Cellular Networks

The coexistence of different Radio Access Technologies (RATs) requires a need for Common Radio Resource Management (CRRM) to support the provision of Quality of Service (QoS) and the efficient utilization of radio resources. The provision of QoS is an important and challenging issue in the design of integrated services packet networks. Call admission control (CAC) is an integral part of the problem. Clearly, without CAC, providing QoS guarantees will be impossible. There is unfairness in allocation of radio resources among heterogeneous mobile terminals in heterogeneous wireless networks. In this paper, an Adaptive-Terminal Modality-Based Joint Call Admission Control (ATJCAC) algorithm is proposed to enhance connection-level QoS and reduce call blocking/dropping probability. The proposed ATJCAC algorithm makes call admission decisions based on mobile terminal modality (capability), network load, adaptive the bandwidth of ongoing call and radio access technology (RAT) terminal support index. Simulation results show that the proposed ATJCAC scheme reduces call blocking/dropping probability.

Effect of weekend admission on geriatric hip fractures

BACKGROUND The care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented.With respect to hip fractures,however,there is no consensus about the presence of a so-called“weekend effect”.This study sought to determine the effects,if any,of weekend admission on care of geriatric hip fractures admitted to a large tertiary care hospital.It was hypothesized that geriatric hip fracture patients admitted on a weekend would have longer times to medical optimization and surgery and increased complication and mortality rates relative to those admitted on a weekday.AIM To determine if weekend admission of geriatric hip fractures is associated with poor outcome measures and surgical delay.METHODS A retrospective chart review of operative geriatric hip fractures treated from 2015-2017 at a large tertiary care hospital was conducted.Two cohorts were compared:patients who arrived at the emergency department on a weekend,and those that arrived at the emergency department on a weekday.Primary outcome measures included mortality rate,complication rate,transfusion rate,and length of stay.Secondary outcome measures included time from emergency department arrival to surgery,time from emergency department arrival to medical optimization,and time from medical optimization to surgery.RESULTS There were no statistically significant differences in length of stay(P=0.2734),transfusion rate(P=0.9325),or mortality rate(P=0.3460)between the weekend and weekday cohorts.Complication rate was higher in patients who presented on a weekend compared to patients who presented on a weekday(13.3%vs 8.3%;P=0.044).Time from emergency department arrival to medical optimization(22.7 h vs 20.0 h;P=0.0015),time from medical optimization to surgery(13.9 h vs 10.8 h;P=0.0172),and time from emergency department arrival to surgery(42.7 h vs 32.5 h;P<0.0001)were all significantly longer in patients who presented to the hospital on a weekend compared to patients who presented to the hospital on a weekday.CONCLUSION This study provided insight into the“weekend effect”for geriatric hip fractures and found that day of presentation has a clinically significant impact on delivered care.

Evaluating Hospital Admission/Discharge Rates at the Community Level

Hospital admission/discharges rates are generating increased attention from health care providers and payors. This study focused on evaluation of inpatient hospital admission/discharge rates for Syracuse and other New York State metropolitan areas during 2014 and 2015. It provided comparative information concerning this subject and suggested how this approach to analysis of hospital utilization could be carried out using publicly available data. The study data demonstrated that hospital admission/discharge rates per 1000 population increased with patient age in all of these areas. The study data suggested that differences in hospital admission/discharge rates among the New York State metropolitan areas were generally consistent between 2014 and 2015. Utica and New York City produced the highest rates. Rochester and Albany produced the lowest rates. Utilization rates for Syracuse were considerably lower than for Utica and New York City and slightly higher than for Rochester and Albany. This analysis demonstrated that most of the differences between aggregate rates for Syracuse and Rochester were produced by elderly patients, especially those aged 75 years and over. The analysis demonstrated that most of these differences in admission rates for the elderly were produced by adult medicine patients aged 75 years and over. Most of these differences were generated by patients with respiratory, digestive, and orthopedic disorders. Additional data suggested that the highest readmission rates for adult medicine and adult surgery were produced by patients aged 75 years and over.