Increased rate of cholecystectomies performed with doubtful or no indications after laparoscopy introduction: a single center experience

Background During recent years laparoscopic cholecystectomy has dramatically increased, sometimes resulting in overtreatment. Aim of this work was to retrospectively analyze all laparoscopic cholecystectomies performed in a single center in order to find the percentage of patients whose surgical treatment may be explained with this general trend, and to speculate about the possible causes. Methods 831 patients who underwent a laparoscopic cholecystectomy from 1999 to 2008 were retrospectively analyzed. Results At discharge, 43.08% of patients were operated on because of at least one previous episode of biliary colic before the one at admission; 14.08% of patients presented with acute lithiasic cholecystitis; 14.68% were operated on because of an increase in bilirubin level; 1.56% were operated on because of a previous episode of jaundice with normal bilirubin at admission; 0.72% had gallbladder adenomas, 0.72% had cholangitis, 0.36% had biliodigestive fistula and one patient (0.12%) had acalculous cholecystitis. By excluding all these patients, 21.18% were operated on without indications. Conclusions The broadening of indications for laparoscopic cholecystectomy is undisputed and can be considered a consequence of new technologies that have been introduced, increased demand from patients, and the need for practice by inexperienced surgeons. If not prevented, this trend could continue indefinitely.

The role of *language in early childhood mathematics

Math literacy is imperative to succeed in society. Experience is key for acquiring math literacy. A preschooler's world is full of mathematical experiences. Children are continually counting, sorting and comparing as they play. As children are engaged in these activities they are using language as a tool to express their mathematical thinking. If teachers are aware of these teachable moments and help children bridge their daily experiences to mathematical concepts, math literacy may be enhanced. This study described the interactions between teachers and preschoolers, determining the extent to which teachers scaffold children's everyday language into expressions of mathematical concepts. Of primary concern were the teachers' responsive interactions to children's expressions of an implicit mathematical utterance made while engaged in block play. The parallel mixed methods research design consisted of two strands. Strand 1 of the study focused on preschoolers' use of everyday language and the teachers' responses after a child made a mathematical utterance. Twelve teachers and 60 students were observed and videotaped while engaged in block play. Each teacher worked with five children for 20 minutes, yielding 240 minutes of observation. Interaction analysis was used to deductively analyze the recorded observations and field notes. Using a priori codes for the five mathematical concepts, it was found children produced 2,831 mathematical utterances. Teachers ignored 60% of these utterances and responded to, but did not mediate 30% of them. Only 10% of the mathematical utterances were mediated to a mathematical concept. Strand 2 focused on the teacher's view of the role of language in early childhood mathematics. The 12 teachers who had been observed as part of the first strand of the study were interviewed. Based on a thematic analysis of these interviews three themes emerged: (a) the importance of a child's environment, (b) the importance of an education in society, and (c) the role of math in early childhood. Finally, based on a meta-inference of both strands, three themes emerged: (a) teacher conception of math, (b) teacher practice, and (c) teacher sensitivity. Implications based on the findings involve policy, curriculum, and professional development.

Give Us This Day

GIVE US THIS DAY is a collection of poetry grounded in the lyrical tradition that speaks to the conflicting need for structure and the inherent desire to be free. It focuses on those moments of rupture, when the structure, whether physical, emotional, psychological or political, is broken. The title poem sets the tone for the collection, capturing the idea that today is all one can truly know. Throughout the five sections of the collection, one comes to understand a complex family story, where right and wrong is blurred in the reality of existence. The sections, representing various parts of the day, are a parallel to the individual stories, speaking to the idea that a single day contains both times of light and darkness, similar to a life. The collection takes place in several cityscapes from Moscow to Delhi, Washington, D.C. to Miami. There are correlations drawn between familial settings and political unrest and tension. Often the political atmosphere is alluded to and drawn into context through the use of intimate personal vignettes. In contrast to the urban noise, there is pervasive natural imagery of gardens and tropical locales which mimic the physical life cycle, climaxing in the blossom.