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

A comprehensive compilation of the seismic stratigraphy markers along the Adriatic Sea

Data base compilation, Adriatic sea (Seanoe document)The Mediterranean Sea is a natural laboratory for addressing questions on the formation and evolution of continental margins and the relationship between surface and deep processes. The evaporites deposited during the Messinian Salinity Crisis strongly impact its sedimentary and geomorphology evolution. We present here a compilation of the main regional seismic stratigraphic markers throughout the Central and South Adriatic Sea (CAB and SAB). The following original (uninterpolated) interpretations are provided in xyz format (z in second twt): i) Top of the Mesozoic formation, ii) Base and Top of the Gessoso Solfifera along the CAB, iii) Base and Top of the MSC detrital formation along the SAB, iv) Top of the Upper Unit, v) Base and Top of the middle Pliocene unit, vi) Seafloor. The available reflection seismic dataset the data set is compiled of processed vintage seismic profiles from the Videpi database

The late Messinian event: a worldwide tectonic revolution

A review of geological and geophysical observations points towards a worldwide kinematic change at around 6 Ma. The synchronicity of many manifestations (tectonics, magmatism, kinematics, ecological events, among others) at ~6 Ma, similar to those recognized from time to time on the geological timescale, argues for a global geodynamic event that has led to many regional consequences on Earth's surface. In particular, we propose that this global event was the main trigger for the three fold increase in sediment deposits in the world ocean over the last ~5 Ma, but also for the onset of the Messinian Salinity Crisis in the Mediterranean area, one of the most severe ecological crises in the Earth's history. We suggest this Messinian revolution to be the last occurrence of cyclic successions of global events

Co-evolution assists geographic dispersal: the case of Madagascar

International audienceInterspecific associations may limit the dispersal of individual species, but may also facilitate it when entire co-evolved systems expand their geographic ranges. We tested the recent proposal that episodic land bridges linked Africa and Madagascar at three stages during the Cenozoic by comparing divergence estimates of Madagascar's angiosperm taxa with their dispersal mechanisms. Plants that rely on gravity for seed dispersal indicate at least two episodes of land connection between Africa and Madagascar, in the Early Palaeocene and Early Oligocene. Seed dispersal by strepsirrhine primates possibly evolved in the Palaeocene, with the divergence of at least one endemic Malagasy angiosperm genus, Burasaia (Menispermaceae). This genus may have facilitated the lemur colonization of Madagascar. Frugivory, nectarivory and gummivory probably generalized in the Oligocene, with the co-evolution of modern lemurs and at least 10 new Malagasy angiosperm families. In the Late Miocene, more angiosperms were probably brought from Africa by birds via a discontinuous land connection, and radiated on Madagascar in diffuse association with birds (asities) and dwarf nocturnal lemurs (cheirogaleids). During the same connective episode, Madagascar was probably colonized by hippopotamuses, which both followed and re-seeded a variety of plants, forming the grassy Uapaca 'tapia' forest and ericoid 'savoka' thicket

Des crises récentes Causes globales de la Crise messinienne

International audienceLa crise Messinienne, point de vue géodynamique La Mer Méditerranée s'est-elle ou non asséchée ? Tel est le débat qui a enflammé et enflamme toujours la communauté géologique méditerranéenneentendons par là la communauté qui s'intéresse à la Méditerranée (cf. le chapitre « La Crise de salinité messinienne »). Changeons de point de vue et posons le problème différemment : quelle que soit sa cause, il y a bel et bien un dépôt important d'évaporites en un temps restreint à la fin du Miocène, bien après la formation des bassins et l'arrêt des mouvements des morceaux de plaques qui les ont formés. L'écart est de plus de 15 Ma pour ce qui concerne le bassin Liguro-Provençal. Il est encore plus considérable en Méditerranée Orientale puisque les bassins Ionien et Levantin datent du Mésozoïque (voir l'article de Julie Tugend et al. dans ce numéro). Ce point n'amène aucune controverse. Cette simple observation rend ce phénomène étrange et même unique : les dépôts de sel dans les bassins océaniques mondiaux sont situés à la fin de la genèse des marges, avant la création de la croûte océanique. En Méditerranée, ce n'est pas le cas : le sel se dépose dans un bassin formé, après l'arrêt des mouvements pour la majeure partie de la Méditerranée. Il se dépose sur une séquence sédimentaire miocène épaisse, dont la topographie est plate. Mieux ! prenons le point de vue de Sirius, cher à Voltaire, et éloignons-nous de cette région fort intéressante : défocalisons notre regard. Que nous raconte cet événement unique et méditerranéen sur notre planète Terre ? Comment s'inscrit-il dans son histoire ? Les mouvements globaux, les phase

Major kinematic revolutions: the underside of the maps

International audienc

Co-evolution assists geographic dispersal: the case of Madagascar

Interspecific associations may limit the dispersal of individual species, but may also facilitate it when entire co-evolved systems expand their geographic ranges. We tested the recent proposal that episodic land bridges linked Africa and Madagascar at three stages during the Cenozoic by comparing divergence estimates of Madagascar’s angiosperm taxa with their dispersal mechanisms. Plants that rely on gravity for seed dispersal indicate at least two episodes of land connection between Africa and Madagascar, in the Early Palaeocene and Early Oligocene. Seed dispersal by strepsirrhine primates possibly evolved in the Palaeocene, with the divergence of at least one endemic Malagasy angiosperm genus, Burasaia (Menispermaceae). This genus may have facilitated the lemur colonization of Madagascar. Frugivory, nectarivory and gummivory probably generalized in the Oligocene, with the co-evolution of modern lemurs and at least 10 new Malagasy angiosperm families. In the Late Miocene, more angiosperms were probably brought from Africa by birds via a discontinuous land connection, and radiated on Madagascar in diffuse association with birds (asities) and dwarf nocturnal lemurs (cheirogaleids). During the same connective episode, Madagascar was probably colonized by hippopotamuses, which both followed and re-seeded a variety of plants, forming the grassy Uapaca ‘tapia’ forest and ericoid ‘savoka’ thicket

Geodispersal as a Biogeographic Mechanism for Cenozoic Exchanges between Madagascar and Africa

International audienc

Structural and sedimentary origin of the Gargano - Pelagosa gateway and impact on sedimentary evolution during the Messinian Salinity Crisis

International audienceCirculation of water masses, sediment, and biotope between the sub-basins of the Mediterranean Sea strongly depends on morphological oceanic gateways. These geological features react to geodynamic reorganisation through volcanism, vertical movements, and/or the segmentation of sedimentary basins. Despite the palaeogeographic relevance of straits and oceanic-gateways, their evolution and impact on sedimentary transports and deposition in the Mediterranean remain in general poorly constrained. The Gargano-Pelagosa gateway is here first recognized as an influential element of the palaeogeographic/environmental evolution of the central-southern Apenninic foredeep and wedge-top domains during the Messinian, as shown by the integration of (i) seismic lines, (ii) well information from the Adriatic Sea, and (iii) a review of both onshore and offshore structural data and Messinian depositional environments. A palinspastic evolution is proposed for the Apennine and south Adriatic foredeeps during the Messinian Salinity Crisis (MSC: 5.97-5.33 Ma). We highlight the implication of the pre-MSC structural legacy and the development of the Apennine and Dinarid-Albanian chains in 1) the isolation of the Apennine foredeep from the deep central Mediterranean domains at the peak of the MSC; 2) the vertical movements at the Gargano-Pelagosa structure and the Apulian Platform and 3) their implication in the deposition of a chaotic sedimentary body