Safety and affordability of an elective Saturday list at Pietersburg Hospital, Limpopo, South Africa

Background. The backlog of patients waiting for operations continues to be a problem in many public hospitals in South Africa (SA), with elective surgery procedures being postponed for up to 2 years.Objective. To determine the rate of death in hospital or out of hospital within 30 days of an elective procedure performed on a Saturday, and to determine the cost incurred by paying staff members who perform these operations.Method. A prospective, observational descriptive cohort study of all patients undergoing inpatient general surgery operations during weekdays and weekends between 1 September 2015 and 31 August 2016 (1 year) at Pietersburg Hospital (PBH), Limpopo, SA. Microsoft Excel 2010 (Microsoft, USA) was used to analyse and derive descriptive statistics. The finance department at the hospital calculated the overtime pay for theatre staff who operated on Saturdays.Results. The study included 1 352 operations (607 elective and 745 emergency procedures). Saturday elective operations contributed 133/607 (22%), and the rate of death for these operations was 1.5%. The most common procedures performed on a Saturday were hernia repair and amputation. The cost for 8 hours of work on a Saturday was ZAR13 900, amounting to a total of ZAR333 600 for 24 Saturdays.Conclusion. Performing minor surgery on a Saturday had a mortality rate of 1.5%, and a theatre staff cost of ~ZAR2 317 per patient, excluding surgeons’ fees. If surgeons were to be paid the costs would be ZAR3 450 per patient

Provision of an emergency theatre in tertiary hospitals is cost-effective: Audit and cost of cancelled planned elective general surgical operations at Pietersburg Hospital, Limpopo Province, South Africa

Background. Cancellations of planned elective surgical operations increase financial cost to the patient and the hospital. Objectives. To determine the rate and reasons for cancellations, estimate the cost incurred by such cancellations and recommend possible solutions. Methods. We did a prospective descriptive study of cancellations of elective general surgical operations over the 1-year period January - December 2014 in the main theatre at Pietersburg (PTB) Hospital, Limpopo Province, South Africa. All patients listed on the theatre booking slate for elective general surgical operations before the cut-off time of 13h00 on the day before the anticipated operation were included. Epi Infoversion 7 was used to analyse the data and derive the descriptive statistics. Results. There were 537 booked patients (median age 47 years, range 1 - 94); a total of 298 operations were performed, and 239 were cancelled (cancellation rate 44.5%). Reasons for cancellation were as follows: theatre needed for an emergency n=154 (64.4%), theatre equipment failure and lack of consumables n=17 (7.1%), non-theatre equipment failure n=10 (4.2%), prolonged time of operations n=13 (5.4%), abnormal blood results n=8 (3.3%), patient comorbidity and poor general condition n=9 (3.8%), patients absent from the ward n=8 (3.3%), patients not starved n=2 (0.8%), patients’ condition improved significantly n=3 (1.3%), nurses’ strike n=5 (2.1%), rebooking of cases for senior surgeons or other specialty n=2 (0.8%), and other reasons n=8 (3.3%). The cost per inpatient per day was estimated at ZAR4 890 at PTB Hospital and ZAR2 100 at district hospitals, and the total cost per cancelled operation was ZAR25 860. Conclusions. Over the 1-year period 44.5% of elective operations at PTB Hospital were cancelled, 64.4% because the theatre was needed for an emergency operation. We recommend that a theatre dedicated to emergencies be opened at PTB Hospital. The cost incurred due to cancellations was about ZAR6 million for the hospital, with additional cost and emotional trauma for the patients

On the fluid-fluid phase separation in charged-stabilized colloidal suspensions

We develop a thermodynamic description of particles held at a fixed surface potential. This system is of particular interest in view of the continuing controversy over the possibility of a fluid-fluid phase separation in aqueous colloidal suspensions with monovalent counterions. The condition of fixed surface potential allows in a natural way to account for the colloidal charge renormalization. In a first approach, we assess the importance of the so called ``volume terms'', and find that in the absence of salt, charge renormalization is sufficient to stabilize suspension against a fluid-fluid phase separation. Presence of salt, on the other hand, is found to lead to an instability. A very strong dependence on the approximations used, however, puts the reality of this phase transition in a serious doubt. To further understand the nature of the instability we next study a Jellium-like approximation, which does not lead to a phase separation and produces a relatively accurate analytical equation of state for a deionized suspensions of highly charged colloidal spheres. A critical analysis of various theories of strongly asymmetric electrolytes is presented to asses their reliability as compared to the Monte Carlo simulations

A reinforcement-learning-based model for resilient load balancing in Hyperledger Fabric

Blockchain with its numerous advantages is often considered a foundational technology with the potential to revolutionize a wide range of application domains, including enterprise applications. These enterprise applications must meet several important criteria, including scalability, performance, and privacy. Enterprise blockchain applications are frequently constructed on private blockchain platforms to satisfy these criteria. Hyperledger Fabric is one of the most popular platforms within this domain. In any privacy blockchain system, including Fabric, every organisation needs to utilise a peer node (or peer nodes) to connect to the blockchain platform. Due to the ever-increasing size of blockchain and the need to support a large user base, the monitoring and the management of different resources of such peer nodes can be crucial for a successful deployment of such blockchain platforms. Unfortunately, little attention has been paid to this issue. In this work, we propose the first-ever solution to this significant problem by proposing an intelligent control system based on reinforcement learning for distributing the resources of Hyperledger Fabric. We present the architecture, discuss the protocol flows, outline the data collection methods, analyse the results and consider the potential applications of the proposed approach

Survey and scientific evaluation of medicinal plants used by the Pahan and Teli tribal communities of Natore district, Bangladesh

The Pahans and the Telis are two of the smallest indigenous communities in Bangladesh. The Pahans, numbering about 14,000 people are widely scattered in several northern districts of the country, while the Telis are such a small community that nothing has been reported on their numbers and lifestyle. Both tribes are on the verge of disappearance. One each of the Pahan and the Teli community was located after much search in two adjoining villages of Natore district, Bangladesh. Since the tribes were found to still depend on their traditional medicinal practitioners for treatment of ailments, it was the objective of the present study to document their traditional usage of medicinal plants and to evaluate such plants against modern research-based pharmacological activity studies on these plants. Interviews were conducted of the practitioners of the Pahan and Teli community of Natore district with the help of a semi-structured questionnaire and using the guided field-walk method. Plant specimens aspointed out by the practitioners were collected and pressed on the field and identification completed at the Bangladesh National Herbarium. The Pahan tribal practitioners used 13 plants distributed into 9 families for treatment of 14 different ailments. The Teli tribal practitioner used 15 plants divided into 14 families for treatment of 17 different ailments. Eight out of the thirteen plants used by the Pahan tribal practitioner (61.5%) had reported relevant pharmacological activities in the scientific literature, while six out of the fifteen plants used by the Teli tribal practitioners (40%) had such relevant pharmacological activities in accordance with their usage. The medicinal plants used by the Pahans and Telis warrant further scientific studies toward discovery of lead compounds and efficacious drugs and the documentation and protection of the traditional medical knowledge held by these tribes

Structural coloration of chitosan-cationized cotton fabric using photonic crystals

Conventional textile coloration is a wet process involving high levels of water and chemicals consumption and wastewater generation. However, colour in textiles can also be generated by other mechanisms such as: absorption, emission, diffraction, interference and photochromism.[1] Chromotropic effect refers to reversible colour transformation due to external chemical or physical influence.[2] Photonic crystals are an important class of chromotropic materials. Colloidal crystals with a periodicity on the scale of half the wavelength of visible light exhibit structural colours similar to natural opals due to a diffraction effects that result in the appearance of a photonic band gap that forbids propagation of certain wavelengths.[3] Structural colouration is emerging as an innovative technology to produce colourful textiles materials.[4] Various colours impossible to reproduce by chemical coloration can be created by modifying the periodicity of the nanostructures or the environmental conditions using a single material.[5, 6] Photonic crystals can be applied on textile fabrics by colloid self-assembly and the structural colours can be controlled by adjusting the microspheres size and the viewing angles.[7] However, their application for textile structural coloration has been barely reported.[8] In this work, P(St-MMA-AA) composite nanospheres were deposited onto chitosan-cationized woven cotton fabrics. The structural colours of the deposited photonic crystals on the fabrics and its washing fastness were investigated.info:eu-repo/semantics/publishedVersio

Genetic analysis of cardiac SCN5A Gene in Iranian patients with hereditary cardiac arrhythmias.

SCN5A encodes alpha subunit of the major sodium channel (Nav1.5) in human cardiac tissue. Malfunction of this cardiac sodium channel is associated with a variety of cardiac arrhythmias and myocardial inherited diseases. Fifty-three members from three families each diagnosed with long-QT syndrome type 3 (LQTS3), Brugada syndrome (BrS), or sick sinus syndrome (SSS) were included in this observational, cross-sectional study. In this study, we analyzed the sequences of coding region of the SCN5A gene. Eleven members of the LQTS family (39%) showed p.Gln1507-Lys1508-Pro1509del mutation, 8 of BrS family (50%) showed p.Arg222Ter nonsense mutation, and 5 of 9 SSS family members (55%) showed a novel p.Met1498Arg mutation in the SCN5A gene. p.Gln1507-Lys1508-Pro1509del mutation, p.Arg222Ter nonsense mutation, and p.Met1498Arg in LQTS, BrS, and SSS, respectively, are reported for the first time in the Iranian population. Information regarding underlying genetic defects would be necessary for verifying certain clinically diagnosed arrhythmia types, carrier screening in affected families, and more precise therapy of the patients are required

Role of viral and bacterial pathogens in causing pneumonia among Western Australian children: A case-control study protocol

Introduction: Pneumonia is the leading cause of childhood morbidity and mortality globally. Introduction of the conjugate Haemophilus influenzae B and multivalent pneumococcal vaccines in developed countries including Australia has significantly reduced the overall burden of bacterial pneumonia. With the availability of molecular diagnostics, viruses are frequently detected in children with pneumonia either as primary pathogens or predispose to secondary bacterial infection. Many respiratory pathogens that are known to cause pneumonia are also identified in asymptomatic children, so the true contribution of these pathogens to childhood community-acquired pneumonia (CAP) remains unclear. Since the introduction of pneumococcal vaccines, very few comprehensive studies from developed countries have attempted to determine the bacterial and viral aetiology of pneumonia. We aim to determine the contribution of bacteria and viruses to childhood CAP to inform further development of effective diagnosis, treatment and preventive strategies. Methods and analysis: We are conducting a prospective case-control study (PneumoWA) where cases are children with radiologically confirmed pneumonia admitted to Princess Margaret Hospital for Children (PMH) and controls are healthy children identified from PMH outpatient clinics and from local community immunisation clinics. The case-control ratio is 1:1 with 250 children to be recruited in each arm. Nasopharyngeal swabs are collected from both cases and controls to detect the presence of viruses and bacteria by PCR; pathogen load will be assessed by quantitative PCR. The prevalence of pathogens detected in cases and controls will be compared, the OR of detection and population attributable fraction to CAP for each pathogen will be determined; relationships between pathogen load and disease status and severity will be explored. Ethics and dissemination: This study has been approved by the human research ethics committees of PMH, Perth, Australia (PMH HREC REF 2014117EP). Findings will be disseminated at research conferences and in peer-reviewed journals