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

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

The Politics of Power: A Social Architecture Analysis of the 2005-2008 Federal Shield Law Debate in Congress

Would a federal shield law hamper the U.S. Department of Justice\u27s power to combat terrorism and other crimes? Would the law protect the media from the chilling effects of federal subpoenas? Or would the law unwisely grant the already powerful media legal rights denied to other citizens? And who should have the power to decide whether to allow the media to refuse to comply with federal subpoenas? These and similar questions about how power should be distributed among branches of the federal government and the media were at the center of the Congressional hearings and debate on the proposed federal shield law. Social architecture is a metaphor that views lawmaking as a process of distributing power among groups in society. The metaphor rests on the principles that legal and social structures are products of design and that law can define the power relationships in society. This article explicates the distribution-of-power arguments surrounding the shield law and concludes, in part, that the federal shield law was derailed due to Congress\u27s failure to agree on how to resolve the power issues. When shield law legislation again comes before Congress, Congress should enact a shield law that distributes power in a way that remains true to the broad outlines of the social architecture drawn by the Framers

Off-Therapy Headaches in Pediatric Brain Tumor Patients: A Retrospective Review

To determine the incidence, timing, and characteristics of headaches in a population of off-therapy pediatric brain tumor patients, a retrospective chart review was conducted on 3 subpopulations of children followed in a multidisciplinary neuro-oncology clinic in the Southeastern United States. Data collected included tumor type and location, treatment, associated symptoms, and description and timing of headaches. In all, 81 charts were reviewed from which headaches in 3 subtypes of tumors were identified (29 medulloblastomas, 36 cerebellar juvenile pilocytic astrocytomas [JPAs], and 16 craniopharyngiomas). Off-therapy headaches were noted in 6 (21%) of medulloblastomas, 10 (28%) of JPAs, and 19 (56%) of craniopharyngiomas. Almost half of those patients with prediagnosis headaches had recurrent off-therapy headaches. Given the incidence of this symptom, headache must be highlighted in posttreatment and late effects monitoring.Whether provided by the oncology team or primary care provider, headache assessment, treatment, and prevention counseling can be improved through utilization of newly developed tools and written educational materials. Experienced nurses can play key roles in this aspect of posttreatment pediatric care of brain tumor patients

Hemingway and Textual Studies

Examines the absence of corrected textual editions of Hemingway\u27s works, a situation once described by scholar Michael Reynolds as curious and appalling. Illustrates how even recently published editions in the Hemingway Library series, edited by Seán Hemingway, remain problematic for scholars because they generally perpetuate faulty transcriptions from the manuscripts. Recognizing that (s)mall errors greatly influence our interpretations, Trogdon argues for corrected editions of all of Hemingway\u27s work and expects that as some of the earliest works reach public domain status in the coming years, interested scholars may be poised to produce them

Family Dynamics and Redefinitions of Papa -hood

As it traces the effects of influential recent scholarship on Hemingway\u27s identities, the essay wonders why little attention has been paid to his biographical image as a father figure or how he represented the Papa-implied father in his fiction. Delves into family background, including accounts of Clarence Hemingway\u27s parental abuse and depression, and identifies an ambivalence about fatherhood in many of Hemingway\u27s works. Highlights conflicting depictions of Hemingway\u27s parenting in biographies by Paul Hendrickson and James Hutchisson as well as the record of fathers and sons in Islands in the Stream. Suggests that as-yet unpublished letters may profitably lead to future scholarly discussions of the multiple meanings of Papa