Choice of operative method for pancreaticojejunostomy and a multivariable study of pancreatic leakage in pancreaticoduodenectomy

BACKGROUND As one of the major abdominal operations,pancreaticoduodenectomy(PD)involves many organs.The operation is complex,and the scope of the operation is large,which can cause significant trauma in patients.The operation has a high rate of complications.Pancreatic leakage is the main complication after PD.When pancreatic leakage occurs after PD,it can often lead to abdominal bleeding and infection,threatening the lives of patients.One study found that pancreatic leakage was affected by many factors including the choice of pancreaticojejunostomy method which can be well controlled.AIM To investigate the choice of operative methods for pancreaticojejunostomy and to conduct a multivariate study of pancreatic leakage in PD.METHODS A total of 420 patients undergoing PD in our hospital from January 2014 to March 2019 were enrolled and divided into group A(n=198)and group B(n=222)according to the pancreatointestinal anastomosis method adopted during the operation.Duct-to-mucosa pancreatojejunostomy was performed in group A and bundled pancreaticojejunostomy was performed in group B.The operation time,intraoperative blood loss,and pancreatic leakage of the two groups were assessed.The occurrence of pancreatic leakage after the operation in different patients was analyzed.RESULTS The differences in operative time and intraoperative bleeding between groups A and B were not significant(P>0.05).In group A,the time of pancreatojejunostomy was 26.03±4.40 min and pancreatic duct diameter was 3.90±1.10 mm.These measurements were significantly higher than those in group B(P<0.05).The differences in the occurrence of pancreatic leakage,abdominal infection,abdominal hemorrhage and gastric retention between group A and group B were not significant(P>0.05).The rates of pancreatic leakage in patients with preoperative albumin<30 g/L,preoperative jaundice time≥8 wk,and pancreatic duct diameter<3 mm,were 23.33%,33.96%,and 19.01%,respectively.These were significantly higher than those in patients with preoperative albumin≥30 g/L,preoperative jaundice time<8 wk,and pancreatic duct diameter≥3 cm(P<0.05).Logistic regression analysis showed that preoperative albumin<30 g/L,preoperative jaundice time≥8 wk,and pancreatic duct diameter<3 mm were risk factors for pancreatic leakage after PD(odds ratio=2.038,2.416 and 2.670,P<0.05).CONCLUSION The pancreatointestinal anastomosis method during PD has no significant effect on the occurrence of pancreatic leakage.The main risk factors for pancreatic leakage include preoperative albumin,preoperative jaundice time,and pancreatic duct diameter.

Is it the time to reconsider the choice of valves for cardiac surgery： mechanical or bioprosthetic？

Valvular heart disease is a pathologic process involving one or more of the four valves(aortic,pulmonary,mitral and tricuspid)of the heart typified by stenosis or regurgitation and leading to patient symptoms.The most common causes are tissue degeneration,rheumatic fever and congenital heart diseases.Aortic valve replacement(AVR)using either mechanical or bioprosthetic(tissue)valves via open-heart surgical

Regularization and Choice of the Parameter for the Third Kind Nonlinear Volterra-Stieltjes Integral Equation Solutions

The article is considering the third kind of nonlinear Volterra-Stieltjes integral equations with the solution by Lavrentyev regularizing operator. A uniqueness theorem was proved, and a regularization parameter was chosen. This can be used in further development of the theory of the integral equations in non-standard problems, classes in the numerical solution of third kind Volterra-Stieltjes integral equations, and when solving specific problems that lead to equations of the third kind.

HSDPA is the inevitable choice of 3G development in the future

If WCDMA is stepping into mature period as the gradual progress of GSM, then HSDPA is becoming the focus as the gradual progress of WCDMA to which industry is paying close attention. HSDPA is a mobile broadband solution based on WCDMA. Just add the

Choice of Adaptation Strategies to Climate Variability among Smallholder Farmers in the Maize Based Cropping System in Namutumba District, Uganda

Smallholder farmers in Namutumba district draw on a combination of adaptation strategies to respond to effects of climate variability. However, there is limited scholarly evidence and explanation that has been conducted on the factors that influence the choice of alternative sets of strategies that smallholder farmers use in response to climate variability specific stress and literature that disentangles climatic stressors specific adaptation options. A multi-stage sampling procedure was employed to select the study area and household respondents. The study used cross-sectional research design to collect both quantitative and qualitative data. Household data was collected from 160 respondents with a structured questionnaire supported by key informant interviews. Multinomial logit modeling (MNL) was used to determine the relative influence of selected household socio-demographic factors on the choice of adaptation strategies against the dry spell. Principal Components Analysis (PCA) was used to create weighted adaptation index for categorizing various similar adaptation strategies. In order to respond to the impact of climate variability stresses, smallholder farmers have adapted growing drought-resistant crops (12.2%), extension of the agricultural frontier into wetlands during the dry spells (37%), whereas use of crop rotation (9.8%) is the most dominant strategies used to manage pest and diseases, similarly soil and water conservation (15.3%) and climate-smart planning basin (11%) are the most dominant adaptation strategies use to manage flood. Empirical results from multinomial logit modeling showed that predictor variables gender, level of education, years of farming, house size, access to credit, and own radio have a significant influence on the choice of adaptation strategies with differences significant level during the dry spell. The study recommends that future policies should focus on strengthening the existing extension training package, strengthening the existing farmer’s groups and cooperatives, encouraging informal social networks in order to boost smallholder farmers’ adaptation to climate variability.

A Gender Analysis on the Participation and Choice of Improved and Local Haricot Bean (<i>Phaseolus vulgaris L</i>.) by Farmers in Cameroon

Men and women farmer participation and choice of variety could guide breeding and drive the adoption of different haricot bean varieties. Thus, understanding how gender influences participation and choice of bean cultivation and marketing is fundamental. The study sought to analyse how socio-cultural norms determine women and men, participation and choice of variety for cultivation and sale in Cameroon’s West region. A mixed-method was used in collecting data from men and women farmers in six subdivisions in the West region of Cameroon in 2019. Result reveals that women provide most of the labour on haricot bean production than men, who are more involved in selling to national and regional markets. Participation and role were driven by socio-cultural norms of what is expected of men and women in a society where women provide food and men income for household upkeep. Women preferred varieties that were less labour intensive and food taste for household consumption while men went for labour intensive as long as they were market-oriented and high yielding. Thus, breeders should develop varieties that are mostly preferred by women, which meet the market and household demand.

Determinants of Technical University Students’ Choice of Banks: Empirical Evidence from Takoradi Technical University, Ghana

Background: The current competitive banking environment in Ghana demands that banks identify the factors key to their survival and work on these factors to ensure they remain in business. This involves the banks knowing what influences customers to choose to do business with one bank over the other. Objective: The study aimed at determining the factors the influence Technical University student’s selection of banks. Methods: Data from a cross-sectional survey of 545 student respondents of Takoradi Technical University was analysed using the statistical technique of factor analysis. Results: Four factors were adduced to be influencing bank selection amongst Takoradi Technical University students: namely, Robust E-banking, Customer Experience, Access to ATMs and Third Party Influence. Conclusion: While some of the factors are universal in nature others present with subtle nuances dependent on the milieu in which a bank finds itself, making it imperative that banks study the market in which they are operating and implement strategies deemed most suitable for attracting and retaining customers.

Key Factors Affecting Farmers’ Choice of Corn Reduction under the China’s New Agriculture Policy in the ‘Liandaowan’ Areas, Northeast China

Farmers are the main land managers, and their production decisions crucially affect crop outputs and farmland preservation.Understanding the motivations and factors underlying farmers’ decision making is a fundamental to implementation polices of government.This study analyzed factors that influence farmers’ choice of corn reduction under the China’s new agriculture policy in the ‘Liandaowan’ areas of Northeast China.This study collected data from 106 randomly selected households in 34 villages in ‘Liandaowan’ areas of Northeast China using a semi-structured questionnaire.Results showed that the Chinese corn structural adjustment plan confronted with many constraints, and most of farmers insist on planting corn.Drought and low accumulated temperature, no suitable substitution crop, farmers’ preferences, farmers’ education and age, relatively high comparative benefit of corn, the availability of machinery and technical assistance, subsidies and low family incomes all influence farmers’ choice of corn substitution.Based on our experimental results, we derived important policy implications for promoting corn structural adjustment incorporate increase crop diversity, promote soybean and corn rotation, provide adequate agricultural extension services, and increase the corn substitution subsidies and improve farmers’ income.

Choice of Species in China's Plantation Forestry

This paper reviews the new developments in the choice of tree species for China’s plantation forestry in relation to forest regionalization and site classification. After a brief discussion on the fundamental principles of choosing species,it gives the statistical data of the species composition of established forest plantations and recommendation for suitable tree species for plantations in some important forestry regions. Results of studies in 3 different cases have been given to illustrate the research approach in choice of tree species in accordance with the planting sites.

Internet-Based Optimization and Choice of Insert Grooves for Face-Milling

Manufacture is facing more furiously competition in the new century. It tends to be globalized. Rapid response and technology innovation have become the key factor to the success of manufacture enterprise. At present, internet-based manufacturing develops rapidly. With the development of engineering material and machining techniques, better cutting properties of metal cutting tools are required. The world is paying more attention to the study of indexable carbide inserts with three-dimensional complex grooves which can affect cutting properties directly and chip-controlling. So the variety and specification of indexable insert develop quickly and the application of insert with three-dimensional complex chip-former becomes wider and wider. Because milling is an interrupted cutting, the process of milling is complicated and the failure of the milling inserts is severe. It is important to choose suitable milling inserts groove for particular machining conditions before actual machining, it will extend tool life and raise productivity. Optimization and choice of inserts with complex groove via internet may serve for manufacture enterprises all over the world. The milling inserts with three-dimensional complex grooves are optimized and chosen via Internet in this paper. The face-milling process is studied, with the mathematics models of cutting force for different shape of cutting edges established, the cutting forces predicted and stress-fields of different insert grooves analyzed by FEM, according to the predictable results and the most suitable insert groove for particular machining conditions are optimized and chosen. The complex groove optimization and choice are based on a client/server model, with the client and server being on different machines across the internet. Communication between the client and server uses the TCP/IP. The result of optimization and choice will be sent to the users via Internet. Manufacturers all over the world can get the desired insert groove without paying for expensive experiments. Thus, the cost and lead time of products are reduced.

The Connotation and Path Choice of Socialist Core Value System

The socialist core value system(scVs)is a multi-layered systematic logical structure:with Marxism as the backbone which determines the fundamental nature of this value system;the common ideal of socialism with Chinese characteristics as the embodiment of its goals;national spirit and the spirit of the times as its spiritual power;and the concept of honor as its moral foundation.SCVS construction focuss on practice,and its implementation includes the following three aspects;focusing on people's livelitood to increase the attractiveness of sCVs;vigorously developing productivity and expanding the material basis of the guiding functions of SCVS;and establishing an effective mechanism for publicity and education.While practicing SCVs,objective laws need to be followed and public enthusiasm need to be mobilized,path choice for development subjects and objective practice need to be highlighted,and policy system need to be improved gradually in practice,so that a linkage mechanism for all people to participate can be formed.

Influencing Factors and Path Choice of Rebuilding Rural Financial Supervision System

The necessity of rebuilding Chinese rural financial supervision system is expounded. Rebuilding rural financial supervision system is conducive to normalizing rural financial order and forming the benign competitive situation; to clarifying the role played by rural financial organization and providing better financial services for "three agriculture";to forming safe rural financial environment to promote the development of rural economy and national economy. The restricting factors of rebuilding Chinese rural financial supervision system are analyzed. The major reasons are that rural financial legislation is relatively backward and the supervision department lacks the necessary legal basis. The administrative supervision is insufficient, which lead to the mal-position, administrative offside and vacancy of rural financial supervision;rural financial organization mechanism is unreasonable and the internal supervision mechanism is relatively bad;supervision organization of rural financial industry is imperfect and the function is imperfect; public's supervision awareness is weak and social supervision mechanism develops slowly. The paths for rebuilding Chinese rural financial supervision system are put forward including accelerating rural financial legislation to provide perfect legal evidence for rural financial supervision system; clarifying the position on governmental functions and fully displaying the leading role of rural financial supervision; establishing specialized rural financial supervision organization to perfect its supervision functions; vigorously cultivating people's supervision awareness to promote the development of social supervision mechanism.

Factors Affecting Mode Choice of Work Trips in Developing Cities—Gaza as a Case Study

The lack of efficient application of transportation planning process in developing cities, such as Gaza, leads to deficiency in adopting the suitable transport policies to mitigate the transportation problems resulting from urbanization and rapid increase of population. The mode choice model is probably the most important element in transportation planning and policy making. The aim of this study is to develop mode choice model for work trips in Gaza city and therefore investigating the factors that affect the employed people’s choice for transport modes. The model was developed using about two thirds of 552 questionnaires distributed for this purpose. The rest remaining third of questionnaires were used to validate the chosen models. The results of this research show that the factors that significantly affect the choice of transport modes are: total travel time, total cost divided by personal income, ownership of means of transport, distance, age, and average family monthly income. The developed model is able to predict the choice behavior of employed people in Gaza city as it is valid at 95% confidence level. This study can be used by transportation planners to predict the employed people’s behavior and travel demand analysis. The developed model can be used for predicting the future modal split by inputting predicted future value of exploratory variables.

Terminal fertility control: Clients’ own reason for the choice of the contraceptive method

Background: The prevalence of contraceptive use has increased worldwide due to the development and introduction of modern contraceptives and the establishment of organized family planning programs. In Nigeria, there is a very slow rise in contraceptive use prevalence, resulting in high fertility rate. Generally contraceptive is either used for birth spacing, or for the purpose of terminal fertility control to limit the number of children, and the choice of method for this purpose varies. Aims and Objectives: To determine the contraceptive methods of choice among clients seeking terminal fertility control, and their reasons for the choice of such methods. Materials and Methods: A cross-sectional study of clients attending the family planning clinic of Ladoke Akintola University of Technology Teaching hospital over a period of twenty-four months, between July, 2009 and June, 2011. All clients who had completed their family, and wanted a contraceptive method to limit their family size filled the semi-structured questionnaire after giving their informed consent. Clients’ own reasons for the choice of the particular contraceptive method were grouped, entered into SPSS work sheet, and analyzed using SPSS version 17. Result: There were five hundred and ninety-two new contraceptive method acceptors during the study period, of which 264 (44.6%) were for terminal fertility control. Progestogen-only injectable contraceptive was the method of choice for terminal fertility control by 145 (54.9%) of the clients, while 85 (32.2%) made intrauterine contraceptive device (copper-T) their method of choice, and the least chosen method was female surgical sterilization (2, 0.8%). Ease of administration, satisfaction with previous use, long duration of action, and husband’s preference were the reasons for the choice of the methods. Conclusion: There is awareness of terminal fertility control in Nigeria, especially in the southwestern region of the country, and this may be responsible for the decreasing prevalence of grandmultiparity in the region. However, reversible contraceptive method is the preferred option for this purpose.

A Proposed Method for Choice of Sample Size without Pre-Defining Error

Sample size is very important in statistical research because it is not too small or too large. Given significant level α, the sample size is calculated based on the z-value and pre-defined error. Such error is defined based on the previous experiment or other study or it can be determined subjectively by specialist, which may cause incorrect estimation. Therefore, this research proposes an objective method to estimate the sample size without pre-defining the error. Given an available sample X = {X1, X2, ..., Xn}, the error is calculated via the iterative process in which sample X is re-sampled many times. Moreover, after the sample size is estimated completely, it can be used to collect a new sample in order to estimate new sample size and so on.

Similarities and Differences in the Underlying Factors Influencing Male and Female Students of Technical Universities in the Choice of Banks: Evidence from Takoradi Technical University, Ghana

Background: This paper is a follow up to an earlier one on a study that sought to determine the factors that, in general, influence Takoradi Technical University students’ selection of banks, given the keen competition in the banking sector in Ghana. Having found the said factors in the first study, and in the face of evidence of a difference in the factors that influence bank choice elsewhere with respect to sex, the study whose findings is the subject of this paper sought to establish whether there is any such dichotomy amongst Takoradi Technical University students. Objectives: The study sought to 1) determine the factors that influence the selection of banks by males, 2) determine the factors that influence the selection of banks by females, and 3) determine whether there are any differences and similarities between male and female students with respect to the factors that influence bank selection. Methods: Data was obtained from 545 students, comprising 364 male students and 181 female students through a cross-sectional survey and was analysed using the statistical method of factor analysis, having initially established through the chi-square test of independence that bank choice and sex are not independent. Results: Four (4) factors were identified as influencing bank selection amongst the female students as against six (6) in the case of the male students. The factors identified for the female students are Customer Experience, Third Party Influence, E-banking, and Access to ATMs and that for the male students are Secure E-banking, Customer Experience, Promotion Strategy, Intelligent Responsiveness, Access to ATMs and Third Party Influence. Conclusion: Male and female students of Takoradi Technical University differ with respect to some of factors that influence bank choice. Even for the factors that are common, the importance female students attach to them is not the same as that of male students. The factors male students consider when making bank choices appear to be more strategic and wide-ranging than the females, with the latter tending to place premium on customer experience more than the former.

Determinants Factors for the Choice of the Width Prosthetic Upper Central Incisor: Review of the Literature

Materials and Methods: The authors conducted a review of the literature around the theme, determinants of the choice of the width of the upper central incisor (WUCI), through search web including Pub Med, Inari and Google. Fifteen of the most recent publications since 2005 have been selected from twenty publications. Sample size (n), age range (AR), average bi zygomatic distance (BZD), choice determinants, type of study, and mathematical formula between WUCI and BZD were the study’s interest variables. Sociodemographic characteristics, facial anatomical marks and the size of the patient’s teeth for anterosuperior were the main factors to be assessed. Results: Out of 22 included articles, the Asian continent represents 59% in which India is the leading country with 27.3% followed by American 22.8%. The most Determinants choice for the width upper central incisor in craniofacial and anterior teeth method from the published papers were BZD (100%;n = 22) and WUCI (81.8%;n = 18). Conclusion: Application of mathematical formulation maybe help to predict the exact width of the upper central incisor.