The design of a knowledge-based system for quality management in healthcare: Case study

YesThe current healthcare systems have numerous gaps that need to be filled to reach the best practice. This paper presents a novel approach to design and validate a hybrid knowledge-based system (KBS) to evaluate QM of healthcare environment (QMHE) using a hybrid system that has not been used before. It will be combined with gauge absence perquisite (GAP) method to sustain a successful operation of the large number of key performance indicators (KPIs) that involved in QMHE and to detect the gap between each KPI and the anticipated point. Out of 354 KB rules answered, the system has categorised 225 as GPs and the remaining 128 as BPs. The 128 bad points are categorised into different problem categories (20 PC-1, 34 PC-2, 34 PC-3, 40 PC-4, and 0 PC-5) where they represent the actions that need to be enhanced to reach the desired level of quality management

Assessing quality management system at a tertiary hospital in Oman using a hybrid knowledge-based system

YesThe cost of medical care is snowballing at an alarming and unmaintainable rate universally. Consequently, the need for a trusted quality management (QM) system at healthcare organizations is a must. Such system will aid the healthcare governance to increase the effectiveness and decrease the cost. It will help in minimizing the risk and enhancing patient safety. Several challenges facing healthcare QM in Oman are creating computerizing monitoring tool and confirming commitment of decision makers at all levels. The Report of Quality and Patient Safety (RQPS) in Oman 2016 highlighted the low level of patient safety and quality culture among staff. It recommended to inaugurate a well-defined organizational chart based on each healthcare organization’s vision and mission. Therefore, it is important to design a national accreditation system that is accredited by an international accreditation body. Such step will help in prioritizing the needs and minimizing the cost of maintaining and upgrading systems. To overcome these challenges, this article is presenting a novel methodology of hybrid knowledge-based (KB) system to assess QM in healthcare environment (QMHE) using gauging absence of prerequisites tool for benchmarking and analytical hierarchy process for prioritizing. The KB-QMHE model can be used as a standard to assess QM at any healthcare organization around the globe. The results showed that 852 questions were answered by the quality managers in a tertiary hospital in Oman; the percentage of bad points in this hospital was 32%. The KB-QMHE model has clearly shown that the priority 1, in level 0, is to focus on the patient-centered dimension in the healthcare quality dimensions submodule. Output, also, suggested a prioritized action plan covering healthcare governance module, healthcare leadership module and healthcare organization’s resources module in level 1–3

Productivity of Saltbush (Atriplex) Species Under Saline Soil and Water Conditions in Oman

A field observation trial was carried out at Agricultural Research Center, Rumais, Sultanate of Oman to evaluate the productivity and forage quality of two species of Saltbush viz. Quali saltbush (Artiplex lentiformis L.) And Fourwing saltbush (Atriplex canescens L), both are perennial and of North American origin. Plants were irrigated with brackish water (EC more than 10.00 dS/m) under drip irrigation and grown with minimum tillage and sub-optimum management conditions. Biomass production was evaluated in terms of five characters i.e. plant height, plant width, plant volume, green fodder yield/plant and green fodder yield/ha over the experimental period (747 d). Arriplex lenformis produced a total green fodder yield of 53.29 kg/plant equivalent to 59.21 t/ha as compared to that of 31.27 kg/plant (34.75 t/ha) produced by Atriplex canescens. The cut yields and interaction effects (between the species and cuts) were also significantly different with respect to all the characters. Chemical composition of the Atriplex species indicated that A Ientiformis had higher levels of Na, K, Cl and Ca as compared to A canescens. The studies of nutrient composition of bulk samples of the Atriplex species revealed that the fresh material contained 34.30% dry matter. On dry matter basis, the Atriplex material had 9.40% crude protein (CP), 24.00% crude fiber (CF), l.5% extract ( EE), 19.60% ash and 45.50% nitrogen free extract (NFE). Despite its high ash content, Atriplex material appeared to be a nutritious and cheap source of nitrogen complementation

miR-19a-3p containing exosomes improve function of ischemic myocardium upon shock wave therapy

AIMS: As many current approaches for heart regeneration exert unfavorable side-effects, the induction of endogenous repair mechanisms in ischemic heart disease is of particular interest. Recently, exosomes carrying angiogenic miRNAs have been described to improve heart function. However, it remains challenging to stimulate specific release of reparative exosomes in ischemic myocardium. In the present study, we sought to test the hypothesis that the physical stimulus of shock wave therapy (SWT) causes the release of exosomes. We aimed to substantiate the pro-angiogenic impact of the released factors, to identify the nature of their cargo, and to test their efficacy in vivo supporting regeneration and recovery after myocardial ischemia. METHODS AND RESULTS: Mechanical stimulation of ischemic muscle via SWT caused extracellular vesicle (EV) release from endothelial cells both in vitro and in vivo. Characterization of EVs via electron microscopy, nanoparticle tracking analysis and flow cytometry revealed specific exosome morphology and size with presence of exosome markers CD 9, CD81 and CD63. Exosomes exhibited angiogenic properties activating protein kinase b (Akt) and extracellular-signal regulated kinase (ERK) resulting in enhanced endothelial tube formation and proliferation. A miRNA array and transcriptome analysis via next-generation sequencing were performed to specify exosome content. miR-19a-3p was identified as responsible cargo, antimir-19a-3p antagonized angiogenic exosome effects. Exosomes and target miRNA were injected intramyocardially in mice after left anterior descending artery (LAD) ligation. Exosomes resulted in improved vascularization, decreased myocardial fibrosis and increased left ventricular ejection fraction as shown by transthoracic echocardiography. CONCLUSIONS: The mechanical stimulus of SWT causes release of angiogenic exosomes. miR-19a-3p is the vesicular cargo responsible for the observed effects. Released exosomes induce angiogenesis, decrease myocardial fibrosis and improve left ventricular function after myocardial ischemia. Exosome release via SWT could develop an innovative approach for the regeneration of ischemic myocardium

Effectiveness of a mindfulness and acceptance-based intervention for improving the mental health of adolescents with HIV in Uganda: An open-label trial

Adolescents with HIV (AWH) face the double burden of dealing with challenges presented by their developmental phase while coping with stigma related to HIV, affecting their mental health. Poor mental health complicates adherence to daily treatment regimens, requiring innovative psychosocial support strategies for use with adolescents. We assessed the effectiveness of a mindfulness and acceptance-based intervention on the mental health of AWH in Uganda. One hundred and twenty-two AWH, mean age 17 ±1.59 (range 15 to 19 years), 57% female, receiving care at a public health facility in Kampala were enrolled in an open-label randomized trial (ClinicalTrials.gov: NCT05010317) with assessments at pre-and post-intervention. The mindfulness and acceptance-based intervention involved weekly 90-minute group sessions for four consecutive weeks facilitated by two experienced trainers. Sessions involved clarifying values, skillfully relating to thoughts, allowing and becoming aware of experiences non-judgmentally, and exploring life through trial and error. The control group received the current standard of care. Three mental health domains (depression, anxiety, and internalized stigma) were compared between the intervention and control groups. A linear mixed effects regression was used to analyze the effect of the intervention across the two time points. Results showed that the intervention was associated with a statistically significant reduction in symptoms of depression (β = -10.72, 95%CI: 6.25, -15.20; p < .0001), anxiety (β = -7.55, 95%CI: 2.66, -12.43; p = .0003) and stigma (β = -1.40, 95%CI: 0.66 to -2.15; p = .0004) over time. Results suggest that mindfulness and acceptance-based interventions have the potential to improve the mental health of AWH

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Kenyan blood donors.

The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Africa is poorly described. The first case of SARS-CoV-2 in Kenya was reported on 12 March 2020, and an overwhelming number of cases and deaths were expected, but by 31 July 2020, there were only 20,636 cases and 341 deaths. However, the extent of SARS-CoV-2 exposure in the community remains unknown. We determined the prevalence of anti-SARS-CoV-2 immunoglobulin G among blood donors in Kenya in April-June 2020. Crude seroprevalence was 5.6% (174 of 3098). Population-weighted, test-performance-adjusted national seroprevalence was 4.3% (95% confidence interval, 2.9 to 5.8%) and was highest in urban counties Mombasa (8.0%), Nairobi (7.3%), and Kisumu (5.5%). SARS-CoV-2 exposure is more extensive than indicated by case-based surveillance, and these results will help guide the pandemic response in Kenya and across Africa

Temporal trends of SARS-CoV-2 seroprevalence during the first wave of the COVID-19 epidemic in Kenya.

Observed SARS-CoV-2 infections and deaths are low in tropical Africa raising questions about the extent of transmission. We measured SARS-CoV-2 IgG by ELISA in 9,922 blood donors across Kenya and adjusted for sampling bias and test performance. By 1st September 2020, 577 COVID-19 deaths were observed nationwide and seroprevalence was 9.1% (95%CI 7.6-10.8%). Seroprevalence in Nairobi was 22.7% (18.0-27.7%). Although most people remained susceptible, SARS-CoV-2 had spread widely in Kenya with apparently low associated mortality

Tropical tree growth driven by dry-season climate variability

Interannual variability in the global land carbon sink is strongly related to variations in tropical temperature and rainfall. This association suggests an important role for moisture-driven fluctuations in tropical vegetation productivity, but empirical evidence to quantify the responsible ecological processes is missing. Such evidence can be obtained from tree-ring data that quantify variability in a major vegetation productivity component: woody biomass growth. Here we compile a pantropical tree-ring network to show that annual woody biomass growth increases primarily with dry-season precipitation and decreases with dry-season maximum temperature. The strength of these dry-season climate responses varies among sites, as reflected in four robust and distinct climate response groups of tropical tree growth derived from clustering. Using cluster and regression analyses, we find that dry-season climate responses are amplified in regions that are drier, hotter and more climatically variable. These amplification patterns suggest that projected global warming will probably aggravate drought-induced declines in annual tropical vegetation productivity. Our study reveals a previously underappreciated role of dry-season climate variability in driving the dynamics of tropical vegetation productivity and consequently in influencing the land carbon sink.We acknowledge financial support to the co-authors provided by Agencia Nacional de Promoción Científica y Tecnológica, Argentina (PICT 2014-2797) to M.E.F.; Alberta Mennega Stichting to P.G.; BBVA Foundation to H.A.M. and J.J.C.; Belspo BRAIN project: BR/143/A3/HERBAXYLAREDD to H.B.; Confederação da Agricultura e Pecuária do Brasil - CNA to C.F.; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES, Brazil (PDSE 15011/13-5 to M.A.P.; 88881.135931/2016-01 to C.F.; 88887.199858/2018-00 to G.A.-P.; Finance Code 001 for all Brazilian collaborators); Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq, Brazil (ENV 42 to O.D.; 1009/4785031-2 to G.C.; 311874/2017-7 to J.S.); CONACYT-CB-2016-283134 to J.V.-D.; CONICET to F.A.R.; CUOMO FOUNDATION (IPCC scholarship) to M.M.; Deutsche Forschungsgemeinschaft - DFG (BR 1895/15-1 to A.B.; BR 1895/23-1 to A.B.; BR 1895/29-1 to A.B.; BR 1895/24-1 to M.M.); DGD-RMCA PilotMAB to B.T.; Dirección General de Asuntos del Personal Académico of the UNAM (Mexico) to R.B.; Elsa-Neumann-Scholarship of the Federal State of Berlin to F.S.; EMBRAPA Brazilian Agricultural Research Corporation to C.F.; Equatorian Dirección de Investigación UNL (21-DI-FARNR-2019) to D.P.-C.; São Paulo Research Foundation FAPESP (2009/53951-7 to M.T.-F.; 2012/50457-4 to G.C.; 2018/01847‐0 to P.G.; 2018/24514-7 to J.R.V.A.; 2019/08783-0 to G.M.L.; 2019/27110-7 to C.F.); FAPESP-NERC 18/50080-4 to G.C.; FAPITEC/SE/FUNTEC no. 01/2011 to M.A.P.; Fulbright Fellowship to B.J.E.; German Academic Exchange Service (DAAD) to M.I. and M.R.; German Ministry of Education, Science, Research, and Technology (FRG 0339638) to O.D.; ICRAF through the Forests, Trees, and Agroforestry research programme of the CGIAR to M.M.; Inter-American Institute for Global Change Research (IAI-SGP-CRA 2047) to J.V.-D.; International Foundation for Science (D/5466-1) to M.I.; Lamont Climate Center to B.M.B.; Miquelfonds to P.G.; National Geographic Global Exploration Fund (GEFNE80-13) to I.R.; USA’s National Science Foundation NSF (IBN-9801287 to A.J.L.; GER 9553623 and a postdoctoral fellowship to B.J.E.); NSF P2C2 (AGS-1501321) to A.C.B., D.G.-S. and G.A.-P.; NSF-FAPESP PIRE 2017/50085-3 to M.T.-F., G.C. and G.M.L.; NUFFIC-NICHE programme (HEART project) to B.K., E.M., J.H.S., J.N. and R. Vinya; Peru ‘s CONCYTEC and World Bank (043-2019-FONDECYT-BM-INC.INV.) to J.G.I.; Peru’s Fondo Nacional de Desarrollo Científico, Tecnológico y de Innovación Tecnológica (FONDECYT-BM-INC.INV 039-2019) to E.J.R.-R. and M.E.F.; Programa Bosques Andinos - HELVETAS Swiss Intercooperation to M.E.F.; Programa Nacional de Becas y Crédito Educativo - PRONABEC to J.G.I.; Schlumberger Foundation Faculty for the Future to J.N.; Sigma Xi to A.J.L.; Smithsonian Tropical Research Institute to R. Alfaro-Sánchez.; Spanish Ministry of Foreign Affairs AECID (11-CAP2-1730) to H.A.M. and J.J.C.; UK NERC grant NE/K01353X/1 to E.G.Peer reviewe

Conjunctive use of reclaimed water and groundwater in crop rotations

Irrigated agriculture in Oman relies solely on groundwater and Aflaj (Falaj is a canal system, which provides water for a community of farmers for domestic and agricultural use). With the increasing scarcity of freshwater available to agriculture, the need to use of reclaimed water (RW) from Sewage Treatment Plants (STP) in agriculture has increased. In this study, we explored how RW from an STP can be used directly, without Aquifer Storage and Recovery, as a source of irrigation water in conjunction with groundwater for agriculture. Average data from Muscat, Oman in the years from 1996 to 2010 was used for calculation of crop water requirement. Wheat, cowpea and maize were chosen as crops to be grown in rotation through the year. Using RW irrigation conjunctively with groundwater cropping areas of wheat, cowpea and maize can be increased by 323, 250 and 318% respectively, against utilization RW only. Of the total irrigation requirement 57.6% was met with reclaimed water (RW) and 42.4% was met with groundwater (GW). Therefore, it is recommended that decision makers should consider piping RW to areas where groundwater of good quality is available to conjunctively use and meet crop water requirements, rather than piping it to areas where groundwater is saline and unsuitable for irrigation. This will prevent disposal of RW to the sea and minimize stress on fresh groundwater zones