The Percutaneous Nephrolithotomy Global Study: Classification of Complications

Purpose: This study evaluated postoperative complications of percutaneous nephrolithotomy (PCNL) and the influence of selected factors on the risk of complications using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database. Patients and Methods: The CROES PCNL Global Study collected prospective data for consecutive patients who were treated with PCNL at centers around the world for 1 year. Complications were evaluated by the modified Clavien classification system. Results: Of 5724 patients with Clavien scores, 1175 (20.5%) patients experienced one or more complications. The most frequent complications were fever and bleeding. Urinary leakage, hydrothorax, hematuria, urinary tract infection, pelvic perforation, and urinary fistula also occurred in >= 20 patients in each group. The majority of complications (n = 634, 54.0%) were classified as Clavien grade I. Two patients died in the postoperative period. The largest absolute increases in mean Clavien score were associated with American Society of Anesthesiologists (ASA) physical status classification IV (0.75) or III (0.34), anticoagulant medication use (0.29), positive microbiologic culture from urine (0.24), and the presence of concurrent cardiovascular disease (0.15). Multivariate regression analysis revealed that operative time and ASA score were significant predictors of higher mean Clavien scores. Conclusion: The majority of complications after PCNL are minor. Longer operative time and higher ASA scores are associated with the risk of more severe postoperative complications in PCNL

Witness to Hope: Catholic Schools Respond to COVID-19

The twin uncertainties of the pandemic and the economic downturn have taken a toll on our Catholic schools. Yet reports across the country are that Catholic schools have been very successful in remote learning. Although there are well-documented efforts to define the values of Catholic schools, these values are not fully known and there is still not a well-crafted national value proposition for Catholic schools. As the context surrounding Catholic schools has changed, it has become imperative that Catholic schools coalesce around a new value proposition during uncertain times. What follows is an attempt by a group of dedicated Catholic school stakeholders determined to change the narrative. As our schools have pivoted to new forms of delivery and connections, this ad hoc group represents the same type of creative efforts to form a community. As a committee, we identified five themes of hope that can continue to guide the work and witness of our Catholic schools: prayer, partnership with families, personalization, persistence, and planning. In the following sections, we provide a rationale and overview of each theme. We also include relevant testimonials of diverse stakeholders to illuminate each theme and give voice to the hope across our school communities

COVID Witness to Hope: Catholic Schools Respond to COVID-19

The twin uncertainties of the pandemic and the economic downturn have taken a toll on our Catholic schools. Yet reports across the country are that Catholic schools have been very successful in remote learning. Although there are well-documented efforts to define the values of Catholic schools, these values are not fully known and there is still not a well-crafted national value proposition for Catholic schools. As the context surrounding Catholic schools has changed, it has become imperative that Catholic schools coalesce around a new value proposition during uncertain times. What follows is an attempt by a group of dedicated Catholic school stakeholders determined to change the narrative. As our schools have pivoted to new forms of delivery and connections, this ad hoc group represents the same type of creative efforts to form a community. As a committee, we identified five themes of hope that can continue to guide the work and witness of our Catholic schools: prayer, partnership with families, personalization, persistence, and planning. In the following sections, we provide a rationale and overview of each theme. We also include relevant testimonials of diverse stakeholders to illuminate each theme and give voice to the hope across our school communities

Impaired Accessory Cell Function in a Human Dendritic Cell Line after Human Immunodeficiency Virus Infection

We generated human dendritic cell (DC) hybridoma cell lines by fusing HGPRT-deficient promonocytic U937 cells with immature DCs obtained by culturing peripheral blood monocytes with interleukin-4 (IL-4; 1,000 U/ml) and granulocyte-macrophage colony-stimulating factor (100 U/ml) for 7 days and mature DCs by treatment with tumor necrosis factor alpha (12.5 μg/ml) for 3 days. Only one fusion with immature DCs was successful and yielded four cell lines—HB-1, HB-2, HB-3, and HB-9—with an overall fusion efficiency of 0.0015%. The cell lines were stable in long-term culture, displayed morphological features typical of DCs, and expressed distinct class I and class II molecules not present on U937 (A*031012, B*51011, Cw*0701, DRB3*01011 52, and DR5*01011). A representative cell line, HB-2, that expressed DC markers including CD83, CD80 and CD86 could be induced to produce IL-12 through CD40 stimulation. After human immunodeficiency virus (HIV) infection, there was impairment of antigen-presenting cell (APC) function, which was manifested by an inability to stimulate allogeneic T-cell responses. There was no change in expression of major histocompatibility complex class I and class II antigens, CD83, CD40, CD4, CD11c, CD80, CD86, CD54, and CD58, or IL-12 production in the HIV-infected HB-2 cells. The HIV-infected HB-2 cells induced T-cell apoptosis in the cocultures. T-cell proliferation could be partially restored by using ddI, indinivir, and blocking anti-gp120 and anti-IL-10 antibodies. Our data suggest that there are multiple mechanisms that DCs use to inhibit T-cell responses in HIV-infected patients. The HB-2 cell line could be a useful model system to study APC function in HIV-infected DCs

Identifying policy impacts in the crisis: Microsimulation evidence on tax and welfare

Ireland?s banking, property and fiscal crises, combined with a worldwide Great Recession have had severe implications for household incomes. Particular attention has focused on how incomes at various levels have been affected by tax and welfare policy responses to the overall crisis. This paper describes how SWITCH, the ESRI tax-benefit model, has been rebased to use data from SILC (Survey on Income and Living Conditions) 2010, capturing the major fall in household incomes and rise in unemployment. Selected analyses based on 2008 and 2010 data are reported, to give insights into the distributional and incentive impacts of tax and welfare policy up to 2012

Referral patterns after a seizure admission in an English region:an opportunity for effective intervention? An observational study of routine hospital data

OBJECTIVES: To identify emergency seizure admissions to hospital and their subsequent access to specialist outpatient services. DESIGN: Algorithmic analysis of anonymised routine hospital data over 7 years using specialist follow-up by 3 months as the target outcome. POPULATION: All adults resident in Merseyside and Cheshire, England. MAIN OUTCOMES: Whether, and when, access to the specialist advice that might prevent further admissions was offered. RESULTS: 1.4% of all emergency medical admissions are as a result of seizure. In the following 12 months 35% were readmitted and experienced a mean of 2.3 emergency department visits. Only 27% (48% of those already known to specialists and 13% of those not known) were offered appointments. Subsequent attendance at a specialist clinic is more likely if already known to a clinic, if aged <35 years, if female, or required a longer spell in hospital. Extrapolation from other work suggests 100 000 bed days per annum could be saved. CONCLUSIONS: Most seizure admissions are not being referred for the help that could prevent future admissions. The majority of those that are referred are not seen within an appropriate time frame. Our service structures are not providing an optimum service for people with epilepsy

A low resource subglacial bedrock sampler: The percussive rapid access isotope drill (P-RAID)

The paleoclimate community has an interest in distributed subglacial bedrock sampling but, while capable drill systems do exist, they are often incompatible with Twin Otter logistics. To address this issue, a design built on the existing low footprint ice-sampler, the Rapid Access Isotope Drill (RAID) is investigated. The new device will retain key features of the parent system, but the ice drilling elements of the RAID will be replaced by a self-contained rotary-percussive core-drill capable of penetrating ice-consolidated and rocky terrain at and below the ice/rock interface. This new front-end will only be deployed once the interface itself has been attained, providing a pristine core sample from the underlying terrain. The proposed Percussive Rapid Access Isotope Drill (P-RAID) has been inspired by planetary drilling technologies to allow autonomous operations at the bottom of the hole. This paper details the development and testing of the proof-of-concept hardware. The mechanical and electrical design challenges encountered, and the results obtained from a series of prolonged cold chamber tests will be discussed, alongside lessons learned from initial testing in Antarctica