Background and Objective(s). Rouviere’s sulcus (RS) is an important anatomical landmark. The aim of this study was to find the distribution of anatomical characteristics of RS seen during laparoscopic cholecystectomy in the population of our part of the world and its association with complications. Methods. This is a prospective observational study involving patients of age ≥16 years who underwent laparoscopic cholecystectomy for uncomplicated gall stone at BPKIHS between May and July 2019. Result. 230 cases were analyzed, and RS was present in 90.4%. Open sulcus type was the commonest (54%), followed by scar type (22.9%), closed sulcus type (12.5%), and slit type (10.6%), respectively. In 59.1% of cases, it was oblique to the anterior, inferior, and external edge of the liver, while in the remaining cases, it was transverse. The mean ± SD values for operative time and duration of hospital stay in the RS visible and the RS not visible groups were 29.16 ± 8.736 and 42.9 ± 23.646 minutes, and 1.26 ± 0.440 and 1.90 ± 0.910 days, respectively (p value ≤0.001). One minor complication occurred in each group: RS initially visible group and RS visible on the adhesion release group, while 3 minor complications occurred in the RS not visible group. Only one major complication occurred in the RS not visible group. Conclusion. Identification of RS by operating surgeons is a predictor of safe laparoscopic cholecystectomy.

A precise understanding of the optical properties of the instrumented Antarctic ice sheet is crucial to the performance of the IceCube Neutrino Observatory, a cubic-kilometer Cherenkov array of 5,160 digital optical modules (DOMs) deployed in the deep ice below the geographic South Pole. We present an update to the description of the ice tilt, which describes the undulation of layers of constant optical properties as a function of depth and transverse position in the detector. To date, tilt modeling has been based solely on stratigraphy measurements performed by a laser dust logger during the deployment of the array. We now show that it can independently be deduced using calibration data from LEDs located in the DOMs. The new fully volumetric tilt model not only confirms the magnitude of the tilt along the direction orthogonal to the ice flow obtained from prior dust logging, but also includes a newly discovered tilt component along the flow.

The science goals of IceCube-Gen2 include multi-messenger astronomy, astroparticle and particle physics. To this end, the observatory will include several detection methods including a surface array and in-ice optical sensors. The array will have an approximately 8 km 2 surface coverage consisting of elevated scintillator panels and radio antennas to detect air showers in the energy range of several 100 TeV to a few EeV. The observatory's design is unique in that the measurements using the surface array can be combined with the observations of ≥ 300 GeV muons, produced in the hadronic cascades, using the optical detectors in the ice. This allows for an enhanced ability to study cosmic-ray and hadronic physics as well as to boost the sensitivity for astrophysical neutrinos from the southern sky by reducing the primary background, atmospheric muons. We will present the baseline design of the surface array and highlight the expected scientific capabilities.

Cosmic-ray air showers emit radio waves that can be used to measure the properties of cosmic-ray primary particles. The radio detection technique presents several advantages, such as low cost and year-round duty cycle as well as the ability to provide high sensitivity to X max and energy estimation with minimal theoretical uncertainties, making it a promising tool for studying cosmic rays at the highest energies. However, the primary limitation of radio detection is the irreducible background from various sources that obscure the impulsive signals generated by air showers. To address this issue, we investigated the use of Convolutional Neural Networks (CNNs), trained on CoREAS simulations and radio backgrounds measured by a prototype station at the South Pole. We developed two different CNNs: a Classifier that distinguishes between cosmic ray event radio signals and pure background waveforms, and a Denoiser that mitigates background noise to recover the underlying cosmic-ray signal. After training the networks we apply them to the air-shower data to search for radio events. With two months data, we were able to identify 51 candidate events. The event's arrival direction reconstructed using CNN denoised radio waveforms is found to be in good agreement with the IceTop reconstruction. Finally, our approach demonstrated improved directional reconstruction compared to traditional methods.

Background: Prescription is a written instruction by a health care personnel to pharmacist to dispense drug(s). Irrational drug prescribing is a global problem, particularly in developing and transitional countries. This study was conducted to see the status of World Health Organization (WHO) core prescription indicators, complementary indices and prescription errors. Methods: It was a quantitative cross-sectional descriptive study carried out among inpatients of general surgery of tertiary hospital in eastern Nepal. Ethical approval for the study was obtained from the Institutional Review Committee. It was a convenience sampling. Calculated Sample size was 224. Enrollment of patients started on 16 May 2018 with the last case being enrolled on 1 Oct 2019 after obtaining informed consent. Relevant data was entered in a semi-structured proforma. Microsoft excel 2016 and IBM Statistical Package for the Social Sciences (SPSS) v. 21 were used for descriptive statistics. Results: Median age of inpatients was 40 (24 - 54) years with male: female ratio being 1.05. Total 1492 drugs were prescribed in 224 prescriptions. Mean number of drugs prescribed was 6.66 ± 2.33. Percentage of drugs prescribed by generic name was 25.60%. Prescriptions with at least one antimicrobial agent was 89.3%. Prescriptions with at least one injection was 92.9%. Percentage of drugs prescribed from the WHO Essential Medicine List was 66.48%. Other complementary prescribing indicators and prescription errors were also calculated. Conclusions: Most prescription indicators were inadvertently deviated away from WHO standards. Prescription errors were comparable to other studies.