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

Nano and Battery Anode: A Review

Improving the anode properties, including increasing its capacity, is one of the basic necessities to improve battery performance. In this paper, high-capacity anodes with alloy performance are introduced, then the problem of fragmentation of these anodes and its effect during the cyclic life is stated. Then, the effect of reducing the size to the nanoscale in solving the problem of fragmentation and improving the properties is discussed, and finally the various forms of nanomaterials are examined. In this paper, electrode reduction in the anode, which is a nanoscale phenomenon, is described. The negative effects of this phenomenon on alloy anodes are expressed and how to eliminate these negative effects by preparing suitable nanostructures will be discussed. Also, the anodes of the titanium oxide family are introduced and the effects of Nano on the performance improvement of these anodes are expressed, and finally, the quasi-capacitive behavior, which is specific to Nano, will be introduced. Finally, the third type of anodes, exchange anodes, is introduced and their function is expressed. The effect of Nano on the reversibility of these anodes is mentioned. The advantages of nanotechnology for these electrodes are described. In this paper, it is found that nanotechnology, in addition to the common effects such as reducing the penetration distance and modulating the stress, also creates other interesting effects in this type of anode, such as capacitive quasi-capacitance, changing storage mechanism and lower volume change

Role of Glass Composition on Mechanical Properties of Shape Memory Alloy-Metallic Glass Composites

In this work, the molecular dynamics (MD) simulation was applied to design a laminated composite structure comprised of the shape memory alloy (SMA) and Cu-Zr metallic glasses (MGs). A wide range of MG compositions was considered to tune the mechanical features and improve the homogenous plastic deformation during the tension loading. The results indicated that the martensitic transformation in the SMA inhibited the sudden shear band propagation in the composite for all the samples. Moreover, it was revealed that the mechanism of plasticity was significantly affected by the change of MG composition. In the Cu-rich MGs, the formation and propagation of thick shear bands occurred at the end of the tension loading; however, the increase in Zr content induced the interaction of multiple shear bands with finer configurations in the system. Nevertheless, the excessive Zr addition in the MG composition facilitated the aggregation of nanopores at the interface of SMA and MGs, which may be due to the softening effect in the Zr-rich MGs. Finally, it is concluded that an optimized MG composition is required for the trade-off between the plasticity and the strength in the SMA-MG composites