Dynamics of basic planning indicators of the surgical wards at fifth multiprofile hospital for active treatment-Sofia ad

The hospital is the most complex institutions in modern healthcare system. (1) It is a service facility with properties that provide its specific complexity. As such institution, the hospital has a set of resources that are used in various out- put processes. The efficiency degree is a ratio between the activity results resources expenses. Achieving the optimum level of efficiency, means reaching a certain level of activ- ity with an optimum level of resources (5). Continuously rising health care funds put to health officials the issue of cost-effective allocation and spending of health resources. Management of diagnostic and treatment process in the hospital has to ensure efficient use of personnel labour and the medical equipment, available diagnostic and therapeu- tic methods, and tools of different nature (including future development in this respect), so as to achieve the most fa- vourable outcome of disease in the most rational use of hospital resources (3). Hospital bed is the main material resources of the hospital. It is necessary a link to established between the actual use of beds and their theoretical maximum use (5). Whether the beds are more or less used, in terms of effec- tiveness, the stay can be adequate or not. The stay is a clas- sic intermediate product and as such is used for diagnosis and / or treatment of patients (6). Bed/day ratio for each patient is determined by the disease and in a direct relation of clinical discretion of the physi- cian. It also depends on external factors, from the foreign medical decision and outcome processes in other units. The most important indicators for the organization of hospital services are: (St. Gladilov) (2). Utilization of beds (in days) - shows on average how many days within a year one bed was occupied by patients. Bed/day number for the period is divided by the average number of beds;The hospital is the most complex institutions in modern healthcare system. (1) It is a service facility with properties that provide its specific complexity. As such institution, the hospital has a set of resources that are used in various out- put processes. The efficiency degree is a ratio between the activity results resources expenses. Achieving the optimum level of efficiency, means reaching a certain level of activ- ity with an optimum level of resources (5). Continuously rising health care funds put to health officials the issue of cost-effective allocation and spending of health resources. Management of diagnostic and treatment process in the hospital has to ensure efficient use of personnel labour and the medical equipment, available diagnostic and therapeu- tic methods, and tools of different nature (including future development in this respect), so as to achieve the most fa- vourable outcome of disease in the most rational use of hospital resources (3). Hospital bed is the main material resources of the hospital. It is necessary a link to established between the actual use of beds and their theoretical maximum use (5). Whether the beds are more or less used, in terms of effec- tiveness, the stay can be adequate or not. The stay is a clas- sic intermediate product and as such is used for diagnosis and / or treatment of patients (6). Bed/day ratio for each patient is determined by the disease and in a direct relation of clinical discretion of the physi- cian. It also depends on external factors, from the foreign medical decision and outcome processes in other units. The most important indicators for the organization of hospital services are: (St. Gladilov) (2). Utilization of beds (in days) - shows on average how many days within a year one bed was occupied by patients. Bed/day number for the period is divided by the average number of beds

Mucosa-associated invariant T cells link intestinal immunity with antibacterial immune defects in alcoholic liver disease

Background/aims: Intestinal permeability with systemic distribution of bacterial products are central in the immunopathogenesis of alcoholic liver disease (ALD), yet links with intestinal immunity remain elusive. Mucosa-associated invariant T cells (MAIT) are found in liver, blood and intestinal mucosa and are a key component of antibacterial host defences. Their role in ALD is unknown. Methods/design: We analysed frequency, phenotype, transcriptional regulation and function of blood MAIT cells in severe alcoholic hepatitis (SAH), alcohol-related cirrhosis (ARC) and healthy controls (HC). We also examined direct impact of ethanol, bacterial products from faecal extracts and antigenic hyperstimulation on MAIT cell functionality. Presence of MAIT cells in colon and liver was assessed by quantitative PCR and immunohistochemistry/gene expression respectively. Results: In ARC and SAH, blood MAIT cells were dramatically depleted, hyperactivated and displayed defective antibacterial cytokine/cytotoxic responses. These correlated with suppression of lineage-specific transcription factors and hyperexpression of homing receptors in the liver with intrahepatic preservation of MAIT cells in ALD. These alterations were stronger in SAH, where surrogate markers of bacterial infection and microbial translocation were higher than ARC. Ethanol exposure in vitro, in vivo alcohol withdrawal and treatment with Escherichia coli had no effect on MAIT cell frequencies, whereas exposure to faecal bacteria/antigens induced functional impairments comparable with blood MAIT cells from ALD and significant MAIT cell depletion, which was not observed in other T cell compartments. Conclusions: In ALD, the antibacterial potency of MAIT cells is compromised as a consequence of contact with microbial products and microbiota, suggesting that the ‘leaky’ gut observed in ALD drives MAIT cell dysfunction and susceptibility to infection in these patients

Mucosa-associated invariant T cells link intestinal immunity with antibacterial immune defects in alcoholic liver disease

Intestinal permeability with systemic distribution of bacterial products are central in the immunopathogenesis of alcoholic liver disease (ALD), yet links with intestinal immunity remain elusive. Mucosa-associated invariant T cells (MAIT) are found in liver, blood and intestinal mucosa and are a key component of antibacterial host defences. Their role in ALD is unknown.We analysed frequency, phenotype, transcriptional regulation and function of blood MAIT cells in severe alcoholic hepatitis (SAH), alcohol-related cirrhosis (ARC) and healthy controls (HC). We also examined direct impact of ethanol, bacterial products from faecal extracts and antigenic hyperstimulation on MAIT cell functionality. Presence of MAIT cells in colon and liver was assessed by quantitative PCR and immunohistochemistry/gene expression respectively.In ARC and SAH, blood MAIT cells were dramatically depleted, hyperactivated and displayed defective antibacterial cytokine/cytotoxic responses. These correlated with suppression of lineage-specific transcription factors and hyperexpression of homing receptors in the liver with intrahepatic preservation of MAIT cells in ALD. These alterations were stronger in SAH, where surrogate markers of bacterial infection and microbial translocation were higher than ARC. Ethanol exposure in vitro, in vivo alcohol withdrawal and treatment with Escherichia coli had no effect on MAIT cell frequencies, whereas exposure to faecal bacteria/antigens induced functional impairments comparable with blood MAIT cells from ALD and significant MAIT cell depletion, which was not observed in other T cell compartments.In ALD, the antibacterial potency of MAIT cells is compromised as a consequence of contact with microbial products and microbiota, suggesting that the 'leaky' gut observed in ALD drives MAIT cell dysfunction and susceptibility to infection in these patients

Hydrogen Transport and Rationalization of Porosity Formation during Welding of Titanium Alloys

The transport of hydrogen during fusion welding of the titanium alloy Ti-6Al4V is analyzed. A coupled thermodynamic/kinetic treatment is proposed for the mass transport within and around the weld pool. The modeling indicates that hydrogen accumulates in the weld pool as a consequence of the thermodynamic driving forces that arise; a region of hydrogen depletion exists in cooler, surrounding regions in the heat-affected zone and beyond. Coupling with a hydrogen diffusion-controlled bubble growth model is used to simulate bubble growth in the melt and, thus, to make predictions of the hydrogen concentration barrier needed for pore formation. The effects of surface tension of liquid metal and the radius of preexisting microbubble size on the barrier are discussed. The work provides insights into the mechanism of porosity formation in titanium alloys. © The Minerals, Metals and Materials Society and ASM International 2011