Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Local ecological knowledge and perception of the causes, impacts and effects of Sargassum massive influxes: a binational approach

ABSTRACTCoastal communities of the Caribbean Sea and Gulf of Mexico have been affected by atypical influxes of pelagic macroalgae (Sargassum genus) since 2011, entailing ecological, economic and social impacts in need of characterization. We compiled and documented local ecological knowledge (LEK) and perceptions across diverse stakeholder groups from coastal communities in Mexico (Quintana Roo) (n=50 participants) and the United States (Florida) (n=36 participants) through on-site and online interviews and workshops undertaken from January to March of 2022, to understand how the knowledge of this phenomenon varies among communities and to characterize ecological and well-being impacts. Participants in Quintana Roo associated these influxes with both global phenomena (e.g., climate change) and local scale processes (e.g., currents/wind patterns) while Florida participants associated these events more with the latter. The communities in both regions perceived that the economy and the environment were the most impacted well-being categories. While influxes effects were mostly negative (80%) according to Quintana Roo participants (e.g., affected fisheries), Florida participants considered many positive effects of Sargassum (40%) on several well-being and ecological components (e.g., nursery habitat for marine species). In general, the perception of Sargassum as a problem was less pronounced in Florida, and these differences in perception are related to the magnitude of these influxes’ effect on the daily life of these communities. Overall, macroalgae management is still mainly focused on beach cleanup. Documenting LEK is important to delineate scientific research priorities and to provide decision makers with resources to develop efficient public policies and coastal management decisions

Toward a combined merchant-regulatory mechanism for electricity transmission expansion

Electricity transmission, Financial transmission rights, Incentive regulation, Loop-flow problem, D24, L51, L94,

A Merchant Mechanism for Electricity Transmission Expansion

We propose a merchant mechanism to expand electricity transmission based on long-term financial transmission rights (FTRs). Due to network loop flows, a change in network capacity might imply negative externalities on existing transmission property rights. The system operator thus needs a protocol for awarding incremental FTRs that maximize investors’ preferences, and preserves certain currently unallocated FTRs (or proxy awards) so as to maintain revenue adequacy. In this paper we define a proxy award as the best use of the current network along the same direction as the incremental awards. We then develop a bi-level programming model for allocation of long-term FTRs according to this rule and apply it to different network topologies. We find that simultaneous feasibility for a transmission expansion project crucially depends on the investor-preference and the proxy-preference parameters. Likewise, for a given amount of pre-existing FTRs the larger the current capacity the greater the need to reserve some FTRs for possible negative externalities generated by the expansion changes. Copyright Springer Science+Business Media, Inc. 2006Electricity transmission, Financial transmission rights, Merchant transmission expansion, Bi-level programming, Power flow model, L51, L91, L94, Q40,