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

Geophysical Assessment of Structurally Controlled Mineral Resources at Wadi El-Nakheel, Eastern Desert, Egypt

It is of great importance to evaluate simple methods to identify mineral occurrence for the future development of society. Applying a reconnaissance magnetic data analysis can help detect the main structural trends mounted to the occurrence of minerals. In this study, geological and geophysical data were analyzed to evaluate the main structural trends affecting mineralization in the area of Wadi El-Nakheel. Geomagnetic data were processed to remove the earth’s magnetic field and reduce the magnetic pole. Some mathematical filters related to detecting and enhancing boundaries between rock units, depending on their magnetization affinity, were applied, including the first vertical derivative, the analytic signal, and 3D Euler deconvolution. After structural analysis of these data, we reached the following findings: The main structural trends from the surface and subsurface estimations were the northwest–southeast trend and the northeast–southwest trend. The orientation and origin of Wadi El-Nakheel are aligned with the main structural trend affecting the area that formed during the Red Sea Rift movement and the Pan-African orogeny. The depth of the deep-seated structure controlling the valley is 1500 m and all mineral occurrence is mainly structurally controlled in the studied area; phosphate ore outcrops are usually aligned with the northwest–southeast geological trend, and metallic ores are related to basement rock succession and the main dominant geological structures in the studied area. Finally, the magnetic method was demonstrated to be a reliable tool for detecting the subsurface boundary between geologic units

Geometry of the Magma Chamber and Curie Point Depth Beneath Hawaii Island: Inferences From Magnetic and Gravity Data

This study used land gravity and airborne magnetic data to investigate the depth to the magmatic chamber and map the heat flow distribution beneath the active volcanoes of Hawaii Island using the Curie point depth (CPD) and gravity modeling. Obtaining some of the ground-based geophysical measurements was problematic due to accessibility limitations; therefore, this study used available data. The CPD and magnetic data were used to map the depth to the bottom of the magnetic layer by calculating the depth to the Curie isotherm (540°C) beneath Hawaii Island. The spectral peak method was used to calculate the depths to the shallow and deep magnetic sources for the entire island, and the CPD was calculated using the centroid method. A two-dimensional density model for two Earth layers was constructed using forward modeling of the gravity data. A large plume of dense intrusive material was observed beneath the three adjacent volcanoes of Mauna Loa, Mauna Kea, and Kilauea, and two small chambers were found to be located beneath the Kohala and Hualalai volcanoes. Based on the gravity modeling results, the depth to the magma layer varied from 0.5 to 10 km, and the heat flow was higher close to the volcanic eruption zones. The current study is informative and cost effective for the world’s most active volcanic areas.Water Resource

Influence of natural and anthropogenic factors on the hydrogeology and hydrogeochemistry of Wadi Itwad Aquifer, Saudi Arabia: Assessment using multivariate statistics and PMWIN simulation

The quantity and quality of the aquifers have been depleted by human activities such as industrialization, the use of fertilizers, excessive pumping, and the discharge of domestic wastewater. The government of Saudi Arabia (SA) built three dams in the Wadi Itwad so that Abha city could get 15,000 m3/d of water. Ten groundwater samples have been collected from ten wells (Well 1 – Well 10) located in Wadi Itwad. The samples were analyzed for total dissolved solids (TDS), electrical conductivity (EC), pH, turbidity, temperature, chloride (Cl-), potassium (K), sulphate (SO42-), nitrate (NO3–), nitrite (NO2–), fluoride (F-), ammonia (NH4), radium (Ra)-226, 228, and 234, total uranium (TU), and total faecal coliforms to evaluate the aquifer quality and quantity and to preserve it by isolating it during dry periods. Geographic Information System (GIS)–Inverse Distance Weighting (IDW) contour maps were utilized to collect and display the aquifer's hydrogeological parameters. The southeast of the downstream area shows the highest, whereas the lowest drawdown was in the northeastern and southwest parts of the downstream area. The TDS concentration was consistently within a narrow range of 573 to 606 ppm, and the anomalies in the SO42- and NO3– concentrations were consistent with and representative of runoff from agricultural areas. The low levels of NO2–, F-, and NH4 indicated negligible pollution. The concentration of radioactive elements was below the maximum contaminant level. Different hydrogeochemical processes within the aquifer system were distinguished using multivariate statistical analyses, including correlation analysis (CA), principal component analysis (PCA), hierarchical cluster analysis (HCA), and one-way analysis of variance (ANOVA). The Processing Modflow Windows (PMWIN) groundwater modeling explains that the abstraction rate needs to be lowered during the first few days of pumping and then raised again afterwards. This could aid in decreasing withdrawals and enhancing aquifer hydrogeological properties

Integrated Geophysical Assessment of Groundwater Potential in Southwestern Saudi Arabia

Saudi Arabia is seeking fresh groundwater resources to face the increase in anthropogenic activities. The groundwater storage variations and occurrence were investigated and the surface and subsurface structures influencing the groundwater resources in the research area were defined using a combined study of Gravity Recovery and Climate Experiment, aeromagnetic data, and electrical resistivity data with other relevant datasets. Results are: The groundwater storage fluctuation is calculated at −0.34 ± 0.01 mm/yr during the period 04/2002-12/2021. The area is receiving an average annual rainfall rate of 117.6 mm during the period 2002 to 2019. Three structural trends, defined in the directions of NS, NNW, and NNE are cutting the sedimentary cover and the basement rocks. The sedimentary cover ranges from 0 to 1.2 km thick. Vertical electrical sounding results indicate three main geoelectric layers: the surface geoelectrical layer of higher resistivity values (428-9626 Ω. m) is made up of unconsolidated Quaternary sediments; the water-bearing layer of saturated sands with a resistivity range between 5.1 and 153 Ω. m and with depths vary from 1 to 94 m, and highly fractured basement rocks with resistivity values ranging from 813 to 6030 Ω. m. The integrated results are useful in providing a comprehensive image of the study area’s surface and subsurface structures, as well as groundwater potential in the southwestern part of Saudi Arabia. Our integrated approach provides a reproducible model for assessing groundwater potential in arid and semiarid areas.Water Resource

Origin of mysterious geothermal gas emissions in the middle of the Western Desert, stable shelf area, Dakhla Oasis, Egypt

Abstract This work responds to what was reported in various audio-visual media channels and to queries and explanations from individuals and local residents on the causes of gaseous and thermal emissions from the Earth near the vicinity of the village of Al-Hindaw in Dakhla city, New Valley Governorate, Egypt. At the location of the fume exit area, magnetic, seismic, and electromagnetic geophysical investigations were carried out to identify the factor(s) responsible for the event in question. Rock samples were collected and studied geochemically and radiographically to assess their chemical compositions, as well as the quantity of organic chemicals that may have contributed to the burning and temperature increase. In light of the results of the geochemical and geophysical research, it is believed that the self-ignitions are the result of near-surface reactions and oxidation instead of volcanic activity, such as the presence of magma or other comparable phenomena

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)