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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Impaired hypoxic response in senescent mouse brain

'This is the author's version of a work that was accepted for publication in International Journal of Developmental Neuroscience. Changes resulting from the publishing process, such as structural formatting and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in International Journal of Developmental Neuroscience, 29 (6) (2011) 10.1016/j.ijdevneu.2011.06.003'Tissue hypoxia leads to activation of endogenous adaptive responses that involve a family of prolyl hydroxylase domain proteins (PHD1-3) with oxygen sensing properties, hypoxia inducible transcription factors (HIFs), and cytoprotective HIF target genes such as erythropoietin (EPO) and vascular endothelial growth factor (VEGF). The hypoxic induction of these genes is regulated by oxygen-dependent hydroxylation of HIF alpha subunits by PHDs, which signals their proteasomal degradation. In this study, mice of different age were exposed to hypoxia or subjected to cerebral ischemia after hypoxic pre-conditioning. We found an impaired hypoxic response in the brain, characterized by elevated levels and impaired downregulation of PHD1. Furthermore, an attenuated hypoxic activation of VEGF and EPO, as well as of other HIF-target genes such glucose transporter-1 and carbonic anhydrase 9 was found in senescent brain. Finally, we observed a loss of the protective effect of hypoxic pre-conditioning on subsequent cerebral ischemia with increasing age. Thus, the impaired hypoxic adaptation, resulting in compromised hypoxic activation of neuroprotective factors, could contribute to neurodegenerative processes with increasing age, and might have implications for treating age-related disorders.Peer reviewedFinal Accepted Versio

The evolution of public policy with regard to the environment: a legal perspective over the last fifty years

From a survey of official and unofficial sources of government public policy, it is apparent that environmental public policy is reflected chiefly in legislation. A review of South African environmental legislation from the 17th century to the present day reveals a progressive development in the ambit and scope of the country's environmental legislation. By contrast, judicial environmental law-making is scant. It is concluded that environmental legislation has evolved as a reaction to particular sectional interests and concerns, rather than as a result of an overall environmental policy or strategy. It is submitted that the declaration of actual environmental policies, provided for in the Environment Conservation Act 73 of 1989 could play a significant role in redressing this imbalance and could set the scene for environmental law-making at judicial level. -Author

Optical solitons and other solutions to Kaup–Newell equation with Jacobi elliptic function expansion method

In this paper, we studied Kaup–Newell (KN) equation in coupled vector form without four-wave mixing terms in birefringent fibers. We employed Jacobi elliptic function expansion method in order to demonstrate sub-pico-second optical soliton solutions. Beside bright and dark solitons, Jacobi elliptic function solutions and hyperbolic solutions are obtained. Moreover, the graphs for some solution are presented. © 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature

Selective nano alumina supported vanadium oxide catalysts for oxidative dehydrogenation of ethylbenzene to styrene using CO2 as soft oxidant

Nano alumina-supported V2O5 catalysts with different loadings have been tested for the dehydrogenation of ethylbenzene with CO2 as an oxidant. High surface area nano-alumina was prepared and used as support for V2O5 as the catalyst. The catalysts were synthesized by impregnation techniques followed by calcinations and microwave treatment, denoted as V2O5/γ-Al2O3-C and V2O5/γ-Al2O3-MW, respectively. The V2O5 loading was varied on nano-alumina from 5 to 30 wt%. The support and catalysts were characterized by X-ray diffraction (XRD), Barett–Joyner–Halenda (BJH) pore-size distribution, N2-adsorption isotherms, Fourier transform infrared (FT-IR), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and temperature programed desorption (TPD-NH3). The characterization results indicated that V2O5 is highly dispersed on alumina up to 30%-V2O5/γ-Al2O3-MW prepared by MW method. The TPD studies indicated that there are significant differences in acid amount and strength for V2O5/γ-Al2O3-C and V2O5/γ-Al2O3-MW-catalysts. The catalytic activity of the prepared catalysts was evaluated in the temperature range 450–600 °C in relation to the physicochemical properties and surface acidity. The results revealed that optimum catalytic activity and selectivity (∼100%) toward styrene production were obtained using 10% V2O5/γ-Al2O3-MW catalyst treated with microwave

Derivatives of Cucurbitacin-E-glucoside produced by Curvularia lunata NRRL 2178: Anti-inflammatory, antipyretic, antitumor activities, and effect on biochemical parameters

Cucurbitacin E glucoside (1) is a tetracyclic triterpenoid glucoside, isolated from Cucurbitaceae plants. In the present study the pharmacological and biochemical effects of cucurbitacin-E-glucoside and two of its microbial transformation derivatives (2 and 3) produced by Curvularia lunata NRRL 2178, were investigated. The isolated compounds were identified by 1H and 13C NMR spectroscopy. The obtained results showed that 2 and 3 possess anti-inflammatory and antipyretic effects, compared with indomethacin and acetaminophen. Oral administration of 2 and 3 at dose of 1/10 of LD50 for 30 days resulted in a significant decrease in the serum levels of glucose, cholesterol and triacylglycerol. Cucurbitacin–E-glucoside showed moderate cytotoxicity against tumor cell lines while compound 3 proved to be selective against colon carcinoma cell lines