An integrative approach to medical laboratory equipment risk management.

Medical Laboratory Equipment (MLE) is one of the most influential means for diagnosing a patient in healthcare facilities. The accuracy and dependability of clinical laboratory testing is essential for making disease diagnosis. A risk-reduction plan for managing MLE is presented in the study. The methodology was initially based on the Failure Mode and Effects Analysis (FMEA) method. Because of the drawbacks of standard FMEA implementation, a Technique for Ordering Preference by Similarity to the Ideal Solution (TOPSIS) was adopted in addition to the Simple Additive Weighting (SAW) method. Each piece of MLE under investigation was given a risk priority number (RPN), which in turn assigned its risk level. The equipment performance can be improved, and maintenance work can be prioritized using the generated RPN values. Moreover, five machine learning classifiers were employed to classify TOPSIS results for appropriate decision-making. The current study was conducted on 15 various hospitals in Egypt, utilizing a 150 MLE set of data from an actual laboratory, considering three different types of MLE. By applying the TOPSIS and SAW methods, new RPN values were obtained to rank the MLE risk. Because of its stability in ranking the MLE risk value compared to the conventional FMEA and SAW methods, the TOPSIS approach has been accepted. Thus, a prioritized list of MLEs was identified to make decisions related to appropriate incoming maintenance and scrapping strategies according to the guidance of machine learning classifiers.

The Bioactive Substances in Spent Black Tea and Arabic Coffee Could Improve the Nutritional Value and Extend the Shelf Life of Sponge Cake after Fortification.

The study aimed to evaluate the potential use of spent coffee powder (SCP) and spent tea powder (STP) as bioactive supplements for sponge cake. To achieve this aim, we initially compared the chemical properties of spent tea and coffee powders with those of their raw forms. Subsequently, three supplemented cake blends were prepared (1, 2, and 3% of SCP and STP) to test the effect of their addition on the chemophysical characteristics, sensory attributes, and shelf life of the final products. Our results indicated that spent tea and coffee are prospective materials for polyphenols. Spent tea powder could retain up to 72% (theaflavin trigallate), while spent coffee powder could retain up to 63.9% (1-caffeoylquinic acid) of the identified compounds compared to the raw materials. Furthermore, spent tea and coffee powders contained high levels of dietary fiber (18.95 and 31.65 g/100 g dry weight) and the elements potassium (254.6 and 1218.2 mg/100 g of DW), phosphorus (189.8 and 161.3 mg/100 g of DW), calcium (904.1 and 237.8 mg/100 g of DW), and magnesium (158.8 and 199.6 mg/100 g of DW). In addition, the fortified samples with SCP and STP significantly enhanced the nutritional values while retaining good sensory qualities compared to those of the control sample. Moreover, cakes fortified with the highest concentrations of SCP and STP (3%) showed a significant decrease in malondialdehyde content (MDA; 17.7 and 18.0 µg/g) and microbiological counts (2.4 and 2.5 log cfu/g) compared to the control cake after 14 days of storage. These findings suggest that incorporating SCP and STP into cakes not only enhances their nutritional value but also extends their shelf life. By utilizing these waste products, we can contribute to a more sustainable and ecofriendly food industry.

Coexistence of diverse heavy metal pollution magnitudes: Health risk assessment of affected cattle and human population in some rural regions, Qena, Egypt.

OBJECTIVE: The purpose of this study was to measure the mean concentrations of heavy metals including aluminum (Al), arsenic, nickel (Ni), mercury, lead (Pb), and cadmium (Cd) and to assess the health hazards due to the exposure of cattle/human population to a distinct or the mixture of heavy metals through various sources. MATERIALS AND METHODS: A total of 180 samples including water sources, animal feed, and raw cows' milk from rural regions in Qena, Egypt, were examined using the inductively coupled plasma emission spectrometer (ICP; iCAP 6200). RESULTS: The data highlighted heavy metal pollution with variable concentrations among most of the investigated regions. All concentrations of Al, Ni, and Cd detected in the feeding stuff showed a strong correlation to their respective levels in milk rather than those detected in water (R 2= 0.072 vs. 0.039, 0.13 vs. 0.10, and 0.46 vs. 0.014, respectively) (p < 0.05). Anisocytosis and poikilocytosis with a tendency to rouleaux formation were evident, and basophilic stippling was a pathognomic indicator for heavy metal toxicity, especially Pb. Leukopenia and macrocytic anemia were shown in 50% and 65% of examined cattle, respectively. The target hazard quotients values were more than one (>1) for all heavy metals from water intake for both children and adults and Al and Cd in milk for children, and the hazard index values were indicated higher for noncarcinogenic health hazards. The target cancer risk values predispose people in the surveyed villages to higher cancerous risks due to exposures to the mixture of heavy metal through the consumption of water and milk. CONCLUSION: The bioaccumulation and transmission of heavy metal mixtures from water sources and feeding material have detrimental influences on milk pollution and cattle health which seem to be a serious issue affecting public health in those rural communities.

Monte Carlo sensitivity analysis of vehicle suspension energy harvesting in frequency domain.

Regenerative shock absorbers (RSAs) have still not entered production lines despite the promising potentials in energy efficiency and emission reduction. Vibration energy harvesting from vehicle dampers has been replicating the dynamics of passive viscous dampers. An accurate frequency-based analysis of the harvestable energy and dynamics for vehicle suspensions under typical operating conditions is essentially needed for designing functional Vibratory Regenerative Dampers (VRDs). This paper proposes frequency-based parametrical bandwidth sensitivity analyses of both the vehicular suspension dynamics and energy harvesting potentiality in accordance with the Monte Carlo sensitivity simulations. This provides insights into which suspension parameter could highly broaden the harvestable power magnitude, which contributes positively to conceptualizing an efficient design of a wide broad-banded energy harvesting damper leading to improved harvesting efficiencies in different road conditions. The conducted sensitivity analysis included the change in both frequency and amplitude bandwidth of the dissipative damping power, body acceleration, dynamic tire load, and suspension deflection. During the sensitivity simulations, a 2-DOFs (degrees-of-freedom) quarter-car model is considered, being excited by harmonic excitations. The selected suspension parameters were normally randomized according to the Gaussian probability distribution based on their nominal values and a 30% SD (standard deviation) with respect to the uniformly randomized excitation frequency. The results inferred higher sensitivity change in the harvestable power bandwidth versus the excitation parameters, damping rate, and tire properties. Conversely, the harvestable power hardly broadened with respect to the body and wheel masses and the spring stiffness.

Determinants of maternal adaptation to mentally disabled children in El Minia, Egypt.

This study was carried out in a governmental school for mentally disabled children in El Minia. We assessed maternal adaptation and the relationship between maternal sociodemographic factors and adaptation as well as examining maternal distress. All 100 mothers with children aged 6-18 years attending the school were recruited in the study. Three tools were used: demographic data sheet, adaptation scale to assess the nature of mothers' interaction and patterns of psychosocial adaptation and depression scale to detect the presence of psychiatric disorders among the mothers. Only 35.0% of the mothers adapted positively to their child's condition; 62.9% of those had female children. Negatively adapted mothers were slightly older than positively adapted mothers and had more children. Maternal education and occupation were significantly associated with psychosocial adaptation. Knowledge of mothers about their child's condition significantly affected adaptation as well as the dependency of children in eating, drinking and sleeping. Two-thirds of mothers had high levels of psychopathology.

Malaria preventive measures, health care seeking behaviour and malaria burden in different epidemiological settings in Sudan.

OBJECTIVES: To provide information about preventive measures and treatment seeking behaviour as well as an estimate of the malaria burden in different epidemiological settings for effective monitoring and evaluation of the ongoing efforts. METHODS: Cross-sectional survey carried out in four areas representing different levels of transmission to explore the use of preventive measures, care-seeking behaviour and accessibility in addition to point prevalence was followed by a follow-up phase in which the health workers registered and reported all fever cases including malaria. The relation between the reported malaria incidence, the product of symptomatic/asymptomatic ratio and the prevalence of confirmed malaria cases was used to develop the equation that could predict the true malaria incidence. RESULTS: Thousand households and 3628 individuals were surveyed. The presence of any net varied between 6.6% and 40%; the percentage of people who reportedly slept under mosquito nets in the previous night varied between 35 and 80. Prompt use of medications ranged between 14 and 48% with a delay of more than 24 h noticed in different areas. The mean number of individuals per household who reported use of anti-malarial drugs in the last 2 weeks ranged between 0.6 (SD = 0.92) and 1.2 (SD = 1.1), with variable cost per treatment and affordability. The prevalence of asymptomatic parasitaemia, fever and confirmed malaria at time of the survey differed by area. The incidence of malaria during the follow-up period was estimated to be 8.5, 178.6, 23.7 and 10.3 episodes per 1000 population in Malakal, Elrank, Elhosh and El Matama, respectively. Based on this, a prediction equation was developed. CONCLUSION: We found suboptimal health care seeking behaviour, coverage and use of preventive measures with a high malaria burden. We developed a model for future estimation of malaria episodes.

Consumers' views on generic medicines: a review of the literature.

OBJECTIVES: To review the literature on consumers' knowledge, attitudes and opinions of the use of generic medicines. METHOD: A narrative review of studies conducted from 1970 to 2008 on consumers perceptions and views towards generic medicines was performed. An extensive literature search was undertaken using indexing services available at the authors' institution library. The following keywords were used for the search: brand, generic, multisource, medications, medicines, drugs, pharmaceuticals and consumers, customers, and patients. Electronic databases searched were Medline, Inside Web, ISI Web of Knowledge, Science Direct, Springer Link, JSTOR, Proquest, Ebsco Host and Google Scholar. These electronic databases were searched for full text papers published in English from 1970 to October 2008. KEY FINDINGS: Twenty studies were identified. Eleven were from the USA, four were from Europe, two were from Canada and one each was from Australia, Brazil and Malaysia. In general, consumers showed mixed reactions towards the use of generic medicines. This was evident from the divergence of views observed by country development level, consumers' socioeconomic characteristics, drug product characteristics, pharmaceutical reimbursement system, policy environment, contact with health care professionals, past experience with medications, and knowledge of the seriousness of a medical condition. CONCLUSIONS: Patient confidence and knowledge pertaining to generic medicines use have increased over the past four decades, especially in developed countries. Mass educational efforts, financial incentives, and greater communication among patients and health care professionals were seen as major drivers to the uptake of generic medicines among consumers.

Split-skin graft in the management of diabetic foot ulcers.

OBJECTIVE: To compare the effects of split-thickness skin grafts versus a conservative wound dressing on the healing times of diabetic foot ulcers and the length of hospital stay. METHOD: In this prospective case-controlled study, 50 patients consented to skin grafting (graft group) and 50 preferred to be managed by conservative dressings (control group). Wound management in both groups was standardised with regard to the dressing materials (which comprised a multilayer dressing including paraffin gauze and diluted povidone-iodine soaked gauze), wound care and surgeon involvement. Graft take, ulcer recurrence rate and donor-site morbidity were assessed. Healing times and the length of hospital stay were compared between the two groups. RESULTS: A 100% skin graft take was recorded in 84% of the patients on the fifth postoperative day and in 62% on weeks 3 and 8. All patients in the graft group healed completely, but 8% had an ulcer recurrence and 4% a superficial infection within the following year. The mean healing time and mean length of hospital stay were significantly less in the graft group compared with the control group (p<0.001), reflecting results of similar studies. CONCLUSION: Split-skin grafting is an effective method of managing diabetic foot ulcers as, compared with the conservative dressings used in this study, it reduced healing times and the length of hospital stay, while donor-site morbidity was minimal.

Assessment of groundwater contamination by nitrate leaching from intensive vegetable cultivation using geographical information system.

This study employed the Geographical Information System (GIS) technology to investigate nitrate contamination of groundwater by agrochemical fertilizers in the Kakamigahara Heights, Gifu Prefecture, central Japan. Thematic information and chemical data of groundwater from the Heights were analyzed in a GIS environment to study the extent and variation of nitrate contamination and to establish spatial relationships with responsible land use types. The high and correlated concentrations of Ca(2+), Mg(2+), SO(4)(2-), and NO(3)(-) reflected the polluted nature of the unconfined highly permeable Kakamigahara aquifer. Ninety percent of the water samples showed nitrate concentrations above the human affected value (3 mg/l NO(3)(-)), while more than 30% have exceeded the maximum acceptable level (44 mg/l NO(3)(-)) according to Japan regulations. The spatial analyses indicated that groundwater contamination by nitrate is closely associated with one specific land use class, the "vegetable fields". The nitrate concentration of groundwater under vegetable fields was significantly higher than that under urban land or paddy fields. Most of the unacceptable nitrate levels were encountered in boreholes assigned to "vegetable fields" but a few were also found in boreholes allotted to "urban" class. Therefore, the vegetable fields were considered the principal source of nitrate contamination of groundwater in the Kakamigahara. However, contamination from urban sources is also possible.

Patient satisfaction with three dental speciality services: a centre-based study.

OBJECTIVE: To assess the level of patient satisfaction with three dental speciality services: oral surgery, periodontics, and fixed prosthodontics. SUBJECTS AND METHODS: A sample of 1,242 patients, aged 16 years and over who received dental care at least twice at the main dental centre, Al-Amiri, Kuwait, were interviewed during May-August 1998 by independent researchers concerning their experience of previous visits. Patients reported their level of satisfaction on a 5-point Likert scale for the items in the questionnaire, which focused on four areas: access, dentist's communication, staff helpfulness, and structural aspects of the practice. RESULTS: On average 49.4% (25.9-89.6%) of participating patients rated the level of care received as excellent. Areas rated poorest included waiting time for an appointment and waiting time in the clinic to access the dentist. Participants were less satisfied with doctor's explanation of illness, dental treatment and confidentiality of medical records. The areas that received excellent ratings by patients included: (a) communication (listening and understanding complaints 40.0% and courteous treatment 57.8%), and (b) structural aspects (availability of infection control and safety measures 89.6% and packed sterilized instruments 78.9%). CONCLUSION: Findings indicate that the level of patient satisfaction was reasonably high. Areas identified as needing improvement included: dentist-patient communication skills, medical records, appointment systems, and shortening of the waiting time to access the dentist.

Study of larvivorous fish for malaria vector control in Somalia, 2002.

An intervention study was conducted on the introduction of the larvivorous fish Oreochromis spilurus spilurus as a method of malaria vector control in Kalabeydh village, northern Somalia. This species is resistant to chlorine in water up to a concentration of 1.0 mg/L. Fish were introduced into 25 berkit (reservoirs). After 1 month the number of larvae in each berkit was reduced by between 16.5% and 78.6% (mean 52.8%). Community acceptance and participation was good. The introduction of larvivorous fish is a cheap method of malaria vector control, but its sustainability needs special consideration and education of the community is important, especially to cover the dry season, when most of the berkit dry up.