Ugly Feet, OCD, and Other Intimations of Resistance

Ugly Feet, OCD, and Other Intimations of Resistance is a connected collection of personal essays that lie at the intersection of disability and masculinity

Olenekian sulfur isotope records: Deciphering global trends, links to marine redox changes and faunal evolution

The sulfur (S) isotope composition of carbonate associated sulfate (CAS) in carbonate rocks has been used to assess variations in paleo-oceanographic redox conditions and its relationship to biotic changes in Earth’s history, including the Smithian – Spathian transition. However, previous CAS studies of the Olenekian are mostly based on nearshore continental shelf sections and report highly variable δ34S values mostly offset from those of contemporaneous evaporites, casting doubt on the utility of the CAS proxy during this interval. The current study presents new CAS isotopic data from three well-dated carbonate successions which were deposited in continental shelf (Qiakong) and offshore marine (Wadi Musjah and Jebel Aweri) environments during the Olenekian (Smithian – Spathian). The aim of the study was to constrain the temporal and spatial variations in sulfur cycling and its relation to marine redox and faunal changes across the Smithian – Spathian transition (ca. 250.5 – 248.8 Ma). The CAS dataset is complemented by rare earth element (REE) concentration data and thin section petrography. Using a suite of optical and geochemical techniques, the preservation of near-primary CAS isotopic information in the studied samples is evaluated. Results indicate that of the three sections investigated, the offshore sections mostly preserve near-primary marine sulfate S-isotope compositions while the continental shelf Qiakong section suffers from post-depositional alteration of CAS. Comparisons of our new, as well as previously published CAS δ34S data, with the evaporite δ34S record suggests that although Olenekian CAS δ34S values may have been modified by abiotic factors such as ocean-atmosphere oxygenation levels. Keywords: sulfur isotopes, SSB, sulfur cycle, seawater sulfate, marine redox, CA

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

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

OPTIMAX 2017 : radiation dose, image quality optimisation,the use of new technology in medical imaging

This year OPTIMAX settled in Oslo. After the successof previous years, we are proud to present the fourthEbook. As in previous years, the group was madeup of PhD-, MSc- and BSc students as well astutors from the seven European partner universities.Professional mix was drawn from medical physics/physics and radiography. OPTIMAX 2017 was partlyfunded by the partner universities and partly by theparticipants. Two students from South Africa and twofrom Brazil were invited by Hanze UAS (Groningen)and ESTeSL (Lisbon) summer school includedlectures and group projects in which experimentalresearch was conducted in four teams. Four research projects were performed with a focuson radiation dose optimization and image quality,namely: Possible dose reduction for pediatric patientsfor conventional radiology; Can the tube voltage belowered with the use of direct-conversion flat paneldetector system?; Impact of body size and kV in chestradiography; Quantity assessment on Image quality ofCBCT images of head phantom with implants of metaland ceramic objects.The last day of OPTIMAX 2017there was a poster session and a conference, in whichthe research teams presented their posters and oralpresentations. This book comprises of two sections, the first twochapters concern generic background informationabout international teamwork during the OPTIMAXsummerschool. The next chapters with theory on which the researchprojects were built. The second section containsthe research papers of the four research projects.Two research papers, Can the tube voltage belowered with the use of direct-conversion flat-paneldetector system? And Impact of body size and kV inchest radiography: Experimental receiver operatingcharacteristic analysis using a Multipurpose ChestPhantom “Lungman” have been accepted for the ECRconference, Vienna, 2018 as oral presentations

Geological observation in southeastern Zanskar and adjacent Lahul area (northern Himalaya).

The paper deals with the stratigraphic and structural setting of the sedimentary sequence cropping out in southeastern Zanskar and adjacent Lahul areas. The Tibetan Zone succession of southeastern Zanskar consists of about 6000 m of sediments, Late Precambrian~ ?Eocene in age, arranged in two superposed slabs (Pugh tal Unit, below, and Zangla Unit, above) tectonically resting upon the High Himalayan Crystalline. The Pughtal sequence, mostly terrigenous with carbonate units in the Cambrian, Silurian and Carboniferous, is about 2500 m thick. It was deposited from ?Late Precambrian to Carboniferous or ?Early Permian. The Permian Panjal Traps constitute the "sole" of the Zangla Unit, whose sedimentary sequence, about 3000 m thick, mainly carbonatic, spans from Late Permian (Kuling Formation) to Middle Jurassic (Kioto Limestone) in eastern Zanskar. In the Zangla area Late Jurassic/Cretaceous formations (Spiti Shales, Giumal Sandstone, Chikkim Limestone) are also present. Towards northwest, the sequence ranges up to Paleocene (Spanboth Formation) and ?Eocene (Chulung La Slates). Au nord de la Haute Chaine, dans la partie septentrionale de I'Himalaya, la marge continentale indienne a vu plus de 6000 m de sediments se deposer depuis I'Infracambrien jusqu'a I'Eocene. Lors de l'orogenese himalayenne, ces sediments ont ete decolles de leur substratum originel, dMormes et metamorphises de maniere differenciee suivant leur position. Ils reposent en contact tectonique sur la nappe cristalline du Haut-Himalaya. L'unite inferieure ou unite de Pughtal consiste, la ou elle est complete, en plus de 2500 m de sediments en partie detritiques terrigenes mais marque par l'edification de plates-formes carbonatees au Cambrien, Silurien et Carbonifere. Dans cette unite on releve deux grandes sequences sedimentaires separees par l'evenement epirogenique et magmatique tardi-Cambrien (500 rna), contrecoup de l'orogenese pan-africaine. Un niveau massif de vo1canites basaltiques permiennes ~ les Panjal Traps ~ forme la base ou sole de I'unite superieure (nappe de Zangla). Cette unite, plissee de maniere disharmonique, recouvre progressivement vers l'ouest des niveaux de plus en plus anciens de l'unite inferieure, niveaux eux-memes replisses en grands plis couches kilometriques a vergence nord. Dans la partie occidentale (Ringdom) l'unite superieure repose directement sur la nappe cristalline. Cette unite montre une serie sedimentaire avec des carbonates de plate-forme bien developpes au Trias superieur et au Lias puis des sediments surtout pelagiques et en partie detritiques terrigenes au Jurassique superieur et au Cretace. Des la fin du Cretace et jusqu'au Paleocene superieur s'edifie a nouveau une plate-forme peu profonde. La serie se termine par des couches continentales attribuees a l'Eocene. L'evolution geodynamique durant Ie Paleozoique et Ie Mesozoique est analysee. II en ressort que la sedimentation, a partir de I'Ordovicien, est regJee plus par des grands cycles eustatiques que par des mouvements tectoniques ou epirogeniques regionaux (les orogeneses caledoniennes, hercyniennes et cretacees des auteurs)