Petrology and geochemistry of the NWA 3368 Eucrite

We report the petrology and geochemistry of NWA 3368, a new non-cumulate, monomict eucrite breccia with a variety of clast sizes and a pink-tinted matrix. Analytical techniques include electron microprobe, INAA, and ICP-MS

Atrial fibrillation after gastrointestinal surgery: incidence and associated risk factors

BACKGROUND: Atrial fibrillation (AF) is a common dysrhythmia that can occur after major physiological stress including surgery (postoperative AF). There are few data on postoperative AF after abdominal surgery. We set out to define the incidence of de novo postoperative AF after abdominal surgery and associated risk factors. METHODS: The Patient History Integrated Data store administrative database was interrogated for patients aged ≥65 y undergoing abdominal surgery from April 2012 to April 2014. Patients with pre-existing AF were excluded. The primary outcome was diagnosis of AF. RESULTS: Two thousand nine hundred and sixty-seven cases were included of whom 187 developed postoperative AF within 90 d (6.3%). The rate of postoperative AF varied by operation and was highest in small bowel resection (17.2%) and lowest in biliary surgery (4.8%). Median time to detection of postoperative AF was 32 d. Patients who developed postoperative AF were significantly older than those who did not develop AF (median age 75.3 y versus 72.4 y, P < 0.01). Logistic regression modeling found increasing age (odds ratio [OR] 1.03 [confidence interval {CI} 1.01-1.06], hypertension OR 1.73 [CI 1.19-2.51]), congestive cardiac failure (OR 3.04 [CI 1.88-4.92], and vascular disease OR 2.29 [CI 1.39-3.37]) were predictive of the development of postoperative AF within 30 d. The area under the curve for this model was 0.733. CONCLUSIONS: Postoperative AF affects a significant number of patients after abdominal surgery. Demographics such as history of cardiovascular disease might aid prediction of postoperative AF. Postoperative AF is mostly identified after discharge, suggesting the need for postoperative screening

Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis

BACKGROUND: Ischaemic colitis is an infrequent but serious complication following repair of abdominal aortic aneurysm (AAA), with high mortality rates. This systematic review set out to identify risk factors for the development of ischaemic colitis after AAA surgery. METHODS: A systematic search of the MEDLINE, EMBASE and CINAHL databases was performed. This search was limited to studies published in the English language after 1990. Abstracts were screened by two authors. Eligible studies were obtained as full text for further examination. Data was extracted by two authors, and any disputes were resolved via consensus. Extracted data was pooled using Mantel-Haenszel random effects models. Bias was assessed using two Cochrane-approved tools. Effect sizes are expressed as relative risk ratios alongside the 95 % confidence interval. Statistical significance was defined at the level of p < 0.05. RESULTS: From 388 studies identified in the initial search, 33 articles were included in the final synthesis and analysis. Risk factors were grouped into patient (female gender, disease severity) and operative factors (peri-procedural hypotension, operative modality). The risk of ischaemic colitis was significantly higher when undergoing emergency repair versus elective (risk ratio (RR) 7.36, 3.08 to 17.58, p < 0.001). Endovascular repair reduced the likelihood of ischaemic colitis (RR 0.22, 0.12 to 0.39, p < 0.001). DISCUSSION: The quality of published evidence on this subject is poor with many retrospective datasets and inconsistent reporting across studies. Despite this, emergency presentation and open repair should prompt close monitoring for the development of IC

Resource variation in colorectal surgery; a national centre-level analysis.

BACKGROUND: Delivery of quality colorectal surgery requires adequate resources. We set out to assess the relationship between resources and outcomes in English colorectal units. METHODS: Data was extracted from the ACPGBI resource questionnaire to profile resources. This was correlated with Hospital Episode Statistics (HES) outcome data including 90-day mortality and readmissions. Patient satisfaction measures were extracted from the Cancer Experience Patient Survey (CEPS) and compared at unit level. Centres were divided by workload into low, middle, and top tertile. RESULTS: Completed questionnaires were received from 75 centres in England. Service resources were similar between low and top tertiles in access to CEPOD theatre, level 2 or 3 beds per 250,000 population or likelihood of having a dedicated colorectal ward. There was no difference in staffing levels per 250,000 unit of population. Each 10% increase in the proportion of cases attempted laparoscopically, was associated with reduced 90-day unplanned readmission (RR 0.94, 95% CI 0.91 to 0.97, p<0.001). The presence of a dedicated colorectal ward (RR 0.85, 95% CI 0.73 to 0.99, p =0.040) was also associated with a significant reduction in unplanned readmissions. There was no association between staffing or service factors and patient satisfaction. DISCUSSION AND CONCLUSIONS: Resource levels do not vary based on unit of population. There is benefit associated with increased use of laparoscopy and a dedicated surgical ward. Alternative measures to assess the relationship between resources and outcome, such as failure to rescue, should be explored in UK practice. This article is protected by copyright. All rights reserved

First results of an Hα based search of classical Be stars in the Perseus Arm and beyond

We investigate a region of the Galactic plane, between 120° ≤ l ≤ 140° and-1° ≤ b≤+4°, and uncover a population of moderately reddened (E(B-V) ~ 1) classical Be stars within and beyond the Perseus and Outer Arms. 370 candidate emission-line stars (13≲r≲16) selected from the Isaac Newton Telescope Photometric Ha Survey of the Northern Galactic plane have been followed up spectroscopically. A subset of these, 67 stars with properties consistent with those of classical Be stars, have been observed at sufficient spectral resolution (δλ ≈ 2-4 Å) at blue wavelengths to narrow down their spectral types. We determine these to a precision estimated to be ±1 subtype and then we measure reddenings via spectral energy distribution fitting with reference to appropriate model atmospheres. Corrections for contribution to colour excess from circumstellar discs are made using an established scaling to Ha emission equivalent width. Spectroscopic parallaxes are obtained after luminosity class has been constrained via estimates of distances to neighbouring A/F stars with similar reddenings. Overwhelmingly, the stars in the sample are confirmed as luminous classical Be stars at heliocentric distances ranging from 2 kpc up to ~12 kpc. However, the errors are presently too large to enable the cumulative distribution function with respect to distance to distinguish between models placing the stars exclusively in spiral arms, or in a smooth exponentially declining distribution.Peer reviewe

The current status of clinical trials in emergency gastrointestinal surgery. A systematic analysis of contemporary clinical trials

BACKGROUND: Emergency gastrointestinal surgery (EGS) conditions represent a significant healthcare burden globally requiring emergency operations that are associated with mortality rates as high as 80%. EGS is currently focussed on quality improvement and internal audits, which occurs at a national or local level. An appreciation of what EGS trials are being conducted is important to reduce research wastage and develop coordinated research strategies in surgery. The primary aim of this study was to identify and quantify recent and active trials in emergency gastrointestinal surgery. The secondary aim was to identify conditions of interest, and which aspects of care were being modified. METHODS: A systematic search of WHO, UK, US, Australian and Canadian trials databases was undertaken using broad terms to identify studies addressing emergency abdominal surgery and specific high-risk diagnoses. Studies registered between 2013-2018 were eligible for inclusion. Data on study topic, design, and funding body were collected. Interventions were classified into 'peri-operative', 'procedural', 'post-operative', 'non-surgical' and 'other' categories. RESULTS: Searches identified 5603 registered trials. After removal of duplicates, 4492 studies remained and 42 were eligible for inclusion. Almost 50% of trials were located in Europe and 17% (n=7) in the USA. The most common condition addressed was acute appendicitis (n=11), with the most common intervention being procedure based (n=23). Hospital based funding was the most common funder (n=30). CONCLUSION: There is large disparity in the number of surgical trials in emergency surgery, which are primarily focussed on high-volume conditions. More research is needed into high-mortality conditions. EVIDENCE LEVEL: 1a (oxford)

UK-based, multisite, prospective cohort study of small bowel obstruction in acute surgical services: National Audit of Small Bowel Obstruction (NASBO) protocol

Introduction Small bowel obstruction (SBO) is a common indication for emergency laparotomy in the UK, which is associated with a 90-day mortality rate of 13%. There are currently no UK clinical guidelines for the management of this condition. The aim of this multicentre prospective cohort study is to describe the burden, variation in management and associated outcomes of SBO in the UK adult population. Methods and analysis UK hospitals providing emergency general surgery are eligible to participate. This study has three components: (1) a clinical preference questionnaire to be completed by consultants providing emergency general surgical care to assesses preferences in diagnostics and therapeutic approaches, including laparoscopy and nutritional interventions; (2) site resource profile questionnaire to indicate ease of access to diagnostic services, operating theatres, nutritional support teams and postoperative support including intensive care; (3) prospective cohort study of all cases of SBO admitted during an 8-week period at participating trusts. Data on diagnostics, operative and nutritional interventions, and in-hospital mortality and morbidity will be captured, followed by data validation. Ethics and dissemination This will be conducted as a national audit of practice in conjunction with trainee research collaboratives, with support from patient representatives, surgeons, anaesthetists, gastroenterologists and a clinical trials unit. Site-specific reports will be provided to each participant site as well as an overall report to be disseminated through specialist societies. Results will be published in a formal project report endorsed by stakeholders, and in peer-reviewed scientific reports. Key findings will be debated at a focused national meeting with a view to quality improvement initiatives

Study of flare energy release using events with numerous type III-like bursts in microwaves

The analysis of narrowband drifting of type III-like structures in radio bursts dynamic spectra allows to obtain unique information about primary energy release mechanisms in solar flares. The SSRT spatially resolved images and a high spectral and temporal resolution allow direct determination not only the positions of its sources but also the exciter velocities along the flare loop. Practically, such measurements are possible during some special time intervals when the SSRT (about 5.7 GHz) is observing the flare region in two high-order fringes; thus, two 1D scans are recorded simultaneously at two frequency bands. The analysis of type III-like bursts recorded during the flare 14 Apr 2002 is presented. Using-muliwavelength radio observations recorded by SSRT, SBRS, NoRP, RSTN we study an event with series of several tens of drifting microwave pulses with drift rates in the range from -7 to 13 GHz/s. The sources of the fast-drifting bursts were located near the top of the flare loop in a volume of a few Mm in size. The slow drift of the exciters along the flare loop suggests a high pitch-anisotropy of the emitting electrons.Comment: 16 pages, 6 figures, Solar Physics, in press, 201

The ionized nebula surrounding the red supergiant W26 in Westerlund 1

We present Hα images of an ionized nebula surrounding the M2-5Ia red supergiant (RSG) W26 in the massive star cluster Westerlund 1. The nebula consists of a circumstellar shell or ring ∼0.1 pc in diameter and a triangular nebula ∼0.2 pc from the star that in high-resolution Hubble Space Telescope images shows a complex filamentary structure. The excitation mechanism of both regions is unclear since RSGs are too cool to produce ionizing photons and we consider various possibilities. The presence of the nebula, high stellar luminosity and spectral variability suggests that W26 is a highly evolved RSG experiencing extreme levels of mass-loss. As the only known example of an ionized nebula surrounding an RSG W26 deserves further attention to improve our understanding of the final evolutionary stages of massive stars

A Systematic Review of Patients’ Values, Preferences, and Expectations for the Diagnosis and Treatment of Male Lower Urinary Tract Symptoms

Context: Understanding men's values and preferences in the context of personal, physical, emotional, relational, and social factors is important in optimising patient counselling, facilitating treatment decision-making, and improving guideline recommendations. Objective: To systematically review the available evidence regarding the values, preferences, and expectations of men towards the investigation and treatment (conservative, pharmacological, and surgical) of male lower urinary tract symptoms (LUTS). Evidence acquisition: We searched electronic databases until August 31, 2020 for quantitative and qualitative studies that reported values and preferences regarding the investigation and treatment of LUTS in men. We assessed the quality of evidence and risk of bias using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) and GRADE Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approaches. Evidence synthesis: We included 25 quantitative studies, three qualitative studies, and one mixed-methods study recruiting 9235 patients. Most men reported urodynamic testing to be acceptable, despite discomfort or embarrassment, as it significantly informs treatment decisions (low certainty evidence). Men preferred conservative and less risky treatment options, but the preference varied depending on baseline symptom severity and the risk/benefit characteristics of the treatment (moderate certainty). Men preferred pharmacological treatments with a low risk of erectile dysfunction and those especially improving urgency incontinence (moderate certainty). Other important preference considerations included reducing the risk of acute urinary retention or surgery (moderate certainty). Conclusions: Men prefer lower-risk management options that have fewer sexual side effects and are primarily effective at improving urgency incontinence and nocturia. Overall, the evidence was rated to be of low to moderate certainty. This review can facilitate the treatment decision-making process and improve the trustworthiness of guideline recommendations. Patient summary: We thoroughly reviewed the evidence addressing men's values and preferences regarding the management of urinary symptoms and found that minimising adverse effects is particularly important. Further research to understand other factors that matter to men is required. (C) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.Peer reviewe