The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

“Since Feeling is First”: Exploring the Affective Dimension of Teacher Licensure Exams

Los exámenes de licencia para profesorado dan forma de manera directa a la demografía racial de la profesión docente. Éste es particularmente el caso de los exámenes de "habilidades básicas", que son requisitos de ingreso al programa en Estados Unidos y que están expandiéndose a otros países. Este estudio cualitativo exploró una dimensión importante pero poco explorada por los examinadores: los estados emocionales y afectivos. En concreto, nos interesamos por la dimensión afectiva del evento de realización de la prueba. Nuestros resultados revelan una serie de estados afectivos positivos y negativos experimentados tanto por los futuros profesores afroamericanos y blancos durante el examen, así como los procesos de evaluación que producen estos estados. Nuestros resultados también ponen de relieve la importancia de las actividades de preparación antes del examen para ayudar a aliviar los estados afectivos negativos durante el examen.Teacher licensure exams directly shape the racial demographics of the teaching profession. This is particularly the case for “basic skills” exams that are program entrance requirements in the United States and expanding into other countries. This qualitative study explored an important yet overlooked dimension of these exams for test takers: emotional and affective states. Specifically, we were interested in the affective dimension of the test-taking event. Our findings reveal a number of positive and negative affective states that both African American and White preservice teachers experience during the exam and the processes of appraisal that produce these states. Our findings also highlight the importance of preparation activities prior the exam to help alleviate negative affective states during the exam.

“Porque Sentir es lo Primero”: Explorando la Dimensión Afectiva de los Exámenes de Licencia para Profesorado

Teacher licensure exams directly shape the racial demographics of the teaching profession. This is particularly the case for “basic skills” exams that are program entrance requirements in the United States and expanding into other countries. This qualitative study explored an important yet overlooked dimension of these exams for test takers: emotional and affective states. Specifically, we were interested in the affective dimension of the test-taking event. Our findings reveal a number of positive and negative affective states that both African American and White preservice teachers experience during the exam and the processes of appraisal that produce these states. Our findings also highlight the importance of preparation activities prior the exam to help alleviate negative affective states during the exam.Los exámenes de licencia para profesorado dan forma de manera directa a la demografía racial de la profesión docente. Éste es particularmente el caso de los exámenes de "habilidades básicas", que son requisitos de ingreso al programa en Estados Unidos y que están expandiéndose a otros países. Este estudio cualitativo exploró una dimensión importante pero poco explorada por los examinadores: los estados emocionales y afectivos. En concreto, nos interesamos por la dimensión afectiva del evento de realización de la prueba. Nuestros resultados revelan una serie de estados afectivos positivos y negativos experimentados tanto por los futuros profesores afroamericanos y blancos durante el examen, así como los procesos de evaluación que producen estos estados. Nuestros resultados también ponen de relieve la importancia de las actividades de preparación antes del examen para ayudar a aliviar los estados afectivos negativos durante el examen

A supervised exercise intervention fails to improve subjective and objective sleep measures among older adults with and without HIV

Background Chronic sleep disruption can have significant negative health effects and prior studies suggest that people with HIV (PWH) have disproportionately higher rates of sleep problems. Methods We evaluated baseline sleep of sedentary, older adults (50–75 years) with (n = 28) and without HIV (n = 29) recruited into a 24-week exercise study. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI); objective sleep parameters were assessed using wrist-worn actigraphy. Regression models were used to investigate changes in outcomes. Results Fifty-seven participants completed the intervention. At baseline, PWH had significantly lower sleep efficiency (88.7 [95% CI 86, 91]%) compared to controls (91.8 [95% CI 91, 93]%; p = 0.02); other sleep measures indicated poorer sleep among PWH but did not reach statistical significance (p ≥ 0.12). Overall, sleep outcomes did not significantly change with the exercise intervention (all p > 0.05). In adjusted analyses, PWH demonstrated a decrease in total sleep time (–22.1 [–43.7, –0.05] p = 0.045) and sleep efficiency (–1.3 [–2.5, –.01], p = 0.03) during the 24 weeks of exercise; these differences were attenuated and no longer significant after adjusting for exercise intensity. At the completion of the intervention, compared to controls, PWH had significantly poorer sleep by PSQI score (2.2 [0.6, 3.8]; p = 0.006) and sleep efficiency (–2.8 [–5.4,–0.2]%; p = 0.04). Conclusions In this study, sleep disturbance was more prevalent in sedentary older PWH compared to uninfected controls. An exercise intervention had minimal effect on sleep impairments among PWH nor controls. Among older adults, interventions beyond cardiovascular and resistance exercise may be needed to significantly alter subjective and objective sleep outcomes

Cerebrospinal Fluid Spermidine, Glutamine and Putrescine Predict Postoperative Delirium Following Elective Orthopaedic Surgery

Abstract Delirium is a marker of brain vulnerability, associated with increasing age, pre-existing cognitive impairment and, recently, cerebrospinal fluid (CSF) biomarkers of Alzheimer’s disease. This nested case-control study used a targeted quantitative metabolomic methodology to profile the preoperative CSF of patients (n = 54) who developed delirium following arthroplasty (n = 28) and those who did not (n = 26). The aim was to identify novel preoperative markers of delirium, and to assess potential correlations with clinical data. Participants without a diagnosis of dementia (≥65 years) undergoing elective primary hip or knee arthroplasty were postoperatively assessed for delirium once-daily for three days. Groups were compared using multivariate, univariate and receiving operator characteristic (ROC) methods. Multivariate modelling using Orthogonal Partial Least Squares-Discriminant Analysis (OPLS-DA) of metabolomic data readily distinguished between delirium and control groups (R2 ≤ 0.56; Q2 ≤ 0.10). Three metabolites (spermidine, putrescine and glutamine) significantly differed between groups (P < 0.05; FDR < 0.07), and performed well as CSF biomarkers (ROC > 0.75). The biomarker performance of the two polyamines (spermidine/putrescine) was enhanced by ratio with CSF Aβ42 (ROC > 0.8), and spermidine significantly correlated with Aβ42 (pearson r = −0.32; P = 0.018). These findings suggest that spermidine and putrescine levels could be useful markers of postoperative delirium risk, particularly when combined with Aβ42, and this requires further investigation