Proposed Framework for Smart Healthcare Services

Smart healthcare is of great interest to researchers and governments due to the increasing development of new smart cities. However, there is no current standard practice to format the cloud computing infrastructure and to assist the healthcare system architect in designing a comprehensive solution for the basic services that are required by the healthcare users while taking into consideration a balanced approach towards their specific functional and non-functional needs such as openness, scalability, concurrency, interoperability and security factors. The integration of smart healthcare services with cloud computing needs a concrete framework. The main objective of this paper is to analyze the different frameworks that discuss smart healthcare services and reach to a conclusion of the common factors to arrive at a unified and smart framework

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The uptake of Eriochrome Black T dye from aqueous solutions utilizing waste activated sludge: Adsorption process optimization using factorial design

In the present study, the sorption of Eriochrome Black T dye from aqueous solution on waste sludge was investigated by employing the factorial design method. Currently, there are worldwide interests to using inexpensive and commercially available adsorbent materials for contaminant removal. Design expert software was employed to examine the influence of different concentrations of dye, adsorbent dosage, contact time and pH on the removal efficiency of Eriochrome Black T using sludge. Additionally, the factorial design was applied to examine the interaction effect of these four variables on the adsorption process. The results were also subjected to examine the correlation between the actual and theoretical EBT dye removal efficiencies (%) which showed how closely the predicted distribution results followed the experimental values. Moreover, the experimental results were subjected to Halsey and Jovanovic adsorption isotherms to explain the adsorption process. The experimental data followed Jovanovic model with higher R2 (0.9997) than the Halsey model. Keywords: Factorial design, Adsorption, EBT, Sludge, Isotherm mode

Ultrastructure and histopathological alteration in the ovaries of Callosobruchus maculatus (F.) (Coleoptera, Chrysomelidae) induced by the solar radiation

The ultrastructure and histopathological changes in the ovarioles were tested in normal adult females and in those developed from solar energy treated pupae (53 °C for 15 min) of Callosobruchus maculatus. The telotrophic ovarioles of C. maculatus contain germarium region followed by vitellarium region which constitutes the vitellarium. The germarium houses trophocytes and the vitellarium consists of ovarian follicles. At the germarium region of the ovariole, the trophocyte or nurse cell nucleus contains uniformly spaced clumps of heterochromatin. The cytoplasm contains numerous free ribosomes and mitochondria. At the vitellarium region, follicular epithelial cells form a layer around the oocyte, each cell contains a large oval nucleus with abundant heterochromatin, and the cytoplasm contains mitochondria, free ribosomes and dark spherical globules. Also the vitellarium includes the previtellogenic oocyte which is the most anterior one and two last vitellogenic oocytes at the posterior end as the yolk was deposited. Oocyte microvilli are interdigitated with those of the follicle cells. The ooplasm consists primarily of electron-dense yolk bodies and lipid droplets. These phases could be identified in the ovarioles of normal females and to a less extent in those of females developed from the treated pupae. In the ovarian follicles of the treated generation, degeneration of the cell components of trophocytes, follicular epithelium and oocytes were the most obvious signs of damage. Also, lacking of yolk bodies and vacuolation in the border of the ooplasm were observed. The damage was more pronounced in the ovarioles of (F.) progeny of the treated generation

Carbapenem-resistant Klebsiella pneumoniae isolates from Egypt containing blaNDM-1 on IncR plasmids and its association with rmtF

Objectives: The aim of this study was to characterize carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates recovered from clinical specimens at a tertiary care hospital in Egypt over a period of 15 months. Methods: Eight CRKP isolates were included in this study. The minimum inhibitory concentrations of different antibiotics were determined by broth microdilution and Etest methods. Multilocus sequence typing was performed. Antibiotic resistance genes were assessed by PCR and DNA sequencing. Plasmid analysis was done by S1 nuclease digestion of whole genomic DNA followed by pulsed-field gel electrophoresis (S1-PFGE). Result: Eight carbapenem-resistant NDM-1-producing K. pneumoniae isolates of three different sequence types (ST) were identified (ST147, ST11, and ST17), in which blaNDM-1 was carried by either IncR or untypeable plasmids. Seven out of the eight isolates also contained the rmtF methylase gene. Conclusion: This study describes the occurrence of IncR plasmids carrying blaNDM-1 and rmtF in Egypt, raising concerns regarding this type of replicon and its role in the transmission of these resistance determinants