Mediastinitis is a devastating sternal wound complication. The aim of this study was to identify the incidence, risk factors, mortality, and different treatment modalities of mediastinitis after isolated coronary artery bypass grafting. From January 2007 to May 2010, 1424 patients who underwent isolated coronary artery bypass grafting were studied retrospectively; 1398 (group 1) had no mediastinitis, and 26 (group 2) developed mediastinitis. The diagnosis and classification of mediastinitis were based on the criteria of the Center for Disease Control and Prevention and the Emory classification, respectively. Multivariate analysis showed only 4 risk factors: diabetes mellitus, obesity, prolonged postoperative intensive care unit stay, and prolonged intubation time. On univariate analysis, female sex, renal failure, and reexploration for bleeding were also significant risk factors. The incidence of mediastinitis (1.83%) and the subsequent mortality rate (7.69%) were comparable to those of previous reports. Early detection and aggressive management of mediastinitis play major roles in decreasing the related mortality and morbidity. The Emory classification with some modification is very helpful in choosing the proper treatment modality.

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Purpose Change orders in construction projects may lead to an increase in time and cost highlighting the need for a systematic analysis of the causes of change orders. Each cause of change orders has a probability of occurrence and impact; therefore, there is a need to reassess the causes of change orders based on the probability and impact. The purpose of this paper is to determine the risk score for each factor and develop a model for estimating the overall change orders based on the measured and latent variables. Design/methodology/approach The research methodology consists of four parts. The first part identifies the causes of change orders in road projects from a literature review and develops the final list using the Delphi technique. The second part includes designing the final questionnaire to determine the probability and impact of each factor on the five-point Likert scale and 237 questionnaires received validity. The data were divided into training and testing sets and analyzed using AMOS software. Findings The proposed structural equation model presents an insight into the influence of measured and latent factors, which are not obvious in the traditional equations. The main cause for change orders was a change in design. Originality/value The results of this research are expected to improve the execution of road projects by identifying the main causes of the change orders and hence the project manager can develop a proper risk response plan.

Such results of LVAD implantation in Kuwait indicate the feasibility of establishing De Novo LVAD programs in low volume LVAD centers (≤10 implants/year) with promising results and offer a new era of hope for treating advanced heart failure patients.

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