The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Biological control of aflatoxin production in corn using non-aflatoxigenic Aspergillus flavus administered as a bioplastic-based seed coating

Biocontrol techniques for reducing aflatoxin contamination in corn kernels usually involve massive application of non-aflatoxigenic A. flavus to soil. In this study, applying biocontrol agents directly to corn by incorporation into a seed coating was explored. Seeds were film-coated with a starch-based bioplastic formulation containing two conventional pesticides (insecticide: imidacloprid; fungicide: metalaxyl-M) and spores of non-aflatoxigenic A. flavus NRRL 30797. Application of the bioplastic seed-coating with or without additives did not affect seed germination or seedling growth. The coating remained adherent to seed surfaces, reducing seed dust release. Incorporating biocontrol A. flavus into the bioplastic seed coating resulted in a decreased percentage of aflatoxin-producers in recoverable field soil isolates and significantly lower aflatoxin contamination of harvested corn kernels relative to seed coating with pesticides alone in the following field locations: (i) Northern Italy in 2016, where biocontrol seed coating reduced aflatoxin contamination from 7.1 to 2.1 ng g\ue2\u88\u921; (ii) Mississippi Delta in a low aflatoxin contamination field, where biocontrol seed coating reduced aflatoxin contamination from 5.8 to 3.1 ng g\ue2\u88\u921in 2015 and from 33.4 to 8.2 ng g\ue2\u88\u921in 2016; and (iii) Mississippi Delta in a high aflatoxin contamination field, where biocontrol seed coating reduced aflatoxin contamination from 74.4 to 15.1 ng g\ue2\u88\u921(79.7%) in 2015 and from 95.0 to 16.0 ng g\ue2\u88\u921(85.2%) in 2016. These results suggest that seed coating may be a useful approach to deliver biocontrol agents for reducing aflatoxin contamination in corn

A liquid bioplastic formulation for film coating of agronomic seeds

Interest in industrial and domestic applications of biodegradable plastics from renewable sources is increasing, but their use in agriculture is still limited (e.g., mulching films, plant pots, and plant clips). However, a sprayable liquid bioplastic formulation was recently evaluated for application of microbial biocontrol agents to agricultural and horticultural crops. In this study bioplastic formulation has been evaluated for use in film-coating seeds of two agronomic species, corn and canola. Bioplastic seed coating was achieved using procedures and equipment designed for commercial polymer film-coating of tablets. Germination of both species was unaffected by the thin bioplastic coating. Bioplastic coatings containing spores of the plant-growth promoting fungus, Trichoderma harzianum, significantly stimulated the growth of corn and canola seeds. In corn seedlings, shoot and root lengths were 29% and 44% longer, respectively, in seeds coated with T. harzianum-containing bioplastic than in uncoated seeds. Similarly, in canola seedlings shoot and root lengths were 19% and 20% longer, respectively, in seeds coated with T. harzianum-containing bioplastic than in uncoated seeds. In a paper-roll assay, including T. harzianum spores prevented reduced germination caused by a mixture of the insecticide imidacloprid and the fungicide metalaxyl-M in bioplastic seed coatings. The adhesive and plastic properties of bioplastic reduced dust-off from bioplastic-coated seeds by 96% in corn and 99% in canola compared to seeds coated with a commercial polymer

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used