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

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)

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

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

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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

Successful Treatment of Suicidal Risk

Abstract. Background: In this article we focused on analyzing surveyed patient-generated responses based on two outcome questions derived from a suicide-specific framework called the Collaborative Assessment and Management of Suicidality (CAMS): Q1 – "Were there any aspects of your treatment that were particularly helpful to you? If so, please describe these. Be as specific as possible." Q2 – "What have you learned from your clinical care that could help you if you became suicidal in the future?" Aims: To develop a reliable coding system based on formerly suicidal patients' responses to two open-ended prompts and examine most frequently identified themes. Method: The present study utilized a consensual qualitative research process to examine responses of clinically resolved suicidal patients, based on the CAMS resolution criteria (i.e., three consecutive CAMS sessions reporting the effective management of suicidal risk), to two Suicide Status Form (SSF) outcome questions (n = 49 for Q1, and n = 52 for Q2). Results: Reliable coding systems were developed and used to determine major themes of successful patient responses. Conclusion: The results of this study provide insight into patients' experiences of a successful treatment for suicidal risk with larger implications for suicide-specific treatments in general. </jats:p