Fundoplication in neurologically impaired children: Nissen or Thal?

Background/purpose Gastroesophageal reflex disease (GERD) is a highly prevalent problem in infants and children with severe neurological impairment (33–75%). It occurs in 44–67% of children undergoing antireflux surgery. This study is conducted to compare the results of fundoplication, according to the Nissen and Thal procedure for management of GERD in neurologically impaired children.Materials and methods Between May 2007 and January 2011, 69 neurologically impaired children with severe GERD underwent fundoplication (Nissen= 32, Thal= 37) with construction of a Stamm gastrostomy tube in 58 patients. The male-to-female ratio was 1.6 : 1; the mean age was 1.8 years. Preoperative workup of the patients included upper gastrointestinal tract contrast series, upper gastrointestinal tract endoscopy, and a 24-h pH study.Results Perinatal asphyxia was the most common cause of neurological impairment (30.4%). Feeding dysfunction represented the most common indication for surgery (52.2%). Recurrence of symptoms was found in 14 patients (20.3%); 10 patients (14.5%) died because of respiratory failure. Acid pH-metry showed a statistically significant difference between preoperative and postoperative data; however, this difference was insignificant on comparing the postoperative parameters of the Nissen fundoplication group with the Thal fundoplication group.Conclusion GERD in neurologically impaired children is a very common problem associated with a high failure rate after properly performed fundoplication. In our series, the outcome of Thal fundoplication showed an insignificant difference when compared with that of Nissen fundoplication with less dissection and less dysphagia or gas bloat. Long-term evaluation is needed as incidence of recurrence increases with time secondary to the persistent comorbidities. Further refinement of management strategies is required to decrease incidence of recurrence and to improve the overall quality of life. Keywords: fundoplication, gastroesophageal reflux disease, neurological impairmen

PRACTICE OF PATIENT’S RIGHTS AMONG PHYSICIANS AND NURSES IN TWO EGYPTIAN HOSPITALS FROM PATIENTS’PERSPECTIVE

Background: The Universal Declaration of Human Rights clarifies the meaning of human dignity in the law. This is achieved by providing a legal and an ethical basis to improve the standards of care for the patients and giving important guidance on various critical, social, legal, and ethical issues. Aim: The aim of the study is to assess various practices of patient’s rights among physicians and nurses in two Egyptian hospitals from patients’ perspective. Material and Methods: A cross-sectional descriptive study was conducted on 200 in-patients at the medical and surgical wards of the Alexandria Main University Hospital (AMUH) and the Matrouh General Hospital (MGH).  Close ended questionnaire was used to identify the practice of patient’s rights among physicians and nurses from patients’ perspective or views Results: Almost 27 % of patients in the Alexandria Main University Hospital and 53 % of patients in Matrouh General Hospital did not have any awareness about their rights. 5.0% of physicians and nurses had good practice and 42 % of them had moderate practice in Alexandria Main University Hospital, while 29 % of physicians and nurses in Matrouh General Hospital had moderate practice. The highest mean practice scores of patient’ rights aspects in Alexandria Main University Hospital and Matrouh General Hospital was health care and respect as human being. Thus, this was followed by adequate information, a given written consent, and health education and environment. Conclusion: The practice of patient’s rights among physician and nurses are in a poor level. Poor practice without doubt, is related to deficiency of awareness and attitude, lack of training, inadequate supervision and guidance, inadequate policy and procedure, limited budget and facilities, and unsupported management. Keywords: Practice, Patient’s Rights, Physicians, Nurses

Ácidos grasos propilenados como emulsionantes.

Hydroxy propylenyl stéarate, palmitate, laurate, oléate and linoleate were prepared by reaction of propylene oxide with fatty acid at 160 °C for five hours stirring in presence of potassium hydroxide as a catalyst. Physico-chemical properties of the five products, regarding their use as emulsifiers, were determined.Se prepararon estearato, palmitato, laurato, oleato y linoleato de hidroxipropilenilos mediante reacción de oxido de propileno con ácido graso a 160 °C durante cinco horas de agitación en presencia de hidróxido potásico como catalizador. Se determinaron las propiedades físico-químicas de los cinco productos, en cuanto a su uso como emulsionantes

SLA-aware operational efficiency in AI-enabled service chains: challenges ahead

Service providers compose services in service chains that require deep integra tion of core operational information systems across organizations. Additionally, advanced analytics inform data-driven decision-making in corresponding AI-ena-bled business processes in today’s complex environments. However, individual partner engagements with service consumers and providers often entail individu-ally negotiated, highly customized Service Level Agreements (SLAs) comprising engagement-specific metrics that semantically differ from general KPIs utilized on a broader operational (i.e., cross-client) level. Furthermore, the number of unique SLAs to be managed increases with the size of such service chains. The resulting complexity pushes large organizations to employ dedicated SLA management sys-tems, but such ‘siloed’ approaches make it difficult to leverage insights from SLA evaluations and predictions for decision-making in core business processes, and vice versa. Consequently, simultaneous optimization for both global operational process efficiency and engagement-specific SLA compliance is hampered. To address these shortcomings, we propose our vision of supplying online, AI-supported SLA analyt-ics to data-driven, intelligent core workflows of the enterprise and discuss current research challenges arising from this vision. Exemplified by two scenarios derived from real use cases in industry and public administration, we demonstrate the need for improved semantic alignment of heavily customized SLAs with AI-enabled operational systems. Moreover, we discuss specific challenges of prescriptive SLA analytics under multi-engagement SLA awareness and how the dual role of AI in such scenarios demands bidirectional data exchange between operational processes and SLA management. Finally, we discuss the implications of federating AI-sup-ported SLA analytics across organizations

Supply chain planning models with general backorder penalties, supply and demand uncertainty, and quantity discounts

In this thesis, we study three supply chain planning problems. The first two problems fall in the tactical planning level, while the third one falls in the strategic/tactical level. We present a direct application for the first two planning problems in the wind turbines industry. For the third problem, we show how it can be applied to supply chains in the food industry. Many countries and localities have the explicitly stated goal of increasing the fraction of their electrical power that is generated by wind turbines. This has led to a rapid growth in the manufacturing and installation of wind turbines. The globally installed capacity for the manufacturing of different components of the wind turbine is nearly fully utilized. Because of the large penalties for missing delivery deadlines for wind turbines, the effective planning of its supply chain has a significant impact on the profitability of the turbine manufacturers. Motivated by the planning challenges faced by one of the world’s largest manufacturers of wind turbines, we present a comprehensive tactical supply chain planning model for manufacturing of wind turbines in the first part of this thesis. The model is multi-period, multi-echelon, and multi-commodity. Furthermore, the model explicitly incorporates backorder penalties with a general cost structure, i.e., the cost structure does not have to be linear in function of the backorder delay. To the best of our knowledge, modeling-based supply chain planning has not been applied to wind turbines, nor has a model with all the above mentioned features been described in the literature. Based on real-world data, we present numerical results that show the significant impact of the capability to model backorder penalties with general cost structures on the overall cost of supply chains for wind turbines. With today’s rapidly changing global market place, it is essential to model uncertainty in supply chain planning. In the second part of this thesis, we develop a two-stage stochastic programming model for the comprehensive tactical planning of supply chains under supply uncertainty. In the first stage, procurement decisions are made while in the second stage, production, inventory, and delivery decisions are made. The considered supply uncertainty combines supplier random yields and stochastic lead times, and is thus the most general form of such uncertainty to date. We apply our model to the same wind turbines supply chain. We illustrate theoretical and numerical results that show the impact of supplier uncertainty/unreliability on the optimal procurement decisions. We also quantify the value of modeling uncertainty versus deterministic planning. Supplier selection with quantity discounts has been an active research problem in the operations research community. In this the last part of this thesis, we focus on a new quantity discounts scheme offered by suppliers in some industries. Suppliers are selected for a strategic planning period (e.g., 5 years). Fixed costs associated with suppliers’ selection are paid. Orders are placed monthly from any of the chosen suppliers, but the quantity discounts are based on the aggregated annual order quantities. We incorporate all this in a multi-period multi-product multi-echelon supply chain planning problem and develop a mixed integer programming (MIP) model for it. Leading commercial MIP solvers take 40 minutes on average to get any feasible solution for realistic instances of our model. With the aim of getting high-quality feasible solutions quickly, we develop an algorithm that constructs a good initial solution and three other iterative algorithms that improve this initial solution and are capable of getting very fast high quality primal solutions. Two of the latter three algorithms are based on MIP-based local search and the third algorithm incorporates a variable neighborhood Descent (VND) combining the first two. We present numerical results for a set of instances based on a real-world supply chain in the food industry and show the efficiency of our customized algorithms. The leading commercial solver CPLEX finds only a very few feasible solutions that have lower total costs than our initial solution within a three hours run time limit. All our iterative algorithms well outperform CPLEX. The VND algorithm has the best average performance. Its average relative gap to the best known feasible solution is within 1% in less than 40 minutes of computing time.Ph.D

Biological activities of some Xylooligosaccharides from Lignocellulosic wastes

Xylooligosaccharides (XOS's) exhibited considerable biological activities and be incorporated into many food products and in pharmaceutical and drug industry. XOS's were produced from xylose-containing polysaccharides (XPS's) obtained from natural, xylan-rich, agro-industrial wastes, i.e., corncobs and sugarcane bagasse. The yields of XPS's were 32.10% and 27.20% from corncobs and sugarcane bagasse, respectively. The preparation of XOS's was done by partial hydrolysis of XPS's obtained from corncobs and sugarcane bagasse, either chemically by oxalic acid (0.25N) or by fungal attack by Aspergillus niger and by Trichoderma reesei. The partial hydrolysis of XPS's; resulted in production of (8) mixtures comprising total of (18) individual oligosaccharides. This was followed by evaluation of their biological activities, including their prebiotic, anticoagulant and fibrinolytic actions. The results showed that the tested XOS-mixtures enhanced the growth of the probiotic bacteria. This indicates that the studied XOS's can be considered as promising prebiotics. Additionally, the tested XOS's showed very low anticoagulant effect, and for fibrinolytic activity ranged between, moderate to very low activity

Recommendations for management of diabetes during Ramadan: update 2015

Since the first ADA working group report on the recommendations for management of diabetes during Ramadan in 2005 and our update in 2010, we received many inquiries asking for regular updates on information regarding education, nutritional habits and new oral and injectable agents that may be useful for the management of patients with diabetes during Ramadan. Patients can be stratified into their risk of hypoglycemia and/or complications prior to the start of the fasting period of Ramadan. Those at high risk of hypoglycemia and with multiple diabetic complications should be advised against prolonged fasting. Even in the lower hypoglycemia risk group, adverse effects may still occur. In order to minimize adverse side effects during fasting in patients with diabetes and improve or maintain glucose control, education and discussion of glucose monitoring and treatment regimens should occur several weeks prior to Ramadan. Agents such as metformin