BackgroundThe ASA physical classification score has a major impact on the observed/expected (O/E) mortality ratio in the NSQIP General Vascular Mortality Model. The difference in predicted mortality is greatest between ASAs 3 and 4. We hypothesized under-classified ASA scores significantly affect the O/E mortality.MethodsWe conducted a retrospective review of NSQIP essential surgery cases from January 2014 to December 2014 (n = 1264) with mortality sub-analysis (n = 33) at our institution. We recorded transfer and emergency status and independently calculated the ASA score for mortalities using published definitions. A random sample of 50 survivors and 10 emergency survivors were reviewed and ASA recalculated. We performed statistical modeling to simulate the effects of ASA misclassifications. Statistical analysis was performed using JMP 10 and SAS 9.4.ResultsASA was under-classified in 18.2% of mortalities, most commonly ASAs 3 and 4. Sixteen percent of ASA 3 survivors were misclassified, including 60% in the emergency subgroup (p < 0.05 vs. elective cases). Patients transferred from other institutions were more likely to be emergency cases than non-transferred patients (43.5 vs. 7.84%, p < 0.05). Transferred patients had a higher proportion of ASAs 3–5 vs. ASAs 1–2 compared with non-transfers (84.38 vs. 49.76%, p < 0.05) Simulation data showed ASA misclassification underestimated predicted mortality by 2.5 deaths on average.ConclusionASA misclassification significantly impacts O/E mortality. With accurate ASA classification, observed mortality would not have exceeded expected mortality in our institution. Education regarding the impact of ASA scoring is critical to ensure accurate O/E mortality data at hospitals using NSQIP to assess surgical quality.
A growing body of evidence supports critical consciousness as a developmental asset for young people, including its benefits for educational and vocational outcomes. National dynamics and policies in the U.S., such as restricting immigration and asylum, have raised the salience of critical consciousness as a protective factor for the career development of Latinx immigrant youth. In this manuscript, we first review the nature and benefits of critical consciousness for Latinx immigrant youth. We then highlight how college and career readiness (CCR) and the components of critical consciousness (CC) can be simultaneously fostered among Latinx immigrant high school students, drawing upon our own work in the context of an afterschool program. We introduce a framework to illustrate this integration, and describe a series of intervention activities and processes designed to simultaneously build CC and CCR. Finally, we provide recommendations and describe caveats and challenges to developing classroom-based career education curricula that integrate CCR and CC.
Outlines the development of the Asia Pacific Economic Co‐operation Forum (APEC), which began as a deliberately informal discussion group in 1989, and traces the evolution of its membership and organizational structure. Summarizes the research and planning work undertaken to date, pointing out that decisions are consensus‐based and not binding on members. Lists the issues identified as crucial to the Asian economic crisis by the 1998 APEC meeting and discusses its role in Asia and in the global economy. Admits that significant, tangible results have been few so far and considers the reasons why; but believes it has the potential to “establish itself as a viable force in dealing with the economic problems of its members”.
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