9 research outputs found
The effect of increased pressure on interfacial heat transfer in the aluminium gravity die casting process
Impact on Fertility Rate and Embryo-Larval Development Due to the Association Acidification, Ocean Warming and Lead Contamination of a Sea Urchin Echinometra lucunter (Echinodermata: Echinoidea)
Feminist Research in Transitional Justice Studies: Navigating Silences and Disruptions in the Field
What is the minimal dose for resistance exercise effectiveness in prostate cancer patients? Systematic review and meta-analysis on patient-reported outcomes
Utilization of Coal and Biomass Ash
Sustainable utilization of the ash generated from the combustion of coal or biomass is a big challenge for the power industry. Huge quantities of ash are generated and, in general, they are disposed-off in ash ponds. However, recent regulatory requirements demand 100% utilization of ash. So many new areas of ash utilization are being explored by the researchers and ash managers. Bulk utilization sectors are cement industry, construction, bricks, landfill, mine back filling, and soil amendment for growing plants. Efforts to enhance the use in value-added low-volume sectors like fertilizer, cenosphere, catalyst support, zeolites, aerogels, and so on are continuously evolving. The heterogeneity of the ash properties is one of the main challenges for advocating a generalized utilization pattern of the ash. Biomass has some typical properties that limit its use for some sectors. However, beneficiation of both coal and biomass ash and use of other additives could improve the suitability of the ashes to multifarious uses
Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study
Appendicitis risk prediction models in children presenting with right iliac fossa pain (RIFT study): a prospective, multicentre validation study.
Background
Acute appendicitis is the most common surgical emergency in children. Differentiation of acute appendicitis from conditions that do not require operative management can be challenging in children. This study aimed to identify the optimum risk prediction model to stratify acute appendicitis risk in children.
Methods
We did a rapid review to identify acute appendicitis risk prediction models. A prospective, multicentre cohort study was then done to evaluate performance of these models. Children (aged 5\u201315 years) presenting with acute right iliac fossa pain in the UK and Ireland were included. For each model, score cutoff thresholds were systematically varied to identify the best achievable specificity while maintaining a failure rate (ie, proportion of patients identified as low risk who had acute appendicitis) less than 5%. The normal appendicectomy rate was the proportion of resected appendixes found to be normal on histopathological examination.
Findings
15 risk prediction models were identified that could be assessed. The cohort study enrolled 1827 children from 139 centres, of whom 630 (34\ub75%) underwent appendicectomy. The normal appendicectomy rate was 15\ub79% (100 of 630 patients). The Shera score was the best performing model, with an area under the curve of 0\ub784 (95% CI 0\ub782\u20130\ub786). Applying score cutoffs of 3 points or lower for children aged 5\u201310 years and girls aged 11\u201315 years, and 2 points or lower for boys aged 11\u201315 years, the failure rate was 3\ub73% (95% CI 2\ub70\u20135\ub72; 18 of 539 patients), specificity was 44\ub73% (95% CI 41\ub74\u201347\ub72; 521 of 1176), and positive predictive value was 41\ub74% (38\ub75\u201344\ub74; 463 of 1118). Positive predictive value for the Shera score with a cutoff of 6 points or lower (72\ub76%, 67\ub74\u201377\ub74) was similar to that of ultrasound scan (75\ub70%, 65\ub73\u201383\ub71).
Interpretation
The Shera score has the potential to identify a large group of children at low risk of acute appendicitis who could be considered for early discharge. Risk scoring does not identify children who should proceed directly to surgery. Medium-risk and high-risk children should undergo routine preoperative ultrasound imaging by operators trained to assess for acute appendicitis, and MRI or low-dose CT if uncertainty remains.
Funding
None