Modeling a Nb\u3csub\u3e3\u3c/sub\u3eSn Cryounit in GPT at UITF

Nb3Sn is a prospective material for future superconducting radio frequency (SRF) accelerator cavities. Compared to conventional niobium, the material can achieve higher quality factors, higher temperature operation, and potentially higher accelerating gradients (Eacc ≈ 96 MV/m). In this work, we performed modeling of the Upgraded Injector Test Facility (UITF) at Jefferson Lab utilizing newly constructed Nb3Sn cavities. We studied the effects of the buncher cavity and varied the gun voltage from 200-500 keV. We have calibrated and optimized the SRF cavity gradients and phases for the Nb3Sn five-cell cavities\u27 energy gains with the framework of the General Particle Tracer (GPT). Our calculations show the beam goes cleanly through the unit. There is full energy gain out of the second SRF cavity but not from the first SRF cavity due to non-relativistic phase shifts

Experience of Laparoscopic Cholecystectomy at Lumbini Medical College Teaching Hospital

  Introduction: The difficult gallbladder is the most common difficult laparoscopy being performed by generalsurgeons all over the world and the potential one that places the patient at significant risk. The present study aimed to study all the cases of laparoscopic cholecystectomy conducted in current setup at Lumbini Medical College and Teaching Hospital, to compare the results with the published literature and also analyze the complications and ways to decrease the incidence of conversion to open procedure.   Methods: Five hundred twenty five patients age 10-90 years, male:female ratio of 1:3.86 with body weight 45-65 kilogram, who had undergone laparoscopic cholecystectomy for symptomatic cholelithiasis without choledocholithiasis from April 2011 to April 2013 were studied.   Results: All the laparoscopic cholecystectomy (LC) were without major complications. Only nineteen out of five hundred twentyfive (3.6%) required conversion to open cholecystectomy (OC). Reasons for conversion included: dense omental or visceral adhesions; two (0.38%), unclear anatomy; 16 (3.04%), common bile duct injury; one (0.19%). There were 20 cases of shrunken gallbladder suspicious of malignancy but didn’t required conversion.   Conclusion: Laparoscopic cholecystectomy is the preferred method in our setup even in difficult cases

Anxiety and depression among people living in quarantine centers during COVID-19 pandemic: a mixed method study from western Nepal

Background In response to the COVID-19 pandemic, incoming travelers were quarantined at specific centers in Nepal and major checkpoints in Nepal-India border. Nepal adopted a generic public health approaches to control and quarantine returnee migrants, with little attention towards the quality of quarantine facilities and its aftermath, such as the poor mental health of the returnee migrants. The main objective of this study was to explore the status of anxiety and depression, and factors affecting them among returnee migrants living in institutional quarantine centers of western Nepal. Methods A mixed method approach in this study included a quantitative survey and in-depth interviews (IDIs) among respondents in quarantine centers of Karnali province between 21st April and 15th May 2020. Survey questionnaire utilized Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) tools, which were administered among 441 quarantined returnee migrants. IDIs were conducted among 12 participants which included a mix of six quarantined migrants and healthcare workers each from the quarantine centres. Descriptive and inferential analyses were conducted on quantitative data; and thematic analysis was utilized for qualitative data. Results Mild depression (9.1%; 40/441) and anxiety (16.1%; 71/441) was common among respondents followed by moderate depression and anxiety {depression (3.4%; 15/441), anxiety (4.1%; 18/441)} and severe depression and anxiety {depression (1.1%; 5/441), anxiety (0.7%; 3/441)}. Anxiety and depression were independent of their socio-demographic characteristics. Perceived fear of contracting COVID-19, severity and death were prominent among the respondents. Respondents experienced stigma and discrimination in addition to being at the risk of disease and possible loss of employment and financial responsibilities. In addition, poor (quality and access to) health services, and poor living condition at the quarantine centres adversely affected respondents’ mental health. Conclusion Depression and anxiety were high among quarantined population and warrants more research. Institutional quarantine centers of Karnali province of Nepal were in poor conditions which adversely impacted mental health of the respondents. Poor resource allocation for health, hygiene and living conditions can be counterproductive to the population quarantined

Modeling a Nb\u3csub\u3e3\u3c/sub\u3eSn Cryounit in GPT in UITF

Nb₃Sn is a prospective material for future superconducting RF (SRF) accelerator cavities. The material can achieve higher quality factors, higher temperature operation and potentially higher accelerating gradients (E_{acc} 96 MV/m) compared to conventional niobium. In this work, we performed modeling of the Upgraded Injector Test Facility (UITF) at Jefferson Lab utilizing newly constructed Nb₃Sn cavities. We studied the effects of the buncher cavity and varied the gun voltages from 200-500 keV. We have calibrated and optimized the SRF cavity gradients and phases for the Nb₃Sn five-cell cavities energy gains with the framework of General Particle Tracer (GPT). Our calculations show the beam goes cleanly through the unit. There is full energy gain out of the second SRF cavity but not from the first SRF cavity due to non-relativistic phase shifts

Bunch Length Measurements at the CEBAF Injector at 130 kV

In this work, we investigated the evolution in bunch length of beams through the CEBAF injector for low to high charge per bunch. Using the General Particle Tracer (GPT), we have simulated the beams through the beamline of the CEBAF injector and analyzed the beam to get the bunch lengths at the location of chopper. We performed these simulations with the existing injector using a 130 kV gun voltage. Finally, we describe measurements to validate these simulations. The measurements have been done using chopper scanning technique for two injector laser drive frequency modes: one with 500 MHz, and another with 250 MHz

CEBAF Injector Model for K\u3csub\u3eL\u3c/sub\u3e Beam Conditions

The Jefferson Lab KL experiment will run at the Continuous Electron Beam Accelerator Facility with a much lower bunch repetition rate (7.80 or 15.59 MHz) than nominally used (249.5 or 499 MHz). While the proposed average current of 2.5 - 5.0 µA is relatively low compared to the maximum CEBAF current of approximately 180 µA, the corresponding bunch charge is atypically high for CEBAF injector operation. In this work, we investigated the evolution and transmission of low-rep-rate, high-bunch-charge (0.32 to 0.64 pC) beams through the CEBAF injector. Using the commercial software General Particle Tracer, we have simulated and analyzed the beam characteristics for both values of bunch charge. We performed these simulations with the existing injector using a 130 kV gun voltage. We have calculated and measured the transmission as a function of the photocathode laser spot size and pulse length. We report on the findings of these simulations and optimum parameters for operating the experiment

Co-trimoxazole versus azithromycin for the treatment of undifferentiated febrile illness in Nepal: study protocol for a randomized controlled trial.

BACKGROUND: Undifferentiated febrile illness (UFI) includes typhoid and typhus fevers and generally designates fever without any localizing signs. UFI is a great therapeutic challenge in countries like Nepal because of the lack of available point-of-care, rapid diagnostic tests. Often patients are empirically treated as presumed enteric fever. Due to the development of high-level resistance to traditionally used fluoroquinolones against enteric fever, azithromycin is now commonly used to treat enteric fever/UFI. The re-emergence of susceptibility of Salmonella typhi to co-trimoxazole makes it a promising oral treatment for UFIs in general. We present a protocol of a randomized controlled trial of azithromycin versus co-trimoxazole for the treatment of UFI. METHODS/DESIGN: This is a parallel-group, double-blind, 1:1, randomized controlled trial of co-trimoxazole versus azithromycin for the treatment of UFI in Nepal. Participants will be patients aged 2 to 65 years, presenting with fever without clear focus for at least 4 days, complying with other study criteria and willing to provide written informed consent. Patients will be randomized either to azithromycin 20 mg/kg/day (maximum 1000 mg/day) in a single daily dose and an identical placebo or co-trimoxazole 60 mg/kg/day (maximum 3000 mg/day) in two divided doses for 7 days. Patients will be followed up with twice-daily telephone calls for 7 days or for at least 48 h after they become afebrile, whichever is later; by home visits on days 2 and 4 of treatment; and by hospital visits on days 7, 14, 28 and 63. The endpoints will be fever clearance time, treatment failure, time to treatment failure, and adverse events. The estimated sample size is 330. The primary analysis population will be all the randomized population and subanalysis will be repeated on patients with blood culture-confirmed enteric fever and culture-negative patients. DISCUSSION: Both azithromycin and co-trimoxazole are available in Nepal and are extensively used in the treatment of UFI. Therefore, it is important to know the better orally administered antimicrobial to treat enteric fever and other UFIs especially against the background of fluoroquinolone-resistant enteric fever. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02773407 . Registered on 5 May 2016

A Practitioner’s Toolkit for Insulin Motivation in Adults with Type 1 and Type 2 Diabetes Mellitus: Evidence-Based Recommendations from an International Expert Panel

Aim To develop an evidence-based expert group opinion on the role of insulin motivation to overcome insulin distress during different stages of insulin therapy and to propose a practitioner’s toolkit for insulin motivation in the management of diabetes mellitus (DM). Background Insulin distress, an emotional response of the patient to the suggested use of insulin, acts as a major barrier to insulin therapy in the management of DM. Addressing patient-, physician- and drug-related factors is important to overcome insulin distress. Strengthening of communication between physicians and patients with diabetes and enhancing the patients' coping skills are prerequisites to create a sense of comfort with the use of insulin. Insulin motivation is key to achieving targeted goals in diabetes care. A group of endocrinologists came together at an international meeting held in India to develop tool kits that would aid a practitioner in implementing insulin motivation strategies at different stages of the journey through insulin therapy, including pre-initiation, initiation, titration and intensification. During the meeting, emphasis was placed on the challenges and limitations faced by both physicians and patients with diabetes during each stage of the journey through insulinization. Review Results After review of evidence and discussions, the expert group provided recommendations on strategies for improved insulin acceptance, empowering behavior change in patients with DM, approaches for motivating patients to initiate and maintain insulin therapy and best practices for insulin motivation at the pre-initiation, initiation, titration and intensification stages of insulin therapy. Conclusions In the management of DM, bringing in positive behavioral change by motivating the patient to improve treatment adherence helps overcome insulin distress and achieve treatment goals