Bowel Ischemia Score Predicts Early Operation in Patients With Adhesive Small Bowel Obstruction

Background Nonoperative management of adhesive small bowel obstruction (SBO) is successful in up to 80% of patients. Current recommendations advocate for computed tomography (CT) scan in all patients with SBO to supplement surgical decision-making. The hypothesis of this study was that cumulative findings on CT would predict the need for operative intervention in the setting of SBO. Methods This is an analysis of a retrospectively and prospectively collected adhesive SBO database over a 6-year period. A Bowel Ischemia Score (BIS) was developed based on the Eastern Association for the Surgery of Trauma guidelines of CT findings suggestive of bowel ischemia. One point was assigned for each of the six variables. Early operation was defined as surgery within 6 hours of CT scan. Results Of the 275 patients in the database, 249 (90.5%) underwent CT scan. The operative rate was 28.3% with a median time from CT to operation of 21 hours (Interquartile range 5.2-59.2 hours). Most patients (166/217, 76.4%) with a BIS of 0 or 1 were successfully managed nonoperatively, whereas the majority of those with a BIS of 3 required operative intervention (5/6, 83.3%). The discrimination (area under the receiver operating characteristic curve) of BIS for early surgery, any operative intervention, and small bowel resection were 0.83, 0.72, and 0.61, respectively. Conclusion The cumulative signs of bowel ischemia on CT scan represented by BIS, rather than the presence or absence of any one finding, correlate with the need for early operative intervention.

Performance evaluation of the aerogel RICH counter for the Belle II spectrometer using early beam collision data

The Aerogel Ring Imaging Cherenkov (ARICH) counter serves as a particle identification device in the forward end-cap region of the Belle II spectrometer. It is capable of identifying pions and kaons with momenta up to $4\>$GeV$\>$c$^{-1}$ by detecting Cherenkov photons emitted in the silica aerogel radiator. After the detector alignment and calibration of the probability density function, we evaluate the performance of the ARICH counter using early beam collision data. Event samples of $D^{\ast +} \to D^0 \pi^+ (D^0 \to K^-\pi^+)$ were used to determine the $\pi(K)$ efficiency and the $K(\pi)$ misidentification probability. We found that the ARICH counter is capable of separating kaons from pions with an identification efficiency of $93.5 \pm 0.6 \, \%$ at a pion misidentification probability of $10.9 \pm 0.9 \, \%$. This paper describes the identification method of the counter and the evaluation of the performance during its early operation.

The development and early operation of Clinical Commissioning Groups (CCGs)

Chapter 3 deals with the development and early operation of Clinical Commissioning Groups (CCGs) of GPs. Building upon the context set out in chapter 2, we examine the factors affecting early CCG development, highlighting the complexity of their governance structures, approaches taken to engaging with their members and the development of external relationships with a wide range of new bodies. We found an explicitly ‘bottom up’ approach to policy implementation, with CCGs given considerable lee-way in developing their structures and processes. As a result, the history of previous commissioning structures and arrangements played an important role in the development of each CCG, as did the approach taken by local leaders and by the PCT/ developing NHS England local team. Engagement with local bodies such as Health and Wellbeing Boards and Local Authorities were also significantly affected by local history and geography. We found that the approach taken by NHS England to CCG development, with early freedom to develop as they chose increasingly curtailed by more prescriptive guidance and a complex assurance regime, led to some frustrations for those involved.