Incidental Gallbladder Cancer

Gallbladder cancer (GBC) is a rare but fatal disease with an incidence of less than 5000 new cases per year in the United States. Less than 20% of GBC cases are diagnosed preoperatively. The remaining cases are diagnosed either after laparoscopic cholecystectomy or intraoperatively. GBC is discovered incidentally during histopathology following 0.25–3.0% of laparoscopic cholecystectomies; however, this constitutes 74–92% of all GBC. The most pivotal and important step is accurate patient staging. Staging dictates disease management and treatment options and predicts survival. Because of the fatality of GBC and its poor prognosis, attempts of curative surgery are limited to localized resectable disease

A systematic review of barriers and enablers associated with uptake of influenza vaccine among care home staff

Barriers and enablers to vaccination of care home (CH) staff should be identified in order to develop interventions to address them that increase uptake and protect residents. We aimed to synthesis the evidence describing the barriers and enablers that affect the influenza vaccination uptake of care home (CH) staff. Method: We searched PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, AMED, IBSS, SCOPUS to identify quantitative, qualitative or mixed-method studies. Data related to health or social care workers in CHs reported barriers or enablers were extracted and mapped to the Theoretical Domains Framework (TDF); the data within each domain were grouped and categorized into key factors affecting influenza vaccine uptake among CH staff. Results: We screened 4025 studies; 42 studies met our inclusion criteria. Thirty-four (81%) were surveys. Five theoretical domains were frequently reported as mediators of influenza vaccine uptake: Beliefs about consequences (32 studies), Environmental context and resources (30 studies), Emotions (26 studies), Social influences (25 studies), Knowledge (22 studies). The low acceptance rate of the influenza vaccine among CH staff can be attributed to multiple factors, including insufficient understanding of the vaccine, its efficacy, or misconceptions about the vaccine (knowledge), perceiving the vaccine as ineffective and unsafe (beliefs about consequences), fear of influenza vaccine and its side effects (emotions), and experiencing limited accessibility to the vaccine (environmental context and resources). Conclusion: Interventions aimed at increasing influenza vaccine uptake among CH staff should focus on addressing the barriers identified in this review. These interventions should include components such as enhancing knowledge by providing accurate information about vaccine benefits and safety, addressing negative beliefs by challenging misconceptions, managing concerns and fears through open communication, and improving accessibility to the vaccine through convenient on-site options. This review provides a foundation for the development of tailored Interventions to improve influenza vaccine uptake among CH staff

An MMC based HVDC system with optimized AC fault ride-through capability and enhanced circulating current suppression control

Modular multilevel converter (MMC) is a proven technology for HVDC applications due to its salient features such as modularity and excellent power quality. To ensure best possible grid support, recent grid codes require incorporating fault ride-through (FRT) strategies so that HVDC converter stations remain connected and maintain reliable operation under various symmetrical and asymmetrical AC faults. In this paper, a communication-free enhanced fault ride-through technique without the need of DC chopper has been proposed. The proposed FRT strategy ensures quick post fault recovery operation and can effectively manage DC link and capacitor voltages within safe limits. Along with proposed FRT strategy, in order to avoid high circulating current (CC) inside an MMC, this paper has proposed an optimal circulating current control approach based on proportional resonant and PI controllers in an abc reference frame. The suggested technique lowers the ripple in capacitor voltages while reducing the magnitude of the CC. Under both balanced and unbalanced ac grid conditions, the ripple in the dc link voltage is also reduced without the use of dual synchronous reference frame or any additional controllers. Simulation results confirm the effectiveness of the proposed FRT and CC suppression techniques for a 580-kV, 850-MW MMC-based HVDC system

Protocol of the process evaluation of cluster randomised control trial for estimating the effectiveness and cost-effectiveness of a complex intervention to increase care home staff influenza vaccination rates compared to usual practice (FluCare)

Background: Influenza (flu) vaccination rates in UK care home staff are extremely low. Less than 40% of staff in care homes are vaccinated for influenza (flu), presenting risks to the health of frail residents and potential staff absence from cross-infection. Staff often do not perceive a need for vaccination and are unaware they are entitled to free flu vaccination. The FluCare study, a cluster randomised control trial (RCT), uses behavioural interventions to address barriers. Videos, posters, and leaflets are intended to raise awareness of flu vaccination benefits and debunk myths. On-site staff vaccination clinics increase accessibility. Financial incentives to care homes for improved vaccination rates and regular monitoring influence the environment. This paper outlines the planned process evaluation which will describe the intervention’s mechanisms of action, explain any changes in outcomes, identify local adaptations, and inform design of the implementation phase. Methods/design: A mixed method process evaluation to inform the interpretation of trial findings. Objectives: • Describe the intervention as delivered in terms of dose and fidelity, including adaptations and variations across care homes. • Explore the effects of individual intervention components on primary outcomes. • Investigate the mechanisms of impact. • Describe the perceived effectiveness of relevant intervention components (including videos, leaflets, posters, and flu clinics) from participant perspectives (care home manager, care home staff, flu clinic providers). • Describe the characteristics of care homes and participants to assess reach. A purposive sample of twenty care homes (ten in the intervention arm, ten in the control arm) for inclusion in the process evaluation. Data will include (1) study records including care home site profiles, (2) responses to a mechanism of action questionnaire, and (3) semi-structured interviews with care home staff and clinic providers. Quantitative data will be descriptively reported. Interview data will be thematically analysed and then categories mapped to the Theoretical Domains Framework. Discussion: Adopting this systematic and comprehensive process evaluation approach will help ensure data is captured on all aspects of the trial, enabling a full understanding of the intervention implementation and RCT findings

The Impact of Psychosocial Factors of Physical Health Outcomes: A Review of the Biopsychosocial Model in Family Medicine

Discontent with the biological model of illness—which is still the predominant healthcare model—led to the development of the biopsychosocial model, which was described in Engel's seminal Science paper forty years ago. It is the foundation of the International Classification of Functioning (WHO ICF) developed by the World Health Organization Clinical outcomes for functional disorders and chronic diseases treated in family medicine may be improved by the biopsychosocial approach. Since clinical performance metrics and standards are biomedically focused, family medicine doctors have no financial incentive to implement the biopsychosocial paradigm in their practices. Implementing the biopsychosocial approach in family medicine may be hampered by workload and incompetence

Seroprevalence of antibodies to SARS-CoV-2 among blood donors in the early month of the pandemic in Saudi Arabia

Background: Serologic testing provides better understanding of SARS-CoV-2 prevalence and its transmission. This study was an investigation of the prevalence of antibodies to SARS-CoV-2 among blood donors in Saudi Arabia. Objective: To estimate the seroprevalence of anti-SARS-CoV-2 antibodies among blood donors in Saudi Arabia during the early phase of the COVID-19 pandemic. Methods: Serology results and epidemiological data were analyzed for 837 adult blood donors, with no confirmed SARS-CoV-2 infection, in Saudi Arabia from 20th to 25th May 2020. Seroprevalence was determined using electrochemical immunoassay to detect anti-SARS-CoV-2 antibodies. Results: The overall seroprevalence of anti-SARS-CoV-2 antibodies was 1.4% (12/837). Non-citizens had higher seroprevalence compared with citizens (OR 13.6, p = 0.001). Secondary education was significantly associated with higher seroprevalence compared with higher education (OR 6.8, p = 0.005). The data showed that the highest seroprevalence was in Makkah (8.1%). Uisng Makkah seroprevalence as the reference, the seroprevalence in other areas was: Madinah 4.1% (OR 0.48, 95% CI 0.12-1.94), Jeddah 2.3% (OR 0.27, 95% CI 0.31-2.25), and Qassim 2.9 % (OR 0.34, 95% CI 0.04-2.89) and these were not statistically different from seroprevalence in the Makkah region. Conclusions: At the early months of the COVID-19 pandemic in Saudi Arabia, the seroprevalence of antibodies to SARS-CoV-2 among blood donors was low, but was higher among non-citizens. These findings may indicate that non-citizens and less educated individuals may be less attentive to preventive measures. Monitoring seroprevalence trends over time require repeated sampling

Mesenteric Fibromatosis Presenting as an Irreducible Inguinal Hernia

Mesenteric fibromatosis is a rare benign tumor of the abdominal cavity. It can present as a sporadic case or as a part of polyposis syndromes. It often infiltrates surrounding structures but rarely metastasizes. Surgical resection is the treatment of choice. The following is a case report of a mesenteric fibromatosis mass presenting as an irreducible inguinal hernia

Combined epidural-general anesthesia (CEGA) in patients undergoing pancreatic surgery: comparison between bupivacaine 0.125% And 0.25%

Assist Prof., Anesthesia Department, Liver Institute, Mounofia University Associat.Prof.,Anaesthesia, King Khaled University Hospital (KKUH), Riyadh Prof. Anesthesia, Head of department of Anesth&ICU (KKUH), King Saud University Assist. Prof., Head of Hepatobiliary Unit, KKUH, Riyadh, KSABackground: Major abdominal surgery results in homodynamic instability mainly due to endogenous prostacyclin release, bleeding, major intercompartemental fluid shift and the hormonal surgical response. This study compared the effects of low thoracic epidural anesthesia with 0.125% and 0.25% bupivacaine on haemodynamic variables, sevoflurane requirements, and stress hormone responses during pancreatic surgery under combined epidural-general anaesthesia (CEGA). Materials and Methods: Forty patients undergoing different pancreatic surgery were randomly allocated into two equal groups to receive 10 ml of either isobaric bupivacaine 0.125% (group I) or 0.25% (group II) by low thoracic epidural with sevoflurane general anaesthesia. Sevoflurane was adjusted to achieve a target bispectral index (BIS) of 40–60. Measurements included the inspired (FISEVO) and the end-tidal sevoflurane concentrations (E'SEVO), blood pressure (BP) and heart rate (HR) before surgery and every 5 min during surgery for 2 h, and stress hormones. Plasma samples for stress response evaluation were taken before and 1 and 2 h after the start of surgery for measurements of epinephrine, and cortisol. Results: During surgery, both groups were similar for HR, BP and BIS, but FISEVO and E'SEVO were significantly higher and more fluctuated with bupivacaine 0.125% than with 0.25%. Moreover, the total amount of propofol used for induction of general anesthesia and the total fentanyl used during anesthesia were significantly low in 0.25% bupivacaine group. Intraoperative requirements of ephedrine were higher in 0.25% bupivacaine group. Intraoperative blood loss and fluid requirements were significantly increase in 0.125% group. Plasma concentrations of epinephrine and cortisol were found to be higher with bupivacaine 0.125% as compared with 0.25%. Conclusion: Combined thoracic epidural-general anesthesia (CEGA) for pancreatic surgery, with 0.25% bupivacaine significantly reduces sevoflurane requirements, blood loss and fluid requirements. In addition, bupivacaine 0.25% suppressed the stress hormone responses better than 0.125% did. However this was on the expenses of more ephedrine requirements

Design of Novel Modified Double-Ended Forward Converter for Stepper Motor Drive

This paper presents the design and analysis of a modified double-ended forward converter (DEFC) for stepper motor-based robotic applications. The proposed converter topology provides galvanic isolation between the input and output while also higher efficiency with a smooth operative system, making it suitable for use in robotic systems that require both power and control signals to be transmitted. The paper also discusses the control strategy for the converter, which uses Proportional Integral (PI) to regulate the output voltage and current. The control strategy is implemented using a microcontroller-based system, which provides precise control of the output parameters. The converter is tested using a stepper motor-based load, and the results demonstrate the effectiveness of the proposed topology and control strategy. In addition to the experimental results, the paper also presents a detailed analysis of the converter’s performance. The analysis includes the input voltage and current, capacitor voltage, MOSFET parameters, output voltage and current, and calculation of efficiency. The analysis results show that the proposed converter topology and control strategy offer high efficiency comparing to existing converting approaches. Overall, the proposed double-ended forward converter offers a suitable solution for stepper motor-based robotic applications, providing efficient and reliable power and control signals. The results demonstrate the effectiveness of the proposed converter topology and control strategy, making it a promising option for use in future robotic systems