A study of changing trends of maternal mortality at the tertiary care centre, MMC & RI Mysore, India

Background: Maternal mortality is a reflection of the care given to women by the society. It is tragic that deaths occur during the natural process of child birth and most of them are preventable. Aims and objectives: To study the maternal mortality and the causes resulting in maternal death over 5 years in a tertiary care centre, Cheluvamba hospital, MMC & RI, Mysore. To find out avoidable factors and use information thus generated to reduce maternal mortality.Methods: A retrospective study of all maternal deaths from June 2008 to June 2013. All maternal deaths were reviewed and studied in detail including admission death interval and cause of death.  Results: Maternal mortality ratio ranged between 262 to 109/100000 births. The causes of death were hypertensive disorders (30.4%), haemorrhage (24.8%), anaemia (14.8%), sepsis (6.8%) and others (23.2%). Maximum deaths (70.6%) occurred in women between 20-29 years of age, multigravida contributed to 54.96% of maternal mortality. 42 % were unbooked, 97% were referred cases. Conclusions: Overall maternal mortality was 215/100000 live births. Maternal deaths due to direct obstetric causes were 87% and indirect were 13 %. The causes of potentially preventable deaths include haemorrhage, anaemia, sepsis, disseminated intravascular coagulation and its complications. Hypertensive disorders were the leading cause of death, followed by haemorrhage. Anaemia was an important indirect cause of death. Most maternal deaths are preventable by optimum utilization of existing MCH facilities, identifying the bottlenecks in health delivery system, early identification of high risk pregnancies and their timely referral to tertiary care centre

Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records

Objectives: To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. Methods: A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. Results: In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18–£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123–8,502). Incremental QALYs will increase by 2,142 (range 2,032–2,256). The estimated cost per QALY gained is £7,129 (range £6,775–£7,506). Net monetary benefits will be £49.02 million (range £45.72–£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. Conclusions: Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals

Sensing distress – towards a blended method for detecting and responding to problematic customer experience events

Excellent Customer Experience (CE) is a strategic priority for many large service organisations in a competitive marketplace. CE should be seamless, and in most cases it is, with customers ordering, paying for and receiving services that align with their expectations. However, in rare cases, an exceptional process event leads to service delivery delay or failure, and both the customer and organ-isation end up in complex recovery situations as a result. Unless this recovery is handled effectively inefficiency, avoidable costs and brand damage can result. So how can organisations sense when these problems are occurring and how can they respond to avoid these negative consequences? Our paper proposes a blended methodology where process mining and qualitative user research com-bine to give a holistic picture of customer experience issues, derived from a par-ticular customer case study. We propose a theoretical model for detecting and responding to customer issues, and discuss the challenges and opportunities of such a model when applied in practice in large service organisations

"Tricky to get your head around": Information work of people managing chronic kidney disease in the UK

People diagnosed with a chronic health condition have many information needs which healthcare providers, patient groups, and resource designers seek to support. However, as a disease progresses, knowing when, how, and for what purposes patients want to interact with and construct personal meaning from health-related information is still unclear. This paper presents findings regarding the information work of chronic kidney disease patients. We conducted semi-structured interviews with 13 patients and 6 clinicians, and observations at 9 patient group events. We used the stages of the information journey – recognizing need, seeking, interpreting, and using information – to frame our data analysis. We identified two distinct but often overlapping information work phases, ‘Learning’ and ‘Living With’ a chronic condition to show how patient information work activities shift over time. We also describe social and individual factors influencing information work, and discuss technology design opportunities including customized education and collaboration tools

Bile duct involvement by hepatocellular carcinoma: A rare occurrence and poor prognostic indicator in bile duct brushing samples

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153086/1/cncy22185_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153086/2/cncy22185.pd

Design, synthesis, molecular modelling and in vitro screening of monoamine oxidase inhibitory activities of novel quinazolyl hydrazine derivatives

Funding: Deanship of Scientific Research at Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia (project # 7101).A new series of N'-substituted benzylidene-2-(4-oxo-2-phenyl-1,4-dihydroquinazolin-3(2H)-yl)acetohydrazide (5a-5h) has been synthesized, characterized by FT-IR, NMR spectroscopy and mass spectrometry and tested against human monoamine oxidase (MAO) A and B. Only (3-methoxy-4-hydroxy)benzoyl substituted compounds gave submicromolar inhibition of MAO-A and MAO-B. Changing the phenyl substituent to methyl on the unsaturated quinazoline ring (12a-12d) decreased inhibition but a less flexible linker (14a-14d) resulted in selective micromolar inhibition of hMAO B providing insight for ongoing design.Publisher PDFPeer reviewe

Domain crossing: how much expertise is enough?

In CSCW, how much do we need to know about another domain/culture before we observe, intersect and intervene with designs. What optimally would that other culture need to know about us? Is this a “how long is a piece of string” question, or an inquiry where we can consider a variety of contexts and to explicate best practice. The goal of this panel will be to develop heuristics for such practice

Clinical Outcomes, Costs, and Cost-effectiveness of Strategies for Adults Experiencing Sheltered Homelessness During the COVID-19 Pandemic

Importance: Approximately 356 000 people stay in homeless shelters nightly in the United States. They have high risk of contracting coronavirus disease 2019 (COVID-19). / Objective: To assess the estimated clinical outcomes, costs, and cost-effectiveness associated with strategies for COVID-19 management among adults experiencing sheltered homelessness. / Design, Setting, and Participants: This decision analytic model used a simulated cohort of 2258 adults residing in homeless shelters in Boston, Massachusetts. Cohort characteristics and costs were adapted from Boston Health Care for the Homeless Program. Disease progression, transmission, and outcomes data were taken from published literature and national databases. Surging, growing, and slowing epidemics (effective reproduction numbers [Re], 2.6, 1.3, and 0.9, respectively) were examined. Costs were from a health care sector perspective, and the time horizon was 4 months, from April to August 2020. / Exposures: Daily symptom screening with polymerase chain reaction (PCR) testing of individuals with positive symptom screening results, universal PCR testing every 2 weeks, hospital-based COVID-19 care, alternative care sites (ACSs) for mild or moderate COVID-19, and temporary housing were each compared with no intervention. / Main Outcomes and Measures: Cumulative infections and hospital-days, costs to the health care sector (US dollars), and cost-effectiveness, as incremental cost per case of COVID-19 prevented. / Results: The simulated population of 2258 sheltered homeless adults had a mean (SD) age of 42.6 (9.04) years. Compared with no intervention, daily symptom screening with ACSs for pending tests or confirmed COVID-19 and mild or moderate disease was associated with 37% fewer infections (1954 vs 1239) and 46% lower costs ($6.10 million vs$3.27 million) at an Re of 2.6, 75% fewer infections (538 vs 137) and 72% lower costs ($1.46 million vs$0.41 million) at an Re of 1.3, and 51% fewer infections (174 vs 85) and 51% lower costs ($0.54 million vs$0.26 million) at an Re of 0.9. Adding PCR testing every 2 weeks was associated with a further decrease in infections; incremental cost per case prevented was $1000 at an Re of 2.6,$27 000 at an Re of 1.3, and $71 000 at an Re of 0.9. Temporary housing with PCR every 2 weeks was most effective but substantially more expensive than other options. Compared with no intervention, temporary housing with PCR every 2 weeks was associated with 81$39.12 million) at an Re of 2.6, 82% fewer infections (95) and 2568% higher costs ($38.97 million) at an Re of 1.3, and 59$38.94 million) at an Re of 0.9. Results were sensitive to cost and sensitivity of PCR and ACS efficacy in preventing transmission. / Conclusions and Relevance: In this modeling study of simulated adults living in homeless shelters, daily symptom screening and ACSs were associated with fewer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and decreased costs compared with no intervention. In a modeled surging epidemic, adding universal PCR testing every 2 weeks was associated with further decrease in SARS-CoV-2 infections at modest incremental cost and should be considered during future surges

A Modeling Study on How Cell Division Affects Properties of Epithelial Tissues Under Isotropic Growth

Cell proliferation affects both cellular geometry and topology in a growing tissue, and hence rules for cell division are key to understanding multicellular development. Epithelial cell layers have for long times been used to investigate how cell proliferation leads to tissue-scale properties, including organism-independent distributions of cell areas and number of neighbors. We use a cell-based two-dimensional tissue growth model including mechanics to investigate how different cell division rules result in different statistical properties of the cells at the tissue level. We focus on isotropic growth and division rules suggested for plant cells, and compare the models with data from the Arabidopsis shoot. We find that several division rules can lead to the correct distribution of number of neighbors, as seen in recent studies. In addition we find that when also geometrical properties are taken into account other constraints on the cell division rules result. We find that division rules acting in favor of equally sized and symmetrically shaped daughter cells can best describe the statistical tissue properties