Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Search for narrow resonances using the dijet mass spectrum in pp collisions at s√=8 TeV

Results are presented of a search for the production of new particles decaying to pairs of partons (quarks, antiquarks, or gluons), in the dijet mass spectrum in proton-proton collisions at s√=8  TeV. The data sample corresponds to an integrated luminosity of 4.0  fb−1, collected with the CMS detector at the LHC in 2012. No significant evidence for narrow resonance production is observed. Upper limits are set at the 95% confidence level on the production cross section of hypothetical new particles decaying to quark-quark, quark-gluon, or gluon-gluon final states. These limits are then translated into lower limits on the masses of new resonances in specific scenarios of physics beyond the standard model. The limits reach up to 4.8 TeV, depending on the model, and extend previous exclusions from similar searches performed at lower collision energies. For the first time mass limits are set for the Randall–Sundrum graviton model in the dijet channel

Center Stage: The Crucial Role of Macrophytes in Regulating Trophic Interactions in Shallow Lake Wetlands

Hydrophilic, or water-loving, macrophytes characterize wetland ecosystems, indicating prerequisite conditions of hydric soils and sufficient hydrology. The presence of such macrophytes is a key descriptor in multiple wetland def- initions (Lewis 2001a) and macrophytes may be further used to actually describe particular types of wetlands, such as cattail marshes. Macrophytes contribute significant biomass to wetland systems and represent a critical component of wetland biogeochemistry as primary producers and drivers of organic matter cycling within aquatic systems. In this chapter, we argue that macrophytes occupy the center of trophic interactions in shallow lakes, influ- encing outcomes through structural, behavioral and chemical interactions. We define shallow lakes as permanently flooded wetlands that often contain submerged or floating macrophytes and that may be surrounded by emergent vegetation (i.e.marshy habitat). Shallow remains a relative term in limnology circles, but typically is less than 3 m average depth, such that macrophytes can fill a substantial portion of the water column and stratification is neither pre- dictable nor long-term. Such systems may be termed lakes, ponds or wetlands, depending on their size and the ecological context. Macrophytes may regulate trophic interactions in ephemeral systems without permanent inundation