How can patient journey in surgical wards of a referral hospital be improved?

Background: We studied the patient journey in surgical wards in order to find an effective and efficient way of scheduling in surgical wards.Methods: We applied Root cause analysis (RCA) model within three months in a referral hospital. After understanding root causes of the events occurred through a focus discussion group, required interventions were proposed according to literatures, experiences, and preference of the stakeholders. Possible interventions were also analyzed based on its ability to reduce contributing factors in the events and the belief of process-owner that if interventions can be implemented.Results: The results were provided for five main steps: 1) the most important root cause was “not prioritizing patients and pre-scheduling the number of surgical procedures in the days before”. 2) Constraints indicated that workforce weren't allocated proportionally to the number of surgical operations in varying shift lengths, increased numbers of on-calls physicians increased related costs, the admission of patients in VIP wards have been getting a high priority, and surgeon compensation based on fee for service method was challenging. 3) The current situation of allocating three rooms on average for each physician can be changed depending on numbers of surgeries. 4) Proposed interventions are establishing a computer registration system, reforming payment methods, setting up an electronic waiting list, development of scheduling guidelines, and Applying MIP model.Conclusions: Implementing of scheduling reforms requires a comprehensive action plan system and predefined functional indicators. These should be achieved with considering comments of all clinical and technical groups to ensure the feasibility of an operating room schedule.Keywords: patient journey, surgery, scheduling, Root cause analysis (RCA), patient transfe

Automated Crowdturfing Attacks and Defenses in Online Review Systems

Malicious crowdsourcing forums are gaining traction as sources of spreading misinformation online, but are limited by the costs of hiring and managing human workers. In this paper, we identify a new class of attacks that leverage deep learning language models (Recurrent Neural Networks or RNNs) to automate the generation of fake online reviews for products and services. Not only are these attacks cheap and therefore more scalable, but they can control rate of content output to eliminate the signature burstiness that makes crowdsourced campaigns easy to detect. Using Yelp reviews as an example platform, we show how a two phased review generation and customization attack can produce reviews that are indistinguishable by state-of-the-art statistical detectors. We conduct a survey-based user study to show these reviews not only evade human detection, but also score high on "usefulness" metrics by users. Finally, we develop novel automated defenses against these attacks, by leveraging the lossy transformation introduced by the RNN training and generation cycle. We consider countermeasures against our mechanisms, show that they produce unattractive cost-benefit tradeoffs for attackers, and that they can be further curtailed by simple constraints imposed by online service providers

MODELING DRUG ELUTING STENTS FOR CORONARY ARTERY BIFURCATION CONSIDERING NON-NEWTONIAN EFFECTS

ABSTRACT 1 Drug Eluting Stents (DES) are commonly used for the treatment of stenotic arteries. Restenosis can be treated by delivering anti-thrombotic and anti-proliferative drugs to the arterial wall. The main mechanism of the drug eluting stent is to allow diffusion of the drug from the coating on the stent, into the arterial wall over a prolonged period of time. Investigation of blood flow hemodynamics and shear stress are of great importance in understanding the transport of drugs through the circulatory systems and predicting the performance of drug eluting stents. While drug eluting stent effectively reduces restenosis rate, the conventional drug eluting stent should be optimized to be used in the bifurcation stenting. Various flow patterns due to specific designs of drug eluting stent influence drug delivery. Numerical simulation techniques are appropriate approaches to study such phenomena which can be used to optimize the design of drug eluting stents for bifurcations. In this paper, the complexity of drug eluting stent function in the bifurcation is presented by employing computational fluid dynamics analysis for various stent strut designs. Drug transportation through the lumen and determination of local drug concentrations in arterial wall is carried out for both Newtonian and non-Newtonian flow * Corresponding author conditions. It is, to the author"s best knowledge, the first investigation of drug dispersion in arterial bifurcation considering the effects of both the blood rheological properties and stent strut design. NOMENCLATUR

Oral consumption of α-linolenic acid increases serum BDNF levels in healthy adult humans

Background aims: Dietary omega-6 and omega-3 fatty acids have remarkable impacts on the levels of DHA in the brain and retina. Low levels of DHA in plasma and blood hamper visual and neural development in children and cause dementia and cognitive decline in adults. The level of brain-derived neurotrophic factors (BDNF) changes with dietary omega-3 fatty acid intake. BDNF is known for its effects on promoting neurogenesis and neuronal survival. Methods: In this study, we examined the effect of the oral consumption of α-Linolenic acid (ALA) on blood levels of BDNF and Malondialdehyde (MDA) in healthy adult humans. 30 healthy volunteers, 15 men and 15 women, were selected randomly. Each individual served as his or her own control. Before consuming the Flaxseed oil capsules, 5cc blood from each individual was sampled in order to measure the plasma levels of BDNF and MDA as baseline controls. During the experiment, each individual was given 3 oral capsules of flaxseed oil, containing 500mg of alpha linolenic acid, daily for one week. Then, plasma levels of BDNF and MDA were tested. Results: The plasma levels of BDNF and MDA significantly (P < 0.05) increased in individuals who received the oral capsules of ALA. Plasma levels of BDNF increased more in the women in comparison with the men. Conclusion: ALA treatment could be a feasible approach to reduce size of infarcts in stroke patients. Thus, ALA could be used in adjunction with routine stroke therapies to minimize brain lesions caused by stroke. © 2015 Hadjighassem et al.; licensee BioMed Central

Antibiotic treatment leads to the elimination of Wolbachia endosymbionts and sterility in the diplodiploid collembolan Folsomia candida

<p>Abstract</p> <p>Background</p> <p><it>Wolbachia </it>is an extremely widespread bacterial endosymbiont of arthropods and nematodes that causes a variety of reproductive peculiarities. Parthenogenesis is one such peculiarity but it has been hypothesised that this phenomenon may be functionally restricted to organisms that employ haplodiploid sex determination. Using two antibiotics, tetracycline and rifampicin, we attempted to eliminate <it>Wolbachia </it>from the diplodiploid host <it>Folsomia candida</it>, a species of springtail which is a widely used study organism.</p> <p>Results</p> <p>Molecular assays confirmed that elimination of <it>Wolbachia </it>was successfully achieved through continuous exposure of populations (over two generations and several weeks) to rifampicin administered as 2.7% dry weight of their yeast food source. The consequence of this elimination was total sterility of all individuals, despite the continuation of normal egg production.</p> <p>Conclusion</p> <p>Microbial endosymbionts play an obligatory role in the reproduction of their diplodiploid host, most likely one in which the parthenogenetic process is facilitated by <it>Wolbachia</it>. A hitherto unknown level of host-parasite interdependence is thus recorded.</p

Regulation of Thromboxane Receptor Signaling at Multiple Levels by Oxidative Stress-Induced Stabilization, Relocation and Enhanced Responsiveness

Thromboxane A(2) (TxA(2)) is a major, unstable arachidonic acid metabolite, and plays a key role in normal physiology and control of vascular tone. The human thromboxane receptor (TPβ), expressed in COS-7 cells, is located predominantly in the endoplasmic reticulum (ER). Brief hydrogen peroxide exposure increases the efficiency of translocation of TPβ from the ER into the Golgi complex, inducing maturation and stabilization of TPβ. However, the ultimate fate of this post-ER TPβ pool is not known, nor is its capacity to initiate signal transduction. Here we specifically assessed if functional TPβ was transported to the plasma membrane following H(2)O(2) exposure.We demonstrate, by biotinylation and confocal microscopy, that exposure to H(2)O(2) results in rapid delivery of a cohort of TPβ to the cell surface, which is stable for at least eight hours. Surface delivery is brefeldin A-sensitive, indicating that translocation of this receptor cohort is from internal pools and via the Golgi complex. H(2)O(2) treatment results in potentiation of the increase to intracellular calcium concentrations in response to TPβ agonists U46619 and 8-iso PGF(2α) and also in the loss of ligand-dependent receptor internalization. Further there is increased responsiveness to a second application of the agonist. Finally we demonstrate that the effect of H(2)O(2) on stimulating surface delivery is shared with the FP prostanoid receptor but not the EP3 or EP4 receptors.In summary, brief exposure to H(2)O(2) results in an immediate and sustained increase in the surface pool of thromboxane receptor that is capable of mediating a persistent hyper-responsiveness of the cell and suggests a highly sophisticated mechanism for rapidly regulating thromboxane signaling

LPS Regulates SOCS2 Transcription in a Type I Interferon Dependent Autocrine-Paracrine Loop

Recent studies suggest that SOCS2 is involved in the regulation of TLR signaling. In this study, we found that the expression of SOCS2 is regulated in human monocyte-derived DC by ligands stimulating TLR2, 3, 4, 5, 8 and 9 signaling. SOCS2 induction by LPS was dependent on the type I IFN regulated transcription factors IRF1 and IRF3 as shown by using silencing RNAs for IRFs. Blocking endogenous type I IFN signaling, by neutralizing antibodies to the receptor IFNAR2, abolished SOCS2 mRNA expression after TLR4 stimulation. Transcription factors STAT3, 5 and 6 displayed putative binding sites in the promoter regions of the human SOCS2 gene. Subsequent silencing experiments further supported that STAT3 and STAT5 are involved in LPS induced SOCS2 regulation. In mice we show that SOCS2 mRNA induction is 45% lower in bone marrow derived macrophages derived from MyD88−/− mice, and do not increase in BMMs from IRF3−/− mice after BCG infection. In conclusion, our results suggest that TLR4 signaling indirectly increases SOCS2 in late phase mainly via the production of endogenous type I IFN, and that subsequent IFN receptor signaling activates SOCS2 via STAT3 and STAT5

Re-branding Abu Dhabi: From oil giant to energy titan

This article presents a case study of Abu Dhabi\u27s \u27energy re-branding\u27 since 2005 when it declared its intention to transform itself from an oil exporter to a total energy giant that also embraces alternative (renewable and nuclear) energy. The first part of the article identifies the benefits of this policy for Abu Dhabi\u27s external diplomacy but argues that the real driver is the emirate\u27s domestic gas shortage and its effects on economic diversification and political legitimacy. The second part of the article discusses the motivations and interactions of local and foreign agents by focusing on the implementation of alternative energy platforms. It therefore provides a rare glimpse of the policy-making process in Abu Dhabi. The final part of the article examines the extent to which energy re-branding may be linked to a process by the government to reiterate, reinterpret and repudiate Emirati identity in order to enhance regime legitimacy in the twenty-first century. © 2012 Macmillan Publishers Ltd

Circulating power: humanitarian logistics, militarism and the United Arab Emirates

While critical authors have interrogated the roots of business logistics, this paper extends the analysis and contributes to a larger critique of the cohering field of Humanitarian Logistics (HL), noting the overlap in the logistical cartographies of militarism and humanitarianism. The focus is on the UAE’s expanding logistics space into the Horn of Africa and the production of specialised HL zones like Dubai International Humanitarian City (DIHC). The article makes three core arguments. First, a logistics lens enables us to expand the study of aid beyond immediate conflict zones, into more distant spaces often constructed as ‘stable’. Second, the placement of logistics at the core of aid delivery has been a key mechanism for inserting market imperatives into humanitarian activities. Third, this gives countries outside the advanced core, such as the UAE, power to leverage and expand their logistics space for multiple purposes, in war making, aid, and commercial activities