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

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

High strain rate constitutive modeling of aluminum nitride including a first-order phase transformation

This work presents a computational constitutive model for materials exhibiting a first-order phase transition. The model can represent both recoverable and non-recoverable volume loss characterized by first-order phase transitions. Aluminum Nitride (AIN) is used to demonstrate the model. AIN has a first-order phase transition from the wurtzite (hexagonal) structure to the rock salt (cubic) structure. This phase transformation has been observed under static high pressure testing and inferred to be occurring under high strain rate shock wave loading. The phase transition begins at an approximate hydrostatic pressure of 16GPa where a 20% volume loss commences. The volume loss has been inferred to be non-recoverable. The model used for this study was previously developed for crushable materials, but is demonstrated herein that it can be straightforwardly applied to materials that exhibit a first-order phase change. Constants are obtained for the model using AIN test data. Plate impact experiments are simulated using the model, demonstrating the ability of the model to capture the material behavior. The model is also used to evaluate the recoverability of the volume loss and implies that the volume loss is non-recoverable

Failure and penetration response of borosilicate glass during multiple short-rod impact

In Anderson Jr CE, Orphal DL, Behner T, Templeton, DW [Failure and penetration response of borosilicate glass during short-rod impact. Int J Impact Eng 2009, doi:10.1016/j.ijimpeng.2008.12.002.1 it was demonstrated that the failure front (FF) produced by the penetration of a borosilicate glass target by a gold rod ceased to propagate a short time after the rod was fully eroded. This strongly suggests that progression of the FF is not described by a wave equation. Here it is shown that propagation of the FF is reinitiated if a second co-axial rod, spaced a distance from the first, impacts the glass at the bottom of the penetration channel. The experiments were performed in reverse ballistic mode with two short rods spaced apart. In some experiments both rods were gold; in other experiments, one rod was copper and the other gold. FF propagation was measured using high-speed photography; rod penetration was measured using multiple, independent flash X-rays. Much of the observed phenomenology can be modeled assuming that the rod, either first or second, "communicates" with the FF at a speed corresponding to the bulk sound speed of the undamaged glass

Interface defeat of long rods impacting oblique silicon carbide

This paper presents experimental results for an unconfined oblique ceramic impacted by long gold rods. The obliquity angle of the ceramic was 60, the impact velocities varied between 0.90 km/s and 1.65 km/s. The ceramic impact surface was either bare or covered with a copper plate as a buffer. Dwell of the rod was observed by means of multiple X-ray images. The effect of the obliquity angle and the buffer on the dwell-penetration transition velocity was examined and compared to existing normal impact data