Lessons From India in Organizational Innovation: A Tale of Two Heart Hospitals

Recent discussions in health reform circles have pinned great hopes on the prospect of innovation as the solution to the high-cost, inadequate-quality U.S. health system. But U.S. health care institutions--insurers, providers and specialists--have ceded leadership in innovation to Indian hospitals such as Care Hospital in Hyderabad and the Fortis Hospitals around New Delhi, which have U.S.-trained doctors and can perform open heart surgery for $6000 (compared to$100,000 in the United States). The Indian success is a window into America\u27s stalemate with inflating costs and stagnant innovation

Melanocytes are selectively vulnerable to UVA-mediated bystander oxidative signaling.

Long-wave UVA is the major component of terrestrial UV radiation and is also the predominant constituent of indoor sunlamps, both of which have been shown to increase cutaneous melanoma risk. Using a two-chamber model, we show that UVA-exposed target cells induce intercellular oxidative signaling to non-irradiated bystander cells. This UVA-mediated bystander stress is observed between all three cutaneous cell types (i.e., keratinocytes, melanocytes, and fibroblasts). Significantly, melanocytes appear to be more resistant to direct UVA effects compared with keratinocytes and fibroblasts, although melanocytes are also more susceptible to bystander oxidative signaling. The extensive intercellular flux of oxidative species has not been previously appreciated and could possibly contribute to the observed cancer risk associated with prolonged UVA exposure

Organically templated three-dimensional open-framework metal selenites with a diamondoid network

Three-dimensional open-framework metal selenites of the formula, [H2N(CH2)4NH2]0.5[M(HSeO3)(Se2O5)] (M=Zn, Co or Ni), containing both selenite and diselenite units and intersecting 10-membered channels, have been prepared hydrothermally in the presence of piperazine. The compounds are isomorphous and crystallize in the P-1 space group. The structure is built up of MO6 dimers along with Se2O5 and HSeO3 units, the first two forming sheets, which are connected by the selenite units to yield a three-dimensional non-interpenetrating diamondoid network. The 10-membered channels have an unusual structure, being formed by 4-membered (M2Se2) and 6-membered (M2Se4) rings

Review on Type-2 fuzzy in biomedicine

Application of physiological and biological ethics to clinical practice is called medical science or Bio-medicine. This branch includes biochemistry, molecular biology, biological engineering neuro science, immunology, pathology and other life science applied to medicine. In this paper, a review has been done for creating a new path and motivation in this field for the new researchers as an application of fuzzy logic in life science areas. Since medical field has uncertainty in nature this topic will be very useful for the future researc

Economic effects of prolonged clopidogrel therapy after percutaneous coronary intervention

ObjectivesThis study examined the incremental cost-effectiveness of extending clopidogrel therapy from one month to one year after percutaneous coronary intervention (PCI) in an unselected, heterogeneous patient population.BackgroundClinical trials suggest that prolonging clopidogrel therapy for up to one year after PCI reduces downstream cardiac events. However, clopidogrel therapy is costly and may increase bleeding risk.MethodsUsing decision analysis, we compared the outcomes and cost of prolonging clopidogrel treatment from one month to one year after PCI with the alternative strategy of discontinuing therapy one month after the procedure. Event rates were based on 3,976 PCI patients who were treated between January 1999 and December 2001 at the Duke Medical Center and received no more than one month of clopidogrel after the procedure. Baseline characteristics and event rates were obtained from Duke clinical information systems. The effect of prolonged clopidogrel therapy on event rates was based on the Clopidogrel for the Reduction of Events During Observation (CREDO) trial per-protocol data. Unit costs and the effect of myocardial infarction (MI) on life expectancy were based on published sources.ResultsExtending clopidogrel therapy from one month to one year after PCI cost $879 per patient and reduced the risk of MI by 2.6$15,696 per year of life saved. Economic attractiveness of therapy varied with baseline risk, the effect of prolonged therapy on MI risk, and the price of clopidogrel.ConclusionsProlonging clopidogrel therapy for one year after PCI is economically attractive, particularly in high-risk patients

Probiotics and Beneficial Microorganisms in Biopreservation of Plant-Based Foods and Beverages

Maintaining the overall quality and shelf life of plant-based food and beverages is particularly important yet challenging to the food industry. Demand for natural preservation techniques has increased with the rising concerns over food safety and consumer awareness, e.g., health consciousness and food trends such as veganism and the demand for clean, labelled foods. Thus, a technique such as biopreservation has the potential to enhance food safety while fostering the quality, originality and naturalness of food. The application of probiotic microorganisms to foods and beverages provides various health benefits in addition to improved shelf life, stability and microbial safety of the food. The provision of probiotics is known to deliver various health benefits for the host’s gut health. Therefore, this review aims to investigate the importance of biopreservation and the role of probiotics in the food industry. An attempt was made to explore the various possibilities of shelf-life enhancement through the use of probiotic microorganisms as biopreservatives. Noticeable improvements in the shelf life of plant-based foods and beverages were observed due to the antimicrobial effects exerted by probiotics and potential probiotic strains which make them useful alternatives to artificially synthesized chemical preservatives

Weak acids as an alternative anti-microbial therapy

Weak acids such as acetic acid and N-acetyl cysteine (NAC) at pH less than their pKa can effectively eradicate biofilms due to their ability to penetrate the biofilm matrix and the cell membrane. However, the optimum conditions for their activity against drug resistant strains, and safety, need to be understood for their application to treat infections or to inactivate biofilms on hard surfaces. Here, we investigate the efficacy and optimum conditions at which weak acids can eradicate biofilms. We compared the efficacy of various mono and triprotic weak acids such as N-acetyl cysteine (NAC), acetic acid, formic acid and citric acid, in eradicating biofilms. We found that monoprotic weak acids/acid drugs can kill mucoid P. aeruginosa mucA biofilm bacteria provided the pH is less than their pKa, demonstrating that the extracellular biofilm matrix does not protect the bacteria from the activity of the weak acids. Triprotic acids, such as citric acid, kill biofilm bacteria at pH ​< ​pKa1. However, at a pH between pKa1 and pKa2, citric acid is effective in killing the bacteria at the core of biofilm microcolonies but does not kill the bacteria on the periphery. The efficacy of a monoprotic weak acid (NAC) and triprotic weak acid (citric acid) were tested on biofilms formed by Klebsiella pneumoniae KP1, Pseudomonas putida OUS82, Staphylococcus aureus 15981, P. aeruginosa DK1-NH57388A, a mucoid cystic fibrosis isolate and P. aeruginosa PA_D25, an antibiotic resistant strain. We showed that weak acids have a broad spectrum of activity against a wide range of bacteria, including antibiotic resistant bacteria. Further, we showed that a weak acid drug, NAC, can kill bacteria without being toxic to human cells, if its pH is maintained close to its pKa. Thus weak acids/weak acid drugs target antibiotic resistant bacteria and eradicate the persister cells in biofilms which are tolerant to other conventional methods of biofilm eradication

Field application of a genetically engineered microorganism for polycyclic aromatic hydrocarbon bioremediation process monitoring and control

On October 30, 1996, the US Environmental Protection Agency (EPA) commenced the first test release of genetically engineered microorganisms (GEMs) for use in bioremediation. The specific objectives of the investigation were multifaceted and include (1) testing the hypothesis that a GEM can be successfully introduced and maintained in a bioremediation process, (2) testing the concept of using, at the field scale, reporter organisms for direct bioremediation process monitoring and control, and (3) acquiring data that can be used in risk assessment decision making and protocol development for future field release applications of GEMs. The genetically engineered strain under investigation is Pseudomonas fluorescens strain HK44 (King et al., 1990). The original P. fluorescens parent strain was isolated from polycyclic aromatic hydrocarbon (PAH) contaminated manufactured gas plant soil. Thus, this bacterium is able to biodegrade naphthalene (as well as other substituted naphthalenes and other PAHs) and is able to function as a living bioluminescent reporter for the presence of naphthalene contamination, its bioavailability, and the functional process of biodegradation. A unique component of this field investigation was the availability of an array of large subsurface soil lysimeters. This article describes the experience associated with the release of a genetically modified microorganism, the lysimeter facility and its associated instrumentation, as well as representative data collected during the first eighteen months of operation

Thrombosis in vasculitis: from pathogenesis to treatment

In recent years, the relationship between inflammation and thrombosis has been deeply investigated and it is now clear that immune and coagulation systems are functionally interconnected. Inflammation-induced thrombosis is by now considered a feature not only of autoimmune rheumatic diseases, but also of systemic vasculitides such as Behçet’s syndrome, ANCA-associated vasculitis or giant cells arteritis, especially during active disease. These findings have important consequences in terms of management and treatment. Indeed, Behçet’syndrome requires immunosuppressive agents for vascular involvement rather than anticoagulation or antiplatelet therapy, and it is conceivable that also in ANCA-associated vasculitis or large vessel-vasculitis an aggressive anti-inflammatory treatment during active disease could reduce the risk of thrombotic events in early stages. In this review we discuss thrombosis in vasculitides, especially in Behçet’s syndrome, ANCA-associated vasculitis and large-vessel vasculitis, and provide pathogenetic and clinical clues for the different specialists involved in the care of these patients