Gall stones: a fundamental clinical review

Formation of stones in the gall bladder is known as cholelithiasis. About 10% to 20% of Western population are suffering from gall stones and this percentage is increasing day by day. Biochemically gall stones are classified into black pigment stones, brown pigment stones and cholesterol stones. Gall stones can be anatomically located at two possible sites; in the gall bladder known as cholelithiasis and in the common bile duct known as choledocholithiasis. Gall stones may present with symptoms known as symptomatic gallstones or without symptoms known as asymptomatic gallstones. The major causes of gallstones are high cholesterol diet, low bile salt levels, decreased gall bladder motility etc. Obesity, female gender, family history, rapid weight loss and vitamin B12 or folic acid deficiency are considered as important risk factors in the development of gall stones. The clinical presentations include acute cholecystitis and febrile illness with pain and tenderness in the right upper quadrant (Murphy sign). Generalized body weakness and weight loss are considered as generalized symptoms of gallstones. The complications include cholangitis, empyema of gall bladder, pancreatitis, abscess formation, porcelain gall bladder and gall bladder perforation. The differential diagnosis of gall stones is carried out based on endoscopy, ALT and AST serum levels. Non-surgical treatment for gall stones is oral dissolution therapy. The standard surgical treatment for gall stones is cholecystectomy

Seismic behavior of triple tunnel complex in soft soil subjected to transverse shaking

Combining multiple tunnels into a single tunnel complex while keeping the surrounding area compact is a complicated procedure. The condition becomes more complex when soft soil is present and the area is prone to seismic activity. Seismic vibrations produce sudden ground shaking, which causes a sharp decrease in the shear strength and bearing capacity of the soil. This results in larger ground displacements and deformation of structures located at the surface and within the soil mass. The deformations are more pronounced at shallower depths and near the ground surface. Tunnels located in that area are also affected and can undergo excessive distortions and uplift. The condition becomes worse if the tunnel area is larger, and, thus, the respective tunnel complex needs to be properly evaluated. In this research, a novel triple tunnel complex formed by combining three closely spaced tunnels is numerically analyzed using Plaxis 2D software under variable dynamic loadings. The effect of variations in lining thickness, the inner supporting structure, embedment depth on the produced ground displacements, tunnel deformations, resisting bending moments, and the developed thrusts are studied in detail. The triple tunnel complex is also compared with the rectangular and equivalent horizontal twin tunnel complexes in terms of generated thrusts and resisted seismic-induced bending moments. From the results, it is concluded that increased thickness of the lining, inner structure, and greater embedment depth results in decreased ground displacements, tunnel deformations, and increased resistance to seismic-induced bending moments. The comparison of shapes revealed that the triple tunnel complex has better resistance against moments with the least amount of thrust and surface heave produced

Exploring relationship among factors of virtual communities, trust and buying in Pakistan

Currently the world is experiencing a tremendous growth in the use of social networking sites (SNS). Virtual communities is Increasing day by day, there is still a lack of studies analyze on role of virtual community in impulse buying on the base of trust. Dramatic change in the technology it play role for the virtual communities. Virtual community is a group of people who share common interest and practices, who tend to communicate to each other on the regular base over internet via a common mechanism or location (e.g. social networking websites). Generally, virtual communities serve discussion forums where people communicate with each other and sharing common interest via an electronic media. Virtual communities play role both the retailer and consumer to communicate and discuss information regarding various product of interest

Diabetes insipidus: the basic and clinical review

Diabetes insipidus (DI) is a complex disease. DI is inability of the body to conserve water. Polydipsia and polyuria are the major manifestations of DI. DI has various variants including central diabetes insipidus (due to defect in ADH secretion), nephrogenic diabetes insipidus (due to defect in ADH receptors or urea receptors), gestational diabetes insipidus (due to catabolism of ADH by placental vasopressinase) and primary polydipsia (due to massive fluid intake). The cause of various variants of DI is either acquired or congenital. High plasma osmolality due to hypotonic urine excretion can be fatal because it can cause psychosis, lethargy, seizures, coma or even death. Polyuria and polydipsia help in the diagnosis of DI. Differential diagnosis of various variants of DI can be carried out on the basis of water deprivation test, MRI and other radiological techniques. The proper management of DI is the replenishment of water loss and correction of clinical presentations produced as a result of DI, major is hypernatremia. The best management for primary polydipsia is fluid restriction while fluid intake is used for adipsic diabetes insipidus. ADH replacement therapy is widely used to treat DI. DDAVP or desmopressin is mostly preferred ADH analogue because it has less side effects and resistant to placental vasoprssinase

A numerical evaluation of structural hot-spot stress methods in rib-to-deck joint of orthotropic steel deck

This study numerically investigates the limitations of structural hot-spot stress (SHSS) methods and proposes a guideline for the calculation of hot-spot stresses, which can be used for the better evaluation of fatigue-related problems. Four different SHSS evaluation methods have been applied to the rib-to-deck (RD) welded joint in orthotropic steel deck (OSD). These methods are used to calculate SHSS at this critical joint utilizing finite element analyses (FEA) based software Siemens NX.12. The limitations and the accuracy of these methods have been observed under different element types and meshing techniques. Moreover, the effect of the nodal-averaging feature is being studied. Two types of governing stresses are produced by the application of Eurocode fatigue load model-4. Essentially, the bending in deck-plate produces highly non-linear stress at the deck-toe, and the membrane effect in rib-plate generates linear stress at the rib-toe. Guidelines are proposed considering different parameters on these two stress states by applying SHSS evaluation methods. In comparison to other SHSS approaches, the International Institute of Welding (IIW) quadratic stress extrapolation (QSE) method shows better results for solid single-element, and the American Society of Mechanical Engineers (ASME) through thickness stress linearization (TTSL) method stands out in solid cubic-mesh technique. In general, shell elements have more consistent SHSS results as compared to solid elements for both stress states

Numerical evaluation of early-age crack induction in continuously reinforced concrete pavement with different saw-cut dimensions subjected to external varying temperature field

Since 1970, continuously reinforced concrete pavements have been used in Belgium. The standard design concept for CRCP has been modified through several changes made in the design parameters to eliminate the cluster of closely spaced crack patterns, since these crack patterns lead to the development of spalling and punch-out distresses in CRCPs. Despite adjusting the longitudinal reinforcement ratio, slab thickness, and addition of asphalt interlayer, the narrowly spaced cracks could not be effectively removed. The application of transverse partial surface saw-cuts significantly reduced the probability of randomly occurring cracks in the reconstruction project of the Motorway E313 in Herentals, Belgium. The field investigation has also indicated that the early-age crack induction in CRCP is quite susceptible to the saw-cut depth. Therefore, the present study aims to evaluate the effect of different depths and lengths of the partial surface saw-cut on the effectiveness of crack induction in CRCP under external varying temperature field. For this purpose, the FE software program DIANA 10.3 is used to develop the three dimensional finite element model of the active crack control CRCP segment. The characteristics of early-age crack induction in terms of crack initiation and crack propagation obtained from the FE model are compared and discussed concerning the field observations of the crack development on the active crack control E313 test sections. Findings indicate that the deeper saw-cut with longer cut-lengths could be a more effective attempt to induce the cracks in CRCP in desirable distributions to decrease the risk of spalling and punch-out distresses in the long-term performance of CRCP. These findings could be used as guidance to select the appropriate depth and length of saw-cut for active crack control sections of CRCP in Belgium

Evaluating the early-age crack induction in advanced reinforced concrete pavement using partial surface saw-cuts

The technological innovation of continuously reinforced concrete pavement (CRCP) that contains a significantly reduced amount of reinforcement and the same fundamental behavior as CRCP is called advanced reinforced concrete pavement (ARCP). This new concept of a rigid pavement structure is developed to eliminate unnecessary continuous longitudinal steel bars of CRCP by using partial length steel bars at predetermined crack locations. In Belgium, partial surface saw-cuts are used as the most effective crack induction method to eliminate the randomness in early-age crack patterns by inducing cracks at the predetermined locations of CRCP. The reinforcement layout of ARCP is designed based on the distribution of steel stress in continuous longitudinal steel bar in CRCP and the effectiveness of partial surface saw-cuts as a crack induction method. The 3D finite element (FE) model is developed to evaluate the behavior of ARCP with partial surface saw-cuts. The early-age crack characteristics in terms of crack initiation and crack propagation obtained from the FE simulation are validated with the field observations of cracking characteristics of the CRCP sections in Belgium. The finding indicates that there is fundamentally no difference in the steel stress distribution in the partial length steel bar of ARCP and continuous steel bar of CRCP. Moreover, ARCP exhibits the same cracking characteristics as CRCP even with a significantly reduced amount of continuous reinforcement

Comparative Analysis of Shear Strength Prediction Models for Reinforced Concrete Slab-Column Connections

This research aims at comparative analysis of shear strength prediction at slab-column connection, unifying machine learning, design codes and Finite Element Analysis. Current design codes (CDCs) of ACI 318-19 (ACI), Eurocode 2 (EC2), Compressive Force Path (CFP) method, Feed Forward Neural Network (FNN) based Artificial Neural Network (ANN), PSO-based FNN (PSOFNN), and BAT algorithm-based BATFNN are used. The study is complemented with FEA of slab for validating the experimental results and machine learning predictions.In the case of hybrid models of PSOFNN and BATFNN, mean square error is used as an objective function to obtain the optimized values of the weights, that are used by Feed Forward Neural Network to perform predictions on the slab data. Seven different models of PSOFNN, BATFNN, and FNN are trained on this data and the results exhibited that PSOFNN is the best model overall. PSOFNN has the best results for SCS=1 with highest value of R as 99.37% and lowest of MSE, and MAE values of 0.0275%, and 1.214% respectively which are better than the best FNN model for SCS=4 having the values of R, MSE, and MAE as 97.464%, 0.0492%, and 1.43%, respectively.Comment: 34 Pages,25 Figure

The cross-sectional study of anxiety levels and ratio of severity of thirteen symptoms of anxiety among medical students

Background: Anxiety is defined as physical, behavioral, social and psychological response to treat self-concept characterized by subjective, consciously perceived feelings of tension. Nowadays anxiety is most commonly found among medical students. This study was conducted to find out the anxiety levels and ratio of severity of thirteen symptoms of anxiety.Methods: A questionnaire based study was conducted among 178 medical students which tests the level of anxiety and severity of symptoms of anxiety. The questionnaire used was hamilton anxiety rating scale (HAM-A).Results: Out of 178 students, 80 (44.94%) students scored mild anxiety levels, 63 (35.39%) students scored moderate anxiety levels and 35 (19.66%) students scored severe anxiety levels.Conclusions: Mild form of anxiety is much more common among medical students and majority of these medical students are females. Moreover, the symptoms of anxiety including tension, anxious mood, depressed mood, insomnia, fear and CVS symptoms appear with moderate severity in majority of medical students while on the other hand some symptoms including general somatic muscular and sensory symptoms, difficulties in concentration and memory, genitor-urinary symptoms, respiratory symptoms, GIT symptoms and other autonomic symptoms appear with least severity among majority of medical students

Towards On-Device AI and Blockchain for 6G enabled Agricultural Supply-chain Management

6G envisions artificial intelligence (AI) powered solutions for enhancing the quality-of-service (QoS) in the network and to ensure optimal utilization of resources. In this work, we propose an architecture based on the combination of unmanned aerial vehicles (UAVs), AI and blockchain for agricultural supply-chain management with the purpose of ensuring traceability, transparency, tracking inventories and contracts. We propose a solution to facilitate on-device AI by generating a roadmap of models with various resource-accuracy trade-offs. A fully convolutional neural network (FCN) model is used for biomass estimation through images captured by the UAV. Instead of a single compressed FCN model for deployment on UAV, we motivate the idea of iterative pruning to provide multiple task-specific models with various complexities and accuracy. To alleviate the impact of flight failure in a 6G enabled dynamic UAV network, the proposed model selection strategy will assist UAVs to update the model based on the runtime resource requirements.Comment: 8 pages, 5 figures, 1 table. Accepted to IEEE Internet of Things Magazin