Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?

Patients' experiences in the intensive care unit (ICU) can enhance or impair their subsequent recovery. Improving patient and family experiences on the ICU is an important part of providing high quality care. There is little evidence to guide how to do this in a South Asian critical care context. This study addresses this gap by exploring the experiences of critically ill patients and their families in ICUs in Bangladesh and India. We elicit suggestions for improvements from patients, families and staff and highlight examples of practices that support person-centred care. This multi-site hospital ethnography was carried out in five ICUs in government hospitals in Bangladesh and India, selected using purposive sampling. Qualitative data were collected using non-participant observation and semi-structured interviews and analysed using reflexive thematic analysis. A total of 108 interviews were conducted with patients, families, and ICU staff. Over 1000 hours of observation were carried out across the five study sites. We identified important mediators of patient and family experience that span many different aspects of care. Factors that promote person-centred care include access to ICU for families, support for family involvement in care delivery, clear communication with patients and families, good symptom management for patients, support for rehabilitation, and measures to address the physical, environmental and financial needs of the family. This study has generated a list of recommendations that can be used by policy makers and practitioners who wish to implement person-centred principles in the ICU.

Does green investments improve air quality? Evidence for developed and developing European countries.

The aim of this study is to examine the effect of green investments on air quality for developed and developing European countries. In this context, the short- and long-term effects of green investments on air quality were examined by panel generalized method of moments (GMM) and panel causality method. As a result of the GMM analysis, it has been determined that green investments negatively affect the air quality for both developed European countries and developing European countries in the short term, but this effect turns positive in developed countries in the long term. As a result of the panel causality analysis, two-way causality was determined between air quality and green investments.

Laser coagulation and hemostasis of large diameter blood vessels: effect of shear stress and flow velocity.

Photocoagulation of blood vessels offers unambiguous advantages to current radiofrequency approaches considering the high specificity of blood absorption at available laser wavelengths (e.g., 532 nm and 1.064 µm). Successful treatment of pediatric vascular lesions, such as port-wine stains requiring microvascular hemostasis, has been documented. Although laser treatments have been successful in smaller diameter blood vessels, photocoagulation of larger sized vessels is less effective. The hypothesis for this study is that a primary limitation in laser coagulation of large diameter blood vessels (500-1000 µm) originates from shear stress gradients associated with higher flow velocities along with temperature-dependent viscosity changes. Laser (1.07 µm) coagulation of blood vessels was tested in the chicken chorio-allantoic membrane (CAM). A finite element model is developed that includes hypothetical limitations in laser coagulation during irradiation. A protocol to specify laser dosimetry is derived from OCT imaging and angiography observations as well as finite element model results. Laser dosimetry is applied in the CAM model to test the experimental hypothesis that blood shear stress and flow velocity are important parameters for laser coagulation and hemostasis of large diameter blood vessels (500-1000 µm). Our experimental results suggest that shear stress and flow velocity are fundamental in the coagulation of large diameter blood vessels (500-1000 µm). Laser dosimetry is proposed and demonstrated for successful coagulation and hemostasis of large diameter CAM blood vessels.

Large Solitary Pyogenic Liver Abscesses: A Review of Their Management at a Tertiary Care Hospital.

Background and objective Liver abscesses are one of the common surgical diseases to be treated as an emergency in any tertiary care hospital in India. The formation of abscesses in the liver is still a major problem and associated with significant morbidity in developing countries. We come across all types of liver abscesses, such as amoebic (most common), pyogenic, mixed, and occasionally fungal. There have been several studies on the percutaneous modality of treatment for pyogenic liver abscesses. Most of the studies suggest that percutaneous catheter drainage (PCD) offers a better approach than aspirations for treating pyogenic liver abscesses. However, a few recent studies suggest that percutaneous aspiration leads to equally good results when compared to percutaneous drainage. In this study, we aimed to review the management of solitary large pyogenic liver abscesses and to assess the effectiveness of ultrasonography (USG)-guided aspiration in the procedure.  Methods A retrospective study was carried out at the Department of General Surgery of our institute. In this study, a total of 27 patients treated for solitary pyogenic liver abscess were included. All patients with a large liver abscess greater than 5 cm without the features of frank peritonitis were included. These patients were followed up regularly for six months. Results The single-attempt USG-guided aspiration was successful in 70.3% of patients. Repeat USG-guided aspiration was performed in 18.5% of patients. In 7.4% of patients, a USG-guided percutaneous pigtail catheter was placed. And only 3.7% of cases required exploratory laparotomy.  Conclusion Based on our findings, USG-guided aspiration is a fairly efficient method for treating a large solitary pyogenic abscess with acceptable results, shorter hospital stays, and minimal complications.

Digital financial and banking competition network: Evidence from China.

The rapid development of digital finance resulted in fierce competition in the banking industry. The study used Bank-corporate credit data to measure interbank competition based on social network model, and we transformed the regional digital finance index into bank-level digital finance index using each bank's registry and license information. Furthermore, we employed QAP (quadratic assignment procedure) to empirically test the effects of digital finance on the competitive structure among banks. Based on which, we verified its heterogeneity and investigated the mechanisms through which the digital finance affected the banking competition structure. The study finds that, digital finance reshapes the banking competition structure, and intensifies the inter-bank involution while increasing the evolution. The large nation-owned banks have been in central position in the banking network system, with stronger competitiveness and higher strength of digital finance development. For large banks, digital financial development has no significant impact on inter-bank co-opetition and is only more significantly correlated with banking weighted competitive networks. For small and medium-sized banks, digital finance has a significant impact on both co-opetition and competitive pressure. Meanwhile, digital finance also led to the increasing homogeneous competition. In addition, compared with large nation-owned banks, the competitiveness of small and medium-sized joint-equity commercial banks and urban commercial banks are more vulnerable to digital finance and resulting in homogenization problems. Mechanism analysis showed that (1) digital finance promotes the overall competitiveness of the banking industry by improving the inclusiveness of financial services, which expands the service scope (scale effect); (2) digital finance promotes the competition by improving the pricing ability, risk identification ability and finally the capital allocation ability of banks (Pricing effect). The above findings provide new ideas for the governance of banking competition and the realization of a new pattern of economic development.

Efecto del azufre elemental sobre el Ph y la solubilidad de algunos nutrimentos en fosfocomposts / The effect of elementary sulphur on the pH and solubility of some nutrients in phosphocomposts

Se determinó el efecto de las diferentes dosis de azufre elemental (S) sobre pH y solubilidad de algunos nutrimentos en fosfacomposts elaborados con 1kg de bora (Eichhornis crassipes). 800g de estiércol de ganado bovino, 200g de roca fosfórica (RF) y 5g de suelo sulfato ácido, utilizando como inoculante bacterias Thiobacillus sp. Se aplicaron por duplicado, 5 tratamientos con (S) de 0,5, 10, 15, y 20g y abono control sin RF ni (S). Tras 6 meses de incubación se determinaron las cantidades solubles de P, K, Mg, Ca, Fe, Cu, Mn, Zn, NO, NH, y SO, el Ph y la relación C/N en los abonos. Se evaluó el contenido total de los metales mencionados y de N, K, Mg, Fe, Cu, Mn, y Zn fueron mayores en control (p<0,001). Los menores pH se encontraron en fosfocompsts con mayor S. El pH se correlacionó con la concentración de SO (p<0,001). La relación C/N aumentó con el descenso del pH, afectando negativamente la descomposición de materia orgánica y produciendo baja solubilidad de NO, P y K. Se encontró asociación entre NO y pH (p<0,001). Ca, NH, Fe y Mn fueron más solubles con el aumento de la acidéz. El Zn y Mg solubles variaron entre los fosfatos sin relación con pH. Altos contenidos de Ca soluble variaron entre los fosfatos de Ca soluble an alto S reflejaron mayor disolución de la RF; sin embargo, el P disponible disminuyó en fosfocomposts con pH ácidos, posiblemente por su fijación con Fe y baja descompensación de materia orgánica