Management and patient outcomes following admission with acute cholecystitis in Ireland: A national registry-based study.

INTRODUCTION: Acute cholecystitis is a common general surgical emergency, accounting for 3-10 % of all patients attending with acute abdominal pain. International guidelines suggest that emergency cholecystectomy is the treatment of choice for uncomplicated acute cholecystitis where feasible. There is a paucity of published data on the uptake of emergency cholecystectomy in Ireland. AIM: The aim of this study was to evaluate the management of acute cholecystitis in Ireland and to establish the rate of emergency cholecystectomy performed. METHODS: All patients with acute cholecystitis presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics, co-morbidities, length of stay, operative intervention, endoscopic intervention, critical care admissions, in-patient mortality, and readmissions. Propensity score matched analysis and logistic regression were performed to account for selection bias in comparing patients managed with cholecystectomy and those managed conservatively. RESULTS: 20,886 admission episodes were identified involving 17,958 patients. 3585 (20 %) patients underwent emergency cholecystectomy in total. 3436 (96 %) of these were performed laparoscopically, with 140 (4 %) requiring conversion to an open procedure, and common bile duct injuries occurring in 4 (0.1 %) of patients. In comparison to patients treated conservatively, patients who underwent cholecystectomy were younger (median 50 v 60 years, p < 0.001) and more likely to be female (64 % v 55 % p < 0.001). Following propensity score matched analysis, those who had an emergency cholecystectomy had reduced length of stay (LOS) (median 5 days (IQR 3-8) v 6 days (interquartile range (IQR) 3-10), p < 0.001) and fewer readmissions to hospital (282 (8 %) v 492 (14 %), p < 0.001). On logistic regression, age >65 (OR 1.526), CCI >3 (OR 2.281) and non-operative management (OR 1.136) were significant risk factors for adverse outcome. CONCLUSION: Uptake of emergency cholecystectomy in Ireland remains low, and is carried out on a younger, fitter cohort of patients. In those patients, however, it is associated with improved outcomes for cholecystitis compared to conservative management, including shorter LOS and reduced readmission rates for matched cohorts.

Biomarkers of biological aging in recipients of solid organ transplantation and clinical outcomes: A scoping review.

INTRODUCTION: Biological aging is the accumulation of cellular and molecular damage within an individual over time. The biological age of a donor organ is known to influence clinical outcomes of solid organ transplantation, including delayed graft function and frequency of rejection episodes. While much research has focused on the biological age of donor organs, the recipient's biological age may also influence transplantation outcomes. The aim of this scoping review was to identify and provide an overview of the existing evidence regarding biological aging in solid organ transplant recipients and the impact on patient outcomes post-transplant. METHODS: Literature searches were carried out on PubMed, Web of Science, Google Scholar, Embase and TRIP using the phrases 'solid organ transplant', 'cell senescence', 'cell aging' and 'outcomes', using boolean 'and/or' phrases and MeSH terms. Duplicates were removed and abstracts were reviewed by two independent reviewers. Full papers were then screened for inclusion by two reviewers. Data extraction was carried out using a standardised proforma agreed on prior to starting. RESULTS: 32 studies, including data on a total of 7760 patients, were identified for inclusion in this review; 23 relating to kidney transplant recipients, three to liver transplant, five to lung transplant and one to heart transplantation. A wide range of biomarkers of biological aging have been assessed in kidney transplant recipients, whereas studies of liver, lung and heart transplant have predominantly assessed recipient telomere length. The most robust associations with clinical outcomes are observed in kidney transplant recipients, possibly influenced by the larger number of studies and the use of a wider range of biomarkers of biological aging. In kidney transplant recipients reduced thymic function and accumulation of terminally differentiated T cell populations was associated with reduced risk of acute rejection but increased risk of infection and mortality. CONCLUSION: Studies to date on biological aging in transplant recipients have been heavily biased to kidney transplant recipients. The results from these studies suggest recipient biological age can influence clinical outcomes and future research is needed to prioritise robust biomarkers of biological aging in transplant recipients.

Hepatic Cystic Echinococcosis (Hydatid Cyst) in a Six Year Old.

Presentation To describe a case of cystic echinococcosis (CE) in a previously healthy child and review epidemiology of CE in Ireland. Diagnosis A previously healthy 6 year old girl was found to have a cystic lesion in the right lobe of her liver. Serology for Echinococcus granulosus was positive, and radiological features were suggestive of CE. Treatment The patient was pre-treated with anti-helminthic medications before undergoing a liver segmentectomy to remove the cyst, and received further treatment with albendazole after surgery. Histological findings were consistent with CE due to E. granulosus, likely acquired during travel to continental Europe. Conclusion CE should be considered in the differential of children with asymptomatic cysts in the liver and/or lung, and a travel history elucidated in such cases.

Meta-analysis of the cost-effectiveness of early versus delayed cholecystectomy for acute cholecystitis.

Background: Acute calculous cholecystitis (ACC) is a common disease across the world and is associated with significant socioeconomic costs. Although contemporary guidelines support the role of early laparoscopic cholecystectomy (ELC), there is significant variation among units adopting it as standard practice. There are many resource implications of providing a service whereby cholecystectomies for acute cholecystitis can be performed safely. Methods: Studies that incorporated an economic analysis comparing early with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis were identified by means of a systematic review. A meta-analysis was performed on those cost evaluations. The quality of economic valuations contained therein was evaluated using the Quality of Health Economic Studies (QHES) analysis score. Results: Six studies containing cost analyses were included in the meta-analysis with 1128 patients. The median healthcare cost of ELC versus DLC was €4400 and €6004 respectively. Five studies had adequate data for pooled analysis. The standardized mean difference between ELC and DLC was -2·18 (95 per cent c.i. -3·86 to -0·51; P = 0·011; I 2 = 98·7 per cent) in favour of ELC. The median QHES score for the included studies was 52·17 (range 41-72), indicating overall poor-to-fair quality. Conclusion: Economic evaluations within clinical trials favour ELC for ACC. The limited number and poor quality of economic evaluations are noteworthy.

Microwave-assisted Rydberg electromagnetically induced transparency: publisher's note.

This publisher's note corrects an error on page 1 in Opt. Lett.43, 1822 (2018).OPLEDP0146-959210.1364/OL.43.001822.

Microwave-assisted Rydberg electromagnetically induced transparency.

We demonstrate electromagnetically induced transparency (EIT) in a four-level cascade-like system, where the two upper levels are Rydberg states coupled by a microwave field. A two-photon transition consisting of an off-resonant microwave field and an off-resonant optical field forms an effective coupling field to induce transparency of the probe light. We characterize the Rabi frequency of the effective coupling field, as well as the EIT microwave spectra. The results show that microwave-assisted EIT allows us to efficiently access Rydberg states with relatively high orbital angular momentum ℓ=3, which is promising for the study of exotic Rydberg molecular states.

Disclosing large scale adverse events in the US Veterans Health Administration: lessons from media responses.

OBJECTIVES: We examined print, broadcast and social media reports about health care systems' disclosures of large scale adverse events to develop future effective messaging. STUDY DESIGN: Directed content analysis. METHODS: We systematically searched four communication databases, YouTube and Really Simple Syndication (RSS) feeds relating to six disclosures of lapses in infection control practices in the Department of Veterans Affairs occurring between 2009 and 2012. We assessed these with a coding frame derived from effective crisis and risk communication models. RESULTS: We identified 148 unique media reports. Some components of effective communication (discussion of cause, reassurance, self-efficacy) were more present than others (apology, lessons learned). Media about 'promoting secrecy' and 'slow response' appeared in reports when time from event discovery to patient notification was over 75 days. Elected officials' quotes (n = 115) were often negative (83%). Hospital officials' comments (n = 165) were predominantly neutral (92%), and focused on information sharing. CONCLUSIONS: Health care systems should work to ensure that they develop clear messages focused on what is not well covered by the media, including authentic apologies, remedial actions taken, and shorten the timeframe between event identification and disclosure to patients.

Microwave transitions in pairs of Rb Rydberg atoms.

We have observed microwave transitions between pairs of cold Rb atoms, specifically, transitions between the molecular nd(5/2)nd(5/2) and (n+1)d(j)(n-2)f states for 41≤n≤44. (We use the separated atom limits as labels.) The transition is allowed because the dipole-dipole induced configuration interaction between the nd(5/2)nd(5/2) state and the energetically close (n+2)p(3/2)(n-2)f state leads to an admixture of the latter into the former. Such transitions may provide a way of selecting closely spaced pairs of atoms.

Impact of brain tumor location on morbidity and mortality: a retrospective functional MR imaging study.

BACKGROUND AND PURPOSE: fMRI is increasingly used in neurosurgery to preoperatively identify areas of eloquent cortex. Our study evaluated the efficacy of clinical fMRI by analyzing the relationship between the distance from the tumor border to the area of functional activation (LAD) and patient pre- and postoperative morbidity and mortality. MATERIALS AND METHODS: The study included patients with diagnosis of primary or metastatic brain tumor who underwent preoperative fMRI-based motor mapping (n=74) and/or language mapping (n=77). The impact of LAD and other variables collected from patient records was analyzed with respect to functional deficits in terms of morbidity (paresis and aphasia) and mortality. RESULTS: Significant relationships were found between motor and language LAD and the existence of either pre- or postoperative motor (P < .001) and language deficits (P=.009). Increasing age was associated with motor and language deficits (P=.02 and P=.04 respectively). Right-handedness was related to language deficits (P=.05). Survival analysis revealed that pre- and postoperative deficits, grade, tumor location, and LAD predicted mortality. Motor deficits increased linearly as the distance from the tumor to the primary sensorimotor cortex decreased. Language deficits increased exponentially as the distance from the tumor to the language areas decreased below 1 cm. Postoperative mortality analysis showed an interaction effect between motor or language LAD and mortality predictors (grade and tumor location, respectively). CONCLUSIONS: These findings indicate that tumors may affect language and motor function differently depending on tumor LAD. Overall, the data support the use of fMRI as a tool to evaluate patient prognosis and are directly applicable to neurosurgical planning.

Phase-dependent electron-ion recombination in a microwave field.

Using picosecond laser photoionization of Li in a microwave field we have observed phase-dependent reccombination of the photoelectrons with their parent Li+ ions. Recombination occurs at phases of the microwave field such that energy is removed from the photoelectron in the first microwave cycle after excitation, and there are two maxima in the recombination in each microwave cycle. These observations are consistent with observations made using an attosecond pulse train phase locked to an infrared pulse and with the "simpleman's" model, modified to account for the fact that the photoelectrons are produced in a Coulomb potential.

Kilohertz dye laser system for high resolution laser spectroscopy.

We have electro-optically sliced the output light of a commercial Coherent Evolution Nd:YLF laser to pump a kilohertz repetition rate nanosecond dye laser system. Simple and highly adjustable, this laser system can easily be used for initial state preparation for ultrafast systems as well as high resolution spectroscopy.

Gun shot-101: an 8-year review of gunshot injuries in an Irish teaching hospital from a general surgical perspective.

BACKGROUND: Gun-related crime offences have increased in the Republic of Ireland steadily over the past number of years. Regional trauma units are witnessing unprecedented numbers of injuries in the Republic of Ireland with limited prior experience. AIMS: Eight-year retrospective study analysing demographic data, management and outcome of firearm-related injuries. RESULTS: Patients who experience gunshot injuries in this region are statistically likely to be young, male and unemployed with a single shotgun injury to an extremity. Post-operative survival rates of 100% for those who undergo an exploratory laparotomy. CONCLUSION: Ireland has comparable survival outcomes to other international centres with similar patient demographics due to timely and appropriate operative intervention. These results serve to provide a template for further patient management.

Nondispersing Bohr wave packets.

Long-lived, nondispersing circular, or Bohr, wave packets are produced starting from Li Rydberg atoms by exposing them first to a linearly polarized microwave field at the orbital frequency, 17.6 GHz at principal quantum number n=72, which locks the electron's motion into an approximately linear orbit in which the electron oscillates in phase with the microwave field. The microwave polarization is changed to circular polarization slowly compared to the orbital frequency, and the electron's motion follows, resulting in a nondispersing Bohr wave packet.

The human factors of implementing shift work in logging operations.

A fairly recent development in the forest industry is the use of shift work in logging in the southeastern U.S. Logging company owners are implementing shift work as an opportunity to increase production and potentially reduce the cost of producing each unit of wood, without consideration of the potential impacts on the logging crew. There are many documented physiological and psychological impacts on workers from shift work in a variety of industries, although few address forestry workers in the U.S. Semi-structured interviews were performed to gather information about how logging company owners were implementing shift work in seven southeastern states. Data collected during the interviews included employee turnover, shift hours, shift scheduling, safety considerations, and production impacts. Various work schedules were employed. The majority of the schedules encompassed less than 24 hours per day. Permanent and rotating shift schedules were found. None of the logging company owners used more than two crews in a 24-hour period. Additional safety precautions were implemented as a result of working after dark. No in-woods worker accidents or injuries were reported by any of those interviewed. Results indicate that a variety of work schedules can be successfully implemented in the southeastern logging industry.

Many-body ionization in a frozen Rydberg gas.

In a dense gas of 300 microK 85Rb atoms of n approximately 50 ionization occurs on a 100 ns time scale, far too fast to be explained by the motion of the atoms or photoionization by 300 K blackbody radiation. Rapid ionization is accompanied by spectral broadening, with the spectrum becoming continuous at n=88 at a density of 5x10(10)cm(-3). The atomic transitions broaden both smoothly and by the emergence of new features, which we attribute to multiple atom absorptions. We attribute the rapid ionization to a sequence of near resonant dipole-dipole transitions through virtual states in this intrinsically many-body system, culminating in the ionization of some of the atoms.

Emerging options for the management of fecal incontinence in hospitalized patients.

Fecal incontinence is a common problem among hospitalized patients. It predisposes them to complications such as infections and pressure ulcers, resulting in added morbidity and increased length of stay. Despite the prevalence and clinical implications of fecal incontinence, relatively few well-designed studies have been completed assisting clinicians to determine which management strategies prevent complications most effectively. This article will review the prevalence and consequences of fecal incontinence in hospitalized patients and will provide practical suggestions for the management of fecal incontinence, including both traditional care according to clinical guidelines and the role of newer fecal collection devices.

Multiphoton assisted recombination.

We have observed multiphoton assisted recombination in the presence of a 38.8 GHz microwave field. Stimulated emission of up to ten microwave photons results in energy transfer from continuum electrons, enabling recombination. The maximum electron energy loss is far greater than the 2Up predicted by the standard "simpleman's" model. The data are well reproduced by both an approximate analytic expression and numerical simulations in which the combined Coulomb and radiation fields are taken into account.