edgar mamani jimenez - Academia.edu (original) (raw)

Papers by edgar mamani jimenez

Research paper thumbnail of Algorithmic Trading Using Long Short-Term Memory Network and Portfolio Optimization

Investors typically rely on a mix of experience, intuition, knowledge of economic fundamentals an... more Investors typically rely on a mix of experience, intuition, knowledge of economic fundamentals and real-time information to make informed choices and try to get as high a rate of return as possible. Their decisions are customarily more instinct-driven than methodical. Propelled by the need for numerically inspired judgments, ever stronger within the financial community, in recent years the usage of computational and mathematical tools has been taking root. In this work we used a Long Short-Term Memory (LSTM) Network trained on historical prices to predict future daily closing prices of several stocks listed on the Standard & Poor 500 (S&P500) index. We compared the predictions of our LSTM network with those produced by another state-of-the-art approach, the Hidden Markov Model (HMM), in order to validate our findings. We then fed our forecasts into aMarkowitz Portfolio Optimization (PO) procedure to identify the best trading strategy. The purpose of PO, which allows for simultaneous...

Research paper thumbnail of Reinterpreting the role of primary and secondary airports in low-cost carrier expansion in Europe

Journal of Transport Geography, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Research paper thumbnail of Dynamic evolution of European airport systems in the context of Low-Cost Carriers growth

Journal of Air Transport Management, 2017

Research paper thumbnail of Evidence-based guidelines for the use of tracheostomy in critically ill patients

Journal of Critical Care, 2017

Research paper thumbnail of Delivering User Information in Resource-constrained Urban Transit Systems: The Case of Ibague, Colombia

Transportation Research Procedia, 2016

Research paper thumbnail of Estrategias de diseño para brindar confort térmico en vivienda en la ciudad de Loja

Nuestro entorno, al parecer olvidado, cada vez mas deteriorado debido a la indiscriminada toma de... more Nuestro entorno, al parecer olvidado, cada vez mas deteriorado debido a la indiscriminada toma de recursos que de el proviene, por ello debemos ir concienciando a todos los actores que intervienen en el multidisciplinar proceso de construir nuestro entorno. Es necesario tomar conciencia de la importancia del confort termico y las estrategias que de este se derivan; Manejo del calor, La luz, El soleamiento, La ventilacion, La humedad, El sonido en el espacio Urbano; que son fuentes naturales de confort que disminuyen al maximo el uso de fuentes artificiales como luz electrica, calefaccion, etc.. Esta concientizacion nos llevaria a una optimizacion de estos recursos, fuentes naturales que mejoran la calidad de vida dentro de una vivienda y por ende la de las personas que en ellas habitan. Factores que al parecer no son estudiados al momento de concebir una vivienda, en consecuencia el proyectista muchas de las veces se ve liberado de preocuparse de estos factores. La estetica cuando tiene una concepcion herrada suele sepultar la calidad de vida de un espacio arquitectonico, esto en el caso de muchas viviendas que al no tomar en cuenta estos factores resultan convirtiendose en lugares inhabitables. A estos y muchos otros factores se debe el interes de mi estudio por el confort termico, factores como la autoconstruccion, las viviendas a medio terminar, etc.… Este estudio es el que despejara muchas dudas sobre la factibilidad o no de emplear estas estrategias en estas viviendas lo cual sera la conclusion de este estudio.

Research paper thumbnail of Implementación de un silo de pesaje para minerales, utilizados en el proceso de fundición de chatarra en la empresa ADELCA C.A

Improper way to perform the work of weighing minerals by the workers in the company Adelca AC led... more Improper way to perform the work of weighing minerals by the workers in the company Adelca AC led to a series of subsequent problems such as excessive pollution to which workers are exposed and also the physical effort required for these activities, so the next paper describes how to improve the working conditions of employees to perform these activities, improving the quality of working environment for employees By implementing the system for weighing ore mill area weighing process is improved with the use of suitable equipment in an automated process such as the use of a PLC Siemens S300 series, with the right program can be readings have control of information load cells, and in turn they could be used to view a Siemens HMI interface, where you have control to determine relative amounts of mineral to be weighed By automating the process clearly evident results are achieved, such as reduced physical exertion, decreased time of exposure to dust generated by minerals, plus the time used for this process are reduced, thus improving the availability of employees to the company, thus fulfilling the plans of the company in the process of continuous improvement.

Research paper thumbnail of Incidencias de la aplicación de Estrategias de Comprensión Lectora en el aprendizaje de la Lectoescritura en la disciplina de Lengua y Literatura en el Tercero y Cuarto grado de primaria de la Escuela César Augusto Baldizón, Valle de la Laguna, Masaya, Se

Congreso Nacional De Educacion, May 16, 2013

Research paper thumbnail of Diseno De Un Modelo De Mejora Continua Para Impresora Chavez Garcia

Research paper thumbnail of Espumas inyectables de hidroxiapatita obtenidas por el método de espumado de la fase líquida de un cemento de fostato tricálcico alfa

Research paper thumbnail of The Airport Business in a Competitive Environment

Procedia - Social and Behavioral Sciences, 2014

Airports have traditionally been considered as public utility providers, with little potential to... more Airports have traditionally been considered as public utility providers, with little potential to develop significant market opportunities. Liberalisation of the air transport market around the globe has introduced new dynamics into the airport industry. The emergence of competition and the transition in ownership (towards privatisation or commercialisation) demand a different perspective in airport management. This paper aims at explaining the complexity of the airport business, in particular in what concerns the role of the airport as a firm that operates in a network of stakeholders, to produce a set of service packages targeted at several types of customers.

Research paper thumbnail of Legal preparedness: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

Chest, 2014

Significant legal challenges arise when health-care resources become scarce and population-based ... more Significant legal challenges arise when health-care resources become scarce and population-based approaches to care are implemented during severe disasters and pandemics. Recent emergencies highlight the serious legal, economic, and health impacts that can be associated with responding in austere conditions and the critical importance of comprehensive, collaborative health response system planning. This article discusses legal suggestions developed by the American College of Chest Physicians (CHEST) Task Force for Mass Critical Care to support planning and response efforts for mass casualty incidents involving critically ill or injured patients. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. Following the CHEST Guidelines Oversight Committee's methodology, the Legal Panel develope...

Research paper thumbnail of Ethical considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

Chest, 2014

Mass critical care entails time-sensitive decisions and changes in the standard of care that it i... more Mass critical care entails time-sensitive decisions and changes in the standard of care that it is possible to deliver. These circumstances increase provider uncertainty as well as patients' vulnerability and may, therefore, jeopardize disciplined, ethical decision-making. Planning for pandemics and disasters should incorporate ethics guidance to support providers who may otherwise make ad hoc patient care decisions that overstep ethical boundaries. This article provides consensus-developed suggestions about ethical challenges in caring for the critically ill or injured during pandemics or disasters. The suggestions in this article are important for all of those involved in any pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. We adapted the American College of Chest Physicians (CHEST) Guidelines Oversight Committee's methodology to develop suggestions. T...

Research paper thumbnail of Propiedades Psicométricas del Cuestionario de Auto Reporte de la Calidad de Vida KIDSCREEN-27 en Adolescentes Chilenos

Terapia psicológica, 2009

Resumen Se evalúa, las propiedades psicométricas del cuestionario de Calidad de Vida KIDSCREEN-27... more Resumen Se evalúa, las propiedades psicométricas del cuestionario de Calidad de Vida KIDSCREEN-27 adaptado a niños/as y adolescentes chilenos. Participaron 1678 sujetos escolarizados de entre 8 y 18 años. Se evaluó tanto la consistencia interna como indicadores de validez de constructo, discriminante y convergente. El alfa de Cronbach de la escala total como de las distintas dimensiones es superior a 0.70. Los análisis factoriales exploratorio y confirmatorio arrojan evidencia de una estructura similar a la teórica de cinco dimensiones. El instrumento es capaz de discriminar entre hombres y mujeres, así como entre rangos de edad, en diferentes dimensiones. Los resultados permiten decir que el KIDSCREEN-27 presentó coeficientes de fiabilidad y validez aceptables, similares a los de la versión original, permitiendo disponer de un nuevo instrumento que evalúe calidad de vida en Chile y a la vez comparar los resultados obtenidos con otros países que utilicen este instrumento.

Research paper thumbnail of Una aproximación empírica a la relación entre las tasas de interés de los TES de tasa fija y el tipo de cambio en Colombia (2001-2004)

DOCUMENTOS …, 2004

... de los trabajos consultados acerca del tema de relación de tasas de interés y tipos de cambio... more ... de los trabajos consultados acerca del tema de relación de tasas de interés y tipos de cambio, sobresale el de Pradyumna Dash, títulado “The ... desarrollados en la misma línea por Corhay, Tourani y Urbain (1993), Chung y Liu (1994), Serletis y King (1997) o Aggarwal, Inclan y ...

Research paper thumbnail of Evidence-based clinical practice guidelines for prostate cancer: the need for a unified approach

Current Opinion in Urology, 2007

Clinical practice guidelines are being increasingly recognized as critically important to an evid... more Clinical practice guidelines are being increasingly recognized as critically important to an evidence-based practice. This article reviews the different approaches used by leading urological organizations to the development of prostate cancer guidelines. It further introduces the recommendations of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group as a unified approach to guideline development. Clinical guidelines on the management of prostate cancer demonstrate major methodological differences. Most notably, considerable discrepancies with regards to the systems used to grade the quality of the evidence and the strength of recommendation exist. The GRADE approach classifies the quality of evidence as high, moderate, low or very low, according to factors that include study design and execution, and the consistency of the results. It subsequently classifies recommendations as strong or weak, according to the balance between benefits and downsides and the degree of confidence in estimates of the downsides. There is an urgent need to standardize processes used to develop clinical guidelines for the management of patients with prostate cancer by leading urological organizations. Adoption of the GRADE approach would offer considerable rewards in terms of efficiency, guideline credibility and optimal clinical decision-making.

Research paper thumbnail of Healthcare personnel and nosocomial transmission of pandemic 2009 influenza

Critical Care Medicine, 2010

Research paper thumbnail of Nationwide Trends of Severe Sepsis in the 21st Century (2000–2007)

Chest, 2011

S evere sepsis, the presence of the systemic infl ammatory response syndrome caused by an infecti... more S evere sepsis, the presence of the systemic infl ammatory response syndrome caused by an infection with at least one acute organ failure, is a common reason for hospitalization. 1 Mortality rates for severe sepsis far exceed those of common medical conditions such as myocardial infarction and stroke. The aging population of the United States, increased use of chemotherapy, and growing number of patients living with transplants are all likely to increase the frequency of this disease. Moreover, medical advances allow an everincreasing number of persons with multiple or severe chronic diseases to survive into old age. These factors are also associated with an increased risk of organ failure and death. 2 Fortunately, the past decade has seen many advances in the management of severe sepsis. Improved understanding of the pathophysiology of severe sepsis has led to rigorous trials that have resulted in changes in the practice and evolution of care of patients with severe sepsis. 3-16 Previous work has demonstrated that hospitalizations for severe sepsis are expensive and increasingly common. 17,18 However, because these studies were conducted prior to the many recent advances in research Background: Severe sepsis is common and often fatal. The expanding armamentarium of evidencebased therapies has improved the outcomes of persons with this disease. However, the existing national estimates of the frequency and outcomes of severe sepsis were made before many of the recent therapeutic advances. Therefore, it is important to study the outcomes of this disease in an aging US population with rising comorbidities. Methods: We used the Healthcare Costs and Utilization Project's Nationwide Inpatient Sample (NIS) to estimate the frequency and outcomes of severe sepsis hospitalizations between 2000 and 2007. We identifi ed hospitalizations for severe sepsis using International Classifi cation of Diseases, Ninth Revision, Clinical Modifi cation codes indicating the presence of sepsis and organ system failure. Using weights from NIS, we estimated the number of hospitalizations for severe sepsis in each year. We combined these with census data to determine the number of severe sepsis hospitalizations per 100,000 persons. We used discharge status to identify in-hospital mortality and compared mortality rates in 2000 with those in 2007 after adjusting for demographics, number of organ systems failing, and presence of comorbid conditions. Results: The number of severe sepsis hospitalizations per 100,000 persons increased from 143 in 2000 to 343 in 2007. The mean number of organ system failures during admission increased from 1.6 to 1.9 (P , .001). The mean length of hospital stay decreased from 17.3 to 14.9 days. The mortality rate decreased from 39% to 27%. However, more admissions ended with discharge to a long-term care facility in 2007 than in 2000 (35% vs 27%, P , .001). Conclusions: An increasing number of admissions for severe sepsis combined with declining mortality rates contribute to more individuals surviving to hospital discharge. Importantly, this leads to more survivors being discharged to skilled nursing facilities and home with in-home care. Increased attention to this phenomenon is warranted.

Research paper thumbnail of Introduction and executive summary

Research paper thumbnail of Algorithmic Trading Using Long Short-Term Memory Network and Portfolio Optimization

Investors typically rely on a mix of experience, intuition, knowledge of economic fundamentals an... more Investors typically rely on a mix of experience, intuition, knowledge of economic fundamentals and real-time information to make informed choices and try to get as high a rate of return as possible. Their decisions are customarily more instinct-driven than methodical. Propelled by the need for numerically inspired judgments, ever stronger within the financial community, in recent years the usage of computational and mathematical tools has been taking root. In this work we used a Long Short-Term Memory (LSTM) Network trained on historical prices to predict future daily closing prices of several stocks listed on the Standard & Poor 500 (S&P500) index. We compared the predictions of our LSTM network with those produced by another state-of-the-art approach, the Hidden Markov Model (HMM), in order to validate our findings. We then fed our forecasts into aMarkowitz Portfolio Optimization (PO) procedure to identify the best trading strategy. The purpose of PO, which allows for simultaneous...

Research paper thumbnail of Reinterpreting the role of primary and secondary airports in low-cost carrier expansion in Europe

Journal of Transport Geography, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Research paper thumbnail of Dynamic evolution of European airport systems in the context of Low-Cost Carriers growth

Journal of Air Transport Management, 2017

Research paper thumbnail of Evidence-based guidelines for the use of tracheostomy in critically ill patients

Journal of Critical Care, 2017

Research paper thumbnail of Delivering User Information in Resource-constrained Urban Transit Systems: The Case of Ibague, Colombia

Transportation Research Procedia, 2016

Research paper thumbnail of Estrategias de diseño para brindar confort térmico en vivienda en la ciudad de Loja

Nuestro entorno, al parecer olvidado, cada vez mas deteriorado debido a la indiscriminada toma de... more Nuestro entorno, al parecer olvidado, cada vez mas deteriorado debido a la indiscriminada toma de recursos que de el proviene, por ello debemos ir concienciando a todos los actores que intervienen en el multidisciplinar proceso de construir nuestro entorno. Es necesario tomar conciencia de la importancia del confort termico y las estrategias que de este se derivan; Manejo del calor, La luz, El soleamiento, La ventilacion, La humedad, El sonido en el espacio Urbano; que son fuentes naturales de confort que disminuyen al maximo el uso de fuentes artificiales como luz electrica, calefaccion, etc.. Esta concientizacion nos llevaria a una optimizacion de estos recursos, fuentes naturales que mejoran la calidad de vida dentro de una vivienda y por ende la de las personas que en ellas habitan. Factores que al parecer no son estudiados al momento de concebir una vivienda, en consecuencia el proyectista muchas de las veces se ve liberado de preocuparse de estos factores. La estetica cuando tiene una concepcion herrada suele sepultar la calidad de vida de un espacio arquitectonico, esto en el caso de muchas viviendas que al no tomar en cuenta estos factores resultan convirtiendose en lugares inhabitables. A estos y muchos otros factores se debe el interes de mi estudio por el confort termico, factores como la autoconstruccion, las viviendas a medio terminar, etc.… Este estudio es el que despejara muchas dudas sobre la factibilidad o no de emplear estas estrategias en estas viviendas lo cual sera la conclusion de este estudio.

Research paper thumbnail of Implementación de un silo de pesaje para minerales, utilizados en el proceso de fundición de chatarra en la empresa ADELCA C.A

Improper way to perform the work of weighing minerals by the workers in the company Adelca AC led... more Improper way to perform the work of weighing minerals by the workers in the company Adelca AC led to a series of subsequent problems such as excessive pollution to which workers are exposed and also the physical effort required for these activities, so the next paper describes how to improve the working conditions of employees to perform these activities, improving the quality of working environment for employees By implementing the system for weighing ore mill area weighing process is improved with the use of suitable equipment in an automated process such as the use of a PLC Siemens S300 series, with the right program can be readings have control of information load cells, and in turn they could be used to view a Siemens HMI interface, where you have control to determine relative amounts of mineral to be weighed By automating the process clearly evident results are achieved, such as reduced physical exertion, decreased time of exposure to dust generated by minerals, plus the time used for this process are reduced, thus improving the availability of employees to the company, thus fulfilling the plans of the company in the process of continuous improvement.

Research paper thumbnail of Incidencias de la aplicación de Estrategias de Comprensión Lectora en el aprendizaje de la Lectoescritura en la disciplina de Lengua y Literatura en el Tercero y Cuarto grado de primaria de la Escuela César Augusto Baldizón, Valle de la Laguna, Masaya, Se

Congreso Nacional De Educacion, May 16, 2013

Research paper thumbnail of Diseno De Un Modelo De Mejora Continua Para Impresora Chavez Garcia

Research paper thumbnail of Espumas inyectables de hidroxiapatita obtenidas por el método de espumado de la fase líquida de un cemento de fostato tricálcico alfa

Research paper thumbnail of The Airport Business in a Competitive Environment

Procedia - Social and Behavioral Sciences, 2014

Airports have traditionally been considered as public utility providers, with little potential to... more Airports have traditionally been considered as public utility providers, with little potential to develop significant market opportunities. Liberalisation of the air transport market around the globe has introduced new dynamics into the airport industry. The emergence of competition and the transition in ownership (towards privatisation or commercialisation) demand a different perspective in airport management. This paper aims at explaining the complexity of the airport business, in particular in what concerns the role of the airport as a firm that operates in a network of stakeholders, to produce a set of service packages targeted at several types of customers.

Research paper thumbnail of Legal preparedness: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

Chest, 2014

Significant legal challenges arise when health-care resources become scarce and population-based ... more Significant legal challenges arise when health-care resources become scarce and population-based approaches to care are implemented during severe disasters and pandemics. Recent emergencies highlight the serious legal, economic, and health impacts that can be associated with responding in austere conditions and the critical importance of comprehensive, collaborative health response system planning. This article discusses legal suggestions developed by the American College of Chest Physicians (CHEST) Task Force for Mass Critical Care to support planning and response efforts for mass casualty incidents involving critically ill or injured patients. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. Following the CHEST Guidelines Oversight Committee's methodology, the Legal Panel develope...

Research paper thumbnail of Ethical considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

Chest, 2014

Mass critical care entails time-sensitive decisions and changes in the standard of care that it i... more Mass critical care entails time-sensitive decisions and changes in the standard of care that it is possible to deliver. These circumstances increase provider uncertainty as well as patients' vulnerability and may, therefore, jeopardize disciplined, ethical decision-making. Planning for pandemics and disasters should incorporate ethics guidance to support providers who may otherwise make ad hoc patient care decisions that overstep ethical boundaries. This article provides consensus-developed suggestions about ethical challenges in caring for the critically ill or injured during pandemics or disasters. The suggestions in this article are important for all of those involved in any pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. We adapted the American College of Chest Physicians (CHEST) Guidelines Oversight Committee's methodology to develop suggestions. T...

Research paper thumbnail of Propiedades Psicométricas del Cuestionario de Auto Reporte de la Calidad de Vida KIDSCREEN-27 en Adolescentes Chilenos

Terapia psicológica, 2009

Resumen Se evalúa, las propiedades psicométricas del cuestionario de Calidad de Vida KIDSCREEN-27... more Resumen Se evalúa, las propiedades psicométricas del cuestionario de Calidad de Vida KIDSCREEN-27 adaptado a niños/as y adolescentes chilenos. Participaron 1678 sujetos escolarizados de entre 8 y 18 años. Se evaluó tanto la consistencia interna como indicadores de validez de constructo, discriminante y convergente. El alfa de Cronbach de la escala total como de las distintas dimensiones es superior a 0.70. Los análisis factoriales exploratorio y confirmatorio arrojan evidencia de una estructura similar a la teórica de cinco dimensiones. El instrumento es capaz de discriminar entre hombres y mujeres, así como entre rangos de edad, en diferentes dimensiones. Los resultados permiten decir que el KIDSCREEN-27 presentó coeficientes de fiabilidad y validez aceptables, similares a los de la versión original, permitiendo disponer de un nuevo instrumento que evalúe calidad de vida en Chile y a la vez comparar los resultados obtenidos con otros países que utilicen este instrumento.

Research paper thumbnail of Una aproximación empírica a la relación entre las tasas de interés de los TES de tasa fija y el tipo de cambio en Colombia (2001-2004)

DOCUMENTOS …, 2004

... de los trabajos consultados acerca del tema de relación de tasas de interés y tipos de cambio... more ... de los trabajos consultados acerca del tema de relación de tasas de interés y tipos de cambio, sobresale el de Pradyumna Dash, títulado “The ... desarrollados en la misma línea por Corhay, Tourani y Urbain (1993), Chung y Liu (1994), Serletis y King (1997) o Aggarwal, Inclan y ...

Research paper thumbnail of Evidence-based clinical practice guidelines for prostate cancer: the need for a unified approach

Current Opinion in Urology, 2007

Clinical practice guidelines are being increasingly recognized as critically important to an evid... more Clinical practice guidelines are being increasingly recognized as critically important to an evidence-based practice. This article reviews the different approaches used by leading urological organizations to the development of prostate cancer guidelines. It further introduces the recommendations of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group as a unified approach to guideline development. Clinical guidelines on the management of prostate cancer demonstrate major methodological differences. Most notably, considerable discrepancies with regards to the systems used to grade the quality of the evidence and the strength of recommendation exist. The GRADE approach classifies the quality of evidence as high, moderate, low or very low, according to factors that include study design and execution, and the consistency of the results. It subsequently classifies recommendations as strong or weak, according to the balance between benefits and downsides and the degree of confidence in estimates of the downsides. There is an urgent need to standardize processes used to develop clinical guidelines for the management of patients with prostate cancer by leading urological organizations. Adoption of the GRADE approach would offer considerable rewards in terms of efficiency, guideline credibility and optimal clinical decision-making.

Research paper thumbnail of Healthcare personnel and nosocomial transmission of pandemic 2009 influenza

Critical Care Medicine, 2010

Research paper thumbnail of Nationwide Trends of Severe Sepsis in the 21st Century (2000–2007)

Chest, 2011

S evere sepsis, the presence of the systemic infl ammatory response syndrome caused by an infecti... more S evere sepsis, the presence of the systemic infl ammatory response syndrome caused by an infection with at least one acute organ failure, is a common reason for hospitalization. 1 Mortality rates for severe sepsis far exceed those of common medical conditions such as myocardial infarction and stroke. The aging population of the United States, increased use of chemotherapy, and growing number of patients living with transplants are all likely to increase the frequency of this disease. Moreover, medical advances allow an everincreasing number of persons with multiple or severe chronic diseases to survive into old age. These factors are also associated with an increased risk of organ failure and death. 2 Fortunately, the past decade has seen many advances in the management of severe sepsis. Improved understanding of the pathophysiology of severe sepsis has led to rigorous trials that have resulted in changes in the practice and evolution of care of patients with severe sepsis. 3-16 Previous work has demonstrated that hospitalizations for severe sepsis are expensive and increasingly common. 17,18 However, because these studies were conducted prior to the many recent advances in research Background: Severe sepsis is common and often fatal. The expanding armamentarium of evidencebased therapies has improved the outcomes of persons with this disease. However, the existing national estimates of the frequency and outcomes of severe sepsis were made before many of the recent therapeutic advances. Therefore, it is important to study the outcomes of this disease in an aging US population with rising comorbidities. Methods: We used the Healthcare Costs and Utilization Project's Nationwide Inpatient Sample (NIS) to estimate the frequency and outcomes of severe sepsis hospitalizations between 2000 and 2007. We identifi ed hospitalizations for severe sepsis using International Classifi cation of Diseases, Ninth Revision, Clinical Modifi cation codes indicating the presence of sepsis and organ system failure. Using weights from NIS, we estimated the number of hospitalizations for severe sepsis in each year. We combined these with census data to determine the number of severe sepsis hospitalizations per 100,000 persons. We used discharge status to identify in-hospital mortality and compared mortality rates in 2000 with those in 2007 after adjusting for demographics, number of organ systems failing, and presence of comorbid conditions. Results: The number of severe sepsis hospitalizations per 100,000 persons increased from 143 in 2000 to 343 in 2007. The mean number of organ system failures during admission increased from 1.6 to 1.9 (P , .001). The mean length of hospital stay decreased from 17.3 to 14.9 days. The mortality rate decreased from 39% to 27%. However, more admissions ended with discharge to a long-term care facility in 2007 than in 2000 (35% vs 27%, P , .001). Conclusions: An increasing number of admissions for severe sepsis combined with declining mortality rates contribute to more individuals surviving to hospital discharge. Importantly, this leads to more survivors being discharged to skilled nursing facilities and home with in-home care. Increased attention to this phenomenon is warranted.

Research paper thumbnail of Introduction and executive summary