Great Guy

The cold seeped through Officer Moriarity\u27s greatcoat and numbed his body. Steam spiraled from his nostrils in dragonesque patterns, and the far reaches of the street light at the mouth of the alley fell upon him and ricocheted off his badge and buttons as he lumbered toward the street. With cold numbed fingers he tugged a ponderous watch from beneath his coat and paused to examine its scarred face beneath the light ... eleven-thirty, half-an-hour until call-in time

Merry-Go-Round

The merry-go-round and the ferris-wheel spun in opposite directions, making him dizzy. A carnival tune piped from some hidden calliope, and the interwoven chants of concession barkers merged into a constant buzz of incoherency. The noise, the swirl of unorganized movement, and the gaudy splashes of raw color irritated him, and made him angry with himself for being irritated. The atmosphere was infected with a spirit of gayety, and it annoyed him that he was immune

Differentiation of MIS 9 and MIS 11 in the continental record: vegetational, faunal, aminostratigraphic and sea-level evidence from coastal sites in Essex, UK

Multidisciplinary investigations of the vegetational, faunal and sea-level history inferred from the infills of buried channels on the coast of eastern Essex have a direct bearing on the differentiation of MIS 11 and MIS 9 in continental records. New data are presented from Cudmore Grove, an important site on Mersea Island that can be linked to the terrace sequence of the River Thames. The vegetational history has been reconstructed from a pollen sequence covering much of the interglacial represented. The temperate nature of the climate is apparent from a range of fossil groups, including plant remains, vertebrates (especially the rich herpetofauna), molluscs and beetles, which all have strong thermophilous components. The beetle data have been used to derive a Mutual Climatic Range reconstruction, suggesting that mean July temperatures were about 2 °C warmer than modern values for southeast England, whereas mean January temperatures may have been slightly colder. The sea-level history has been reconstructed from the molluscs, ostracods and especially the diatoms, which indicate that the marine transgression occurred considerably earlier in the interglacial cycle than at the neighbouring Hoxnian site at Clacton. There are a number of palynological similarities between the sequence at Cudmore Grove and Clacton, especially the presence of Abies and the occurrence of Azolla filiculoides megaspores. Moreover, both sites have yielded Palaeolithic archaeology, indeed the latter is the type site of the Clactonian (flake-and-core) industry. However, the sites can be differentiated on the basis of mammalian biostratigraphy, new aminostratigraphic data, as well as the differences in the sea-level history. The combined evidence suggests that the infill of the channel at Cudmore Grove accumulated during MIS 9, whereas the deposits at Clacton formed during MIS 11. The infill of a much later channel, yielding non-marine molluscs and vertebrates including Hippopotamus, appears to have formed during the Ipswichian (MIS 5e). This evidence is compared with other important sites of late Middle Pleistocene age in Britain and elsewhere on the continent and the importance of a multidisciplinary approach is stressed

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran