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

Detection of VHE gamma-ray emission from the distant blazar 1ES 1101-232 with HESS and broadband characterisation

18 Pages, 6 FiguresThe blazar 1ES 1101-232 was observed with the High Energy Stereoscopic System (H.E.S.S.) of Atmospheric Cherenkov Telescopes (ACT) in 2004 and 2005, for a live time of 43 hours. VHE (E > 10^11 eV) gamma-rays were detected for the first time from this object. VHE observations of blazars are used to investigate the inner parts of the blazar jets, and also to study the extragalactic background light (EBL) in the near-infrared band. Observations in 2005 were conducted in a multiwavelength campaign, together with the RXTE satellite and optical observations. In 2004, simultaneous observations with XMM-Newton were obtained. 1ES 1101-232 was detected with H.E.S.S. with an excess of 722 photons, at a significance of 12 sigma. The measured VHE gamma-ray flux amounts to dN/dE = (5.63 +- 0.89) x 10^-13 (E/TeV)^-(2.94 +- 0.20) cm^-2 s^-1 TeV^-1, above a spectral energy threshold of 225 GeV. No significant variation of the VHE gamma-ray flux on any time scale was found. 1ES 1101-232 exhibits a very hard spectrum, and at a redshift of z=0.186, is the blazar with the highest confirmed redshift detected in VHE gamma-rays so far. The data allow the construction of truly simultaneous spectral energy distributions of the source, from the optical to the VHE band. Using an EBL model with \nu F_\nu = 14 nW m^-2 sr^-1 at 1.5 \mu m as presented in Aharonian et al. (Nature, 2006, 440, 1018) suggests an intrinsic VHE power output peak of the source at above 3 TeV

HESS Observations of the Prompt and Afterglow Phases of GRB 060602B

8 pages, 4 figures, 1 tableWe report on the first completely simultaneous observation of a gamma-ray burst (GRB) using an array of Imaging Atmospheric Cherenkov Telescopes which is sensitive to photons in the very-high-energy (VHE) gamma-ray range (>~100 GeV). On 2006 June 2, the Swift Burst Alert Telescope (BAT) registered an unusually soft gamma-ray burst (GRB 060602B). The burst position was under observation using the High Energy Stereoscopic System (H.E.S.S.) at the time the burst occurred. Data were taken before, during, and after the burst. A total of 5 hours of observations were obtained during the night of 2006 June 2-3, and 5 additional hours were obtained over the next 3 nights. No VHE gamma-ray signal was found during the period covered by the H.E.S.S. observations. The 99% confidence level flux upper limit (>1 TeV) for the prompt phase (9s) of GRB 060602B is 2.9x10^-9 erg cm^-2 s^-1. Due to the very soft BAT spectrum of the burst compared to other Swift GRBs and its proximity to the Galactic center, the burst is likely associated with a Galactic X-ray burster, although the possibility of it being a cosmological GRB cannot be ruled out. We discuss the implications of our flux limits in the context of these two bursting scenarios

Discovery of VHE gamma-rays from the distant BL Lacertae 1ES0347-121

Aims.Our aim is to study the production mechanism for very-high-energy (VHE; >100 GeV) ?-rays in distant active galactic nuclei (AGN) and use the observed VHE spectrum to derive limits on the Extragalactic Background Light (EBL). We also want to determine physical quantities through the modeling of the object's broad-band spectral energy distribution (SED). Methods: VHE observations (~25 h live time) of the BL Lac 1ES 0347-121 (redshift z = 0.188) were conducted with the High Energy Stereoscopic System (HESS) between August and December 2006. Contemporaneous X-ray and UV/optical observations from the SWIFT satellite are used to interpret the SED of the source in terms of a synchrotron self Compton (SSC) model. Results: An excess of 327 events, corresponding to a statistical significance of 10.1 standard deviations, is detected from 1ES 0347-121. Its photon spectrum, ranging from ~250 GeV to ~3 TeV, is well described by a power law with a photon index of ? = 3.10 ± 0.23stat ± 0.10sys. The integral flux above 250 GeV corresponds to ~2% of the flux of the Crab Nebula above the same threshold. No VHE flux variability is detected within the data set. Conclusions: Constraints on the EBL density at optical to near-infrared wavelengths derived from the photon spectrum of 1ES 0347-121 are close to the strongest limits derived previously. The strong EBL limits confirm earlier findings, that the EBL density in the near-infrared is close to the lower limits from source counts. This implies that the universe is more transparent to VHE ?-rays than previously believed. An SSC model provides a reasonable description of the contemporaneous SED. Affiliations are only available in electronic form at http://www.aanda.or

Detection of extended very-high-energy gamma-ray emission towards the young stellar cluster Westerlund 2

Aims. Results from $\gamma$-ray observations by the HESS telescope array in the direction of the young stellar cluster Westerlund 2 are presented. Methods. Stereoscopic imaging of Cherenkov light emission of $\gamma$-ray induced showers in the atmosphere is used to study the celestial region around the massive Wolf-Rayet (WR) binary WR 20a. Spectral and positional analysis is performed using standard event reconstruction techniques and parameter cuts. Results. The detection of a new $\gamma$-ray source is reported from HESS observations in 2006. HESS J1023-575 is found to be coincident with the young stellar cluster Westerlund 2 in the well-known HII complex RCW 49. The source is detected with a statistical significance of more than 9$\sigma$, and shows extension beyond a point-like object within the HESS point-spread function. The differential $\gamma$-ray spectrum of the emission region is measured over approximately two orders of magnitude in flux. Conclusions.The spatial coincidence between HESS J1023-575 and the young open cluster Westerlund 2, hosting e.g. the massive WR binary WR 20a, requires one to look into a variety of potential models to account for the observed very-high-energy (VHE) $\gamma$-ray emission. Considered emission scenarios include emission from the colliding wind zone of WR 20a, collective stellar winds from the extraordinary ensemble of hot and massive stars in the stellar cluster Westerlund 2, diffusive shock acceleration in the wind-blown bubble itself, and supersonic winds breaking out into the interstellar medium (ISM). The observed source extension argues against a single star origin of the observed VHE emission