The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Differential contributions of set-shifting and monitoring to dual-task interference

It is commonly argued that complex behaviour is regulated by a number of “executive functions” which work to co-ordinate the operation of disparate cognitive systems in the service of an overall goal. However, the identity, roles, and interactions of specific putative executive functions remain contentious, even within widely accepted tests of executive function. The authors present two experiments that use dual-task interference to provide further support for multiple distinct executive functions and to establish the differential contributions of those functions in two relatively complex executive tasks – Random Generation and the Wisconsin Card Sorting Test. Results are interpreted in terms of process models of the complex executive tasks

Cultivar de trigo IAC-24: rendimento de grãos e caracteres agronômicos em três faixas de umidade do solo Wheat cultivar IAC-24: grain yield and agronomic characters under three moisture levels

Num experimento conduzido em casa de vegetação, no Instituto Agronômico de Campinas, SP, em 1985, para estudar o comportamento do cultivar de trigo IAC-24 em três faixas de umidade (0,01-0,03; 0,03-0,50 e 0,50-1,50 MPa), empregaram-se vasos contendo latossolo roxo eutrófico e determinaram-se os seguintes caracteres agronômicos: comprimento da espiga, número de espigas por vaso e por planta, número total de espiguetas e espiguetas desenvolvidas por espiga, número de grãos por espigueta e por espiga e rendimento de grãos. Com o aumento da água disponível no solo, houve acréscimo significativo em todos os caracteres estudados, exceto para grãos por espigueta. Para as condições deste experimento e para os caracteres agronômicos estudados, a faixa de umidade crítica foi de 0,03-0,50 MPa. Desse modo, à medida que a água disponível desceu abaixo dessa faixa, ocorreu um decréscimo acentuado no rendimento de grãos e nos componentes de produção. Na comparação de uso das faixas de umidade do solo de 0,03-0,50 e 0,01-0,03 MPa, houve acréscimos de 39% no rendimento de grãos. Assim, a escolha da faixa de umidade a ser utilizada é de grande importância na produção de grãos e na economicidade da cultura.<br>An experiment with the objective to study the behaviour of the wheat cultivar IAC-24 under three moisture levels (0.01-0.03; 0.03-0.50 and 0.50-1.50 MPa), using pots with soil (Latossolo Roxo eutrófico) was carried out under green-house conditions at Instituto Agronômico, Campinas, State of São Paulo, Brazil, during 1985. It was measured spike lenght, number of spikes per pot and per plant, total number of spikelets per spike, number of grains per spikelet and per spike and grain yield as affected by the three soil moisture levels. All characters increased significantly as the water availability in the soil increased from 0.50-1.50 to 0.01-0.03 MPa. In the experiment the critical moisture level was 0.50 to 0.03 MPa; so as the water potential decreased below this level there was a decrease in grain yield and in the agronomic characteristics. Changing the moisture level of the soil from 0.03-0.50 to 0.01-0.03 MPa, there was a significant increase in the grain yield. The moisture level showed to be very important in studies where grain yield and economic value of the crop are involved

Hypoxic adaptation during development: relation to pattern of neurological presentation and cognitive disability

Children with acute hypoxic-ischaemic events (e.g. stroke) and chronic neurological conditions associated with hypoxia frequently present to paediatric neurologists. Failure to adapt to hypoxia may be a common pathophysiological pathway linking a number of other conditions of childhood with cognitive deficit. There is evidence that congenital cardiac disease, asthma and sleep disordered breathing, for example, are associated with cognitive deficit, but little is known about the mechanism and whether there is any structural change. This review describes what is known about how the brain reacts and adapts to hypoxia, focusing on epilepsy and sickle cell disease (SCD). We prospectively recorded overnight oxyhaemoglobin saturation (SpO 2) in 18 children with intractable epilepsy, six of whom were currently or recently in minor status (MS). Children with MS were more likely to have an abnormal sleep study defined as either mean baseline SpO2 &lt;94 or &gt;4 dips of &gt;4 in SpO2/hour (p = .04). In our series of prospectively followed patients with SCD who subsequently developed acute neurological symptoms and signs, mean overnight SpO2 was lower in those with cerebrovascular disease on magnetic resonance angiography (Mann-Whitney, p = .01). Acute, intermittent and chronic hypoxia may have detrimental effects on the brain, the clinical manifestations perhaps depending on rapidity of presentation and prior exposure.</p