Older Men Working it Out A strong face of ageing and disability

This hermeneutical study interprets and describes the phenomena of ageing and living with disability. The lived experiences of 14 older men and the horizon of this researcher developed an understanding of what it is like for men to grow old and, for some, to live with the effects of a major disability. The study is grounded in the philosophical hermeneutics of Gadamer and framed in the context of embodiment, masculinity, and narrative. I conducted multiple in-depth interviews with older men aged from 67 to 83 years of age. Seven of the participants had experienced a stroke and I was able to explore the phenomenon of disability with them. Through thematic and narrative analyses of the textual data interpretations were developed that identified common meanings and understandings of the phenomena of ageing and disability. These themes and narratives reveal that the men's understandings are at odds with conventional negative views of ageing and disability. These older men are 'alive and kicking', they voice counternarratives to the dominant construction of ageing as decline and weakness, and have succeeded in remaking the lifeworld after stroke. Overall I have come to understand an overarching meaning of older men 'working it out' as illustrative of a strong face of ageing and disability. Older men seek out opportunities to participate actively in community life and, despite the challenges of ageing and disability, lead significant and meaningful lives. These findings challenge and extend our limited understandings of men's experiences of ageing and living with disability. This interpretation offers gendered directions for policy development, clinical practice, and future research

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

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead