Valued Supply Chain for Integrated Hospital Management: A Conceptual Framework

Thispaperbasedonsecondarydata,therefore,theauthorsconstructedconceptualframeworkafterthoroughanalyzedanumerousresearchpapers.DuetoscarcitystudiesonServiceIndustrySupplyChainManagement(SCM),thispaperwouldcreateanobleapproachforthecurrenthealthcaremanagersofhospitalstoreviewandapprisetheiroperationalandstrategicalobjectives.ThisstudyhighlightSupplyChainManagement(SCM)conceptforthehospitalwhichrepresentingaserviceindustry.InadditionthisstudyrevealsthelimitedapplicationofSCMinhospital.Consequentlytheauthorsdescriberecommendationandproposesamodelonvaluedsupplychainmanagementinhospital.Thoughthispaperhighlightsinintensiveanalysis,however,itunlocksfurtherfrontiersfortheprospectiveresearchersaswellaspractitionersinordertodevelopSCMmodelforhospital

Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

Summary Background Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. Methods In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and self-reported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). Findings We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N = 740,815). Across surveys, 15.1%–56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27–2.40) and symptomatic TB (OR 1.49, 95% CI 1.34–1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17–2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55–1.55). For alcohol drinking ≥ twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70–3.62) for subclinical TB and OR 1.43, 95% CI 0.59–3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0–85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. Interpretation Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB

Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

Background Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. Methods In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and self-reported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). Findings We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N = 740,815). Across surveys, 15.1%–56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27–2.40) and symptomatic TB (OR 1.49, 95% CI 1.34–1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17–2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55–1.55). For alcohol drinking ≥ twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70–3.62) for subclinical TB and OR 1.43, 95% CI 0.59–3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0–85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. Interpretation Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB

Tobacco smoking clusters in households affected by tuberculosis in an individual participant data meta-analysis of national tuberculosis prevalence surveys: Time for household-wide interventions?

Tuberculosis (TB) and non-communicable diseases (NCD) share predisposing risk factors. TB-associated NCD might cluster within households affected with TB requiring shared prevention and care strategies. We conducted an individual participant data meta-analysis of national TB prevalence surveys to determine whether NCD cluster in members of households with TB. We identified eligible surveys that reported at least one NCD or NCD risk factor through the archive maintained by the World Health Organization and searching in Medline and Embase from 1 January 2000 to 10 August 2021, which was updated on 23 March 2023. We compared the prevalence of NCD and their risk factors between people who do not have TB living in households with at least one person with TB (members of households with TB), and members of households without TB. We included 16 surveys (n = 740,815) from Asia and Africa. In a multivariable model adjusted for age and gender, the odds of smoking was higher among members of households with TB (adjusted odds ratio (aOR) 1.23; 95% CI: 1.11–1.38), compared with members of households without TB. The analysis did not find a significant difference in the prevalence of alcohol drinking, diabetes, hypertension, or BMI between members of households with and without TB. Studies evaluating household-wide interventions for smoking to reduce its dual impact on TB and NCD may be warranted. Systematically screening for NCD using objective diagnostic methods is needed to understand the actual burden of NCD and inform comprehensive interventions

The impact of climate change on the hydrology of the Halda Basin, southeastern Bangladesh

Theoretical thesis.Includes bibliographical references.Chapter 1: Introduction -- Chapter 2: Detection of recent changes in climate using meteorological data from southeastern Bangladesh -- Chapter 3: Simulating streamflow in the upper Halda Basin of southeastern Bangladesk using SWAT model -- Chapter 4: Combined impacts of future climate and land use changes on stream flow in the upper Halda Basin, Bangladesh -- Chapter 5: Impacts of climate variation on spawn production of Indian major carps in the Halda Basin, Bangladesh -- Chapter 6: Conclusion.Water security is one of the most challenging issues of the 21st century. Developing countries, including Bangladesh,are particularly vulnerable to climate change due to their low capacity for adaptation and mitigation, high population density and poverty. Climate change has already impacted water security in Bangladesh in many ways, mostly in the form of coastal and inland flooding due to higher monsoon precipitation and runoff, increased salinity and reduced flow during the dry season. Thus, this goal of this thesis is to identify current impacts of climate change on the Halda River Basin, southeastern Bangladesh, and assess potential future consequences of climate and land use change on river discharge. Meteorological records from this region indicate that temperature has increased by 0.4-0.6°C per decade since 1980 and 2013, although there has been no trend in mean or total precipitation. A Soil and Water Assessment Tool (SWAT) was used to simulate the catchment dynamics of a data-poor, monsoon driven, small river basin, and to serve as a baseline for scenario modelling. The model showed good agreement with gauge flow data, except during peak flows. The SWAT model was then used to predict the future impact of climate and land use changes, individually and combined, on streamflow in the Halda Basin. Result indicated a likely net gain in streamflow until at least 2060. Future shifts in temperature and precipitation of the Halda River will have broad ranging consequences. Hence, I also explored seasonal and annual relationships between carp spawn production and key climate and hydrological variables (temperature, precipitation and water discharge), finding that temperature plays the dominant role in determining spawn production over different time scales. However, precipitation and water discharge also influence spawn production on seasonal time-scales. The outcomes of this research could be used in designing management and planning tools to facilitate climate change adaptation.1 online resource (168 pages) graphs, tables, cartographic image

Insight into the Mechanism of Salt-Induced Oxidative Stress Tolerance in Soybean by the Application of Bacillus subtilis: Coordinated Actions of Osmoregulation, Ion Homeostasis, Antioxidant Defense, and Methylglyoxal Detoxification

Considering the growth-promoting potential and other regulatory roles of bacteria, we investigated the possible mechanism of the role of Bacillus subtilis in conferring salt tolerance in soybean. Soybean (Glycine max cv. BARI Soybean-5) seeds were inoculated with B. subtilis, either through a presoaking with seeds or a direct application with pot soil. After 20 days of sowing, both the seed- and soil-inoculated plants were exposed to 50, 100, and 150 mM of NaCl for 30 days. A clear sign of oxidative stress was evident through a remarkable increase in lipid peroxidation, hydrogen peroxide, methylglyoxal, and electrolyte leakage in the salt treated plants. Moreover, the efficiency of the ascorbate (AsA)–glutathione (GSH) pathways was declined. Consequently, the plant growth, biomass accumulation, water relations, and content of the photosynthetic pigments were decreased. Salt stress also caused an increased Na+/K+ ratio and decreased Ca2+. On the contrary, the B. subtilis inoculated plants showed increased levels of AsA and GSH, their redox balance, and the activities of the AsA–GSH pathway enzymes, superoxide dismutase, catalase, glutathione peroxidase, glutathione S-transferase, and peroxidase. The B. subtilis inoculated plants also enhanced the activities of glyoxalase enzymes, which mitigated methylglyoxal toxicity in coordination with ROS homeostasis. Besides this, the accumulation of K+ and Ca2+ was increased to maintain the ion homeostasis in the B. subtilis inoculated plants under salinity. Furthermore, the plant water status was uplifted in the salt treated soybean plants with B. subtilis inoculation. This investigation reveals the potential of B. subtilis in mitigating salt-induced oxidative stress in soybean plants through modulating the antioxidant defense and glyoxalase systems along with maintaining ion homeostasis and osmotic adjustments. In addition, it was evident that the soil inoculation performed better than the seed inoculation in mitigating salt-induced oxidative damages in soybean

A free vascularized fibular graft for reconstruction of mandibular bony defect following excision of odontogenic keratocyst

We present a case of reconstruction of a bony defect due to the excision of recurrent mandibular odontogenic keratocyst in a 45 years old diabetic male. Free vascularized fibular composite graft was taken from the contra lateral lower leg to reconstruct the defect. A two team approach consisting of plastic and maxillofacial (MF) surgeon was adopted. The functional and aesthetical outcome was satisfactory and bone healing occurred without any major complication. IMC J Med Sci 2017; 11(2): 70-7

Oilseed <em>Brassica</em> Responses and Tolerance to Salt Stress

Salinity interrupts osmoregulation, hinders water uptake, reduces water content, causes ionic toxicity, reduces chlorophyll content, alters stomatal conductance/movement, decreases enzymatic activity, alters transpiration and photosynthesis, disrupts the antioxidant defense system, and results in the oxidative burst. In turn, seed and oil yield is greatly declined. To overcome salinity-induced osmotic and ionic stress, plants evolve avoidance or tolerance mechanisms in order to protect the cellular components from sustaining growth and development. Ion homeostasis, vacuolar compartmentalization, accumulation of secondary metabolites, hormonal regulation, osmolytes production and by activating defensive responses, plants endure the salinity-induced damages, and enhance the stress tolerance. However, these salt-tolerant traits are greatly varied with species and genotypes as well as the extent of salt stress. Therefore, precise studies in understanding the physiology and molecular biology of stress are important to understand Brassica oilseed crops’ responses and tolerance to salt stress. In this chapter, we summarize the recent findings on the Brassica plants’ response to salt stress and later discuss the possible ways to enhance salt stress tolerance

Combined Impacts of Climate and Land Use Changes on Long-Term Streamflow in the Upper Halda Basin, Bangladesh

In Bangladesh, rapid population growth and associated land-use changes are escalating water scarcity issues, which will be further exacerbated under ongoing climate change. As such, predicting the consequences of climate and land-use change on freshwater supplies is critical for the sustainable management of water resources. In this study, a Soil and Water Assessment Tool (SWAT) associated with a Land Cover Model (LCM) were used to simulate long-term stream flows in the Halda Basin, Bangladesh, under baseline and future climate and land-use change scenarios. In addition, the separate and combined impacts of both types of change on long-term streamflow projections were assessed. Results indicate that by the 2060s, the maximum temperature of the Halda Basin may rise by 1.6 °C in comparison to the baseline 1986–2005 period, while minimum temperature will also increase, albeit at a lower rate than maximum temperature. Precipitation during the dry season is expected to increase, although it may decline in the monsoon period. Simulations show that these changes in climate are likely to increase future streamflow in the Halda catchment, with monthly streamflow influenced mainly by the variability in precipitation. The LCM projected decreases in grassland along with cultivated land at the expense of artificial areas. Combined, future climate and land-use changes are projected to increase annual streamflow, with climate change likely to be a greater driver of altered streamflow than land-use changes. Our results should guide environmental management authorities in more sustainable and strategic water resource planning under global climate change

Simulating streamflow in the Upper Halda Basin of southeastern Bangladesh using SWAT model

Most catchments in tropical regions are ungauged and data deficient, complicating the simulation of water quantity and quality. Yet, developing and testing hydrological models in data-poor regions is vital to support water management. Here, we used the Soil and Water Assessment Tool (SWAT) to predict stream runoff in Halda Basin in Bangladesh. While the calibrated model’s performance was satisfactory (R2 = 0.80, NSE = 0.71), the model was unable to track the extreme low flow peaks due to the temporal and spatial variability of rainfall which may not be fully captured by using data from one rainfall gauging station. Groundwater delay time, baseflow alpha factor and curve number were the most sensitive parameters influencing model performance. This study improves understanding of the key processes of a catchment in a data-poor, monsoon driven, small river basin and could serve as a baseline for scenario modelling for future water management and policy framework