149 research outputs found
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Exploratory Analysis of Preoperative and Postoperative Risk Stratification Tools to Identify Acute Kidney and Myocardial Injury in Patients Undergoing Surgery for Chronic Subdural Haematoma.
Perioperative statistical risk stratification is widespread. Such tools inform intraoperative and postoperative care as part of the National Emergency Laparotomy Audit (NELA)1.
Patients with chronic subdural haematomas (cSDH) are often elderly with significant comorbidity2. Despite this, there is a paucity of literature pertaining to risk stratification models in this cohort3. At our centre, as part of a multidisciplinary improvement initiative (the ‘Improving Care in Elderly Neurosurgery Initiative’ (ICENI)4) (Project ID:PRN7705) we demonstrated a significant association between postoperative complications and length of stay2. As a further analysis within this cohort of operated cSDH, we explore the potential of using retrospective electronic health record (EHR) data to generate prognostic statistical models for the identification of two end-organ complications (myocardial injury –troponin above the upper limit of normal and acute kidney injury (AKI) –a rise in serum creatinine of ≥ 1.5 times baseline). Outcomes were chosen based on data availability and veracity as well as clinical relevance. The integrated nature of our EHR permitted incorporation of variables reflecting intraoperative management. This enabled an exploratory analysis of models that, analogous to NELA, could be used preoperatively and updated postoperatively
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Identification of factors associated with morbidity and postoperative length of stay in surgically managed chronic subdural haematoma using electronic health records: a retrospective cohort study.
INTRODUCTION: Chronic subdural haematoma (cSDH) tends to occur in older patients, often with significant comorbidity. The incidence and effect of medical complications as well as the impact of intraoperative management strategies are now attracting increasing interest. OBJECTIVES: We used electronic health record data to study the profile of in-hospital morbidity and examine associations between various intraoperative events and postoperative stay. DESIGN, SETTING AND PARTICIPANTS: Single-centre, retrospective cohort of 530 cases of cSDH (2014-2019) surgically evacuated under general anaesthesia at a neurosciences centre in Cambridge, UK. METHODS AND OUTCOME DEFINITION: Complications were defined using a modified Electronic Postoperative Morbidity Score. Association between complications and intraoperative care (time with mean arterial pressure <80 mm Hg, time outside of end-tidal carbon dioxide (ETCO2) range of 3-5 kPa, maintenance anaesthetic, operative time and opioid dose) on postoperative stay was assessed using Cox regression. RESULTS: 53 (10%) patients suffered myocardial injury, while 24 (4.5%) suffered acute renal injury. On postoperative day 3 (D3), 280 (58% of remaining) inpatients suffered at least 1 complication. D7 rate was comparable (57%). Operative time was the only intraoperative event associated with postoperative stay (HR for discharge: 0.97 (95% CI: 0.95 to 0.99)). On multivariable analysis, postoperative complications (0.61 (0.55 to 0.68)), anticoagulation (0.45 (0.37 to 0.54)) and cognitive impairment (0.71 (0.58 to 0.87)) were associated with time to discharge. CONCLUSIONS: There is a high postoperative morbidity burden in this cohort, which was associated with postoperative stay. We found no evidence of an association between intraoperative events and postoperative stay.Wellcome Trust Studentshi
Towards More Precise Survey Photometry for PanSTARRS and LSST: Measuring Directly the Optical Transmission Spectrum of the Atmosphere
Motivated by the recognition that variation in the optical transmission of
the atmosphere is probably the main limitation to the precision of ground-based
CCD measurements of celestial fluxes, we review the physical processes that
attenuate the passage of light through the Earth's atmosphere. The next
generation of astronomical surveys, such as PanSTARRS and LSST, will greatly
benefit from dedicated apparatus to obtain atmospheric transmission data that
can be associated with each survey image. We review and compare various
approaches to this measurement problem, including photometry, spectroscopy, and
LIDAR. In conjunction with careful measurements of instrumental throughput,
atmospheric transmission measurements should allow next-generation imaging
surveys to produce photometry of unprecedented precision. Our primary concerns
are the real-time determination of aerosol scattering and absorption by water
along the line of sight, both of which can vary over the course of a night's
observations.Comment: 41 pages, 14 figures. Accepted PAS
Imaging and Demography of the Host Galaxies of High-Redshift Type Ia Supernovae
We present the results of a study of the host galaxies of high redshift Type
Ia supernovae (SNe Ia). We provide a catalog of 18 hosts of SNe Ia observed
with the Hubble Space Telescope (HST) by the High-z Supernova Search Team
(HZT), including images, scale-lengths, measurements of integrated (Hubble
equivalent) BVRIZ photometry in bands where the galaxies are brighter than m ~
25 mag, and galactocentric distances of the supernovae. We compare the
residuals of SN Ia distance measurements from cosmological fits to measurable
properties of the supernova host galaxies that might be expected to correlate
with variable properties of the progenitor population, such as host galaxy
color and position of the supernova. We find mostly null results; the current
data are generally consistent with no correlations of the distance residuals
with host galaxy properties in the redshift range 0.42 < z < 1.06. Although a
subsample of SN hosts shows a formally significant (3-sigma) correlation
between apparent V-R host color and distance residuals, the correlation is not
consistent with the null results from other host colors probed by our largest
samples. There is also evidence for the same correlations between SN Ia
properties and host type at low redshift and high redshift. These similarities
support the current practice of extrapolating properties of the nearby
population to high redshifts pending more robust detections of any correlations
between distance residuals from cosmological fits and host properties.Comment: 35 pages, 12 figures, 4 tables, accepted for publication in A
Rapid neck elongation in Sauropterygia (Reptilia: Diapsida) revealed by a new basal pachypleurosaur from the Lower Triassic of China
Neck elongation has appeared independently in several tetrapod groups, including giraffes and sauropod dinosaurs on land, birds and pterosaurs in the air, and sauropterygians (plesiosaurs and relatives) in the oceans. Long necks arose in Early Triassic sauropterygians, but the nature and rate of that elongation has not been documented. Here, we report a new species of pachypleurosaurid sauropterygian, Chusaurus xiangensis gen. et sp. nov., based on two new specimens from the Early Triassic Nanzhang-Yuan’an Fauna in the South China Block. The new species shows key features of its Middle Triassic relatives, but has a relatively short neck, measuring 0.48 of the trunk length, compared to > 0.8 from the Middle Triassic onwards. Comparative phylogenetic analysis shows that neck elongation occurred rapidly in all Triassic eosauropterygian lineages, probably driven by feeding pressure in a time of rapid re-establishment of new kinds of marine ecosystems
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