A Method for Balancing Provider Schedules in Outpatient Specialty Clinics

Background. Variability in outpatient specialty clinic schedules contributes to numerous adverse effects including chaotic clinic settings, provider burnout, increased patient waiting times, and inefficient use of resources. This research measures the benefit of balancing provider schedules in an outpatient specialty clinic. Design. We developed a constrained optimization model to minimize the variability in provider schedules in an outpatient specialty clinic. Schedule variability was defined as the variance in the number of providers scheduled for clinic during each hour the clinic is open. We compared the variance in the number of providers scheduled per hour resulting from the constrained optimization schedule with the actual schedule for three reference scenarios used in practice at M Health Fairview’s Clinics and Surgery Center as a case study. Results. Compared to the actual schedules, use of constrained optimization modeling reduced the variance in the number of providers scheduled per hour by 92% (1.70–0.14), 88% (1.98–0.24), and 94% (1.98–0.12). When compared with the reference scenarios, the total, and per provider, assigned clinic hours remained the same. Use of constrained optimization modeling also reduced the maximum number of providers scheduled during each of the actual schedules for each of the reference scenarios. The constrained optimization schedules utilized 100% of the available clinic time compared to the reference scenario schedules where providers were scheduled during 87%, 92%, and 82% of the open clinic time, respectively. Limitations. The scheduling model’s use requires a centralized provider scheduling process in the clinic. Conclusions. Constrained optimization can help balance provider schedules in outpatient specialty clinics, thereby reducing the risk of negative effects associated with highly variable clinic settings

The Effect of Vascular Graft and Human Umbilical Cord Blood-Derived CD34+ Stem Cell on Peripheral Nerve Healing

AIM: There are many trials concerning peripheral nerve damage causes and treatment options. Unfortunately, nerve damage is still a major problem regarding health, social and economic issues. On this study, we used vascular graft and human cord blood derived stem cells to find an alternative treatment solution to this problem. MATERIAL AND METHODS: We used 21 female Wistar rats on our study. They were anesthetized with ketamine and we studied right hind limbs. On Group 1, we did a full layer cut on the right sciatic nerve. On Group 2, we did a full layer cut on the right sciatic nerve, and we covered synthetic vascular graft on cut area. On Group 3, we did a full layer cut on right sciatic nerve, and we covered the area with stem cell applied vascular graft. RESULTS: At the end of postoperative 8. weeks, we performed EMG on the rats. When we compared healthy and degenerated areas as a result of EMG, we found significant amplitude differences between the groups on healthy areas whereas there was no significant difference on degenerated  areas between the groups. Then we re-opened the operated area again to reveal the sciatic nerve cut area, and we performed electron microscope evaluation. On the stem cell group, we observed that both the axon and the myelin sheet prevented degeneration. CONCLUSION: This study is a first on using synthetic vascular graft and cord blood derived CD34+ cells in peripheral nerve degeneration. On  the  tissues  that  were  examined  with  electron  microscope,  we  observed  that  CD34+  cells  prevented  both  axonal  and  myelin  sheath degeneration. Nerve tissue showed similar results to the control group, and the damage was minimal

Comparing Benefits from Many Possible Computed Tomography Lung Cancer Screening Programs: Extrapolating from the National Lung Screening Trial Using Comparative Modeling

Background: The National Lung Screening Trial (NLST) demonstrated that in current and former smokers aged 55 to 74 years, with at least 30 pack-years of cigarette smoking history and who had quit smoking no more than 15 years ago, 3 annual computed tomography (CT) screens reduced lung cancer-specific mortality by 20% relative to 3 annual chest X-ray screens. We compared the benefits achievable with 576 lung cancer screening programs that varied CT screen number and frequency, ages of screening, and eligibility based on smoking. Methods and Findings: We used five independent microsimulation models with lung cancer natural history parameters previously calibrated to the NLST to simulate life histories of the US cohort born in 1950 under all 576 programs. ‘Efficient’ (within model) programs prevented the greatest number of lung cancer deaths, compared to no screening, for a given number of CT screens. Among 120 ‘consensus efficient’ (identified as efficient across models) programs, the average starting age was 55 years, the stopping age was 80 or 85 years, the average minimum pack-years was 27, and the maximum years since quitting was 20. Among consensus efficient programs, 11% to 40% of the cohort was screened, and 153 to 846 lung cancer deaths were averted per 100,000 people. In all models, annual screening based on age and smoking eligibility in NLST was not efficient; continuing screening to age 80 or 85 years was more efficient. Conclusions: Consensus results from five models identified a set of efficient screening programs that include annual CT lung cancer screening using criteria like NLST eligibility but extended to older ages. Guidelines for screening should also consider harms of screening and individual patient characteristics

Systematic Mapping of Process Mining Studies in Healthcare

In the last decade, as an emerging technique for business processes management, process mining (PM) has been applied in many domains, including manufacturing, supply-chain, government, healthcare, and software engineering. Particularly in healthcare, where most processes are complex, variable, dynamic, and multi-disciplinary in nature, the application of this technique is growing yet challenging. Several literature reviews, as secondary studies, reveal the state of PM applications in healthcare from different perspectives, such as clinical pathways, oncology processes, and hospital management. In this article, we present the results of a systematic mapping (SM) study which we conducted to structure the information available in the primary studies. SM is a well-accepted method to identify and categorize research literature, in which the number of primary studies is rapidly growing. We searched for studies between 2005 and 2017 in the electronic digital libraries of scientific literature, and identified 172 studies out of the 2428 initially found on the topic of PM in healthcare. We created a concept map based on the information provided by the primary studies and classified these studies according to a number of attributes including the types of research and contribution, application context, healthcare specialty, mining activity, process modeling type and notation/language, and mining algorithm. We also reported the demographics and bibliometrics trends in this domain; namely, publication volume, top-cited papers, most contributing researchers and countries, and top venues. The results of mapping showed that, despite the healthcare data and technique related challenges, the field is rapidly growing and open for further research and practice. The researchers who are interested in the field could use the results to elicit opportunities for further research. The practitioners who are considering applications of PM, on the other hand, could observe the most common aims and specialties that PM techniques are applied.WoSScopu

Induction of lutein production in Scenedesmus obliquus under different culture conditions prior to its semipreparative isolation

Microalgae with their improved growth rates and accumulation of high-value-added products make their commercial production attractive. Among them, lutein, which is a carotenoid, plays a very important role due to its various applications in the food and pharmaceutical industry. Induction of its biosynthesis can be triggered by various stress conditions like light. In this study, three different light intensities (50,150 and 300 mu mol photons/m(2)s) and aeration rates (1, 3, and 5 L/min) were utilized to induce the lutein biosynthesis and biomass productivity in Scenedesmus obliquus. Lutein was isolated by preparative chromatography using a semiprep C-30 column (10 x 250 mm, 5 mu m) and its confirmation was made by LC-MS/MS. According to the results, Scenedesmus obliquus synthesized the maximum lutein (8.01 +/- 0.1 mg/g) with biomass productivity of 1.698 g/L at 150 mu mol photons/m(2)s light intensity using 3 L/min as aeration rate. To the best of the authors' knowledge, this was the first study that the lutein was isolated by preparative chromatography using semiprep C-30 carotenoid column with a simple and rapid separation, which can be used as a reference methodology for the isolation of other carotenoids. Scenedesmus obliquus can be an important alternative source for commercial production of lutein, as it is indicated from the results of this study.Scientific and Technological Research Council of Turkey (TUBITAK) through the COST Project [216Z167]This research was funded by the Scientific and Technological Research Council of Turkey (TUBITAK) through the COST Project 216Z167

Purification of fucoxanthin from the diatom Amphora capitellata by preparative chromatography after its enhanced productivity via oxidative stress

Microalgae with high growth rates represent a potential source of carotenoids including fucoxanthin. For commercial fucoxanthin production, choosing the cultivation system is a critical parameter where the final biomass must contain a high content of the target product. To realize this, the reaction system must allow the use of stress conditions that induce the synthesis of these compounds. In this study, oxidative stress was applied to the diatom Amphora capitellata by the formation of reactive oxygen species in the culture medium through chemical reactions which generate. The effect of this oxidative stress on the amount of fucoxanthin and specific growth rate of A. capitellata was investigated. In the presence of H2O2/NaOCl, fucoxanthin content was 41.83 +/- 0.92 mg g(-1) as determined by HPLC-DAD a 2.20-fold increase compared with the control group. For the purification of fucoxanthin, preparative HPLC using a semi-prep C-30 carotenoid column (10 x 250 mm, 5 mu m) was used for the first time with an isocratic elution of 75:25 (methanol:acetonitrile) mobile phase at a flow rate of 4 mL min(-1). Liquid chromatography tandem mass spectrometry (LC-MS/MS) was employed for the confirmation of fucoxanthin. The developed method has potential to obtain highly pure fucoxanthin for food and pharmaceutical applications using A. capitellata as a commercial source of fucoxanthin, particularly after its enhancement via oxidative stress.This research was funded by the Scientific and Technological Research Council of Turkey (TUBITAK) through the COST Project 216Z167.Scientific and Technological Research Council of Turkey (TUBITAK) through the COST [216Z167

The in vitro effect of antimicrobial photodynamic therapy on Candida and Staphylococcus biofilms

Background/aim: This study was designed to evaluate the effect of antimicrobial photodynamic treatment (APDT) in a biofilm model using combinations of various dyes (rose bengal, riboflavin, and methylene blue) as photosensitizers and light sources (LED and UVA) against staphylococcal and candidal biofilms. Materials and methods: Sterile microtiter plates were used for the development and quantification of the biofilms. APDT was carried out using combinations of the light sources and dyes. The percentage of the growth inhibition was then calculated using a spectrophotometer. The broth media in the wells were aspirated, wells were stained with crystal violet, and optical density values were measured spectrophotometrically. SEM analysis of the impact of APDT on bacterial and fungal biofilms was also performed. Results: The experiments showed that the most efficacious combination was red LED + methylene blue against both staphylococcal and candidal biofilms. A marked inhibition (45.4\%) was detected on both C. albicans and C. parapsilosis biofilms. Red LED + methylene blue was also effective on S. aureus and S. epidermidis biofilms. SEM images suggested that the number of adherent cells and biofilm mass were markedly reduced after APDT treatment. Conclusion: Although the results of this study indicated the in vitro efficacy of APDT, it might also be a promising technique for the control of biofilm growth within intravenous catheters

Impact of Iontophoresis and PACK-CXL Corneal Concentrations of Antifungals in an In Vivo Model

Purpose: To investigate voriconazole (VRZ) penetration and fungal load in the cornea after applying VRZ therapy with various treatment combinations in a fungal keratitis model. Methods: Fifty-four eyes of 27 young albino rabbits were provided for this experimental study. Twelve corneas were inoculated with Candida albicans, 12 corneas were inoculated with Fusarium solani, and 6 eyes were selected as controls. Infected corneas received various treatment combinations including VRZ 1% drop therapy alone, VRZ 1% plus amphotericin B 1% drop combination therapy, iontophoretic VRZ therapy, and VRZ 1% drop therapy after corneal cross-linking. Fungal load was measured by log reduction, and VRZ levels were quantified by liquid chromatography-tandem mass spectrometry. Results: Iontophoresis-assisted VRZ application showed the highest antifungal activity against F. solani keratitis (4-log reduction) and C. albicans keratitis (5-log reduction) compared with other treatment applications. VRZ levels were also found to be the highest in corneas that received iontophoretic VRZ treatment (3.6313 +/- 0.0990 ppb for F.solani keratitis and 1.7001 +/- 0.0065 ppb for C. albicans keratitis) compared with other treatment applications. Conclusions: Iontophoresis seems to provide the highest VRZ concentration and highest antifungal activity in the cornea compared with other treatment applications for C. albicans and F. solani keratitis