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

Coping with crisis - smoke, drought, flood and currency: Iban women and their households in West Kalimantan

In recent years, rural households throughout Indonesia have faced a variety of crises, including severe drought, smoke from forest fires, and floods - all of which have affected subsistence farming. Simultaneous with these problems has been the wider Asian economic crisis that destabilized Indonesia both economically and politically. For rural people, it has affected cash-earning opportunities and prices of basic goods. Focusing on the Iban of West Kalimantan, this paper explores the impacts these various crises have had on Iban farming and wage labor, and how the Iban have coped. It touches on the successful strategies from the past as well as recent local developments that have appeared to cushion the continuing economic uncertainty. This paper contributes to the growing literature on the impact of climatic fluctuation and economic change on the livelihoods of local people in Southeast Asia and other parts of the Third World

Circular labor migration and subsistence agriculture: a case of the Iban in West Kalimantan, Indonesia

This dissertation is an analysis of circular labor migration and its effect on subsistence agriculture among the Iban of West Kalimantan, Indonesia. Based on lengthy field research, it focuses on the intersection of Iban economy, demography, and social organization, including the nature of male labor migration, household composition, the labor exchange system, the role of women in farming and in Iban society generally, and the nature of forest-fallow farming. In this remote area of Indonesian Borneo, Iban subsistence revolves around the cultivation of rice in hill, floodplain, and swamp swiddens. Hill swiddens, cut from long-fallowed forest, are particularly important. In addition, cash cropping, especially of rubber, supplements subsistence farming. However, the lack of good prices and local markets for cash crops results in high frequencies of male wage-labor migration. Circular labor migration refers to a pattern in which people seek work away from home but return after months or years. Among these Iban men, it is largely international, to jobs they find across the border in Malaysia and Brunei. There the wages are higher and the currencies more stable, and men’s earnings can be quite substantial by Indonesian standards. Wages are used to pay for consumer goods, subsistence foods when crops fail, and schooling for children and younger siblings. Chronic male absence negatively affects the home community in a number of ways, including increased workloads on women in farming and domestic activities. However, as this study shows, women are more involved in agriculture regardless of the presence of men, and the absence of men does not negatively affect a household’s ability to produce sufficient rice for itself. Likewise, male absence does not lead to male-poor households farming shorter (and less labor-demanding) fallows, which have been assumed to result in poorer yields. Factors that account for this situation include the widespread use of chainsaws in felling forest for farming, a functioning labor exchange system, household structure and composition, and women’s control of their reproduction

The history of displacement and forced settlement in West Kalimantan, Indonesia: implications for co-managing Danau Sentarum wildlife reserve

The history of local settlement in conservation areas, even that occurring prior to conservation activities, is of great value in efforts to co-manage protected resources. It shows how local people came to be where they are now, and how they view the local landscape. It also indicates how reserve resources have been shaped by the people who have relied on them in the past; and it provides insight into present and future conditions, such as how resource competition between reserve residents is and might be structured and perceived. Thus, in conjunction with studies aimed at understanding present local resource use, attention needs to be given to settlement history in conservation areas as one critical component of the local condition. This paper focuses on the history of population change in and around Danau Sentarum Wildlife Reserve in West Kalimantan, Indonesia, and its implications for co-management. There are numerous communities from two different ethnic groups - Iban swidden farmers and Melayu fishers - located within and around the reserve core, relying to various degrees on its resources. The demographic history of the lakes area is marked by population displacement and forced settlement. Over the years the Iban and the Melayu settled, used, and abandoned the area as wars and raiding ebbed and flowed. Today with a growing local population and increased resource competition, the reserve faces many critical challenges to its future

Punitive expeditions and divine revenge: oral and colonial histories of rebellion and Pacification in western Borneo, 1886–1902

This article presents different accounts of two events in the efforts of Dutch and British colonial authorities to pacify the Iban within their respective territories on the island of Borneo; namely, it presents both the Dutch and British reports of the punitive expeditions in 1886 and 1902 against rebellious Iban headhunters and the oral historical narratives of the Iban today. In addition to providing historical and cultural background to Iban resistance to pacification, it spells out the Iban conception of the past and fragmentation of related narratives. The weight that the oral accounts place on these two events is discussed in that light, with the Iban viewing their colonial experience as the struggle of spiritual forces allied with both the Iban and the European

Slashed and burned: war, environment, and resource insecurity in West Borneo during the late nineteenth and early twentieth centuries

European colonial efforts to pacify ‘rebellious’ Iban in western Borneo during the late nineteenth and early twentieth centuries produced chronic resource insecurity and may have contributed to the recorded destructiveness of Iban swidden cultivation. Negative European opinions towards swiddening may have thus been reinforced by a context that the Europeans themselves created. Drawing on anthropological theories linking swidden cultivation and Iban warfare, this article presents a historical case for the relationship between pacification, resource insecurity, and swidden destructiveness. It also re-evaluates Derek Freeman’s original diagnosis of Iban as ‘prodigal’ farmers, suggesting that there may have been more to Iban pioneering destruction than the wide availability of ‘virgin’ forest

Lines in the forest: internal territorialization and local accomodation in West Kalimantan, Indonesia (1865-1979)

The history of internal territorialization in West Kalimantan, Indonesia, reveals the interplay between state and local concepts of territory. Both colonial and national authorities sought to divide natural resources and ethnic groups through boundary making, and local peoples have accomodated and challenged state concepts of territory in their competition over natural resources. This histroy highlights a common situation in which local people incorporate state boundary concepts in order to make claims on resources in a way the state recognizes. Yet indigenous concepts of territory and resource claims persist as local people seek multiple, practical ways of securing rights to resources, and as the power of the state flactuates over time

Iban forest management and wildlife conservation along the Danau Sentarum periphery, West Kalimantan, Indonesia

Danau Sentarum National Park in West Kalimantan, Indonesia is bordered on three sides by Iban settlements and the forests they manage. The forest management system practiced by an Iban community on the northeastern periphery of the reserve is described here. Iban agroforestry is based on two principal components: swidden cultivation, which creates a field-secondary forest mosaic and various kinds of preserved and managed forest. Iban hunt within these forests, and the species and numbers of animals they encounter are analysed here with respect to their exploitation of the agroforests and fields. The merits and constraints of this management system are discussed. Based on the data analysed here, this system appears to promote some degree of biodiversity conservation and may serve as a partial buffer zone around the nearby wildlife reserve