The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Does excessive alcohol use in teenagers affect their everyday prospective memory?

Objectives: To investigate everyday memory processes in teenagers who drink excessive amounts of alcohol (drinking above the 14/21 units-per-week recommended for females/males respectively), compared with low-dose controls. To consider what implications putative deficits might have upon prevention and potential treatment issue relating to alcohol misuse in teenagers. Design: Existing groups. Setting: Testing took place in quiet rooms in colleges in North-East of England. Participants: 86 teenagers studying at colleges in the North-East of England were tested, 55 of whom were excessive drinkers and 31 drank below the 'safe limits'. Main Outcome Measures: Self-report measures; Prospective Memory Questionnaire and UEL Drug-Use Questionnaire. Results: After controlling for tobacco and strategy use (no other between-group differences were found on the non-memory measures), the excessive alcohol group reported more lapses in memory in their long-term and short-term everyday prospective memory functioning, than the low-dose control group. Conclusions: The findings suggest that teenagers who use excessive amounts of alcohol have selective deficits in their ability to engage in day-to-day activities that rely on memory. Identifying such deficits may help in prevention campaigns and the development of strategies to combat these difficulties may be a useful addition to the knowledge and skills in nurse training

Does excessive alcohol use in teenagers affect their everyday prospective memory?

Objectives: To investigate everyday memory processes in teenagers who drink excessive amounts of alcohol (drinking above the 14/21 units-per-week recommended for females/males respectively), compared with low-dose controls. To consider what implications putative deficits might have upon prevention and potential treatment issue relating to alcohol misuse in teenagers. Design: Existing groups. Setting: Testing took place in quiet rooms in colleges in North-East of England. Participants: 86 teenagers studying at colleges in the North-East of England were tested, 55 of whom were excessive drinkers and 31 drank below the 'safe limits'. Main Outcome Measures: Self-report measures; Prospective Memory Questionnaire and UEL Drug-Use Questionnaire. Results: After controlling for tobacco and strategy use (no other between-group differences were found on the non-memory measures), the excessive alcohol group reported more lapses in memory in their long-term and short-term everyday prospective memory functioning, than the low-dose control group. Conclusions: The findings suggest that teenagers who use excessive amounts of alcohol have selective deficits in their ability to engage in day-to-day activities that rely on memory. Identifying such deficits may help in prevention campaigns and the development of strategies to combat these difficulties may be a useful addition to the knowledge and skills in nurse training

New applications of MIR spectrometry: Quality Assurance practices with new parameters in raw milk analysis

Mid InfraRed (MIR) spectrometry is traditionally applied for quantitative determination of major components of milk such as fat, protein or lactose. For these “traditional” parameters, MIR Filter apparatus techniques have been used for a long time. They used simple models to predict these parameters using a very low number of wavelength. Recently, Fourier-transform infrared spectroscopy (FTIR), a more complex technique, has been proposed. FTIR apparatus collect high-spectral-resolution data over a wide spectral range. This confers a significant advantage over a dispersive spectrometer, which measures intensity over a narrow range of wavelengths at a time. A Fourier transform (a mathematical process) is required to convert the raw data into the actual spectrum. Thanks to additional prediction models developed by researchers and instrument manufacturers, FT-IR spectra can be used beyond quantitative determination of major components of milk such as fat, protein or lactose, to measure other dairy components such as fatty acids and minerals, and also to measure qualitative parameters. However, traditional calibration procedures developed with filter apparatus need to be adapted to respond to the more complex models used. This document focuses on the required checks with the implementation of new quantitative applications and how the quality assurance of the results can be assured. New approaches are presented

Does cannabis use affect prospective memory in young adults?

The aim of the present study was to examine prospective memory impairments associated with cannabis use in young adults. An independent measures design utilising pre-existing groups of users and non-users was employed in which an opportunity sample of 90 undergraduates studying at universities in the north east of England participated. The number of prospective memory failures reported on the Prospective Memory Questionnaire and the number of location—action combinations correctly recalled during a video-based prospective memory task were measured. The number of strategies used to assist memory, level of anxiety and depression, and use of alcohol, nicotine and any other recreational drugs in addition to cannabis were also measured and controlled during the analysis. Analysis revealed no significant differences in the number of self-reported prospective memory failures; however, cannabis users recalled significantly fewer location—action combinations than non-users in the video-based prospective memory task. The findings from the present study suggest that cannabis use has a detrimental effect on prospective memory ability in young adults but users may not be aware of these deficits

Standardization of FT-MIR instruments for milk analysis

Fourier-transform mid-infrared (FT-MIR) spectrometry is the most used method worldwide for compositional analysis and quality checks during routine liquid milk testing. The technique allows fast, non-destructive quantification of the (physico-)chemical properties of raw milk as an alternative to reference test methods, which are usually slow, difficult, expensive and time consuming. In 1961, a patent application was made for an FT-MIR method determining fat, protein and lactose in milk [1]. FT-MIR supplies information that is complementary to chemical information and provides high throughput with high sensitivity in a short response time from small sample volumes [2]. In 1993, the first purpose-built FT-MIR instrument was marketed, the Anadis MI-200 [3]. With the introduction of FT-MIR, equations based on the full range of spectral data have been developed to predict fat, protein, urea and lactose content of milks worldwide. The main components of milk can be linked with characteristic bands in the FT-MIR spectrum of milk because their chemical composition and chemical bonds result in absorbance of light at specific wavenumbers. However, MIR instruments are not stable over time because of physical wear and tear, maintenance operations and replacement of some subcomponents. Therefore, calibration to allow prediction of milk components requires adjustment in routine use for each instrument by slope and intercept correction. Recently, MIR prediction equations have been developed to predict new parameters related to milk composition (fatty acids, detailed protein composition, minerals), technological properties of the milk (ability to coagulate), metabolism of dairy cows (methane emissions, energy balance, energy intake, efficiency, ketosis) and the detection of adulteration. Some of these new parameters are indirect parameters. This means that the prediction equations are not directly related to a component present in the milk, but are the result of interrelation(s) with other known or unknown components, as marked by changes in the MIR spectra. To develop these new indirect equations, it is necessary to build a large spectral database with reference values for each of the properties to be correlated. Reference values should cover a large time period, wide geographical range, number of animals the milk sample originated from and other variables that could influence milk composition. The wider the variability that is captured in the spectral database, the greater will be the robustness of the equation. For a wider applicability of results, a collection of spectra originating from different laboratories, using different models or brands of FTMIR apparatus, in different countries and from different time periods should preferably be used. However, physical use, technical differences, maintenance operations and subcomponent replacement mean that even a single MIR instrument may not be stable over time. This results in spectra obtained from the same milk sample by two different instruments, or from the same instrument at two different times, having noticeable differences. A standardization protocol would help to reduce these differences. Standardization procedures are needed to correct spectra from different spectrometers on a reference basis and to bring all spectra towards a common spectral response in order to reach the following objectives: • Obtain stable predictions over time and correct deviations resulting from hardware modifications • Transfer equations between instruments of the same brand • Transfer equations between instruments of different brands • Create equations for parameters that are difficult or costly to measure by pooling reference analysis results and spectra (creation of a large spectral database) • Benefit qualitative approaches (untargeted approach, detection of abnormal spectra) The purpose of this paper is to give an overview of some existing approaches for spectral standardization

Determination of labeled fatty acids content in milk products, infant formula, and adult/pediatric nutritional formula by capillary gas chromatography : Collaborative study, final action 2012.13

IDF 231:2015 in November 2015. It was decided to merge the two activities after the agreement signed between ISO and AOAC in June 2012 to develop common standards and to avoid duplicate work. The collaborative study was performed after having provided highly satisfactory single-laboratory validation results [Golay, P.A., & Dong, Y. (2015) J. AOAC Int. 98, 1679-1696] that exceeded the performance criteria defined in AOAC Standard Method Performance Requirement (SMPR®) 2012.011 (September 29, 2012) on 12 products selected by the AOAC Stakeholder Panel on Infant Formula (SPIFAN). After a qualification period of 1 month, 18 laboratories participated in the fatty acids analysis of 12 different samples in duplicate. Six samples were selected to meet AOAC SPIFAN requirements (i.e., infant formula and adult nutritionals in powder and liquid formats), and the other Six samples were selected to meet ISO-IDF requirements (i.e., dairy products such as milk powder, liquid milk, cream, butter, infant formula with milk, and cheese). The fatty acids were analyzed directly in all samples without preliminary fat extraction, except in one sample (cheese). Powdered samples were analyzed after dissolution (i.e., reconstitution) in water, whereas liquid samples (or extracted fat) were analyzed directly. After addition of the internal standards solution [C11:0 fatty acid methyl ester (FAME) and C13:0 triacylglycerols (TAG)] to the samples, fatty acids attached to lipids were transformed into FAMEs by direct transesterification using methanolic sodium methoxide. FAMEs were separated using highly polar capillary GLC and were identified by comparison with the retention times of pure analytical standards. Quantification of fatty acids was done relative to C11:0 FAME as internal standard and to instrument response factors (determined separately using calibration standards mixture). The performance of the method (i.e., transesterification) was monitored in all samples using the second internal standard, C13:0 TAG. RSDR values were summarized separately for labeled fatty acids in SPIFAN materials and ISO-IDF materials due to different expression of results. This method was applied to representative dairy, infant formula, and adult/pediatric nutritional products and demonstrated global acceptable reproducibility precision for all fatty acids analyzed (i.e., 46 individuals and/or groups) for these categories of products