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

Recentralisation and its causes: Colombia, 1994-2014

This thesis aims to explain why and how after a comprehensive set of decentralising processes, Colombia experienced significant recentralising policies and reforms (1994-2014). These changes emerged not only against what was expected by leading works on decentralisation in Latin America, but in a way that the existing hypotheses on recentralisation cannot fully account for. This is a hypothesis-generating case study. The growing literature on recentralisation is still very limited. With few exceptions, there are no big theoretical efforts. In general, the case studies assume temporal causal homogeneity. The analyses are excessively focused on the impact of only one type of factor (economic, political or administrative), instead of on the interactions between them. And they are excessively focused on the national governments, while neglecting the explanation of the role of legislators and subnational authorities. Using process-tracing and combining evidence from documentary sources and elite interviews, the thesis suggests that Colombia's recentralisation was an outcome of the interaction between economic inputs and institutional context. When an economic crisis takes place in a decentralised context, one can expect an increase of recentralisation. If an economic boom occurs in the same context, one should expect a decrease of recentralisation. If there is an economic crisis in a recentralised context, one can expect less recentralisation. If, instead, an economic boom occurs in the same context, one should expect even more recentralisation. The causal mechanisms are self-destroying/self-reinforcing dynamics. The thesis provides a deep analysis of the Colombian case plus an updated review of the literature. It also aims to tackle the main definitional issues and brings new concepts for the analysis of the recentralising strategies used by national and intermediate levels of government. Noteworthy, it offers a hypothesis that identifies the relevance of changing institutional contexts, the interactions between different types of factors, and the role of legislators and subnational authorities. Still, this thesis does not aim to propose a general theory of recentralisation.</p

Identification of plant cells in black pigments of prehistoric Spanish Levantine rock art by means of a multi-analytical approach. A new method for social identity materialization using chaîne opératoire

International audienc

Btbd3 expression regulates compulsive-like and exploratory behaviors in mice

BTB/POZ domain-containing 3 (BTBD3) was identified as a potential risk gene in the first genome-wide association study of obsessive-compulsive disorder (OCD). BTBD3 is a putative transcription factor implicated in dendritic pruning in developing primary sensory cortices. We assessed whether BTBD3 also regulates neural circuit formation within limbic cortico-striato-thalamo-cortical circuits and behaviors related to OCD in mice. Behavioral phenotypes associated with OCD that are measurable in animals include compulsive-like behaviors and reduced exploration. We tested Btbd3 wild-type, heterozygous, and knockout mice for compulsive-like behaviors including cage-mate barbering, excessive wheel-running, repetitive locomotor patterns, and reduced goal-directed behavior in the probabilistic learning task (PLT), and for exploratory behavior in the open field, digging, and marble-burying tests. Btbd3 heterozygous and knockout mice showed excessive barbering, wheel-running, impaired goal-directed behavior in the PLT, and reduced exploration. Further, chronic treatment with fluoxetine, but not desipramine, reduced barbering in Btbd3 wild-type and heterozygous, but not knockout mice. In contrast, Btbd3 expression did not alter anxiety-like, depression-like, or sensorimotor behaviors. We also quantified dendritic morphology within anterior cingulate cortex, mediodorsal thalamus, and hippocampus, regions of high Btbd3 expression. Surprisingly, Btbd3 knockout mice only showed modest increases in spine density in the anterior cingulate, while dendritic morphology was unaltered elsewhere. Finally, we virally knocked down Btbd3 expression in whole, or just dorsal, hippocampus during neonatal development and assessed behavior during adulthood. Whole, but not dorsal, hippocampal Btbd3 knockdown recapitulated Btbd3 knockout phenotypes. Our findings reveal that hippocampal Btbd3 expression selectively modulates compulsive-like and exploratory behavior.Brain Research Foundation seed grant (S.C.D.), a NARSAD Independent Investigator award (S.C.D.), R21-MH115395-01 (S.C.D.), Della Martin Foundation (J.A.K.), and training grants: T32 GM07839 (S.L.T.), and T32 DA07255 (S.L.T.)