Index cholecystectomy rates in mild gallstone pancreatitis: a single-centre experience

Background Gallstone pancreatitis (GSP) has evidence-based guidelines regarding management. Both the International Association of Pancreatology/American Pancreatology Association and American College of Gastroenterology recommend index admission cholecystectomy (IAC) in patients presenting with mild GSP. The aim of this study was to examine guideline adherence and GSP recurrence rate when IAC was not performed. A comparison between admitting specialty was also performed to examine the difference in compliance rates.Methods A retrospective chart review was conducted on all patients who presented to the Sunshine Coast Hospital and Health Service with GSP from December 2013 to December 2016. Patient demographics, timing of surgery, admitting specialty, laboratory and imaging results were recorded.Results A total of 95 patients were identified with a first presentation of mild GSP during the study period. Of whom, 66 (69.5%) underwent IAC and 29 (30.5%) were discharged prior to cholecystectomy with 10 of those patients receiving index admission endoscopic sphincterotomy. Five patients (17%) who did not receive IAC were readmitted with gallstone-related complications with the mean time to re-presentation of 12.8 days (range 7-21 days). Patients were more likely to receive IAC when admitted under surgery compared with gastroenterology (76% versus 20%, P < 0.001).Conclusion Two out of three patients presenting with mild GSP underwent IAC in accordance with evidence-based management guidelines. Patients should be admitted under a surgical service to prevent delay in definitive management

Advanced Self-Passivating Alloys for an Application under Extreme Conditions

Self-passivating Metal Alloys with Reduced Thermo-oxidation (SMART) are under development for the primary application as plasma-facing materials for the first wall in a fusion DEMOnstration power plant (DEMO). SMART materials must combine suppressed oxidation in case of an accident and an acceptable plasma performance during the regular operation of the future power plant. Modern SMART materials contain chromium as a passivating element, yttrium as an active element and a tungsten base matrix. An overview of the research and development program on SMART materials is presented and all major areas of the structured R&amp;D are explained. Attaining desired performance under accident and regular plasma conditions are vital elements of an R&amp;D program addressing the viability of the entire concept. An impressive more than 104-fold suppression of oxidation, accompanied with more than 40-fold suppression of sublimation of tungsten oxide, was attained during an experimentally reproduced accident event with a duration of 10 days. The sputtering resistance under DEMO-relevant plasma conditions of SMART materials and pure tungsten was identical for conditions corresponding to nearly 20 days of continuous DEMO operation. Fundamental understanding of physics processes undergone in the SMART material is gained via fundamental studies comprising dedicated modeling and experiments. The important role of yttrium, stabilizing the SMART alloy microstructure and improving self-passivating behavior, is under investigation. Activities toward industrial up-scale have begun, comprising the first mechanical alloying with an industrial partner and the sintering of a bulk SMART alloy sample with dimensions of 100 mm × 100 mm × 7 mm using an industrial facility. These achievements open the way to further expansion of the SMART technology toward its application in fusion and potentially in other renewable energy sources such as concentrated solar power stations.</p

Advanced Self-Passivating Alloys for an Application under Extreme Conditions

Self-passivating Metal Alloys with Reduced Thermo-oxidation (SMART) are under development for the primary application as plasma-facing materials for the first wall in a fusion DEMOnstration power plant (DEMO). SMART materials must combine suppressed oxidation in case of an accident and an acceptable plasma performance during the regular operation of the future power plant. Modern SMART materials contain chromium as a passivating element, yttrium as an active element and a tungsten base matrix. An overview of the research and development program on SMART materials is presented and all major areas of the structured R&amp;amp;D are explained. Attaining desired performance under accident and regular plasma conditions are vital elements of an R&amp;amp;D program addressing the viability of the entire concept. An impressive more than 104-fold suppression of oxidation, accompanied with more than 40-fold suppression of sublimation of tungsten oxide, was attained during an experimentally reproduced accident event with a duration of 10 days. The sputtering resistance under DEMO-relevant plasma conditions of SMART materials and pure tungsten was identical for conditions corresponding to nearly 20 days of continuous DEMO operation. Fundamental understanding of physics processes undergone in the SMART material is gained via fundamental studies comprising dedicated modeling and experiments. The important role of yttrium, stabilizing the SMART alloy microstructure and improving self-passivating behavior, is under investigation. Activities toward industrial up-scale have begun, comprising the first mechanical alloying with an industrial partner and the sintering of a bulk SMART alloy sample with dimensions of 100 mm × 100 mm × 7 mm using an industrial facility. These achievements open the way to further expansion of the SMART technology toward its application in fusion and potentially in other renewable energy sources such as concentrated solar power stations

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially