Generalized roughness of three dimensional ( ∈ , ∈ ∨ q )-fuzzy ideals in terms of set-valued homomorphism.

The objective of this study is to generalize the roughness of a fuzzy set-in three-dimensional structure by introducing ternary multiplication. Many results and theorems of rough fuzzy ideals have been extended from semigroup and semiring, to ternary semiring by introducing the definition of a rough fuzzy subset of ternary semiring. By using the concept of set-valued homomorphism and strong set-valued homomorphism, it is proved generalized lower and upper approximations of ( ∈ , ∈ ∨ q ) -fuzzy ideals (semiprime and prime ideals) of ternary semirings are ( ∈ , ∈ ∨ q ) -fuzzy ideals (semiprime and prime ideals) respectively.

An efficient approach to study multi-polar fuzzy ideals of semirings.

The multi polar fuzzy (m-PF) set has an extensive range of implementations in real world problems related to the multi-polar information, multi-index and multi-attributes data. This paper introduces innovative extensions to algebraic structures. We present the definitions and some important results of m-polar fuzzy subsemirings (m-PFSSs), m-polar fuzzy ideals (m-PFIs), m-polar fuzzy generalized bi-ideals (m-PFGBIs), m-polar fuzzy bi-ideals (m-PFBIs) and m-polar fuzzy quasi-ideals (m-PFQIs) in semirings. The main contributions of the paper include the derivation and proof of key theorems that shed light on the algebraic interplay and computational aspects of m-polar fuzzy ideals (m-PFIs), m-polar fuzzy generalized bi-ideals (m-PFGBIs), m-polar fuzzy bi-ideals (m-PFBIs) and m-polar fuzzy quasi-ideals (m-PFQIs) in semirings along with examples. Moreover, this paper deals with several important properties of m-PFIs and characterizes regular and intra-regular semirings by the properties of these ideals.

Renal Injury in All-Comers After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

Background Acute kidney injury (AKI) following aortic valve replacement is associated with poor prognosis. Transcatheter aortic valve replacement (TAVR) is a novel strategy with a percutaneous approach and early recovery time. We conducted this meta-analysis to compare TAVR to surgical aortic valve replacement (SAVR) and their respective renal outcomes. Methods We searched for randomized controlled trials (RCTs) using MEDLINE, PUBMED, and Google Scholar databases from their inception till April 6, 2019, and included eight trials comparing TAVR to SAVR in cases that reported AKIs. Results We found a significant reduction in AKI after TAVR compared to SAVR at 30 days [n = 66 vs. n = 160, respectively; odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.28-0.51; p: <0.00001, I2 = 0%]. At one year, a trend towards reduced renal failure was noted in the TAVR arm compared to the SAVR arm (n = 74 vs. n = 129, respectively; OR = 0.57, 95% CI = 0.32-1.01; p = 0.05, I2 = 69%). Conclusion Based on our findings and analysis, we have concluded that TAVR is associated with significantly reduced renal injury at 30 days when compared to SAVR.

Consented End.

Description This poem is a reflection upon my personal experience of taking care of a young patient with post-partum sepsis and multi-organ failure following the delivery of her second child. She was able to spend one night at home with her family before suddenly decompensating and becoming encephalopathic. In her last moments awake, she relayed to the EMS her wishes of being placed in hospice. The poem narrates her spouse's internal struggle after respecting the patient's wishes of withdrawal of care.

Hydrocortisone Reduces 28-day Mortality in Septic Patients: A Systemic Review and Meta-analysis.

The goal of this study was to determine the utility of hydrocortisone in septic shock and its effect on mortality. We performed a systematic search from inception until March 01, 2018, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines comparing hydrocortisone to placebo in septic shock patients and selected studies according to our pre-defined inclusion and exclusion criteria. Four reviewers extracted data into the predefined tables in the Microsoft Excel (Microsoft Corp., New Mexico, US) sheet. We used RevMan software to perform a meta-analysis and draw Forest plots. We used a random effects model to estimate risk ratios. A two-sided p-value of ≤ 0.05 was considered statistically significant. A total of five randomized control trials (RCTs) with 5,838 patients were included in our analysis. The primary outcome was mortality at 28 days. Secondary outcomes were intensive care unit (ICU) and in-hospital mortality, mortality at 90 days and one year, reversal of shock, intensive care unit (ICU) and hospital length of stay, incidence of superinfections, and incidence of limb and/or cerebral ischemia. The 28-day mortality was significantly reduced with hydrocortisone, 808 vs. 880 with placebo, Risk Ratio (RR)=0.92, confidence interval (CI) =0.85-0.99, p=0.04, I2=0%. There was no difference in ICU mortality (RR=0.93, CI=0.81-1.08), in-hospital mortality (RR=0.95, CI=0.84-1.08), 90-day mortality (RR=0.93, CI=0.84-1.02, p=0.10), and one-year mortality (RR=0.97, CI=0.84-1.12). Superinfections were significantly common with hydrocortisone, RR=1.16, CI=1.05-1.28, p=0.003. In conclusion, the use of hydrocortisone showed a significant reduction in mortality at 28 days and a trend toward reduced ICU mortality. This mortality reduction was observed at the cost of significantly higher superinfections.