The preoperative prediction of a difficult laparoscopic cholecystectomy

INTRODUCTION: Laparoscopic cholecystectomy has become the standard operative procedure for cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy mainly because of technical difficulty. The aim was to define the possibility of prediction of a difficult outcome preoperatively. AIMS AND OBJECTIVES: 1. To determine the possibility of predicting preoperatively a difficult laparoscopic cholecystectomy. 2. To determine the factors which significantly predict the outcome. 3. To identify patients at risk in an elective setting and thereby enable patient counselling. MATERIALS AND METHODOLOGY: 40 patients with symptomatic gallstones planned for elective surgery and operated upon by a single experienced laparoscopic surgeon were studied by assigning a score depending upon clinical and sonological parameters. RESULTS: Out of 40 cases, 11 had a difficult outcome with scores ranging between 5 and 10. None had a score >10. Age >50, Obesity, Previous hospitalization, Palpable gallbladder and Wall thickness > 4mm on ultrasonogram were found to significantly influence the outcome. The ideal cut off point was a score of 3, which could predict difficulty. Overall the positive predictive value was 78.57%. CONCLUSION: A difficult laparoscopic cholecystectomy can be predicted preoperatively. Patients having high risk may be informed and scheduled appropriately. An experienced surgeon has to operate on these patients, and he or she has to make an early decision to convert in case of difficulty

A Dynamical Analysis of a Mathematical Model on Type-2 Diabetic From Obestiy

The aim of this research is to construct a model for type-2 diabeticfrom obesity using parameters based on the female population in India.We have introduced two control variables as diet with physicalactivity and medication. The positive endemic equilibrium is obtained.The local and global stability of the model are analyzed withsome specific conditions. Numerical simulations are carried out to exhibitthe flow of variables with controls. Our study mainly highlightsthe awareness of metabolic risk by healthy diet, physical activitiesand medications

AVERTING THROUGHPUT OUTAGE LIKELIHOOD WITH RESTRICTED SHIELD

The goal of this paper would be to create a radio resource allocation strategy which allocates traffic channels based on users’ funnel conditions in addition to traffic patterns. There are many causes of this success of OFDMA as multiple access plans. To begin with, the proliferation of orthogonal frequency division multiplexing (OFDM) as favorable transmission plan for broadband wireless links makes OFDMA the “natural” option for multiple accesses. Within this paper we present a singular framework for admission control in OFDMA cells. The framework enables the conjecture of achievable rates given some sources along with a certain group of demands. An OFDMA system is understood to be one out of which each and every user occupies a subset of subcarriers, and every carrier is assigned solely to simply one user anytime. The TGM formula is dependent on greedy sensing, and it is transported out without iterations. It's optimal for that specific funnel that's being assigned. Particularly, the funnel is owned by the consumer that may boost the throughput to the most. The primary concept of the plan would be to first estimate the bandwidth allocation to fulfill the outage requirement from each user, and so the traffic throughput is maximized via a TGM formula coded in this paper. More to the point, these examples show how the value of queue versus. Funnel condition information varies using the traffic load. Maximizing the packets transmitted for every OFDM symbol transmission results in a maximum bound within the throughput

A neo-clerodane diterpene from Teucrium tomentosum. Corrigendum

Corrigendum to Acta Cryst. (2004), E60, o117–o119

Application of 3-D Imaging in a Familial Case of Cleidocranial Dysplasia

Cleidocranial dysplasia (CCD) is a rare inherited disorder affecting dental and skeletal tissues. CCD usually has an autosomal dominant pattern of inheritance and common clinical features seen are aplastic or hypoplastic clavicles, late closure of fontanelle, open skull sutures, retained deciduous teeth, late eruption of permanent teeth and presence of multiple impacted supernumerary teeth. Here, we present a case of CCD in a female patient with positive family history. The diagnosis was confirmed clinically and radiographically. The newer radiographic advancement, CBCT was used to validate the radiographic findings

An investigation on the effects of psychological contract (PC) towards site safety in the south Indian construction industry

The construction sector is India\u27s second-largest industry, contributing to the country\u27s economy and providing many job opportunities. However, construction has been described as a hazardous industry with a high rate of injuries, accidents, and fatalities compared to other sectors worldwide. The psychological contract of safety (PCS) is one of the safety climate (SC) variables that influence worker safety behavior (WSB) actions on construction sites to improve safety. This research investigates the influence of SC factors on PCS and PCS on WSB in construction site safety. A quantitative research method has been adopted in this study, and the data is collected from the construction professionals working in South India. Statistical analyses were performed for the collected data; consisted of stepwise regression analysis and structural equation modelling (SEM) analysis to determine the significance of PCS. The findings disclose that in direct effect, four out of six SC factors contribute to enhancing PCS, namely supervisor safety behavior, co-worker safety behavior, worker involvement, and safety system, and it shows that PCS influences WSB. In indirect effect of SC factor on WSB two factors positively influence namely: supervisor safety behavior, co-worker safety behavior and remaining two negatively influences. The outcome of this study helps the construction professionals to improve safety performance by fulfilling their obligations and improving WSB in construction sites

Interrogating 'effectiveness' in climate change adaptation: 11 guiding principles for adaptation research and practice

The Paris Agreement articulates a global goal on adaptation, which aims to ensure an ‘adequate adaptation response’ to the ‘global temperature goal’, and requires countries to report progress through periodic global stocktakes. However, there remain conceptual and methodological challenges in defining an adaptation goal and mixed evidence on what effective adaptation looks like and how it can be enabled. In this review, we demonstrate how different normative views on adaptation outcomes, arising from different epistemological and disciplinary entry points, can lead to very different interpretations of adaptation effectiveness. We argue that how effectiveness is framed will significantly impact adaptation implementation and outcomes. This, furthermore, represents a way of exercising influence in adaptation decision-making. Eleven principles of effective adaptation are distilled as a way to pluralize guidance in international processes such as the Global Stocktake as well as national and sub-national exercises on tracking and monitoring adaptation

Power Quality Enhancement in Sensitive Local Distribution Grid Using Interval Type-II Fuzzy Logic Controlled DSTATCOM

In the current scenario, integration of renewables, growth of non-linear industrial and commercial loads results in various power quality issues. Among commercial utilities connected to the grid, hospital-operated loads include sensitive, linear, non-linear, and unbalanced loads. These loads are diverse as well as prioritized, which also causes major power quality issues in the local distribution system. Due to its widespread divergence, it leads to harmonic injection and reactive power imbalance. Distribution Static Compensator (DSTATCOM) is proposed as a solution for harmonic mitigation, load balancing, reactive power imbalances, and neutral current compensation. The present work utilizes Interval Type-2 Fuzzy Logic Controller (IT2FLC) with Recursive Least Square (RLS) filter for generating switching pulses for IGBT switches in the DSTATCOM to improve power quality in the Local Distribution Grid. The proposed approach also shows superior performance over Type 1 fuzzy logic controller and Conventional PI controller in mitigating harmonics. For effective realization, the proposed system is simulated using MATLAB software

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries