Availability legibility and adequacy of diagnosis as entered in bed head ticket in a base hospital Sri Lanka: a descriptive cross-sectional study

Introduction: Hospital information storage is done through an internationally accepted coding system. It is very important to have an accurate diagnosis for proper coding. Ministry of Health has issued a circular (No-01-05/99) for the documentation of Bed Head Ticket (BHT) including writing the correct diagnosis.  Objective: To assess the availability, legibility, and adequacy of diagnosis as entered in the BHTs of selected wards in a base hospital in Sri Lanka. Methods: Descriptive cross-sectional study was conducted to assess availability, legibility, and adequacy of diagnosis as entered in 384 BHTs of selected wards in a Base Hospital in Sri Lanka. A data Extraction sheet (DES) was used as a study instrument.  Results: Out of 384 BHTs diagnosis were not available in 12 (3.13%) BHTs and diagnosis were illegible in 36(6.99%) BHTs. In 244(67.59%) BHTs diagnosis were written as abbreviations. Only in136(37.46%) BHTs, diagnosis were written in block capital letters. Conclusion and recommendation: Documentation diagnosis in the BHTs is not according to the standards. Therefore, medical administrators, policymakers, and clinicians should take urgent actions to improve documentation diagnosis in BHTs

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

THE IMPACT OF CUSTOMER RELATIONSHIP MANAGEMENT STRATEGIES ON CUSTOMER BRAND LOYALTY IN TELECOMMUNICATION INDUSTRY, SRI LANKA

Telecommunication corporations are in a constant race to increase profits, retain their customers and gain new customers like never before. Customer Relationship Management (CRM) is aimed at building strong long-term relationships that keep customers coming back. It aims at helping organizations to build individual customer relationships, so that both the company and the customer get the most out of the exchange. The ultimate outcome of CRM is to develop customer loyalty towards organizational brands. The primary objective of this study was to examine the relative impact of CRM strategies on customer brand loyalty in the telecommunication industry. The study was based on primary and secondary data. The primary data was collected through a survey that was conducted within the Colombo city limits as well as in the Gampaha and Kaluthara districts, which are high consumption areas in Sri Lanka. According to the stratified sampling method, a structured questionnaire was distributed among sample of 160 respondents who currently utilize telecommunication services. Five  ypotheses were formed on CRM strategies and central tendency, standard deviation, peason correlation testing, multiple regression analysis etc. were used as data analysis techniques. The findings revealed that CRM strategies have a significant impact on customer loyalty in terms of personalization and interactive management. In other words using customized service systems, paying individual attention to customers, providing necessary service information, proper  fter-sales services and feedback services of suppliers enable to increase their customer loyalty in the  telecommunication sector. Finally, researchers have recommended some CRM strategies and practices to enhance customer loyalty towards telecommunication brands to make a strategic sense towards sustainable growth.For full paper: [email protected]

Mechanistic Studies of an Amine Oxidase Derived from d‑Amino Acid Oxidase

The flavoprotein d-amino acid oxidase has long served as a paradigm for understanding the mechanism of oxidation of amino acids by flavoproteins. Recently, a mutant d-amino acid oxidase (Y228L/R283G) that catalyzed the oxidation of amines rather than amino acids was described [Yasukawa, K., et al. (2014) <i>Angew. Chem., Int. Ed. 53</i>, 4428–4431]. We describe here the use of pH and kinetic isotope effects with (<i>R</i>)-α-methylbenzylamine as a substrate to determine whether the mutant enzyme utilizes the same catalytic mechanism as the wild-type enzyme. The effects of pH on the steady-state and rapid-reaction kinetics establish that the neutral amine is the substrate, while an active-site residue, likely Tyr224, must be uncharged for productive binding. There is no solvent isotope effect on the <i>k</i>_cat/<i>K</i>_m value for the amine, consistent with the neutral amine being the substrate. The deuterium isotope effect on the <i>k</i>_cat/<i>K</i>_m value is pH-independent, with an average value of 5.3, similar to values found with amino acids as substrates for the wild-type enzyme and establishing that there is no commitment to catalysis with this substrate. The <i>k</i>_cat/<i>K</i>_O₂ value is similar to that seen with amino acids as the substrate, consistent with the oxidative half-reaction being unperturbed by the mutation and with flavin oxidation preceding product release. All of the data are consistent with the mutant enzyme utilizing the same mechanism as the wild-type enzyme, transfer of hydride from the neutral amine to the flavin

Industrial and environmental significance of photonic zirconia nanoflakes: Influence of boron doping on structure and band states

A unique zirconia nanomorphology possessing an enhanced photocatalytic efficiency was developed utilizing a convenient single-sol synthesis process which involved in-situ doping of zirconia by boron. The boron-doped zirconia exhibited a flake morphology as opposed to the spherical pure form and subsequent crystallographic investigations implied the phase conversion from binary to single-phase along with the shape due to the doping. Optical characterization indicated a modified band structure with newly generated isolated impurity states within the principle zirconia band edges. As per the X-ray spectroscopy data, boron was detected as chemically bound to oxygen while electron paramagnetic resonance indicated the presence of an adsorbed oxygen lattice. During UV and simulated solar irradiation trials, respective removal capabilities of 90% and 93% of the model compound were accomplished, hence the effectiveness of the photocatalyst was confirmed. The enhanced photoactivity observed in the UV region was attributed to combined effects of the boron-induced isolated impurity states within principle band edges of zirconia, the defect-rich planer morphology, favorable interfacial interactions and the greater availability of oxygen on the lattice. Developed nanoflakes are stable, inert, and efficient hence exhibiting compelling suitability in the remediation of harmful industrial organic compounds

Efficient solid-state dye-sensitized n-ZnO/D-358 dye/p-CuI solar cell

This paper describes the preparation and characterization of FTO/TiO2 dense layer/ZnO nanoporous layer/D-358 Dye/CuI hole collector/Cr-coated FTO and FTO/ZnO dense layer/ZnO nanoporous layer/D-358 Dye/CuI hole collector/Cr-coated FTO dye-sensitized solid-state solar cells. The variations of the solar cell parameters on the thickness of the TiO2 or ZnO dense layer are described. As the thickness (and hence the sheet resistance) of the TiO2 dense layer is increased, the conversion efficiency is gradually increased up to 2.6% at a sheet resistance of 370.0 Omega/square and beyond which it decreases. At this optimum thickness of the TiO2 dense layer, the best conversion efficiency is obtained when the thickness of the ZnO nanoporous layer is 15 mu m. Use of ZnO dense layer instead of TiO2 dense layer also shows the similar trend of variation of solar cell parameters as the thickness of the dense layer is increased. The best conversion efficiency of 3.2% is obtained when the sheet resistance of the ZnO dense layer is 2500 Omega/square and the thickness of the ZnO porous layer is 15 mu m. (C) 2013 Elsevier Ltd. All rights reserved

Novel method to improve performance of dye-sensitized solar cells based on quasi-solid gel-polymer electrolytes

This manuscript is concerned with the successful attempts we have made to circumvent the problems associated with I /I-3 redox couple-containing, ethylene carbonate (EC) and propylene carbonate (PC)-plasticized, polyacrylonitrile (PAN)-based gel polymer electrolyte used in dye-sensitized solar cells (DSCs). We identify the poor pore filling by a quasi-solid to be the major obstacle impeding the performance of such DSCs. In the systematic study reported here, we have prepared four types of DSCs, (a) with only the redox couple containing plasticized gel-polymer electrolyte sandwiched between two electrodes, (b) same electrolyte but hot-pressed for the gel to better penetrate into the pores of the dyed, interconnected, nanocrystalline TiO2 matrix, (c) pores filled with the usual liquid electrolyte (acetonitrile containing I /I-3 redox couple) but reducing the problems of volatile liquids by sealing the pores containing the liquid electrolyte by pressed PAN gel electrolyte and (d) DSC with the usual liquid electrolyte. The efficiencies of the DSCs from (a) to (d) are 4.1%, 5.2%, 8.4% and 9.8%, respectively. The enhanced efficiencies in this order are clearly due to significant enhancements in the short-circuit photocurrent densities of the cells. Our novel invention of (c) cells overcome the problems associated with DSCs based on quasi-solid state gel polymer electrolytes as well as those based on usual less viscous liquid electrolytes. The efficiencies of such former cells (c) are very close to those of the latter cells (d). This simple method can be universally adopted for all quasi-solid-state electrolyte-based DSCs in order to improve their performance and durability. (C) 2014 Elsevier Ltd. All rights reserved