Learning curve for laparoscopic cholecystectomy has not been defined: A systematic review

Background: Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear. Methods: A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle–Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles. Results: Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut-off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies. Conclusions: The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy

PM10 source apportionment based on PMF and chemical tracers during different cruises in Western Mediterranean

In the Western Mediterranean Basin, frequently exposed to high levels of air pollutants, an important source of pollution which influence the emission, is the intensive ship traffic. The Joint Research Centre of the European Commission (JRC, EC) has started a long-term monitoring program along different years over the Mediterranean Sea based on observations from a cruise ship following a regular route in the Western Mediterranean, in collaboration with the Department of Physics of University of Genoa. In this framework, an intensive PM10 sampling campaign was organized in the summer of 2011, in order to fill in the gap of data recovered (in term of PM speciation) during the previous campaigns (Schembari et al., 2014) and to get a better and complete description of PM sources. During this campaign the route of the ship was Civitavecchia-Savona-Barcelona-Palma de Mallorca- Malta (Valletta)-Palermo-Civitavecchia (see Figure 1). The PM samples were collected on Quartz and Teflon filters (47mm diameter, flow rate 2.3 m3/h) using in parallel two Sven Leckel Ingenieurburo sequential samplers, placed on the top of the cabin where the monitoring and meteorological station was located. Samples were analyzed with different techniques: Energy Dispersive X-Ray Fluorescence at the Department of Physics of Genoa (Ariola et al, 2006); Ion Chromatography (Chow and Watson, 1999) at Department of Chemistry of University of Milan; Thermo-optical analysis (Birch and Cary, 1996) at the JRC laboratory. Ion Beam Analysis measurements of the Teflon filters sampled during the week of September 2011, using simultaneously PIXE, EBS and PESA techniques (Chiari, 2005), were performed at the 3 MV Tandetron accelerator of the LABEC laboratory of INFN in Florence. The data were used to identify and characterize the main PM10 sources along the ship route, with a focus on ship emissions, through apportionment Positive Matrix Factorization receptor modelling, PMF (Paatero et al, 1994). Particular attention was given to the evidence of emissions from heavy fuel oil combustion by ships, known to be an important source of secondary sulphate aerosol. Five sources of aerosol were resolved by the PMF analysis with a new database. The analysis allows distinguishing between secondary and primary particle mass resulting from ship emissions: V and Ni were found to be suitable tracers of heavy fuel oil combustion source during the campaign. The source having the largest impact on PM10 was identified as Sulphate source by PMF. The correlations between Sulphate and V and Ni showed the influence of ship emissions on sulphate in marine air masses

Source apportionment of PM10 in the Western Mediterranean based on observations from a cruise ship

Abstract Two intensive PM10 sampling campaigns were performed in the summers of 2009 and 2010 on the ship Costa Pacifica during cruises in the Western Mediterranean. Samples, mainly collected on an hourly basis, were analysed with different techniques (Particle Induced X-Ray Emission, PIXE; Energy Dispersive - X Ray Fluorescence, ED-XRF; Ion Chromatography, IC; Thermo-optical analysis) to retrieve the PM10 composition and its time pattern. The data were used for obtaining information about the sources of aerosol, with a focus on ship emissions, through apportionment using chemical marker compounds, correlation analysis and Positive Matrix Factorization (PMF) receptor modelling. For the campaign in 2010, 66% of the aerosol sulphate was found to be anthropogenic, only minor contributions of dust and sea salt sulphate were observed while the biogenic contribution, estimated based on the measurements of MSA, was found to be more important (26%), but influenced by large uncertainties. V and Ni were found to be suitable tracers of ship emissions during the campaigns. Four sources of aerosol were resolved by the PMF analysis; the source having the largest impact on PM10, BC and sulphate was identified as a mixed source, comprising emissions from ships. The correlations between sulphate and V and Ni showed the influence of ship emissions on sulphate in marine air masses. For the leg Palma–Tunis crossing a main ship route, the correlations between aerosol sulphate and V and Ni were particularly strong (r2 = 0.9 for both elements)

Progress and perspectives in the low-energy kaon-nucleon/nuclei interaction studies at the DAΦNE collider

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Impact of maritime traffic on polycyclic aromatic hydrocarbons, metals and particulate matter in Venice air

Harbours are important hubs for economic growth in both tourism and commercial activities. They are also an environmental burden being a source of atmospheric pollution often localized near cities and industrial complexes. The aim of this study is to quantify the relative contribution of maritime traffic and harbour activities to atmospheric pollutant concentration in the Venice lagoon. The impact of ship traffic was quantified on various pollutants that are not directly included in the current European legislation for shipping emission reduction: (i) gaseous and particulate PAHs; (ii) metals in PM10; and (iii) PM10 and PM2.5. All contributions were correlated with the tonnage of ships during the sampling periods and results were used to evaluate the impact of the European Directive 2005/33/EC on air quality in Venice comparing measurements taken before and after the application of the Directive (year 2010). The outcomes suggest that legislation on ship traffic, which focused on the issue of the emissions of sulphur oxides, could be an efficient method also to reduce the impact of shipping on primary particulate matter concentration; on the other hand, we did not observe a significant reduction in the contribution of ship traffic and harbour activities to particulate PAHs and metals

A 12-bit SAR ADC integrated on a multichannel silicon drift detector readout IC

A 12-bit analog-to-digital converter (ADC) addressed to Silicon-Drift Detectors (SDDs) multichannel readout ASICs for X- and gamma-ray applications is presented. Aiming at digitizing output multiplexed data from the upstream analog filters banks, the converter must ensure 11-bit accuracy and a sampling frequency of about 5 MS/s. The ADC architecture is the charge-redistribution (CR) successive-approximation register (SAR). A fully differential topology has also been chosen for better rejection of common-mode noise and disturbances. The internal DAC is made of binary-scaled capacitors, whose bottom plates are switched by the SAR logic to perform the binary search of the analog input value by means of the monotonic switching scheme. The A/D converter is integrated on SFERA, a multichannel ASIC fabricated in a standard CMOS 0.35 μm 3.3 V technology and it occupies an area of 0.42 mm2. Simulated static performance shows monotonicity over the whole input-output characteristic. The description of the circuit topology and of inner blocks architectures together with the experimental characterization is here presented