A Libertarian Money

After VERY briefly reviewing the last 350 years of money and central bank monetary policy, the author reviews whether recently developed and developing cryptocurrencies provide more stable money. The answer is no. The author proposes that central banks adopt currency board rules that eliminate monetary policy in place of a market determined money supply. Moreover, he proposes that such currencies’ value be anchored to the market value of a small basket of globally traded commodities. By adopting the IMF’s SDR as the currency anchor and replacing SDR allocations with issuing them under currency board rules and eventually replacing the SDR valuation basket of currencies with the above-mentioned commodity basket, the SDR is likely to replace the dollar or any other currency for international payments and reserves

Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation:an individual-patient data meta-analysis of randomised trials

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this recordAIMS: To undertake an individual patient data (IPD) meta-analysis to assess the impact of exercise-based cardiac rehabilitation (ExCR) in patients with heart failure (HF) on mortality and hospitalisation, and differential effects of ExCR according to patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischaemic aetiology, ejection fraction, and exercise capacity. METHODS AND RESULTS: Randomised trials of exercise training for at least 3 weeks compared with no exercise control with 6-month follow-up or longer, providing IPD time to event on mortality or hospitalisation (all-cause or HF-specific). IPD were combined into a single dataset. We used Cox proportional hazards models to investigate the effect of ExCR and the interactions between ExCR and participant characteristics. We used both two-stage random effects and one-stage fixed effect models. IPD were obtained from 18 trials including 3912 patients with HF with reduced ejection fraction. Compared to control, there was no statistically significant difference in pooled time to event estimates in favour of ExCR although confidence intervals (CIs) were wide [all-cause mortality: hazard ratio (HR) 0.83, 95% CI 0.67-1.04; HF-specific mortality: HR 0.84, 95% CI 0.49-1.46; all-cause hospitalisation: HR 0.90, 95% CI 0.76-1.06; and HF-specific hospitalisation: HR 0.98, 95% CI 0.72-1.35]. No strong evidence was found of differential intervention effects across patient characteristics. CONCLUSION: Exercise-based cardiac rehabilitation did not have a significant effect on the risk of mortality and hospitalisation in HF with reduced ejection fraction. However, uncertainty around effect estimates precludes drawing definitive conclusions.This work is supported by UK National Institute for Health Research funding (HTA 15/80/30)

A fully coupled hydro-mechanical model for the modeling of coalbed methane recovery

Most coal seams hold important quantities of methane which is recognized as a valuable energy resource. Coal reservoir is considered not conventional because methane is held adsorbed on the coal surface. Coal is naturally fractured, it is a dual-porosity system made of matrix blocks and cleats (i.e fractures). In general, cleats are initially water saturated with the hydrostatic pressure maintaining the gas adsorbed in the coal matrix. Production of coalbed methane (CBM) first requires the mobilization of water in the cleats to reduce the reservoir pressure. Changes of coal properties during methane production are a critical issue in coalbed methane recovery. Indeed, any change of the cleat network will likely translate into modifications of the reservoir permeability. This work consists in the formulation of a consistent hydro-mechanical model for the CBM production modeling. Due to the particular structure of coal, the model is based on a dual-continuum approach to enrich the macroscale with microscale considerations. Shape factors are employed to take into account the geometry of the matrix blocks in the mass exchange between matrix and fractures. The hydro-mechanical model is fully coupled. For example, it captures the sorption-induced volumetric strain or the dependence of permeability on fracture aperture, which evolves with the stress state. The model is implemented in the finite element code Lagamine and is used for the modeling of one production well. A synthetic reservoir and then a real production case are considered. To date, attention has focused on a series of parametric analyses that can highlight the influence of the production scenario or key parameters related to the reservoir

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

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

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

Cobalt and precious metals in sulphides of peridotite xenoliths and inferences concerning their distribution according to geodynamic environment: A case study from the Scottish lithospheric mantle

Abundances of precious metals and cobalt in the lithospheric mantle are typically obtained by bulk geochemical analyses of mantle xenoliths. These elements are strongly chalcophile and the mineralogy, texture and trace element composition of sulphide phases in such samples must be considered. In this study we assess the mineralogy, textures and trace element compositions of sulphides in spinel lherzolites from four Scottish lithospheric terranes, which provide an ideal testing ground to examine the variability of sulphides and their precious metal endowments according to terrane age and geodynamic environment. Specifically we test differences in sulphide composition from Archaean-Palaeoproterozoic cratonic sub-continental lithospheric mantle (SCLM) in northern terranes vs. Palaeozoic lithospheric mantle in southern terranes, as divided by the Great Glen Fault (GGF). Cobalt is consistently elevated in sulphides from Palaeozoic terranes (south of the GGF) with Co concentrations > 2.9 wt.% and Co/Ni ratios > 0.048 (chondrite). In contrast, sulphides from Archaean cratonic terranes (north of the GGF) have low abundances of Co (< 3600 ppm) and low Co/Ni ratios (< 0.030). The causes for Co enrichment remain unclear, but we highlight that globally significant Co mineralisation is associated with ophiolites (e.g., Bou Azzer, Morocco and Outokumpu, Finland) or in oceanic peridotite-floored settings at slow-spreading ridges. Thus we suggest an oceanic affinity for the Co enrichment in the southern terranes of Scotland, likely directly related to the subduction of Co-enriched oceanic crust during the Caledonian Orogeny. Further, we identify a distinction between Pt/Pd ratio across the GGF, such that sulphides in the cratonic SCLM have Pt/Pd ≥ chondrite whilst Palaeozoic sulphides have Pt/Pd < chondrite. We observe that Pt-rich sulphides with discrete Pt-minerals (e.g., PtS) are associated with carbonate and phosphates in two xenolith suites north of the GGF. This three-way immiscibility (carbonate-sulphide-phosphate) indicates carbonatitic metasomatism is responsible for Pt-enrichment in this (marginal) cratonic setting. These Co and Pt-enrichments may fundamentally reflect the geodynamic setting of cratonic vs. non-cratonic lithospheric terranes and offer potential tools to facilitate geochemical mapping of the lithospheric mantle

Spent fuel sabotage aerosol ratio program : FY 2004 test and data summary.

This multinational, multi-phase spent fuel sabotage test program is quantifying the aerosol particles produced when the products of a high energy density device (HEDD) interact with and explosively particulate test rodlets that contain pellets of either surrogate materials or actual spent fuel. This program has been underway for several years. This program provides data that are relevant to some sabotage scenarios in relation to spent fuel transport and storage casks, and associated risk assessments. The program also provides significant technical and political benefits in international cooperation. We are quantifying the Spent Fuel Ratio (SFR), the ratio of the aerosol particles released from HEDD-impacted actual spent fuel to the aerosol particles produced from surrogate materials, measured under closely matched test conditions, in a contained test chamber. In addition, we are measuring the amounts, nuclide content, size distribution of the released aerosol materials, and enhanced sorption of volatile fission product nuclides onto specific aerosol particle size fractions. These data are the input for follow-on modeling studies to quantify respirable hazards, associated radiological risk assessments, vulnerability assessments, and potential cask physical protection design modifications. This document includes an updated description of the test program and test components for all work and plans made, or revised, during FY 2004. It also serves as a program status report as of the end of FY 2004. All available test results, observations, and aerosol analyses plus interpretations--primarily for surrogate material Phase 2 tests, series 2/5A through 2/9B, using cerium oxide sintered ceramic pellets are included. Advanced plans and progress are described for upcoming tests with unirradiated, depleted uranium oxide and actual spent fuel test rodlets. This spent fuel sabotage--aerosol test program is coordinated with the international Working Group for Sabotage Concerns of Transport and Storage Casks (WGSTSC) and supported by both the U.S. Department of Energy and the Nuclear Regulatory Commission

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