Optimal Planning of Microgrid-Integrated Battery Energy Storage

Battery energy storage (BES) is a core component in reliable, resilient, and cost-effective operation of microgrids. When appropriately sized, BES can provide the microgrid with both economic and technical benefits. Besides the BES size, it is found that there are mainly three planning parameters that impact the BES performance, including the BES integration configuration, technology, and depth of discharge. In this dissertation, the impact of each one of these parameters on the microgrid-integrated BES planning problem is investigated. Three microgrid-integrated BES planning models are developed to individually find the optimal values for the aforementioned parameters. These three microgrid-integrated BES planning models are then combined and extended, by including the impact of microgrid islanding incidents on the BES planning solution, to develop a comprehensive planning model that can be used by microgrid planners to simultaneously determine the installed BES optimal size, integration configuration, technology, and maximum depth of discharge. Besides applications in microgrids, this dissertation investigates the integration of BES to provide other types of support in distribution networks such as load management of commercial and industrial customers, distribution network expansion, and solar PV ramp rate control

5-Fluorouracil in the Treatment of Keloids and Hypertrophic Scars: A Comprehensive Review of the Literature

Hypertrophic (HTSs) and keloid scars are common dermatological complaints produced by disruption of the normal wound-healing process. Despite a wide array of therapeutic options available to treat these lesions, HTSs and keloids continue to pose a significant challenge to clinicians in everyday practice. The chemotherapeutic drug 5-fluorouracil (5-FU) is a well-known treatment option reserved for recalcitrant HTSs and keloid lesions. We present clinicians with a comprehensive review of the published data concerning the use of 5-FU in the treatment of HTSs and keloids. The current evidence suggests that 5-FU is a safe and practical alternative for the treatment of HTSs and keloids as it may substantially improve the appearance of proliferative scars and reduce the chance of recurrence. This therapeutic option is most effective in conjunction with adjuvant therapy such as corticosteroids. Additional randomized controlled clinical trials with large sample sizes should be conducted to corroborate the existing efficacy and safety data in patients with HTSs and keloids. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13555-016-0118-5) contains supplementary material, which is available to authorized users

A Qualitative Survey Study in Managing Patient Obesity for Exploring Self Efficacy among Saudi General Practitioners

This study aimed at investigate the management of obesity patients for exploring the self-efficacy among Saudi general practitioners in a qualitative survey methodology, by conducting interviews that were recorded digitally and transcribed verbatim by a professional transcription service. DE identified data were transferred into NVivo 10 for data organisation and coding. Data were analysed independently by the researchers and coded using social cognitive theory as a guiding framework. Twenty GPs recruited via a snowball sampling strategy to deliver a pilot of an obesity management program (“The Change Program”) participated in semi structured interviews before commencing the pilot. Of the 20 participating GPs (twelve  males and eight female), ages ranged between 33 and 55, and years working in general practice ranged between 5 and 25. The Interviews were face-to-face and were conducted in June and July of 2017. The study concluded that shifting the frame away from weight loss per se and towards these other goals might therefore allow for a more authentic GP-patient interaction and increase the self-efficacy of both GP and patient for healthy lifestyle changes

Retrospective descriptive assessment of clinical decision support medication-related alerts in two Saudi Arabian hospitals

OBJECTIVES: To determine the frequency of clinical decision support system (CDSS) medication-related alerts generated, accepted, or overridden, to assess appropriateness of alert display and overrides, and to characterise the documentation of clinician justification for these overrides in an academic medical centre in Saudi Arabia. MATERIALS AND METHODS: System-generated CDSS reports for the period June 2015 to December 2017 were retrospectively reviewed and analysed. Alerts were classified into different types, and rates of alert overrides calculated as percentages of all generated alerts. A subset of 307 overridden alerts was assessed for appropriateness of display and override by two clinical pharmacists. Physician documentation of reasons for overriding alerts were categorised. RESULTS: A total of 4,446,730 medication-related alerts were generated from both inpatient and outpatient settings, and 4,231,743 (95.2%) were overridden. The most common alert type was 'duplicate drug', accounting for 3,549,736 (79.8%) of alerts. Of 307 alerts assessed for appropriateness, 246 (80%) were judged to be appropriately displayed and 244 (79%) were overridden appropriately. New drug allergy and drug allergy alerts had the highest percentage of being judged as inappropriately overridden. For 1,594,313 alerts (37.7%), 'no overridden reason selected' was chosen from the drop-down menu. CONCLUSIONS: The alert generation and override rate were higher than reported previously in the literature. The small sample size of 307 alerts assessed for appropriateness of alert display and override is a potential limitation. Revision of the CDSS rules for alerts (focusing on specificity and relevance for the local context) is now recommended. Future research should prospectively assess providers' perspectives, and determine patient harm associated with overridden alerts

Adherence of Primary Health Care Physicians to Hypertension Management Guidelines in Aljouf Region of Saudi Arabia

Abstract Introduction: Hypertension affects more than one-third of the world population and is a common public health problem. Primary health care physician's (PHCP's) adherence to the hypertension management guidelines constitutes an essential step for controlling hypertension

Addressing medication errors in an adult oncology department in Saudi Arabia: A qualitative study

Objective: There is a wide range of strategies that could help in minimizing medication errors during healthcare delivery. We undertook a qualitative study to identify recommended solutions to minimize medication errors in an adult oncology department in Saudi Arabia from the perspectives of healthcare professionals. Methods: This was a qualitative study conducted in an adult oncology department in Saudi Arabia. After obtaining the required ethical approvals and written consents from the participants, seven focus group discussions were carried out for data collection. A stratified purposive sampling strategy was used to recruit medical doctors, pharmacists, and nurses. NVivo Pro version 11 was used for data analyses. Inductive content analysis was adopted in the coding of collected data. Result: Our study showed that improving organizational support, staff education, and communication could help in minimizing medication errors in the adult oncology department. Conclusion: The adoption of multiple strategies is required to improve the safety of the medication process in the adult oncology department. We argue that the availability of supportive leadership should be prioritized as it plays a crucial role in determining the effectiveness and efficiency of both staff education and communication

Systematic review of the safety of medication use in inpatient, outpatient and primary care settings in the Gulf Cooperation Council countries

Background Errors in medication use are a patient safety concern globally, with different regions reporting differing error rates, causes of errors and proposed solutions. The objectives of this review were to identify, summarise, review and evaluate published studies on medication errors, drug related problems and adverse drug events in the Gulf Cooperation Council (GCC) countries. Methods A systematic review was carried out using six databases, searching for literature published between January 1990 and August 2016. Research articles focussing on medication errors, drug related problems or adverse drug events within different healthcare settings in the GCC were included. Results Of 2094 records screened, 54 studies met our inclusion criteria. Kuwait was the only GCC country with no studies included. Prescribing errors were reported to be as high as 91% of a sample of primary care prescriptions analysed in one study. Of drug-related admissions evaluated in the emergency department the most common reason was patient non-compliance. In the inpatient care setting, a study of review of patient charts and medication orders identified prescribing errors in 7% of medication orders, another reported prescribing errors present in 56% of medication orders. The majority of drug related problems identified in inpatient paediatric wards were judged to be preventable. Adverse drug events were reported to occur in 8.5–16.9 per 100 admissions with up to 30% judged preventable, with occurrence being highest in the intensive care unit. Dosing errors were common in inpatient, outpatient and primary care settings. Omission of the administered dose as well as omission of prescribed medication at medication reconciliation were common. Studies of pharmacists’ interventions in clinical practice reported a varying level of acceptance, ranging from 53% to 98% of pharmacists’ recommendations. Conclusions Studies of medication errors, drug related problems and adverse drug events are increasing in the GCC. However, variation in methods, definitions and denominators preclude calculation of an overall error rate. Research with more robust methodologies and longer follow up periods is now required.Peer reviewe

Lipid nanocarriers overlaid with chitosan for brain delivery of berberine via the nasal route

This research aimed to design, optimize, and evaluate berberine-laden nanostructured lipid carriers overlaid with chitosan (BER-CTS-NLCs) for efficient brain delivery via the intranasal route. The nanostructured lipid carriers containing berberine (BER-NLCs) were formulated via hot homogenization and ultrasonication strategy and optimized for the influence of a variety of causal variables, including the amount of glycerol monostearate (solid lipid), poloxamer 407 (surfactant) concentration, and oleic acid (liquid lipid) amount, on size of the particles, entrapment, and the total drug release after 24 h. The optimal BER-NLCs formulation was then coated with chitosan. Their diameter, in vitro release, surface charge, morphology, ex vivo permeability, pH, histological, and in vivo (pharmacokinetics and brain uptake) parameters were estimated. BER-CTS-NLCs had a size of 180.9 ± 4.3 nm, sustained-release properties, positive surface charge of 36.8 mV, and augmented ex-vivo permeation via nasal mucosa. The histopathological assessment revealed that the BER-CTS-NLCs system is safe for nasal delivery. Pharmacokinetic and brain accumulation experiments showed that animals treated intranasally with BER-CTS-NLCs had substantially greater drug levels in the brain. The ratios of BER brain/blood levels at 30 min, AUCbrain/AUCblood, drug transport percentage, and drug targeting efficiency for BER-CTS-NLCs (IN) were higher compared to BER solution (IN), suggesting enhanced brain targeting. The optimized nanoparticulate system is speculated to be a successful approach for boosting the effect of BER in treating CNS diseases, such as Alzheimer’s disease, through intranasal therapy

Proton Exchange Membrane Fuel Cells Modeling Using Chaos Game Optimization Technique

For the precise simulation performance, the accuracy of fuel cell modeling is important. Therefore, this paper presents a developed optimization method called Chaos Game Optimization Algorithm (CGO). The developed method provides the ability to accurately model the proton exchange membrane fuel cell (PEMFC). The accuracy of the model is tested by comparing the simulation results with the practical measurements of several standard PEMFCs such as Ballard Mark V, AVISTA SR-12.5 kW, and 6 kW of the Nedstack PS6 stacks. The complexity of the studied problem stems from the nonlinearity of the PEMFC polarization curve that leads to a nonlinear optimization problem, which must be solved to determine the seven PEMFC design variables. The objective function is formulated mathematically as the total error squared between the laboratory measured terminal voltage of PEMFC and the estimated terminal voltage yields from the simulation results using the developed model. The CGO is used to find the best way to fulfill the preset requirements of the objective function. The results of the simulation are tested under different temperature and pressure conditions. Moreover, the results of the proposed CGO simulations are compared with alternative optimization methods showing higher accuracy