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

Definition of the RRE Binding and Activation Domains of the Caprine Arthritis Encephalitis Virus Rev Protein

AbstractCaprine arthritis encephalitis virus (CAEV) is a lentivirus which is closely related by nucleotide sequence and biological properties to visna virus and is more distantly related to the human AIDS virus, HIV-1. Previous studies indicated that the CAEV Rev protein (Rev-C) functions as atrans-activator of mRNA cytoplasmic transport and expression. The function of Rev-C is mediated through an RNA element (RRE-C) present between nucleotides (nt) 7906 and 8110 in the CAEVenvgene. In this study, RNA/protein immunoprecipitation experiments were used to demonstrate that Rev-C binds directly to the 204-nt RRE-Cin vitro.Competition assays illustrate that this interaction is specific for the positive sense RRE-C RNA. Glutaraldehyde crosslinking studies demonstrate that the wildtype Rev-C protein can also form multimeric complexesin vitro.Deletions or amino acid alterations within the basic domain of Rev-C reduce affinity for the RRE and disrupt assembly of Rev-C multimersin vitro,indicating that this domain is involved in RRE binding and Rev multimer formation. Mutations within the leucine-rich domain of Rev-C do not greatly effect RRE-C binding or self-assembly. However, previous results demonstrate that some leucine-rich domain mutants are unable totrans-activate. These data are consistent with the hypothesis that the leucine domain is the effector domain of Rev-C

Preparing a catalogue and bibliography of and researching into independant Labour Party archive

SIGLEAvailable from British Library Document Supply Centre- DSC:8318.172(SSRC-HR--1573)(microfiche) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Towards an Approach for Stakeholder-Oriented Elicitation and Identification of Concerns in EA

Part 5: Enterprise ArchitectureInternational audienceThe concept of concern is used in Enterprise Architecture (EA) to express a stakeholder’s area of interest in a system whose architecture is to be described. Many EA-related problems are rooted in weak stakeholder orientation. We propose an approach to explicitly model stakeholders’ concerns as part of an architecture description. Our contribution is a modeling notation for concern elicitation and a method for concern identification. Our approach is based on goal-oriented requirements engineering and is compatible to the conceptual framework of the ISO 42010 international standard. We claim that our approach allows for a more thorough understanding of stakeholders’ concerns and facilitates a stronger stakeholder orientation in EA