47 research outputs found
Time-variability in the Interstellar Boundary Conditions of the Heliosphere: Effect of the Solar Journey on the Galactic Cosmic Ray Flux at Earth
During the solar journey through galactic space, variations in the physical
properties of the surrounding interstellar medium (ISM) modify the heliosphere
and modulate the flux of galactic cosmic rays (GCR) at the surface of the
Earth, with consequences for the terrestrial record of cosmogenic
radionuclides. One phenomenon that needs studying is the effect on cosmogenic
isotope production of changing anomalous cosmic ray fluxes at Earth due to
variable interstellar ionizations. The possible range of interstellar ram
pressures and ionization levels in the low density solar environment generate
dramatically different possible heliosphere configurations, with a wide range
of particle fluxes of interstellar neutrals, their secondary products, and GCRs
arriving at Earth. Simple models of the distribution and densities of ISM in
the downwind direction give cloud transition timescales that can be directly
compared with cosmogenic radionuclide geologic records. Both the interstellar
data and cosmogenic radionuclide data are consistent with cloud transitions
during the Holocene, with large and assumption-dependent uncertainties. The
geomagnetic timeline derived from cosmic ray fluxes at Earth may require
adjustment to account for the disappearance of anomalous cosmic rays when the
Sun is immersed in ionized gas.Comment: Submitted to Space Sciences Review
Is the Sun Embedded in a Typical Interstellar Cloud?
The physical properties and kinematics of the partially ionized interstellar
material near the Sun are typical of warm diffuse clouds in the solar vicinity.
The interstellar magnetic field at the heliosphere and the kinematics of nearby
clouds are naturally explained in terms of the S1 superbubble shell. The
interstellar radiation field at the Sun appears to be harder than the field
ionizing ambient diffuse gas, which may be a consequence of the low opacity of
the tiny cloud surrounding the heliosphere. The spatial context of the Local
Bubble is consistent with our location in the Orion spur.Comment: "From the Outer Heliosphere to the Local Bubble", held at
International Space Sciences Institute, October 200
History of clinical transplantation
How transplantation came to be a clinical discipline can be pieced together by perusing two volumes of reminiscences collected by Paul I. Terasaki in 1991-1992 from many of the persons who were directly involved. One volume was devoted to the discovery of the major histocompatibility complex (MHC), with particular reference to the human leukocyte antigens (HLAs) that are widely used today for tissue matching.1 The other focused on milestones in the development of clinical transplantation.2 All the contributions described in both volumes can be traced back in one way or other to the demonstration in the mid-1940s by Peter Brian Medawar that the rejection of allografts is an immunological phenomenon.3,4 © 2008 Springer New York
The Galactic Environment of the Sun: Interstellar Material Inside and Outside of the Heliosphere
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