A grey approach to predicting healthcare performance

© 2018 Elsevier Ltd The success of an organization or a particular activity is evaluated through the measurement of key performance indicators (KPIs). The aim of this paper is to analyze and predict the indicators of healthcare performance using grey systems theory. Recent advancements in science and technology have made the healthcare industry extremely efficient at collecting data using electronic claims systems such as electronic health records. Therefore, collecting field level primary data becomes easier and accumulate them to generate secondary data for research purpose and to get an insight of the organization performance is absolutely necessary. Our research analyzes the KPIs of a hospital based on a secondary data source. Since, secondary data contains uncertainty and sometimes poor information, grey prediction model suits best to make a prediction model in this regard. Conventional grey model has considerable drawbacks while making a rigorous prediction model. For this, we apply an improved grey prediction model to predict the KPIs of the healthcare performance indicators. Several error measures in our model give a best fit of the data and allow prediction of the KPIs. The prediction model gives good estimates of the quantitative indicators and produced error rate within an acceptable range. We observe that the KPIs of bed turnover rate (BTR) and bed occupancy rate (BOR) have an increasing trend, whereas the KPIs of average length of stay (ALOS), hospital death rate (HDR) and hospital infection rate (HIR) show a decreasing trend over time. The main contribution of this research is a grey-based prediction model that can provide managers with the information they need to evaluate and predict the performance of a hospital. The research indicates that managers should give greater priority to the indicators which will result in better patients’ satisfaction and improved profit margin. Healthcare managers striving towards better performance will now have an empirical basis upon which to formulate and adjust their strategies, after analyzing the predicted value

The FRIED grid of mass-loss rates for externally irradiated protoplanetary discs

We present an open access grid of 3930 calculations of externally evaporating protoplanetary discs. This spans a range of disc sizes (1-400AU), disc masses, UV field strengths (10-10$^4$G$_0$) and stellar masses (0.05-1.9M$_\odot$). The grid is publicly available for download, and offers a means of cheaply including external photoevaporation in disc evolutionary calculations. It can also be queried using an online tool for quick estimates of instantaneous mass loss rates (e.g for convenient evaluation of real observed systems). The `FRIED' grid itself illustrates that for discs around stars $\leq0.3$M$_\odot$ external photoevaporation is effective down to small radii ($<50$AU) down to UV fields at least as weak as 10G$_0$. At the other end of the scale, in a $10^4$G$_0$ environment photoevaporation is effective down to 1AU even for stellar masses at least as high as 1.9M$_\odot$. We also illustrate in which regimes CO survives in the photoevaporative outflow for significant mass loss rates; marking a system a good candidate to detect external photoevaporation in weak-intermediate UV environments through sub-Keplerian rotation. Finally we make illustrative mass loss rate estimates for discs in Taurus based on the Guilloteau et al. (2011) star-disc parameters, finding that around half are expected to have both significant mass loss and retain CO in the photoevaporative outflow.Comment: 16 pages, 9 figures. Accepted for publication in MNRA

Examining price and service competition among retailers in a supply chain under potential demand disruption

© 2017 Elsevier Ltd Supply chain disruptions management has attracted significant attention among researchers and practitioners. The paper aims to examine the effect of potential market demand disruptions on price and service level for competing retailers. To investigate the effect of potential demand disruptions, we consider both a centralized and a decentralized supply chain structure. To analyze the decentralized supply chain, the Manufacturing Stackelberg (MS) game theoretical approach was undertaken. The analytical results were tested using several numerical analyses. It was shown that price and service level investment decisions are significantly influenced by demand disruptions to retail markets. For example, decentralized decision makers tend to lower wholesale and retail prices under potential demand disruptions, whereas a proactive retailer needs to increase service level with an increased level of possible disruptions. This research may aid managers to analyze disruptions prone market and to make appropriate decision for price and service level. The manufacturer or the retailers will also be able to better determine when to close a market based on the proposed analysis by considering anticipated disruptions. The benefits and usefulness of the proposed approach are explained through a real-life case adopted from a toy supply chain in Bangladesh

Correlative tomography of an exceptionally preserved Jurassic ammonite implies hyponome-propelled swimming

The extreme rarity of soft-tissue preservation in ammonoids has meant there are open questions regarding fundamental aspects of their biology. We report an exceptionally preserved Middle Jurassic ammonite with unrivaled information on soft-body organization interpreted through correlative neutron and X-ray tomography. Three-dimensional imaging of muscles and organs of the body mass for the first time in this iconic fossil group provides key insights into functional morphology. We show that paired dorsal muscles withdrew the body into the shell, rather than acting with the funnel controlling propulsion as in Nautilus. This suggests a mobile, retractable body as a defense strategy and necessitates a distinct swimming mechanism of hyponome propulsion, a trait that we infer evolved early in the ammonoid-coleoid lineage.Copyright © 2021, The Authors. This document is the author’s final accepted version of the journal article. You are advised to consult the published version if you wish to cite from it

Frequency of complementary and alternative medicine utilization in hypertensive patients attending an urban tertiary care centre in Nigeria

<p>Abstract</p> <p>Background</p> <p>To study the frequency and pattern of use of complementary and alternative medicine (CAM) in patients with essential hypertension attending a tertiary hypertension clinic.</p> <p>Methods</p> <p>Two hundred and twenty-five consecutive hypertensive patients attending the hypertension clinic of the Lagos University Teaching Hospital over a 3-month period were interviewed. Socio-demographic data, duration of hypertension, clinic attendance, current blood pressure, and compliance to conventional medications was documented. CAM utilization was explored using both structured and open-ended questions.</p> <p>Results</p> <p>There were 90 (40%) male and 135 (60%) female patients with mean age ± SD overall was 55.1 ± 12.4 years. 88 (39.1%) of the respondents used CAM. Herbal products were the most commonly used CAM type. Amongst the CAM users, the most common herbal product used was garlic (69.3%). Others were native herbs (25%), ginger (23.9%), bitter leaf (<it>Vernonia amygdalina</it>) (9.1%), and aloe vera (4.5%). 2.5% used spiritual therapy. There was no difference in the clinical characteristics, socio-economic status, and blood pressure control of CAM users and non-users. Patients who utilized CAM had higher BMI compared with those who did not, but the difference was not statistically significant (mean BMI ± SD of 29.1 ± 5.6 vs 27.1 ± 5.9 kg/m²; P = 0.05).</p> <p>Conclusion</p> <p>A significant proportion of hypertensive patients attending our tertiary facility and receiving conventional treatment also use CAM therapies. Clinicians need to be aware of this practice, understand the rationale for this health-seeking behaviour, proactively enquire about their use, and counsel patients regarding the potential of some of the therapies for adverse reactions and drug interactions.</p

Modern Slavery, Environmental Degradation and Climate Change: Fisheries, Field, Forests and Factories

In this commentary paper, the current state of research on the tightly connected and bi-directional relationships among modern slavery, environmental degradation and climate change is critically assessed and reviewed. An emerging branch of research has begun to conceptualize linkages between slavery and environmental change. Responding to a gap in the extant literature, this paper synthesizes and makes sense of this emerging research base and proposes a future research agenda for exploring the slavery–environment nexus. Through an exploration of 19 key texts which explicitly examine the relationship between slavery and environmental change, spanning across diverse disciplines and spatial scales, we draw out two key arguments that can be adopted in proposing a future research agenda. Firstly, we identify the sectoral emergence of the nexus, forming primarily around four key sectors: (i) Fisheries, (ii) Fields, (iii) Forests and (iv) Factories. The review suggests that a sufficient exploration of slavery–environment linkages needs to transverse these sectoral boundaries. Secondly, the paper highlights the bi-directional interactions among modern slavery, climate change and environmental degradation. Accordingly, we argue for a holistic lens which explores how slavery practices and environmental change are continually shaping one another. Existing research has provided initial understandings of the relationship among modern slavery, environmental destruction and climate change. However, there remains considerable scope for the connections between the three to be further interrogated and unpacked. Based on the review, the paper sets out three key research agendas, highlighting the need to move beyond a spatially and sectorally confined exploration of slavery–environment interactions towards an integrated and sophisticated interrogation of the nexus. Additionally, we propose the future examination of the deep underlying drivers of slavery–environment interactions and to situate these within contemporary capitalist social and economic relations

A Novel, “Double-Clamp” Binding Mode for Human Heme Oxygenase-1 Inhibition

The development of heme oxygenase (HO) inhibitors is critical in dissecting and understanding the HO system and for potential therapeutic applications. We have established a program to design and optimize HO inhibitors using structure-activity relationships in conjunction with X-ray crystallographic analyses. One of our previous complex crystal structures revealed a putative secondary hydrophobic binding pocket which could be exploited for a new design strategy by introducing a functional group that would fit into this potential site. To test this hypothesis and gain further insights into the structural basis of inhibitor binding, we have synthesized and characterized 1-(1H-imidazol-1-yl)-4,4-diphenyl-2-butanone (QC-308). Using a carbon monoxide (CO) formation assay on rat spleen microsomes, the compound was found to be ∼15 times more potent (IC50 = 0.27±0.07 µM) than its monophenyl analogue, which is already a potent compound in its own right (QC-65; IC50 = 4.0±1.8 µM). The crystal structure of hHO-1 with QC-308 revealed that the second phenyl group in the western region of the compound is indeed accommodated by a definitive secondary proximal hydrophobic pocket. Thus, the two phenyl moieties are each stabilized by distinct hydrophobic pockets. This “double-clamp” binding offers additional inhibitor stabilization and provides a new route for improvement of human heme oxygenase inhibitors

Genetic diversity at the Dhn3 locus in Turkish Hordeum spontaneum populations with comparative structural analyses

We analysed Hordeum spontaneum accessions from 21 different locations to understand the genetic diversity of HsDhn3 alleles and effects of single base mutations on the intrinsically disordered structure of the resulting polypeptide (HsDHN3). HsDHN3 was found to be YSK2-type with a low-frequency 6-aa deletion in the beginning of Exon 1. There is relatively high diversity in the intron region of HsDhn3 compared to the two exon regions. We have found subtle differences in K segments led to changes in amino acids chemical properties. Predictions for protein interaction profiles suggest the presence of a protein-binding site in HsDHN3 that coincides with the K1 segment. Comparison of DHN3 to closely related cereals showed that all of them contain a nuclear localization signal sequence flanking to the K1 segment and a novel conserved region located between the S and K1 segments [E(D/T)DGMGGR]. We found that H. vulgare, H. spontaneum, and Triticum urartu DHN3s have a greater number of phosphorylation sites for protein kinase C than other cereal species, which may be related to stress adaptation. Our results show that the nature and extent of mutations in the conserved segments of K1 and K2 are likely to be key factors in protection of cells