DMAIC methodology for achieving public satisfaction with health departments in various districts of Punjab and optimizing CT scan patient load in urban city hospitals

The health care delivery system in Pakistan is in a process of rapid growth, and it consists of public and private sectors. The provincial government is preliminarily responsible for providing health care facilities within its province except in federally administered areas. In Pakistan, there are three tiers of governmental healthcare delivery systems, which comprise government, semi-government, and parastatal organizations. The purpose of this study is to understand the rapid increase in influx of patients in major city hospitals of the Punjab province. The reasons for patient flow towards the major city areas can vary, but our point of focus is mainly on those patients who are prescribed to get a computed tomography (CT) scan done for better diagnosis and early treatment, including but not limited to roadside accident cases. The study targets the define, measure, analyze, improve and control (DMAIC) problem solving approach to assess the potential cause of CT patient flow and the challenges that the health department is facing to cater to such a patient niche and process while minimizing the congestion in city government hospitals. The approach in this study summarizes with numerous quality tools like Voice of Customer (VOC) which is customer feedback, Customer Output Process Input and Supplier (COPIS) processes use for high-level process map to know what your customer value, Approver Resource Member Interested (ARMI) chart which is use to analyze the stakeholders on management of the project, evaluation with the help of fishbone diagram and house of quality, and for process improvement methodology we use the team brainstorming technique and the kaizen 5-why technique. The technique came up with an idea of a public-private partnership (PPP) project—partnership between public agency and private firm, as the health care industry in Punjab province is going through budgetary issues. In a PPP project, the Government will allocate the space to a private firm to build the facility on their own and provide quality service for CT scan diagnosis to the public of Punjab. The study identified the top 10 critical factors that the patients have expected from the government to be provided on priority. The Kaizen process improvement methodology has been adopted to provide the possible solution of government budgetary issues. The set of tools in this study can be adopted by other PPP projects to enhance the project performance.     

Magnetic Metal Oxide-Based Photocatalysts with Integrated Silver for Water Treatment

In this review, the most recent advances in the field of magnetic composite photocatalysts with integrated plasmonic silver (Ag) is presented, with an overview of their synthesis techniques, properties and photocatalytic pollutant removal applications. Magnetic attributes combined with plasmonic properties in these composites result in enhancements for light absorption, charge-pair generation-separation-transfer and photocatalytic efficiency with the additional advantage of their facile magnetic separation from water solutions after treatment, neutralizing the issue of silver’s inherent toxicity. A detailed overview of the currently utilized synthesis methods and techniques for the preparation of magnetic silver-integrated composites is presented. Furthermore, an extended critical review of the most recent pollutant removal applications of these composites via green photocatalysis technology is presented. From this survey, the potential of magnetic composites integrated with plasmonic metals is highlighted for light-induced water treatment and purification. Highlights: (1) Perspective of magnetic properties combined with plasmon metal attributes; (2) Overview of recent methods for magnetic silver-integrated composite synthesis; (3) Critical view of recent applications for photocatalytic pollutant removal.     

Targeted Mutations in the Fusion Peptide Region of La Crosse Virus Attenuate Neuroinvasion and Confer Protection against Encephalitis

La Crosse virus (LACV) is a major cause of pediatric encephalitis and aseptic meningitis in the Midwestern, Mid-Atlantic, and Southern United States, where it is an emerging pathogen. The LACV Gc glycoprotein plays a critical role in the neuropathogenesis of LACV encephalitis as the putative virus attachment protein. Previously, we identified and experimentally confirmed the location of the LACV fusion peptide within Gc and generated a panel of recombinant LACVs (rLACVs) containing mutations in the fusion peptide as well as the wild-type sequence. These rLACVs retained their ability to cause neuronal death in a primary embryonic rat neuronal culture system, despite decreased replication and fusion phenotypes. To test the role of the fusion peptide in vivo, we tested rLACVs in an age-dependent murine model of LACV encephalitis. When inoculated directly into the CNS of young adult mice (P28), the rLACV fusion peptide mutants were as neurovirulent as the rLACV engineered with a wild-type sequence, confirming the results obtained in tissue culture. In contrast, the fusion peptide mutant rLACVs were less neuroinvasive when suckling (P3) or weanling (P21) mice were inoculated peripherally, demonstrating that the LACV fusion peptide is a determinant of neuroinvasion, but not of neurovirulence. In a challenge experiment, we found that peripheral challenge of weanling (P21) mice with fusion peptide mutant rLACVs protected from a subsequent WT-LACV challenge, suggesting that mutations in the fusion peptide are an attractive target for generating live-attenuated virus vaccines. Importantly, the high degree of conservation of the fusion peptide amongst the Bunyavirales and, structurally, other arboviruses suggests that these findings are broadly applicable to viruses that use a class II fusion mechanism and cause neurologic disease.     

Weekly Nowcasting of New COVID-19 Cases Using Past Viral Load Measurements

The rapid spread of the coronavirus disease COVID-19 has imposed clinical and financial burdens on hospitals and governments attempting to provide patients with medical care and implement disease-controlling policies. The transmissibility of the disease was shown to be correlated with the patient’s viral load, which can be measured during testing using the cycle threshold (Ct). Previous models have utilized Ct to forecast the trajectory of the spread, which can provide valuable information to better allocate resources and change policies. However, these models combined other variables specific to medical institutions or came in the form of compartmental models that rely on epidemiological assumptions, all of which could impose prediction uncertainties. In this study, we overcome these limitations using data-driven modeling that utilizes Ct and previous number of cases, two institution-independent variables. We collected three groups of patients (n = 6296, n = 3228, and n = 12,096) from different time periods to train, validate, and independently validate the models. We used three machine learning algorithms and three deep learning algorithms that can model the temporal dynamic behavior of the number of cases. The endpoint was 7-week forward number of cases, and the prediction was evaluated using mean square error (MSE). The sequence-to-sequence model showed the best prediction during validation (MSE = 0.025), while polynomial regression (OLS) and support vector machine regression (SVR) had better performance during independent validation (MSE = 0.1596, and MSE = 0.16754, respectively), which exhibited better generalizability of the latter. The OLS and SVR models were used on a dataset from an external institution and showed promise in predicting COVID-19 incidences across institutions. These models may support clinical and logistic decision-making after prospective validation.     

Investigation of Structural,Physical, and Attenuation Parameters of Glass: TeO2-Bi2O3-B2O3-TiO2-RE2O3 (RE: La,Ce, Sm,Er, and Yb), and Applications Thereof

A novel series of glass, consisting of B₂O₃, Bi₂O₃, TeO₂, and TiO₂ (BBTT) containing rare earth oxide RE₂O₃, where RE is La, Ce, Sm, Er, and Yb, was prepared. We investigated the structural, optical, and gamma attenuation properties of the resultant glass. The optical energy bands, the linear refractive indices, the molar refractions, the metallization criteria, and the optical basicity were all determined for the prepared glass. Furthermore, physical parameters such as the density, the molar volume, the oxygen molar volume, and the oxygen packing density of the prepared glass, were computed. Both the values of density and optical energy of the prepared glass increased in the order of La₂O₃, Ce₂O₃, Sm₂O₃, Er₂O₃, and then Yb₂O₃. In addition, the glass doped with Yb₂O₃ had the lowest refractive index, electronic polarizability, and optical basicity values compared with the other prepared glass. The structures of the prepared glass were investigated by the deconvolution of infrared spectroscopy, which determined that TeO₄, TeO₃, BO₄, BO₃, BiO₆, and TiO₄ units had formed. Furthermore, the structural changes in glass are related to the ratio of the intensity of TeO₄/TeO₃, depending on the type of rare earth. It is also clarified that the resultant glass samples are good attenuators against low-energy radiation, especially those that modified by Yb₂O₃, which exhibited superior shielding efficiency at energies of 622, 1170, and 1330 keV. The optical and gamma ray spectroscopy results of the prepared glass show that it is a good candidate for nonlinear optical fibers, laser solid material, and optical shielding protection.     

Concentration Dependent Effect of (−)‐Epicatechin on Na+/K+‐ATPase and Ca2+‐ATPase Inhibition Induced by Free Radicals in Hypertensive Patients: Comparison with L‐ascorbic Acid

Although the antioxidant properties of flavonoids are well documented, it is still unclear whether these effects are dependent on radical scavenging or iron chelating activities. Oxidative stress, a state of excessive reactive oxygen species (ROS) activity, is associated with vascular disease conditions such as hypertension. Both the anti‐ and pro‐oxidant effects of tea catechins have been implicated in the alterations of cellular functions that determine their chemoprotective and therapeutic potentials in health and diseases. The present study examined the concentration dependent (10^?7 to 10^?4 m ) effects of (?)‐epicatechin and L‐ascorbic acid on Na⁺/K⁺‐ATPase and Ca²⁺‐ATPase activity in hypertensive patients and normal subjects. L‐ascorbic acid has been used as a positive control to compare the effect of (?)‐epicatechin. A significant (p < 0.0001) decrease in the activities of Na⁺/K⁺‐ATPase and Ca²⁺‐ATPase was observed in hypertensive patients compared with normal subjects. We report that (?)‐epicatechin shows a significant (p < 0.001) dose‐dependent protective effect against oxidative stress induced by tert‐butyl hydroperoxide (t‐BHP), which is manisfested as a decrease in the activity of erythrocyte Na⁺/K⁺‐ATPase and Ca²⁺‐ATPase, in hypertensive patients as well as normal subjects. The effect of L‐ascorbic acid was also significant (p < 0.001) and was comparable with that of (?)‐epicatechin. Copyright © 2012 John Wiley & Sons, Ltd.     

Bilateral uterine artery ligation via minilaparotomy for heavy menstrual bleeding

Objective

To assess the safety and short-term efficacy of bilateral uterine artery ligation (UAL) via minilaparotomy for the management of heavy menstrual bleeding (HMB).

Methods

A prospective study of 30 women with HMB who underwent UAL. The primary outcome was cumulative treatment failure 12 months after the procedure. Treatment failure was defined as the need for hysterectomy during the follow-up period.

Results

At 12 months, 6 women had undergone hysterectomy for bleeding, for a cumulative failure rate of 20% (95% CI, 9%-38%). The number of bleeding days was significantly reduced by 11.9 ± 1.5 days (P < 0.001) and hemoglobin level significantly increased by 1.3 ± 0.15 g/dL (P < 0.001). Of the 30 women, 24 (80%) were satisfied with the results. No major complications were reported during the procedure or median follow-up period of 13.2 months.

Conclusion

Bilateral UAL is a safe and effective minimally invasive procedure that can provide an alternative treatment for HMB.     

CYP1A1 gene polymorphism and polycystic ovary syndrome

The aim of this study was to assess the rates of variant alleles of cytochrome P4501A1 (CYP1A1) in patients with polycystic ovary syndrome (PCOS). It was designed as a case-control study in Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology and Genetics. Forty-eight patients with PCOS served as the study group. Ninety-six regularly cycling women with no clinical and biochemical evidence of hyperandrogenism and polycystic ovary appearance served as the controls. The CYP1A1 variant alleles of all patients were determined via polymerase chain reaction. The rate of the CYP1A1 isoleucine (Ile)/valine (Val) allele was significantly higher in patients with PCOS than in the controls (OR: 7.8, 95% CI: 3.45-17.52, P < 0.001). However, there was no statistically significant difference in the distribution of Val/Val genotype (OR: 4.0, 95% CI: 0.60-26.73). The rate of any Val genotype (Ile/Val or Val/Val) was significantly higher in patients with PCOS compared with the control group (OR: 7.4, 95% CI: 3.33-16.46, P < 0.001). In conclusion, the patients with PCOS had a 7.8-fold higher frequency of CYP1A1 Ile/Val genotype and a 7.4-fold higher frequency of CYP1A1 of any Val genotype (Ile/Val or Val/Val).     

Cryptococcosis masquerading as a tuboovarian abscess.

This report describes a 25-year-old human immunodeficiency virus- seropositive patient who initially presented with clinical features of a tuboovarian abscess. After a poor response to antibiotic therapy, laparotomy and excision of a right-sided, unilocular, pseudocystic ovarian mass measuring 140 x 80 x 60 mm were undertaken. Mucoid gelatinous material, with a glistening appearance and slimy consistency, coated the inner surface of the thick wall. The cyst contained clear, viscid fluid with a similar slimy consistency. Although the macroscopic diagnosis was that of an ovarian mucinous cystadenocarcinoma, histopathologic assessment confirmed a well-circumscribed pseudocystic cryptococcoma with a wall of granulation and fibrous tissue and compressed ovarian stroma. The inner surface was covered by large, paucireactive, extracellular "yeast lakes" of carminophilous Cryptococcus neoformans yeasts of varying shape and size. To the best of our knowledge, this is the first documentation of ovarian cryptococcosis in the English language literature. Despite their rarity in the female genital tract, fungal infections must be considered in the differential diagnosis of patients presenting with pelvic pain of obscure origin and a pelvic mass that is refractory to antibiotic therapy.