200 research outputs found
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Performance of cardiopulmonary exercise testing for the prediction of post-operative complications in non cardiopulmonary surgery: A systematic review
Funder: Wellcome Trust; funder-id: http://dx.doi.org/10.13039/100010269; Grant(s): Clinician PhD Fellowship paid from [Overarching grant: 486 204017/Z/16/ZIntroduction: Cardiopulmonary exercise testing (CPET) is widely used within the United Kingdom for preoperative risk stratification. Despite this, CPETâs performance in predicting adverse events has not been systematically evaluated within the framework of classifier performance. Methods: After prospective registration on PROSPERO (CRD42018095508) we systematically identified studies where CPET was used to aid in the prognostication of mortality, cardiorespiratory complications, and unplanned intensive care unit (ICU) admission in individuals undergoing non-cardiopulmonary surgery. For all included studies we extracted or calculated measures of predictive performance whilst identifying and critiquing predictive models encompassing CPET derived variables. Results: We identified 36 studies for qualitative review, from 27 of which measures of classifier performance could be calculated. We found studies to be highly heterogeneous in methodology and quality with high potential for bias and confounding. We found seven studies that presented risk prediction models for outcomes of interest. Of these, only four studies outlined a clear process of model development; assessment of discrimination and calibration were performed in only two and only one study undertook internal validation. No scores were externally validated. Systematically identified and calculated measures of test performance for CPET demonstrated mixed performance. Data was most complete for anaerobic threshold (AT) based predictions: calculated sensitivities ranged from 20-100% when used for predicting risk of mortality with high negative predictive values (96-100%). In contrast, positive predictive value (PPV) was poor (2.9-42.1%). PPV appeared to be generally higher for cardiorespiratory complications, with similar sensitivities. Similar patterns were seen for the association of Peak VO2 (sensitivity 85.7-100%, PPV 2.7-5.9%) and VE/VCO2 (Sensitivity 27.8%-100%, PPV 3.4-7.1%) with mortality. Conclusions: In general CPETâs ârule-outâ capability appears better than its ability to ârule-inâ complications. Poor PPV may reflect the frequency of complications in studied populations. Our calculated estimates of classifier performance suggest the need for a balanced interpretation of the pros and cons of CPET guided pre-operative risk stratification
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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 âImproving Care in Elderly Neurosurgery Initiativeâ (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 âtroponin above the upper limit of normal and acute kidney injury (AKI) âa rise in serum creatinine of â„ 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
A cryogenic liquid-mirror telescope on the moon to study the early universe
We have studied the feasibility and scientific potential of zenith observing
liquid mirror telescopes having 20 to 100 m diameters located on the moon. They
would carry out deep infrared surveys to study the distant universe and follow
up discoveries made with the 6 m James Webb Space Telescope (JWST), with more
detailed images and spectroscopic studies. They could detect objects 100 times
fainter than JWST, observing the first, high-red shift stars in the early
universe and their assembly into galaxies. We explored the scientific
opportunities, key technologies and optimum location of such telescopes. We
have demonstrated critical technologies. For example, the primary mirror would
necessitate a high-reflectivity liquid that does not evaporate in the lunar
vacuum and remains liquid at less than 100K: We have made a crucial
demonstration by successfully coating an ionic liquid that has negligible vapor
pressure. We also successfully experimented with a liquid mirror spinning on a
superconducting bearing, as will be needed for the cryogenic, vacuum
environment of the telescope. We have investigated issues related to lunar
locations, concluding that locations within a few km of a pole are ideal for
deep sky cover and long integration times. We have located ridges and crater
rims within 0.5 degrees of the North Pole that are illuminated for at least
some sun angles during lunar winter, providing power and temperature control.
We also have identified potential problems, like lunar dust. Issues raised by
our preliminary study demand additional in-depth analyses. These issues must be
fully examined as part of a scientific debate we hope to start with the present
article.Comment: 35 pages, 11 figures. To appear in Astrophysical Journal June 20 200
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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 <80âmm Hg, time outside of end-tidal carbon dioxide (ETCO2) range of 3-5âkPa, 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
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Development and Validation of an Electronic Postoperative Morbidity Score.
BACKGROUND: Electronic health records are being adopted due to numerous potential benefits. This requires the development of objective metrics to characterize morbidity, comparable to studies performed in centers without an electronic health record. We outline the development of an electronic version of the postoperative morbidity score for integration into our electronic health record. METHODS: Twohundred and three frail patients who underwent elective surgery were reviewed. We retrospectively defined postoperative morbidity score on postoperative day 3. We also recorded potential electronic surrogates for morbidities that could not be easily extracted in an objective format. We compared discriminative capability (area under the receiver operator curve) for patients having prolonged length of stay or complex discharge requirements. RESULTS: One hundred thirty-nine patients (68%) had morbidity in â„1 postoperative morbidity score domain. Initial electronic surrogates were overly sensitive, identifying 173 patients (84%) as having morbidity. We refined our definitions using backward logistic regression against "gold-standard" postoperative morbidity score. The final electronic postoperative morbidity score differed from the initial version in its definition of cardiac and neurological morbidity. There was no significant difference in the discriminative capability between electronic postoperative morbidity score and postoperative morbidity score for either outcome (area under the receiver operator curve: 0.66 vs 0.66 for complex discharge requirement, area under the receiver operator curve: 0.66 vs 0.67 for a prolonged length of stay; P> .05 for both). Patients with postoperative morbidity score or electronic postoperative morbidity score-defined morbidity on day 3 had increased risk of prolonged length of stay (P < .001 for both). CONCLUSIONS: We present a variant of postoperative morbidity score based on objective electronic metrics. Discriminative performance appeared comparable to gold-standard definitions for discharge outcomes. Electronic postoperative morbidity score may allow characterization of morbidity within our electronic health record, but further study is required to assess external validity
Incidence of type 2 diabetes in people with a history of hospitalisation for major mental illness in Scotland 2001-2015: a retrospective cohort study
Objective: To determine the incidence of type 2 diabetes in people with a history of hospitalization for major mental illness versus no mental illness in Scotland by time period and sociodemographics.
Research Design and Methods: We used national Scottish population-based records to create cohorts with a hospital record of schizophrenia, bipolar disorder, or depression or no mental illness and to ascertain diabetes incidence. We used quasi-Poisson regression models including age, sex, time period, and area-based deprivation to estimate incidence and relative risks (RRs) of diabetes by mental illness status. Estimates are illustrated for people aged 60 years and in the middle deprivation quintile in 2015.
Results: We identified 254,136 diabetes cases during 2001â2015. Diabetes incidence in 2015 was 1.5- to 2.5-fold higher in people with versus without a major mental disorder, with the gap having slightly increased over time. RRs of diabetes incidence were greater among women than men for schizophrenia (RR 2.40 [95% CI 2.01, 2.85] and 1.63 [1.38, 1.94]), respectively) and depression (RR 2.10 [1.86, 2.36] and 1.62 [1.43, 1.82]) but similar for bipolar disorder (RR 1.65 [1.35, 2.02] and 1.50 [1.22, 1.84]). Absolute and relative differences in diabetes incidence associated with mental illness increased with increasing deprivation.
Conclusions: Disparities in diabetes incidence between people with and without major mental illness appear to be widening. Major mental illness has a greater effect on diabetes risk in women and people living in more deprived areas, which has implications for intervention strategies to reduce diabetes risk in this vulnerable population
Appetite and gut hormone responses to moderate-intensity continuous exercise versus high-intensity interval exercise, in normoxic and hypoxic conditions.
This study investigated the effects of continuous moderate-intensity exercise (MIE) and high-intensity interval exercise (HIIE) in combination with short exposure to hypoxia on appetite and plasma concentrations of acylated ghrelin, peptide YY (PYY), and glucagon-like peptide-1 (GLP-1). Twelve healthy males completed four, 2.6 h trials in a random order: 1) MIE-normoxia, 2) MIE-hypoxia, 3) HIIE-normoxia, and 4) HIIE-hypoxia. Exercise took place in an environmental chamber. During MIE, participants ran for 50 min at 70% of altitude-specific maximal oxygen uptake ( 2max) and during HIIE performed 6 x 3 min running at 90% 2max interspersed with 6 x 3 min active recovery at 50% 2max with a 7 min warm-up and cool-down at 70% 2max (50 min total). In hypoxic trials, exercise was performed at a simulated altitude of 2,980 m (14.5% O2). Exercise was completed after a standardised breakfast. A second meal standardised to 30% of participantsâ daily energy requirements was provided 45 min after exercise. Appetite was suppressed more in hypoxia than normoxia during exercise, post-exercise, and for the full 2.6 h trial period (linear mixed modelling, p 0.05). These findings demonstrate that short exposure to hypoxia causes suppressions in appetite and plasma acylated ghrelin concentrations. Furthermore, appetite responses to exercise do not appear to be influenced by exercise modality
The Luminosity Function of Galaxies in SDSS Commissioning Data
During commissioning observations, the Sloan Digital Sky Survey (SDSS) has
produced one of the largest existing galaxy redshift samples selected from CCD
images. Using 11,275 galaxies complete to r^* = 17.6 over 140 square degrees,
we compute the luminosity function of galaxies in the r^* band over a range -23
< M < -16 (for h=1). The result is well-described by a Schechter function with
parameters phi_* = 0.0146 +/- 0.0012 h^3 Mpc^{-3}, M_* = -20.83 +/- 0.03, and
alpha = -1.20 +/- 0.03. The implied luminosity density in r^* is j = (2.6 +/-
0.3) x 10^8 h L_sun Mpc^{-3}. The surface brightness selection threshold has a
negligible impact for M < -18. We measure the luminosity function in the u^*,
g^*, i^*, and z^* bands as well; the slope at low luminosities ranges from
alpha=-1.35 to alpha=-1.2. We measure the bivariate distribution of r^*
luminosity with half-light surface brightness, intrinsic color, and morphology.
High surface brightness, red, highly concentrated galaxies are on average more
luminous than low surface brightness, blue, less concentrated galaxies. If we
synthesize results for R-band or b_j-band using the Petrosian magnitudes with
which the SDSS measures galaxy fluxes, we obtain luminosity densities 2.0 times
that found by the Las Campanas Redshift Survey in R and 1.4 times that found by
the Two-degree Field Galaxy Redshift Survey in b_j. We are able to reproduce
the luminosity functions obtained by these surveys if we also mimic their
isophotal limits for defining galaxy magnitudes, which are shallower and more
redshift dependent than the Petrosian magnitudes used by the SDSS. (Abridged)Comment: 49 pages, including 23 figures, accepted by AJ; some minor textual
changes, plus an important change in comparison to LCR
Colors of 2625 Quasars at 0<z<5 Measured in the Sloan Digital Sky Survey Photometric System
We present an empirical investigation of the colors of quasars in the Sloan
Digital Sky Survey (SDSS) photometric system. The sample studied includes 2625
quasars with SDSS photometry. The quasars are distributed in a 2.5 degree wide
stripe centered on the Celestial Equator covering square degrees.
Positions and SDSS magnitudes are given for the 898 quasars known prior to SDSS
spectroscopic commissioning. New SDSS quasars represent an increase of over
200% in the number of known quasars in this area of the sky. The ensemble
average of the observed colors of quasars in the SDSS passbands are well
represented by a power-law continuum with (). However, the contributions of the bump
and other strong emission lines have a significant effect upon the colors. The
color-redshift relation exhibits considerable structure, which may be of use in
determining photometric redshifts for quasars. The range of colors can be
accounted for by a range in the optical spectral index with a distribution
(95% confidence), but there is a red tail in the
distribution. This tail may be a sign of internal reddening. Finally, we show
that there is a continuum of properties between quasars and Seyfert galaxies
and we test the validity of the traditional division between the two classes of
AGN.Comment: 66 pages, 15 figures (3 color), accepted by A
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