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

LXIV. - The essential oil of Cinnamomum Oliveri (bail.) or brisbane sassafras

It may be seen that the oils from the bark and from the leaves of Cinnamomum Oliveri contain similar substances in the lower fractions, but differ in the higher ones, no safrole or eugenyl methyl ether being found in that from the leaves. Thus the oil from the bark contains four distinct substances in approximately the following proportions: Pinene ............................. 12-15 per cent. d-Camphor ........................ 18-20 " Safrole ............................ 25-27 " Eugenyl methyl ether ......... 40-45 " The oil from the leaves contains: Pinene ..........................} 25 " Phellandrene (?) ............ d- Camphor ........................ 60 " Phenols and other substances.. . 15 " R. T. Baker (Proc. Linn. Soc. N.S.W., 1897, ii, 275), in his paper on "The Cinnamomums of New South Wales, with a Special Research on the Oil of the Bark of C. Oliveri (Bail.)," gives somewhat incomplete results of a chemical analysis by H. G. Smith, no reference being made to the four main constituents of the oil. He suspects the presence of traces of eugenol, cinnamaldehyde, and cineole, none of which could be detected by the author of the present paper. All Smith's results, however, were based on colour reactions or odour; no analyses were carried out, nor were any derivatives prepared. He also states that none of the terpenes of low boiling point is present, whereas the present work has shown the presence of pinene to the extent of 12-15 per cent. Again, no mention is made by Smith of camphor, although he speaks of a stearoptene (which was not isolated) crystallising at -12°. This was probably a mixture of camphor and safrole, for the present author, using liquid ammonia as refrigerant, succeeded in fractionally crystallising these two substances, and by means of subsequent analyses and preparation of derivatives their compositions were ascertained. It is interesting to note that Margaret E. Scott (T., 1912, 101, 1612) examined the essential oil of the leaves of another sassafras, which, however, is of a different order and species, Athenosperma moschatum (Australian sassafras, native of Victoria), and obtained the following results: Eugenyl methyl ether ......... 50-60 per cent. Pinene ............................ 15-20 " Camphor............................ 15-20 " Safrole ................................. 5-10 " These four substances are identical with those found in the oil from the bark of Cinnamomum Oliveri, but not with those from the leaves

Risk: the ethics of a creative curriculum

Regulations in Higher Education, e.g. subject benchmarks, the qualifications framework (QAA) and the CATs system. play an important role in ensuring the quality of educational standards. They assure students that each CAT point they acquire has value and that ‘graduateness’ is of equal worth regardless of location or subject. In addition, a growing consumer ethos and the introduction of fees encourage students and their financial supporters to view Higher Education as a product. Whilst the student’s own motivation and input is still important, Universities are expected to deliver learning opportunities that maximise the likelihood of successful completion. Innovation and creativity do not sit comfortably within this paradigm. Delivering educational experiences where the outcome is uncertain, or where there are less clear and objective methods for measuring student achievement, presents a risk to educational standards and to student experience. This paper seeks to explore the relationship between risk, ethics and the introduction of creativity and innovation into the curriculum. It is generally accepted that university education should be challenging – encouraging the development of an enquiring mind that does not accept things at face value and the confidence to argue from an alterative viewpoint. These aspirations are related to notions of autonomy as espoused by J S Mill (1859) and others. Nurturing such attributes means respecting the autonomy of the student to make decisions, stand by them and to take responsibility for risk taking and its outcomes. It also means allowing lecturers to design courses that permit change, diversity of practice and risk taking. By contrast an unintended effect of the paradigm outlined above is a culture in which individual academic freedom is stifled by the need for conformity. Success may be measured by the averagely intelligent student, with average levels of motivation, achieving an award one point higher on the value added scale than they came with. The ethical principle of non-maleficence takes precedence such that the possibility of doing harm – to the student or University - outlaws risk taking behaviour in curriculum design and delivery. Utilitarian ethics (West 2004) is effective in surfacing such dilemmas. Its use in detailed analysis may help students and academics to plot the risks and benefits of innovative practice

Antarctic Peninsula sea levels: A real-time system for monitoring Drake Passage transport

Sub-surface pressure (SSP) data from tide gauges at three bases on the Pacific coast of the Antarctic Peninsula, together with SSP information from a bottom pressure recorder deployed on the south side of the Drake Passage, have been used to study the relationships between SSP, Drake Passage transport, and the strength of Southern Ocean zonal winds as represented by the Southern Annular Mode. High correlations were obtained between all parameters, confirming results obtained previously with independent data sets, and demonstrating the value of information from the permanent Rothera base, the southern-most site considered. These are important findings with regard to the design, installation and maintenance of observation networks in Antarctica. In particular, they provide the necessary justification for Antarctic Peninsula tide gauge infrastructure investment in the lead up to International Polar Year. Data delivery from Rothera and Vernadsky is currently being improved and should soon enable the first near real-time system for monitoring Drake Passage transport variability on intraseasonal timescales, an essential component of a Southern Ocean Observing System

Measurement of nitrous oxide emission from agricultural land using micrometeorological methods

The spatial variability of N2O emission from soil makes extrapolation to the field scale very difficult using; conventional chamber techniques ( < 1 m2). Micrometeorological techniques, which integrate N2O fluxes over areas of 0.1 to 1 km2 were therefore developed and compared with chamber methods over arable cropland. Measurements of N2O emission from an unfertilised organic soil (reclaimed from the sea in 1879) were made over a 10 d period at Lammefjord, Denmark. Flux-gradient and conditional sampling techniques were applied using two tunable diode laser spectrometers (TDLs), a Fourier transform infra-red spectrometer (FTIR) and a gas chromatograph (GC). Eddy covariance measurements were also made by the TDLs. Over the 10 d campaign approximately 5 d of continuous fluxes by the different methods were, obtained. Fluxes determined by eddy covariance were in reasonable agreement, showing a mean flux of 269 μg N m2 h−1. Flux-gradient techniques measured a mean flux of 226 μg N m−2 h−1. The mean flux measured by conditional sampling was 379 μg N m−2 h−1. The maximum annual emission of N2O from this soil system was estimated to be 23.5 kg N ha−1