AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiop...AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP).METHODS: Patients undergoing preoperative ERCP (≤90 d before laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1^st of January 1996 to the 31^st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct (≥8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient's history. Suspected prognostic factors and the combination of factors were compared to the result of ERCRRESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%,for three 72.5%, for four or more 91.4%.CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients).Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g.skill of the endoscopist, other diagnostic tools).展开更多
The paper posits that kin sociality and eusociality are derived from the handicap-care principles based on the need-based care to the handicappers from the caregivers for the self-interest of the caregivers. In this p...The paper posits that kin sociality and eusociality are derived from the handicap-care principles based on the need-based care to the handicappers from the caregivers for the self-interest of the caregivers. In this paper, handicap is defined as the difficulty to survive and reproduce independently. Kin sociality is derived from the childhood handicap-care principle where the children are the handicapped children who receive the care from the kin caregivers in the inclusive kin group to survive. The caregiver gives care for its self-interest to reproduce its gene. The individual’s gene of kin sociality contains the handicapped childhood and the caregiving adulthood. Eusociality is derived from the adulthood handicap-care principle where responsible adults are the handicapped adults who give care and receive care at the same time in the interdependent eusocial group to survive and reproduce its gene. Queen bees reproduce, but must receive care from worker bees that work but must rely on queen bees to reproduce. A caregiver gives care for its self-interest to survive and reproduce its gene. The individual’s gene of eusociality contains the handicapped childhood-adulthood and the caregiving adulthood. The chronological sequence of the sociality evolution is individual sociality without handicap, kin sociality with handicapped childhood, and eusociality with handicapped adulthood. Eusociality in humans is derived from bipedalism and the mixed habitat. The chronological sequence of the eusocial human evolution is 1) the eusocial early hominins with bipedalism and the mixed habitat, 2) the eusocial early Homo species with bipedalism, the larger brain, and the open habitat, 3) the eusocial late Homo species with bipedalism, the largest brain, and the unstable habitat, and 4) extended eusocial Homo sapiens with bipedalism, the shrinking brain, omnipresent imagination, and the harsh habitat. The omnipresence of imagination in human culture converts eusociality into extended eusociality with both perception and omnipre展开更多
Literature asserts that prenatal care is an imperative factor for subsequent health care utilization. However, in the Indian settings presence of selection bias while determining the impact of ANC visits on institutio...Literature asserts that prenatal care is an imperative factor for subsequent health care utilization. However, in the Indian settings presence of selection bias while determining the impact of ANC visits on institutional delivery has been overlooked by the researchers. Therefore this paper aims to examine the net impact of ANC visits on subsequent utilization of institutional delivery after removing the presence of selection bias using recent round of National Family Health survey data. The analysis has been carried out in two separate models, in the first model 1-2 ANC visits been compared with no visit and in the second model three or more antenatal care visits with no visit. The propensity score matching analysis used in this study sheds new light into this line of research which provides an effective strategy for controlling the confounding influence of institutional delivery. Employing the propensity score matching estimation approach we found women who made 1-2 ANC visits had 6.6 percent higher chance to deliver in an institution compared to women who made no visit. In addition, if a woman visited health centre three or more than three times, her chances were 31 percent higher to deliver in an institution. Result based on sensitivity analysis suggests that selection bias on unobserved covariates would have to be around 40 percent to alter the impact of 1-2 ANC visits. Findings suggest that interventions which plan to increase institutional delivery should target pregnant women who come for ANC checkups at institution first time, and health workers should encourage women to return to the health centre for more numbers of visits, as our results indicate that three or more ANC visits significantly change the women’s attitudes towards institutional delivery.展开更多
High diversity of species in agroforestry homegardens play main agro-ecological</span></span><span><span><span style="font-family:""> roles in complex and sustainable land ...High diversity of species in agroforestry homegardens play main agro-ecological</span></span><span><span><span style="font-family:""> roles in complex and sustainable land use systems. Efforts are being made in <span>valuing and protecting the age-old practices of agroforestry on scientific basis in homegardens. This study attempted to analyse the scientific basis of households’ practices and </span></span></span></span><span><span><span style="font-family:"">to </span></span></span><span><span><span style="font-family:"">develop strategies for the promotion of sustainable agroforestry homegardens in Matara district of Sri Lanka. Selected </span></span></span><span><span><span style="font-family:"">households were interviewed measuring their concern using </span></span></span><span><span><span style="font-family:"">5-</span></span></span><span><span><span style="font-family:"">point Likert scale, and analysed the qualitative data using non-parametric statistics. The study revealed that scientific basis of household practices in agroforestry homegardens are moderate in selection of appropriate trees and plants, and management of trees <span>and plant health care. Households pay little concern on scientific basis in planning</span> and site placement, land preparation and establishment of trees/crops, and implementing proper cultural practices. There is no significant correlation between scientific basis of practices in agroforestry in relation with size of homegardens, educational level of households, and across the category of their occupations. Resources to use scientific knowledge in practice, and opportunity to improve scientific skills have moderate correlation significantly while availability of scientific information and access to scientific knowledge have significant but low correlation as applying knowledge on scientific basis. The interest to acquire scientific knowledge, and sufficient time to improve scientific knowledge, and other reasons have no significant correlation with scientific basis of hous展开更多
文摘AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP).METHODS: Patients undergoing preoperative ERCP (≤90 d before laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1^st of January 1996 to the 31^st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct (≥8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient's history. Suspected prognostic factors and the combination of factors were compared to the result of ERCRRESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%,for three 72.5%, for four or more 91.4%.CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients).Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g.skill of the endoscopist, other diagnostic tools).
文摘The paper posits that kin sociality and eusociality are derived from the handicap-care principles based on the need-based care to the handicappers from the caregivers for the self-interest of the caregivers. In this paper, handicap is defined as the difficulty to survive and reproduce independently. Kin sociality is derived from the childhood handicap-care principle where the children are the handicapped children who receive the care from the kin caregivers in the inclusive kin group to survive. The caregiver gives care for its self-interest to reproduce its gene. The individual’s gene of kin sociality contains the handicapped childhood and the caregiving adulthood. Eusociality is derived from the adulthood handicap-care principle where responsible adults are the handicapped adults who give care and receive care at the same time in the interdependent eusocial group to survive and reproduce its gene. Queen bees reproduce, but must receive care from worker bees that work but must rely on queen bees to reproduce. A caregiver gives care for its self-interest to survive and reproduce its gene. The individual’s gene of eusociality contains the handicapped childhood-adulthood and the caregiving adulthood. The chronological sequence of the sociality evolution is individual sociality without handicap, kin sociality with handicapped childhood, and eusociality with handicapped adulthood. Eusociality in humans is derived from bipedalism and the mixed habitat. The chronological sequence of the eusocial human evolution is 1) the eusocial early hominins with bipedalism and the mixed habitat, 2) the eusocial early Homo species with bipedalism, the larger brain, and the open habitat, 3) the eusocial late Homo species with bipedalism, the largest brain, and the unstable habitat, and 4) extended eusocial Homo sapiens with bipedalism, the shrinking brain, omnipresent imagination, and the harsh habitat. The omnipresence of imagination in human culture converts eusociality into extended eusociality with both perception and omnipre
文摘Literature asserts that prenatal care is an imperative factor for subsequent health care utilization. However, in the Indian settings presence of selection bias while determining the impact of ANC visits on institutional delivery has been overlooked by the researchers. Therefore this paper aims to examine the net impact of ANC visits on subsequent utilization of institutional delivery after removing the presence of selection bias using recent round of National Family Health survey data. The analysis has been carried out in two separate models, in the first model 1-2 ANC visits been compared with no visit and in the second model three or more antenatal care visits with no visit. The propensity score matching analysis used in this study sheds new light into this line of research which provides an effective strategy for controlling the confounding influence of institutional delivery. Employing the propensity score matching estimation approach we found women who made 1-2 ANC visits had 6.6 percent higher chance to deliver in an institution compared to women who made no visit. In addition, if a woman visited health centre three or more than three times, her chances were 31 percent higher to deliver in an institution. Result based on sensitivity analysis suggests that selection bias on unobserved covariates would have to be around 40 percent to alter the impact of 1-2 ANC visits. Findings suggest that interventions which plan to increase institutional delivery should target pregnant women who come for ANC checkups at institution first time, and health workers should encourage women to return to the health centre for more numbers of visits, as our results indicate that three or more ANC visits significantly change the women’s attitudes towards institutional delivery.
文摘High diversity of species in agroforestry homegardens play main agro-ecological</span></span><span><span><span style="font-family:""> roles in complex and sustainable land use systems. Efforts are being made in <span>valuing and protecting the age-old practices of agroforestry on scientific basis in homegardens. This study attempted to analyse the scientific basis of households’ practices and </span></span></span></span><span><span><span style="font-family:"">to </span></span></span><span><span><span style="font-family:"">develop strategies for the promotion of sustainable agroforestry homegardens in Matara district of Sri Lanka. Selected </span></span></span><span><span><span style="font-family:"">households were interviewed measuring their concern using </span></span></span><span><span><span style="font-family:"">5-</span></span></span><span><span><span style="font-family:"">point Likert scale, and analysed the qualitative data using non-parametric statistics. The study revealed that scientific basis of household practices in agroforestry homegardens are moderate in selection of appropriate trees and plants, and management of trees <span>and plant health care. Households pay little concern on scientific basis in planning</span> and site placement, land preparation and establishment of trees/crops, and implementing proper cultural practices. There is no significant correlation between scientific basis of practices in agroforestry in relation with size of homegardens, educational level of households, and across the category of their occupations. Resources to use scientific knowledge in practice, and opportunity to improve scientific skills have moderate correlation significantly while availability of scientific information and access to scientific knowledge have significant but low correlation as applying knowledge on scientific basis. The interest to acquire scientific knowledge, and sufficient time to improve scientific knowledge, and other reasons have no significant correlation with scientific basis of hous
