The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Cosmic ray effects in microcalorimeter arrays

We have identified signals resulting from cosmic rays and environmental gamma rays depositing energy in the pixels and in the silicon frame of the Astro-E2/X-Ray Spectrometer microcalorimeter array. Coincidences between pixels and between the array and an anti-coincidence detector determined the nature of the events. Pulse shapes and amplitudes from the cosmic ray events helped refine the thermal model of the array chip. We discuss how future arrays can be optimized either for the greatest background rejection or for the highest source count rates

Laboratory Astrophysics Using a Spare XRS Microcalorimeter

The XRS instrument on Astro-E is a fully self-contained microcalorimeter x-ray instrument capable of acquiring optimally filtering, and characterizing events for 32 independent pixels. With the launch of the Astro-E spacecraft, a full flight spare detector system has been integrated into a laboratory cryostat for use on the electron beam ion trap (EBIT) at Lawrence Livermore National Laboratory. The detector system contains a microcalorimeter array with 32 instrumented pixels heat sunk to 60 mK using an adiabatic demagnetization refrio,erator. The instrument has a composite resolution of 8eV at 1 keV and 12eV at 6 keV with a minimum of 95% quantum efficiency. This will allow high spectral resolution, broadband observations of collisionally excited plasmas which are produced in the EBIT experiment. Unique to our instrument are exceptionally well characterized 1000 Angstrom thick aluminum on polyimide infrared blocking filters. The detailed transmission function including the edc,e fine structure of these filters has been measured in our laboratory using an erect field grating spectrometer. This will allow the instrument to perform the first broadband absolute flux measurements with the EBIT instrument. The instrument performance as well as the results of preliminary measurements will be discussed. Work performed under the auspices of the U.S. D.o.E. by Lawrence Livermore National Laboratory under contract W-7405-ENG-48 and was supported by the NASA High Energy Astrophysics Supporting Research and Technology Program

Design of the second generation XRS detector

Microcalorimeter performance is limited by non-ideal effects that were not included in the standard theory of bolometers and microcalorimeters developed 20 years ago by Mather (Appl. Opt. 21 (1982) 1125). These include the hot-electron effect, absorber decoupling, thermometer non-ohmic behavior, and all related extra noise sources. Models that include these effects have been developed and can be used to optimize the design of microcalorimeters for best performance. The design of the array for the XRS detector on the Astro-E2 satellite was completely optimized based on the required performance and on the characteristics of the materials used. The characteristic heat capacity and thermal conductivity of all the detector components have been measured and the values have been used as input to the models to design the detector geometry for best performance. Mechanical modeling has also been carried out in parallel to ensure the mechanical integrity of the microcalorimeter. We report here the analysis involved in the optimization of the detectors, and the comparison between modeled and measured performance

On being a financial manager in a church organisation: understanding the experience

The definitive version is available at www.blackwell-synergy.comMargaret Lightbod

The next-generation microcalorimeter array of XRS on Astro-E2

The square-format 32-pixel microcalorimeter array at the focal plane of the high-resolution X-ray spectrometer on the Astro-E2 X-ray Observatory is the first of a new generation of silicon-based microcalorimeters. This array has numerous advantages over its predecessor, the bilinear array that was launched on Astro-E. Foremost among its benefits are: (1) the energy resolution is improved by a factor of two at 6keV (now 6eV FWHM), (2) the thermal time constant is a factor of two faster, and (3) each pixel has a Gaussian line response. We will discuss the design changes that have led to these and other advantages