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

Effects of overhead canopy on macroinvertebrate production in a Utah stream

1. Macroinvertebrate abundance and production were compared between an open and shaded site of a stream in the Wasatch Mountains, Utah. Mean biomass was significantly higher at the open site for midges (Chironomidae), 4.6x; Baetis bicaudatus, 5.7x; Baetis tricaudatus, 2.3x; Drunella coloradensis, 12x and Cinygmula sp., L6x. Abundance of most other macroinvertebrates (except black flies: Simuliidae) was also greater at the open site, but differences were not significant. Black fly biomass was 1.7x greater at the shaded site. 2. Seasonal production, estimated by the size-frequency and instantaneous growth rate methods, was greater at the open site than the shaded site for most taxa (except black flies) and reflected differences in standing crops between the sites rather than differences in rate of growth. Excluding black flies, production at the open site was twice as high as at the shaded site. 3. The greater abundance and production of most invertebrate taxa at the open site is probably associated with either higher quality food (algae and algal detritus), or a phototactic attraction to sunlit areas. 4. Sampling of large cobbles was an efficient method of sampling all taxa except Cinygmula sp. which was more abundant on smaller substrate particles

Tectonic, eustatic and climatic controls on marginal-marine sedimentation across a flexural depocentre: paddy member of peace river formation (late albian), western Canada foreland basin

In north-central Alberta and adjacent British Columbia, clastic strata of the middle to late Albian Peace River and Shaftesbury formations were deposited in alluvial to shallow-marine environments across the foredeep of the Western Canada Foreland Basin. A high-resolution, log and core-based allostratigraphic framework for the Paddy Member of the Peace River Formation established nine allomembers, PA to PI, bounded by flooding surfaces and apparently equivalent non-marine surfaces. Within the estimated 2 Myr. duration of the Paddy, allomembers allow the evolving palaeogeography and changing relationship between accommodation and sedimentation rates to be analysed on timesteps on the order of 105 years. Paddy strata fill an arcuate depocentre ca 300 km wide, across which the rocks thin eastward from 125 m to ca 5 to 10 m. The northern part of the basin is occupied by muddy, offshore marine deposits that pass abruptly southward into a linear, WSW-ENE-trending body of sandstone deposited in a wave-dominated barrier-strandplain, at least 350 km long. Extending >200 km to the south of the strandplain was a region of shallow brackish to freshwater lagoons and lakes that graded to the SW into alluvial facies. Within the lagoon region, few-m thick, elongate and patchy sandstones represent river-dominated deltas. In allomembers PA to PG, these sandstones are concentrated in the west and south, implying supply from the western Cordillera. In allomembers PH and PI, sandstones are mainly in the east and have a distinctive, quartz-rich composition. They can be correlated eastward into the coeval Pelican Formation, and were sourced probably from the Canadian Shield on the opposite side of the basin. In the western foredeep, alluvial rocks comprise aggradational, unconfined floodplain deposits with ribbon sandstones, dissected, on at least nine separate levels, by palaeovalleys that are confined to the proximal foredeep. Valleys are 10 to 30 m deep, few km wide, and filled with multi-storey channel-bars of pebbly coarse sandstone or conglomerate. Valleys cut down from well-developed interfluve palaeosols that record a falling and then rising water table. Alternating aggradation and degradation, and advance and retreat of the alluvial gravel front is attributed to cycles of varying rainfall intensity, rather than tectonism or eustasy. Apparently, coeval transgressive-regressive successions in the lagoon and marine regions are attributed to few-m scale eustatic changes. On the NE margin of the basin, tidal sandstone fills a northward-opening estuary cut on the basal PaddyGnesioceramus comancheanus (Cragin), proving contemporaneity with at least part of the marine Joli Fou Formation to the east. Paddy allomembers change shape upward from short blunt wedges, through more acutely tapered wedges, to sheets. This change reflects initially rapid flexural subsidence, attributed to active thickening of the adjacent orogenic wedge. A waning rate of deformation permitted wider dispersal of sediment across the basin, driving broad isostatic subsidence beneath increasingly sheet-like rock bodies. A major hiatal surface, VE3, records non-deposition or subtle erosion attributed to erosional unloading and uplift of the adjacent orogen. A subsequent marine transgression is attributed to renewed thickening of the tectonic wedge that triggered deposition of marine mudstone that thickens westward from 0 to >110 m over 300 km. A postulated Milankovitch-band climatic control on both local gravel supply (via fluctuating rainfall), and shoreline movement (via ?Antarctic glacio-eustasy or groundwater storage), might account for cycles of alternating incision and aggradation in the alluvial realm. The same mechanism may also explain why shallow-marine units such as the Cretaceous Viking and Cardium formations contain abundant conglomerate in lowstand shoreface deposits (higher river discharge), yet have highstand shorelines dominated by sandstone (lower river discharge)

Extracellular Signal-regulated Kinase Phosphorylates Tumor Necrosis Factor α-converting Enzyme at Threonine 735: A Potential Role in Regulated Shedding

The ectodomain of certain transmembrane proteins can be released by the action of cell surface proteases, termed secretases. Here we have investigated how mitogen-activated protein kinases (MAPKs) control the shedding of membrane proteins. We show that extracellular signal-regulated kinase (Erk) acts as an intermediate in protein kinase C-regulated TrkA cleavage. We report that the cytosolic tail of the tumor necrosis factor α-converting enzyme (TACE) is phosphorylated by Erk at threonine 735. In addition, we show that Erk and TACE associate. This association is favored by Erk activation and by the presence of threonine 735. In contrast to the Erk route, the p38 MAPK was able to stimulate TrkA cleavage in cells devoid of TACE activity, indicating that other proteases are also involved in TrkA shedding. These results demonstrate that secretases are able to discriminate between the different stimuli that trigger membrane protein ectodomain cleavage and indicate that phosphorylation by MAPKs may regulate the proteolytic function of membrane secretases