Demonstrating competence in endoscopic retrograde cholangiopancratico graphy (ERCP): Recently credentialed operator\u27s performance for deep biliary cannulation over 1 year period from a tertiary care hospital in Pakistan

Objective: To measure the success rate of endoscopic retrograde cholangiopancreaticography biliary cannulation of a recently credentialed endoscopist at a tertiary hospital.Methods: The clinical audit was conducted at the Aga Khan University Hospital. Karachi, and comprised data of all patients who underwent endoscopic retrograde cholangiopancreaticography under the care of a single operator during 2016. Data was retrospectively extracted from patient charts by an assistant blinded to the study. Data extracted included demographics, admission type, details and indication for the procedure, diagnosis, cannulation outcome, duct clearance, complications, follow-up surgical intervention, radiological imaging and mortality post-endoscopy. Data was analysed using SPSS 19.Results: Of 143 procedures performed, 102(71.3%) were included. The mean age was 52±17 years and 54(52.9%) of them were females. Most common indication was choledocholithiasis in 70(68.6%). The average procedure time was 41.5±5.5 minutes. Cannulation success rate was 96(94.1%). Complications included post-procedure pancreatitis in 5(4.9%), minimal bleeding in 8(7.8%) and oesophageal perforation in 1(0.98%). There was no procedure-related mortality.Conclusions: The success rate was high and complications were low with zero mortality

Efficiency Test of Forecasts: an illustration for Carbon Emission

World Economies are facing numerous challenges concurrently. Among them one of most pertinent is global warming. Almost all the countries are victims of climate changes. Therefore, several economic mechanisms in environmental policy have been adopted to combat the distasteful impacts of climate change. The implication of environmental policies for clean energy environment in a country can be accessed via several channels. Forecast analysis is one of them, it reveals the forthcoming arrangement. The direction of the forecast trend discloses the current as well as potential outlook, indicating the intensity of policy brunt. The study evaluated the forecast and their accuracy to ensure the performance of forecast. Carbon emission in Gulf countries and their forecast are used as a case study. ARIMA model is used to obtain the forecast. Afterward, to evaluate the forecast performance, the study utilized the different efficiency criterion defined by Nordhaus (1987). By following the several efficiency test study found consistent and efficient forecasts.  These performance tests ascertain the reliability and accuracy of the trend followed by forecasts.  Accurate Forecasts direct better policy formation and management decision with buoyancy. Moreover, earlier policy resolution becomes more lucid

Ethyl 2-[3-(3,5-Dinitrobenzo­yl)thio­ureido]benzoate

In the title compound, C17H14N4O7S, the dihedral angle between the two benzene rings is 9.04 (15)°. The centroid–centroid distance of 3.9825 (19) Å between nearly parallel benzene rings of adjacent mol­ecules suggests the existence of π-π stacking. Inter­molecular and intra-mol­ecular N—H⋯O hydrogen bonding is present in the structure. The eth­oxy group is disordered over two sets of sites with an occupancy ratio of 0.580 (15):0.420 (15). The crystal studied was an inversion twin

Evaluation of laparoscopic appendectomy vs. open appendectomy: a retrospective study at Aga Khan University Hospital, Karachi, Pakistan

OBJECTIVE: To compare open and laparoscopic appendectomies and to evaluate the level of efficacy of both types of appendectomy performed at Aga Khan University Hospital (AKUH). METHODS: Based on this strong study rationale, a clinical audit of patient\u27s records was performed to evaluate the significance of this technique as a treatment modality. The study population comprised of patients with appendicitis admitted in the Department of Surgery from January 2004 to December 2004. The patients\u27 charts were reviewed to ascertain whether the procedure was done as an acute case or as an elective procedure. The predictor variables explored in this study were: age, gender, ultrasound and CT focused procedure, operative time, post-operative stay, number of hours required for the return of bowel function, use of narcotic analgesia and the total hospital bill of the respective patients. RESULTS: A total of 49 patients\u27 clinical charts were reviewed. Of these, 29 patients had had laparoscopic appendectomies and the remaining 20 had open appendectomies. The mean post-operative stay in days was relatively shorter for laparoscopic appendectomy (1.97 +/- 2.3) compared to open appendectomy (3.1 +/- 1.8). The average time for the return of bowel movement was remarkably lesser for laparoscopic appendectomy (10.6 +/- 8.2) hours than open appendectomy (21 +/- 13) hours. Two of the independent variables: CT focused (P-value: 0.01) and operative times in minutes (P-value: 0.06) were found to be significantly associated with the types of appendectomy. Hence our study found that laparoscopic appendectomy, although relatively expensive, is a safe and effective procedure for the removal of appendix over open appendectomy

Simulation of the research process

This paper presents first steps towards the development of a formal model of the research process. We evaluate the use of simulation as a tool for the evaluation of research strategies in nascent research organizations faced with the absence of significant data. We start by modeling the research process by using the ”Publish or Perish” paradigm, a well-known criteria of evaluation of research. We demonstrate the use of this model for researchers to evaluate the effects of selection of a particular publishing venue over time. We then perform various experiments using this basic idea. By means of various visualization techniques, we see how researchers with similar publishing policies might self-organize in the form of groups. We also evaluate the effects of giving higher weights to articles in journals and see where the effects of publishing in these venues breaks even for both top as well as average acceptance rates

The 1:1 adduct of caffeine and 2-(1,3-dioxoisoindolin-2-yl)acetic acid

In the crystal structure of the title adduct [systematic name: 2-(1,3-dioxoisoindolin-2-yl)acetic acid–1,3,7-trimethyl-1,2,3,6-tetra­hydro-7H-purine-2,6-dione (1/1)], C8H10N4O2·C10H7NO4, the components are linked by an O—H⋯N hydrogen-bond and no proton transfer occurs

catena-Poly[[diaqua­calcium]bis­[μ-2-(1,3-dioxoisoindolin-2-yl)acetato]-κ3 O,O′:O;κ3 O:O,O′]

In the title complex, [Ca(C10H6NO4)2(H2O)2]n, the CaII atom lies on a twofold rotation axis and adopts a dodeca­hedral geometry. The CaII atom is octa­coordinated by two O atoms from two water mol­ecules and six O atoms from four acetate ligands. Each acetate acts as a tridentate ligand bridging two CaII atoms, resulting in a chain running along the c axis. O—H⋯O and C—H⋯O hydrogen bonds connect the chains into a two-dimensional network parallel to [011]. π–π inter­actions between adjacent isoindoline-1,3-dione rings [centroid–centroid distance = 3.4096 (11) Å] further consolidate the structure. One of the carboxylate O atoms is disordered over two sites in a 0.879 (12):0.121 (12) ratio

N-(Benzothia­zol-2-yl)butyramide

The title compound, C11H12N2OS, was synthesized from 2-amino­benzothia­zole and butanoyl chloride in anhydrous acetone. In the crystal structure, mol­ecules are linked by N—H⋯N and C—H⋯O hydrogen bonds and by C—H⋯π inter­actions

A computer-based system for the management of field crop pests

This article describes an expert system, COT-XPERT, developed for controlling insects and diseases affecting cotton crop as well as system for Rice Stem Borers (RSB) simulation. The system works in two parts. The first part addresses the issues of efficient use of knowledge for RSB problems and predicts the population build-up of RSB after a certain period of time by taking into consideration weather factor, number of larvae per square metre present earlier,fecundity of female and dispersal pattern, etc. The second part is an expert system for the management of cotton pests which diagnoses the pest problem by using information about the damage inflicted to the crop or based on its morphology and displays all technical information about the pests as well as efficient control measures for a particular pest. The paper concluded with a mention of some of the limitations and future research directions for enhancing the qualities of the system