9 research outputs found
Closed access techniques forinitial peritoneal entry in laparoscopic surgery: Veress needle versus direct trocar access
No full textDr. Ritvik Resutra, Dr. Rajive Gupta, Dr. Madhu Gupt
Trans umbilical first trocar access during laparoscopic surgery
No full textBackground: In order to perform laparoscopic procedures, it is necessary to first access the peritoneal cavity and establish carbon dioxide pneumoperitoneum. The placement of the first trocar remains a critical step in laparoscopic surgery. In order to minimize complications associated with placement of first trocar, several techniques have been reported. Author describe a surgical technique that provides a quick, safe, and reliable initial access to the peritoneal cavity with its excellent functional and cosmetic results.Methods: Retrospective study of patients who underwent various laparoscopic procedures at Maxx lyfe Hospital, Bathindi, Jammu was carried out by the closed technique for initial access to the peritoneal cavity through the umbilicus from July 2016 to May 2019. In this study, patients who had a prior midline laparotomy with involvement of the umbilicus were excluded.Results: Authors analyzed 456 patients (M = 190; F = 266) in the study period. Average age of the patients was 32 years (range:12-86). A physiologic defect was identified in the umbilical region in all patients who had no history of previous abdominal surgery in that region. The average time to access the peritoneal cavity was 30 seconds (range: 20-50).Conclusions: This technique is quick, safe, reliable, simple, and easy to learn and easy to perform. It is associated with no mortality and minimal morbidity and has excellent cosmetic results. Based on authors experience, authors believe that this method provides surgeons with an effective and safe way to insert the first trocar and recommend it as a routine procedure to access the peritoneal cavity for abdominal laparoscopic surgery
Modified three port laparoscopic cholecystectomy versus conventional four port technique
No full textBackground: The current study was undertaken to compare the results of modified three-port laparoscopic cholecystectomy and conventional three or four-port surgery in terms of technical feasibility, safety of the technique, postoperative pain and need of post-operative analgesia, cosmetic satisfaction of the patient and cost effectiveness and were found to be better with the modified technique.Methods: In modified three port laparoscopic cholecystectomy technique, first 10 mm umbilical, second 5 mm epigastric and third 5 mm subcostal ports are made, i.e., "10-5-5" instead of "10-10-5" or "10-10-5-5" of conventional three or four port techniques and finally, gallbladder is extracted through the umbilical port.Results: The pain in the postoperative period and the requirement of postoperative analgesia were significantly less and there was better cosmetic satisfaction of the patients operated by the modified three port laparoscopic cholecystectomy technique as compared to conventional three or four port surgery.Conclusions: The modified three-port laparoscopic cholecystectomy technique is safe and has the same comfort and feasibility to the surgeon along with added advantage of less pain and better cosmetic appearance to the patient in comparison to the conventional three or four-port surgery, with no obvious increase in complications and is definitely a viable alternative procedure for the management of cholelithiasis
Stitch less, clip less, three ports laparoscopic cholecystectomy: experience of 300 cases
No full textBackground: 300 cases of cholelithiasis were operated by stitch less, clip less, three ports laparoscopic cholecystectomy at Maxx lyfe Hospital, near Bathindi morh, Sunjwan road, Jammu with effect from August 2017 to May 2019. The outcome measures in the form of safety of the technique, postoperative pain, need of postoperative analgesia, number of OT assistants needed, duration of hospital stay, recovery and return to routine work, cosmetic satisfaction of the patient were taken into consideration and were found to be better than in conventional four ports technique of laparoscopic cholecystectomy.Methods: In three port laparoscopic cholecystectomy, first 10 mm umbilical, second 5 mm subxyphoid and third 5 mm subcostal ports are used and telescope is passed into the peritoneal cavity through the umbilical port. Retraction of the gallbladder is done by the long grasping forceps through the 5 mm subcostal port, whereas dissection is accomplished through the subxyphoid port. The gallbladder is retrieved through the subxyphoid port.Results: Mean operative time was 40 minutes and mean duration of postoperative stay in the hospital was 18 hours. Days to return to normal activity was 4 days at an average.Conclusions: The 3-port laparoscopic cholecystectomy technique is safe and has better outcomes in the form of less postoperative pain, less duration of hospital stay, early return to routine work and more cosmetic satisfaction as compared to the conventional 4-port technique, with no obvious increase in bile duct injuries and it can be a viable alternative in the field of minimally invasive surgery
QuestGen: Effectiveness of Question Generation Methods for Fact-Checking Applications
No full textVerifying fact-checking claims poses a significant challenge, even for humans. Recent approaches have demonstrated that decomposing claims into relevant questions to gather evidence enhances the efficiency of the fact-checking process. In this paper, we provide empirical evidence showing that this question decomposition can be effectively automated. We demonstrate that smaller generative models, fine-tuned for the question generation task using data augmentation from various datasets, outperform large language models by up to 8%. Surprisingly, in some cases, the evidence retrieved using machine-generated questions proves to be significantly more effective for fact-checking than that obtained from human-written questions. We also perform manual evaluation of the decomposed questions to assess the quality of the questions generated.Accepted in CIKM 2024 as a short paper 4 pages and 1 page references. Fixed typo in author nam
NO LEGO, YES LOGO: The Federal Court of Appeal Protects Innovation in Kirkbi AG and Lego Canada Inc. v. Ritvik holdings Inc.
No full textThis article will discuss the case at the trial and appellate levels. It will specifically address the underlying policy debate between the majority and the dissenting decisions at the Federal Court of Appeal. The author will compare this debate to two similar international cases involving Lego’s infamous intellectual property litigation. With this recent finding in the 40-year-old saga of international case law surrounding Lego’s trade-mark enforcement strategy, the Appeal Division of the Federal Court of Canada joins the ranks of several other courts that have similarly excluded protection for Lego based on the doctrine of functionality. The comment concludes with some suggestions as to the implications of this decision in respect of its implicit endorsement of branding and marketing, especially in the context of functional modular products, such as Lego. In seeking to uphold competition by allowing others to use the utilitarian elements of expired patents, trade-mark law raises the potential for competitors to ‘‘piggy-back’’ on the goodwill of established competitors. This has created a situation where branding and marketing have become vital for incumbent manufacturers wishing to maintain proprietary protection. As a result of Kirkbi, the makers of functional modular products have limited prospects of maintaining their monopoly rights through trade-mark protection outside of adopting an aggressive branding and packaging strategy, which could include a distinctive ornamental dress on the ware itself or its packaging (i.e., a distinguishing guise). We will briefly question whether the innovation and competition imperative impelling intellectual property policy is served by a regime that endorses branding and its potential inefficiencies
Efficacy of Early Neonatal Vitamin A Supplementation in Reducing Mortality During Infancy in Ghana, India and Tanzania: Study Protocol for a Randomized Controlled Trial.
No full textVitamin A supplementation of 6-59 month old children is currently recommended by the World Health Organization based on evidence that it reduces mortality. There has been considerable interest in determining the benefits of neonatal vitamin A supplementation, but the results of existing trials are conflicting. A technical consultation convened by WHO pointed to the need for larger scale studies in Asia and Africa to inform global policy on the use of neonatal vitamin A supplementation. Three trials were therefore initiated in Ghana, India and Tanzania to determine if vitamin A supplementation (50,000 IU) given to neonates once orally on the day of birth or within the next two days will reduce mortality in the period from supplementation to 6 months of age compared to placebo. The trials are individually randomized, double masked, and placebo controlled. The required sample size is 40,200 in India and 32,000 each in Ghana and Tanzania. The study participants are neonates who fulfil age eligibility, whose families are likely to stay in the study area for the next 6 months, who are able to feed orally, and whose parent(s) provide informed written consent to participate in the study. Neonates randomized to the intervention group receive 50,000 IU vitamin A and the ones randomized to the control group receive placebo at the time of enrollment. Mortality and morbidity information are collected through periodic home visits by a study worker during infancy. The primary outcome of the study is mortality from supplementation to 6 months of age. The secondary outcome of the study is mortality from supplementation to 12 months of age. The three studies will be analysed independent of each other. Subgroup analysis will be carried out to determine the effect by birth weight, sex, and timing of DTP vaccine, socioeconomic groups and maternal large-dose vitamin A supplementation. The three ongoing studies are the largest studies evaluating the efficacy of vitamin A supplementation to neonates. Policy formulation will be based on the results of efficacy of the intervention from the ongoing randomized controlled trials combined with results of previous studies
Assessing the impacts of 1.5 °C global warming – simulation protocol of the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP2b)
No full textIn Paris, France, December 2015, the Conference of the Parties (COP) to the
United Nations Framework Convention on Climate Change (UNFCCC) invited the
Intergovernmental Panel on Climate Change (IPCC) to provide a special
report in 2018 on the impacts of global warming of 1.5 °C
above pre-industrial levels and related global greenhouse gas emission
pathways. In Nairobi, Kenya, April 2016, the IPCC panel accepted the
invitation. Here we describe the response devised within the Inter-Sectoral
Impact Model Intercomparison Project (ISIMIP) to provide tailored,
cross-sectorally consistent impact projections to broaden the scientific
basis for the report. The simulation protocol is designed to allow for (1) separation of the impacts of historical warming starting from pre-industrial
conditions from impacts of other drivers such as historical land-use changes
(based on pre-industrial and historical impact model simulations); (2) quantification
of the impacts of additional warming up to 1.5 °C, including a potential overshoot and long-term impacts up to 2299, and
comparison to higher levels of global mean temperature change (based on the
low-emissions Representative Concentration Pathway RCP2.6 and a no-mitigation
pathway RCP6.0) with socio-economic conditions fixed at 2005 levels; and (3) assessment
of the climate effects based on the same climate scenarios while
accounting for simultaneous changes in socio-economic conditions following
the middle-of-the-road Shared Socioeconomic Pathway
(SSP2, Fricko et al., 2016) and in particular
differential bioenergy requirements associated with the transformation of
the energy system to comply with RCP2.6 compared to RCP6.0. With the aim of
providing the scientific basis for an aggregation of impacts across sectors
and analysis of cross-sectoral interactions that may dampen or amplify
sectoral impacts, the protocol is designed to facilitate consistent impact
projections from a range of impact models across different sectors (global
and regional hydrology, lakes, global crops, global vegetation, regional
forests, global and regional marine ecosystems and fisheries, global and
regional coastal infrastructure, energy supply and demand,
temperature-related mortality, and global terrestrial biodiversity)
Harmonization of global land use change and management for the period 850–2100 (LUH2) for CMIP6
No full textHuman land use activities have resulted in large changes to the biogeochemical and biophysical properties of the Earth's surface, with consequences for climate and other ecosystem services. In the future, land use activities are likely to expand and/or intensify further to meet growing demands for food, fiber, and energy. As part of the World Climate Research Program Coupled Model Intercomparison Project (CMIP6), the international community has developed the next generation of advanced Earth system models (ESMs) to estimate the combined effects of human activities (e.g., land use and fossil fuel emissions) on the carbon-climate system. A new set of historical data based on the History of the Global Environment database (HYDE), and multiple alternative scenarios of the future (2015-2100) from Integrated Assessment Model (IAM) teams, is required as input for these models. With most ESM simulations for CMIP6 now completed, it is important to document the land use patterns used by those simulations. Here we present results from the Land-Use Harmonization 2 (LUH2) project, which smoothly connects updated historical reconstructions of land use with eight new future projections in the format required for ESMs. The harmonization strategy estimates the fractional land use patterns, underlying land use transitions, key agricultural management information, and resulting secondary lands annually, while minimizing the differences between the end of the historical reconstruction and IAM initial conditions and preserving changes depicted by the IAMs in the future. The new approach builds on a similar effort from CMIP5 and is now provided at higher resolution (0.25◦ × 0.25◦) over a longer time domain (850-2100, with extensions to 2300) with more detail (including multiple crop and pasture types and associated management practices) using more input datasets (including Landsat remote sensing data) and updated algorithms (wood harvest and shifting cultivation); it is assessed via a new diagnostic package. The new LUH2 products contain > 50 times the information content of the datasets used in CMIP5 and are designed to enable new and improved estimates of the combined effects of land use on the global carbon-climate system. © Author(s) 2020. This work is distributed under the Creative Commons Attribution 4.0 License
