Cost and efficiency analysis in Iranian primary health centers: a micro costing and data envelopment analysis.

BACKGROUND: Health Complex Model was implemented to provide primary health care services in urban, especially in slum areas. As a pilot at a provincial level, Chamran Health Complex offers healthcare for more than 57,000 residents of Tabriz. Despite the necessity of cost information in healthcare decision-making, there was limited knowledge about the unit cost of services. This study aims to analyze the cost and efficiency of health centers. METHODS: Activity-Based Costing method with direct and step-down allocation methods was adopted. We estimated unit costs in a hypothetical scenario according to national standards to quantify the gap between current and standard practice. Input-oriented Data Envelopment Analysis was administered to measure the efficiency of health centers. RESULTS: The total cost of the complex was $2,841,897, of which 67% ($1910373) and 33% ($931523) were accounted for direct and indirect costs, respectively. The vaccination center had the lowest ($9), and the occupational health center had the highest average unit cost ($76). The average technical efficiency of the health centers was 0.519, where the HC1 and HC3 showed the best performance. CONCLUSION: There is remarkable variability in service costs across health centers, which must be addressed in performance management and contracting practices. Although we found a gap between current and standard practice in terms of staff and facilities according to national standards, Chamran Health Complex has an untouched capacity that can be utilized with better planning and without incurring additional costs. It raises the need for revising national standards by the Iran Ministry of Health.

Bioaccumulation and health risk assessment of exposure to potentially toxic elements by consuming agricultural products irrigated with wastewater effluents.

Potentially toxic elements (PTEs) have many adverse health effects due to bioaccumulation capability and their long persistence in the environment. As a renewable water source, the effluents of municipal wastewater treatment systems have been used to irrigate agricultural products widely. However, the evidence on the bioaccumulation of PTEs in crops irrigated with these effluents is still scarce, with no available study in low and middle-income countries. Therefore, this study aimed to assess the PTEs concentration in the soil and crops irrigated with effluents of Sabzevar wastewater treatment plant and the related health risk by that. The clustered method was used to determine the soil and craps samples. Seventy cumulative samples were randomly prepared in summer and autumn 2016 and 2017 from crops, soil and effluent. Inductively coupled plasma mass spectrometry (ICP-MS) was used to measure PTEs. The health risk of exposure to PTEs was assessed using Monte Carlo simulation technique. Kruskal Wallis test and Posthoc Tukey HSD test were used to assess the mean difference of PTEs between soil, effluent and crops as well as between crops together. The bioaccumulation factor (BAF) magnitude order in different crop samples was Cd > Sr > Cu > Pb > Zn > Co > As > Cr > Ni, respectively. The Cd accumulation in Sugar beet plant was significantly higher than in other samples. The highest hazard quotient (HQ) based on single PTEs was observed for As (mineral) (mean: 5.62 × 10-1 and percentile 95th: 2.13) in Okra. Regarding total HQ (THQ), the highest and lowest mean (percentile 95th) values were 1.50 (3.22) and 2.40 × 10-1 (4.01 × 10-1) for Okra and Watermelon, respectively. The mean concentrations of Co, Cr, Ni and Zn were significantly higher in crops compared to soil and influent samples. Posthoc tests indicated that the concentration of PTEs between investigated crop samples were not statistically significant different (p > 0.05). Overall, our study suggested that irrigation with the effluent of stabilization pond wastewater treatment system exerts a potential health risk due to bioaccumulation of PTEs in crops.

Accuracy of diagnostic assays for the detection of Clostridioides difficile: A systematic review and meta-analysis.

INTRODUCTION: Clostridioides difficile Infection (CDI) has been identified as one of the main causes of nosocomial infection all across the world. Rapid diagnosis of CDI is difficult and poses a significant challenge to physicians worldwide. We undertook a systematic review and meta-analysis to evaluate rapid tests' diagnostic accuracy against toxigenic culture as the reference standard for CDI. METHOD: We searched the PubMed/MEDLINE and EMBASE databases for the relevant records. The QUADAS-2 tool was used to assess the quality of the studies. Diagnostic accuracy measures [i.e., sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratios (PLR), negative likelihood ratios (NLR), and the area under the curve (AUC)] were pooled with a random-effects model. All statistical analyses were performed with Meta-DiSc (Version 1.4, Cochrane Colloquium, Barcelona, Spain) and RevMan (version 5.3; The Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark). RESULTS: We reviewed retrieved records and identified 63 studies that met the inclusion criteria. 26 were about enzyme immunoassay (EIA) (our main index test). The sensitivity of GDH and Tox A/B EIAs were 82% (95% CI: 79-84) and 75% (95% CI: 70-79), respectively. On the other hand, the specificity of GDH EIA was 91% (95% CI: 90-92) and the specificity of Tox A/B EIA was 95% (95% CI: 94-96). Among other index tests, BD Max with 92% has the most sensitivity and cell cytotoxicity neutralization assay (CCNA) has the most specificity (100%). CONCLUSION: This meta-analysis demonstrated that EIAs could be reliable methods for detecting CDI based on their sensitivity, specificity, time and cost-effectiveness, and simplicity in the procedure. Further work to improve rapid tests would benefit from improvements to the methodology.

Multimetallic glycerolate as a precursor template of spherical porous high-entropy oxide microparticles.

High-entropy materials have received notable attention concern on account of their unique structure, tunable properties, and unprecedented potential applications in many fields. In this work, for the first time a NiCoMnZnMg-containing high-entropy glycerolate (HE-Gly) particles has been synthesized using a scalable solvothermal method. The HE-Gly particles were used as a precursor in design of porous high-entropy oxide (HEO) microparticles. The morphological and structural characterizations demonstrate that the temperature of the annealing process, and the composition of the metal ions in the HE-Gly precursors play important roles in determining porosity, crystallinity, and phase separation in HEOs. In fact, HE-Gly exhibited a porous structure of spinel HEOs with secreted MgO phase after annealing process at 800 °C, while the annealing process at 400 °C led to a low-crystallinity spinel phase without phase segregation. Overall, this work describes HE-Gly as a new precursor for altering the composition, crystallinity, and porosity of HEOs. This strategy is scalable for potential high mass productions, paving a new path toward industrial application of high-entropy materials.

Thermodynamically-guided machine learning modelling for predicting the glass-forming ability of bulk metallic glasses.

Glass-forming ability (GFA) of bulk metallic glasses (BMGs) is a determinant parameter which has been significantly studied. GFA improvements could be achieved through trial-and-error experiments, as a tedious work, or by using developed predicting tools. Machine-Learning (ML) has been used as a promising method to predict the properties of BMGs by removing the barriers in the way of its alloy design. This article aims to develop a ML-based method for predicting the maximum critical diameter (Dmax) of BMGs as a factor of their glass-forming ability. The main result is that the random forest method can be used as a sustainable model (R2 = 92%) for predicting glass-forming ability. Also, adding characteristic temperatures to the model will increase the accuracy and efficiency of the developed model. Comparing the measured and predicted values of Dmax for a set of newly developed BMGs indicated that the model is reliable and can be truly used for predicting the GFA of BMGs.

Study on antibiotic resistance and phylogenetic comparison of avian-pathogenic Escherichia coli (APEC) and uropathogenic Escherichia coli (UPEC) isolates.

Avian pathogenic Escherichia coli (APEC) and uropathogenic E. coli (UPEC) can cause vast infections in humans and poultry. The present study was conducted to compare the isolates of the APEC and UPEC pathotypes on the basis phenotypic and genotypic features of antibiotic resistance and phylogenetic differences. Total number of 70 identified E. coli strains, including 35 APEC and 35 UPEC isolates, were isolated from avian colibacillosis and human urinary tract infection (UTI), and were subjected to the antimicrobial susceptibility testing, polymerase chain reaction (PCR) detection of the resistance genes, phylogenetic grouping and DNA fingerprinting with enterobacterial repetitive intergenic consensus PCR (ERIC - PCR) to survey the variability of the isolates. The most resistance rates among all E. coli isolates were, respectively, obtained for Ampicillin (84.20%) and sulfamethoxazole-trimethoprim (65.70%). The APEC and UPEC isolates showed the most susceptibility to imipenem and gentamycin, respectively. Among 70 APEC and UPEC isolates 34.20%, 32.80%, 20.00%, and 12.80% belonged to the A, B2, D, and B1 phylogenetic groups, respectively. Analysis of the DNA fingerprinting phylogenetic tree showed 10 specific clusters of APEC and UPEC isolates. According to the results, the most effective antibiotics and the phenotypic and genotypic predominant resistance patterns of the APEC and UPEC isolates were different. Moreover, APECs and UPECs showed various dominant phylogenetic groups. With all descriptions, the APEC isolates still are potential candidates for carrying important resistance genes and can be one of the possible strains related to human infections.

Patient Satisfaction With the Family Physician Program in Sabzevar, Iran.

BACKGROUND AND OBJECTIVES: Patient satisfaction with the family physician program is an important factor for more favorable treatment results. Evaluation of patient satisfaction improves the services and approximates them to patient's preferences. The family physician program has been executed since late March, 2005 in Iran. This study aimed to measure patient satisfaction with family physician services and determines factors affecting the level of satisfaction in order to propose appropriate suggestions for providing medical services based on patients' expectations. METHODS: Forty-one centers provide healthcare services in rural and urban areas. The participants in this study comprised 1263 people. The data were collected by an inventory with 11 items about demographic specifications, waiting time and the importance of physician's sex and 40 items for assessing the level of patient satisfaction. RESULTS: A total of 1199 patients participated in the current study, 72.1% of them were female and 19.6% waited 10-20 minutes for receiving services. About 55.72% of the participants chose high and very high for the items of the inventory. Total satisfaction with the family physician program decreased with age (p-value=0.029).Moreover, total satisfaction did not show any significant differences in different groups in terms of sex, place of residence, education level and marital status. Also family physicians' sex did not affect patient satisfaction significantly. Based on results of regression model, an increase in patients' age by one year decreased their satisfaction by 0.12 and level of satisfaction in rural patients was lower than that in urban patients by 7.93. CONCLUSIONS: The level of patient satisfaction with family physician services was moderate, which mostly arose from the components of the family physician program and services such as the waiting time, costs, welfare facilities, accessibility and the service-providing team rather than patients' personal characteristics.