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BACKGROUND: Efficient allocation of healthcare resources is essential for meeting the increasing demand for healthcare services. This study aimed at exploring the performance of both one- and two-shift Primary Healthcare Centers (PHCCs) and examining the efficiency of healthcare centers to discover how efficiency is affected by the levels of resource allocation and staffing. MATERIALS AND METHODS: The study was conducted at 31 PHCCs assigned to cover extended hours, from 4:00 PM to 8:00 AM during May-October 2023. Study employed a quantitative approach and the data envelopment analysis technique to assess the efficiency of PHCCs, specifically focusing on night shift performance. Data were collected through interviews and surveys with primary healthcare staff including 99 doctors, 119 nurses, and 139 support staff using structured questionnaire. The DEA technique was utilized to measure the relative efficiency of the PHCCs by comparing the inputs and outputs. RESULTS: Out of 31 PHCCs, 45.2% run two shifts. Over the reported period, a total of 126,619 patient visits were recorded; 81.7% came to the two-shift PHCCs and 18.3% to the one-shift PHCCs. On average, each two-shift PHCC received approximately 161 visits/ shift, and the one-shift received 123 visits. Upper respiratory tract infections accounted for 30% of morbidities and chronic diseases for more than 20%. The performance of the two-shifts PHCCs revealed varying levels of efficiency with a score of 1.00 for the most efficient PHCC and 0.31 for the least efficient PHCC. CONCLUSION: This study underscores the importance of data-driven decision-making for healthcare administrators. Ongoing assessments and benchmarking are essential for continuously improving the quality of healthcare service and optimizing utilization of resources. Future research in this field can further explore the factors that contribute to healthcare efficiency and provide deeper insights into healthcare resource management and optimization of service delivery.

A novel thermal integration approach is introduced for a biomass-driven gas turbine power plant that generates electricity, coolant, and liquefied hydrogen. The designed scheme encompassed an organic flash cycle, a bi-evaporator ejector refrigeration unit, a high-temperature water electrolyzer for hydrogen production, a multi-effect desalination cycle for supplying water for electrolysis process, and a Claude cycle for hydrogen gas liquefaction. The designed system's importance comes back to using biomass feedstock as the input fuel and utilizing the hydrogen liquefaction method. In addition to the possibility of deploying the system in remote areas, it provides the opportunity for hydrogen storage in a smaller volume for more accessible storage and transportation. On the other hand, using a comparative method for selecting an environmentally friendly fluid for the heat recovery subsystem is another crucial aspect of the present study from the environmental aspect. It is found that R161 is the appropriate choice among the seven studied working fluids. Subsequently, a comprehensive evaluation of the entire system's thermodynamic and environmental aspects is performed using an intelligent process. By considering energy and exergy efficiencies along with CO2 emissions as the objective functions, a thorough sensitivity analysis and a triple-objective optimization are carried out. Hence, artificial neural networks for the objectives are developed and integrated into the NSGA-II optimization method. Employing LINMAP decision-making, the values of objective are attained, exhibiting 39.6 % for energy efficiency, 36.1 % for exergy efficiency, and 631.7 kg/MWh for CO2 emissions. Considering the optimum solution, the proposed system is capable of producing electricity, cooling, and liquefied hydrogen with capacities of 4526 kW, 1875 kW, and 21.22 m3/day, respectively. Additionally, the scenario yields an exergoenvironmental index of 0.579 and an exergetic stability index of 0.61. and a liquefied hydrogen generation rate of 21.22 m3/day.

The blood–brain barrier (BBB) limits the efficacy of treatments for malignant brain tumors, necessitating innovative approaches to breach the barrier. This study introduces burst sine wave electroporation (B-SWE) as a strategic modality for controlled BBB disruption without extensive tissue ablation and compares it against conventional pulsed square wave electroporation-based technologies such as high-frequency irreversible electroporation (H-FIRE). Using an in vivo rodent model, B-SWE and H-FIRE effects on BBB disruption, tissue ablation, and neuromuscular contractions are compared. Equivalent waveforms were designed for direct comparison between the two pulsing schemes, revealing that B-SWE induces larger BBB disruption volumes while minimizing tissue ablation. While B-SWE exhibited heightened neuromuscular contractions when compared to equivalent H-FIRE waveforms, an additional low-dose B-SWE group demonstrated that a reduced potential can achieve similar levels of BBB disruption while minimizing neuromuscular contractions. Repair kinetics indicated faster closure post B-SWE-induced BBB disruption when compared to equivalent H-FIRE protocols, emphasizing B-SWE's transient and controllable nature. Additionally, finite element modeling illustrated the potential for extensive BBB disruption while reducing ablation using B-SWE. B-SWE presents a promising avenue for tailored BBB disruption with minimal tissue ablation, offering a nuanced approach for glioblastoma treatment and beyond.

Abstract A semi-industrial demineralization facility was used in six CDI cells to desalinate in two steps. A desalination cycle lowered the feedwater salinity from 1 to 0.5 g/L and produced 200 l/h of demineralized water. This process may be repeated to increase efficiency. Initially, feedwater commenced at 1 g/L. Monitoring both voltage and current during the salt ion removal indicated that CDI cells may recover 30% of the energy utilized. Furthermore, V–Q curves using charge and voltage measurements increased energy recovery by 30%. By cutting off the CDI cells' power source, the electrodes' operating voltage was recorded between 0.85 and 0.9 V, much lower than the external contacts' 1.2 V. The desalination system's efficiency could rise if the electrode voltage was measured and adjusted. In conclusion, storage tanks can provide desalinated water while minimizing water waste; hence, they should be installed. This study examined the physical–technical parameters of a CDI desalination system through experiments and several operational modes. Moreover, it revealed CDI desalination system improvements.

Abstract Aims To evaluate a whole‐food diet strategy (the Monash Pouch diet [MPD]) designed based on the interacting roles dietary factors play with pouch health. Specifically, its tolerability and acceptability, whether it achieved its dietary and metabolic goals, and the effects on symptoms and inflammation were examined. Methods In a 6‐week open‐label trial, patients with ileoanal pouches educated on the MPD were assessed regarding diet tolerability and acceptance, food intake (7‐day food diaries), pouch‐related symptoms (clinical pouchitis disease activity index), and, in 24‐h fecal samples, calprotectin, fermentative biomarkers, and volatile organic compounds (VOC). Results Of 12 patients, 6 male, mean (SD) age 55 (5) and pouch age 13 (2) years, one withdrew with partial small bowel obstruction. Tolerability was excellent in 9 (75%) and acceptance was high (81%). Targeted changes in dietary intake were achieved. Fecal branched‐ to short‐chain fatty acid ratio increased by median 60 [IQR: 11–80]% (P = 0.02). Fecal VOCs for 3 compounds were also increased, 2‐methyl‐5‐propan‐2‐ylcyclohexa‐1,3‐diene (Fold‐change [FC] 2.08), 1,3,3‐trimethyl‐2‐oxabicyclo[2.2.2]octane (FC 3.86), propan‐2‐ol (FC 2.10). All six symptomatic patients achieved symptomatic remission (P = 0.03). Fecal calprotectin at baseline was 292 [176–527] μg/g and at week 5 was 205 [148–310] μg/g (P = 0.72). Conclusion Well tolerated and accepted, the MPD achieved targeted changes in intakes and fermentation of carbohydrates relative to that of protein. There were signals of improvement in symptoms. These results indicate the need for a randomized‐controlled trial. (Trial registration: ACTRN12621000374864; https://www.anzctr.org.au/ACTRN12621000374864.aspx).

Pancreatic cancer is a significant cause of cancer-related mortality and often presents with limited treatment options. Pancreatic tumors are also notorious for their immunosuppressive microenvironment. Irreversible electroporation (IRE) is a non-thermal tumor ablation modality that employs high-voltage microsecond pulses to transiently permeabilize cell membranes, ultimately inducing cell death. However, the understanding of IRE’s impact beyond the initiation of focal cell death in tumor tissue remains limited. In this study, we demonstrate that IRE triggers a unique mix of cell death pathways and orchestrates a shift in the local tumor microenvironment driven, in part, by reducing the myeloid-derived suppressor cell (MDSC) and regulatory T cell populations and increasing cytotoxic T lymphocytes and neutrophils. We further show that IRE drives induce cell cycle arrest at the G0/G1 phase in vitro and promote inflammatory cell death pathways consistent with pyroptosis and programmed necrosis in vivo. IRE-treated mice exhibited a substantial extension in progression-free survival. However, within a span of 14 days, the tumor immune cell populations reverted to their pre-treatment composition, which resulted in an attenuation of the systemic immune response targeting contralateral tumors and ultimately resulting in tumor regrowth. Mechanistically, we show that IRE augments IFN- γ signaling, resulting in the up-regulation of the PD-L1 checkpoint in pancreatic cancer cells. Together, these findings shed light on potential mechanisms of tumor regrowth following IRE treatment and offer insights into co-therapeutic targets to improve treatment strategies.

The present study considered an impingement jet using hybrid nanofluid CuO–Cu/water. A single rounded nozzle was used to impinge a turbulent coolant (water) on the hot circular plate at Reynold’s number range of (5,000–15,000). CuO–Cu nanoparticles were physically synthesized at 50 nm size and dispersed by one-step preparation method. The experimentations were conducted with nanoparticle concentrations range of (0.2–1%) by volume. The results showed that the presence of hybrid nanoparticles exhibits a significant improvement in the overall thermal performance of the working fluid. Where the gained heat interpreted by the Nusselt number was found to be 2.8% (in comparing with deionized water) at ϕ = 1% and Re = 15,000, while the minimum gain in the heat was found to be 0.93% at ϕ = 0.2% and Re = 5,000. Furthermore, it was noted that the excessive increase in CuO–Cu nanoparticle concentration causes more pumping power consumption. Moreover, the CuO–Cu nanoparticles residual layer was found to be formed at a high CuO–Cu concentration, which acts as an insulation layer that hinders the heat exchange. It was also found that the threshold of nozzle-to-plate spacing is H = 4, before which, the heat gain is positive, and negative plummet after.

Locomotor recovery after spinal cord injury (SCI) remains an unmet challenge. Nerve transfer (NT), the connection of a functional/expendable peripheral nerve to a paralyzed nerve root, has long been clinically applied, aiming to restore motor control. However, outcomes have been inconsistent, suggesting that NT-induced neurological reinstatement may require activation of mechanisms beyond motor axon reinnervation (our hypothesis). We previously reported that to enhance rat locomotion following T13-L1 hemisection, T12-L3 NT must be performed within timeframes optimal for sensory nerve regrowth. Here, T12-L3 NT was performed for adult female rats with subacute (7–9 days) or chronic (8 weeks) mild (SCImi: 10 g × 12.5 mm) or moderate (SCImo: 10 g × 25 mm) T13-L1 thoracolumbar contusion. For chronic injuries, T11-12 implantation of adult hMSCs (1-week before NT), post-NT intramuscular delivery of FGF2, and environmentally enriched/enlarged (EEE) housing were provided. NT, not control procedures, qualitatively improved locomotion in both SCImi groups and animals with subacute SCImo. However, delayed NT did not produce neurological scale upgrading conversion for SCImo rats. Ablation of the T12 ventral/motor or dorsal/sensory root determined that the T12-L3 sensory input played a key role in hindlimb reanimation. Pharmacological, electrophysiological, and trans-synaptic tracing assays revealed that NT strengthened integrity of the propriospinal network, serotonergic neuromodulation, and the neuromuscular junction. Besides key outcomes of thoracolumbar contusion modeling, the data provides the first evidence that mixed NT-induced locomotor efficacy may rely pivotally on sensory rerouting and pro-repair neuroplasticity to reactivate neurocircuits/central pattern generators. The finding describes a novel neurobiology mechanism underlying NT, which can be targeted for development of innovative neurotization therapies.

Background: Bacteriocin is a peptidic toxin has many advantages to bacteria in their ecological niche and has strong antibacterial activity. Objective: The aim of this study was to evaluation of bacteriocin using Streptococcus sanguinis isolated from human dental caries. Subjects and Methods: Thirty five streptococcus isolates were diagnosed and tested for their production of bacteriocin, and then the optimal conditions for production of bacteriocin were determined. After that, the purification of bacteriocin was made partially by ammonium sulfate at 95% saturation levels, followed by and gel filtration chromatography using Sephadex G-50 column. Finally, physical characteristics were also studied and determined the bacteriocin stability. Results: Among all streptococcal isolates, the S. sanguinis SH3 isolate with batter antimicrobial activity was selected, and used in further experiments. The optimum conditions for bacteriocin production were in Todd Hewitt broth (THB) supplemented with 1% glucose at 37°C for 24h under anaerobic conditions and inoculum size of (1.2 ˟ 109CFU/ml) and pH 7, where the inhibition zone diameter reached to 29 mm against Enterococcus faecalis. The purified bacteriocin had high inhibitory activity against S. pneumoniae, S. pyogenes, E. faecalis, E. faecium and Leuconostoc mesenteroides. Streptocin SH3 keeps its effectiveness within the pH range 3-10, and temperature until 80ºC for 20 min. Conclusion: Bacteriocin produced from S. sanguinis has high activity against many pathogens and has high stability over wide ranges of temperature and pH, which makes it a good alternative in the medical and food preservation fields

Bone fractures which are treated, the Locking Compression Plate (LCP) with locked screws is commonly employed. Appropriate distance between the LCP and the bone may enhance periosteal blood supply. Aim: This study aims to determine the effect of distance between the LCP and the bone analogue on the stiffness of the locking compression plate itself using Finite Element Analysis (FEA). Method: To investigate the effect of distance between the LCP and three models bone of transversely fractured tibia, the bone fixed with locked Compression Plate (LCP) containing eight holes each is 4.5 mm using cortex screws. Results: The current study revealed that the stiffness construct will be reduced when the distance between the Locking Compression Plate and the bone analogue increased. Conclusion: To preserve the bone's peripheral blood supply, the plate should be kept at a small distance from the bone during internal fixation.

Chronic myelomonocytic leukemia (CMML) is a rare but distinct hematological neoplasm with overlapping features of myelodysplastic syndrome (MDS) and myeloproliferative neoplasm (MPN). Individuals with CMML have persistent monocytosis and bone marrow dyspoiesis associated with various constitutional symptoms like fevers, unintentional weight loss, or night sweats. It is established that there is a strong association of CMML with preceding or coexisting autoimmune diseases and systemic inflammatory syndromes affecting around 20% of patients. Various molecular abnormalities like TET2, SRSF2, ASXL1, and RAS are reported in the pathogenesis of CMML, but no such mutations have been described to explain the strong association of autoimmune diseases and severe inflammatory phenotype seen in CMML. Germline mutation in SH2B adaptor protein 3 (SH2B3) had been reported before to affect a family with autoimmune disorders and acute lymphoblastic leukemia. In this report, we describe the first case of a female subject with many years of preceding history of multiple sclerosis before the diagnosis of CMML. We outline the evidence supporting the pathogenic role of SH2B3 p.E395K germline mutation, connecting the dots of association between autoimmune diseases and CMML genesis.

Thyroid gland is one of the body’s most important glands because it regulates the metabolism of the human body. It controls how the body works by releasing specific hormones into the blood. The two different hormone disorders are hypothyroidism and hyperthyroidism. When these disorders occur, the thyroid gland releases a particular hormone into the blood that regulates the metabolism of the body. Iodine deficiency, autoimmune conditions, and inflammation can contribute to thyroid issues. The disease is diagnosed using a blood test, but there is frequently some noise and disturbance. Techniques for cleaning data can be used to make it simple enough to perform analytics that show the patient's risk of developing thyroid disease. This paper deals with the analysis and classification models used in thyroid disease based on the information gathered from the dataset taken from the UCI machine learning repository. Machine learning plays a crucial role in the detection of thyroid disease. This paper suggests various machine-learning methods for thyroid detection and diagnosis for thyroid prevention.

Heat transfer represented by jet impingement was considered due to the grown demand for such applications in the industry such as heat exchangers, metal cutting, and electronic's component cooling. Hence, ZnO/water nanofluid is embraced to enhance the heat exchanged by impinge nanofluid through a square jet. Five nanofluid were prepared thoroughly with different ZnO concentrations range of (0.1–0.5%) besides a plain de-ionized water for comparison. Validation was performed by comparing the outcome with comparable analogous studies and exhibited a content deviation. The parameter (H/Dh) which denotes the (exit of nozzle-to-hot plat spacing over the hydraulic jet diameter) was varied to be 2–8. The acquired results showed that the adoption of nanofluid in such an arrangement gives further magnification in heat transfer (Nu = 113.9%) at high Reynold's number and nanoparticle concentration (φ = 0.5%, Re = 17500, and H/Dh = 2). Whereas the minimum gained heat (Nu = 43.8%) was detected at nanoparticle concentration of (ɸ = 0.1%), Reynold's number of (Re = 5000), and H/Dh spacing of 8 respectively. It was found that applying excessive heat flux on the target plate causes rapid evaporation once the flow hits the surface plate, which leads to poor thermal performance. Eventually, the gained data were correlated and the empirical correlation is proposed.

Negative effects of using traditional engine fuels on climate change and global warning have produced a scenario of high competition to find an alternative fuel more friendly and unharmful to the environment. Alcohol fuel was found very practical to be mixed with engine designed fuel. In the present work, ethanol was mixed with gasoline in different proportions (10% ethanol + 90% gasoline, 20% ethanol + 80% gasoline, 30% ethanol +70% gasoline, 40% ethanol + 60% gasoline) by utilizing ultrasonic bath to ensure perfect mixing which in turn will increase the fuel energy content.A one-cylinder, four-stroke and spark ignition engine was used to study and analyze the effect of ethanol's/gasoline blend on power, efficiency and exhaust gases. Results showed that power, brake specific fuel consumption and thermal efficiency are improved with the increase of ethanol concentration. On the other hand, ethanol was found to have negative effect on volumetric efficiency.Furthermore, adding ethanol reduce harmful exhaust gasses. It is found that more ethanol is an accompanied with less exhaust gasses. Finally, research octane number and motor octane number are found to be much with ethanol blends. Although lower heating value was found to be higher for pure gasoline, it's found that all other parameters are enhanced with adding ethanol to the engine fuel.

Pancreatic cancer is a significant cause of cancer-related mortality and often presents with limited treatment options. Pancreatic tumors are also notorious for their immunosuppressive microenvironment. Irreversible electroporation (IRE) is a non-thermal tumor ablation modality that employs high-voltage microsecond pulses to transiently permeabilize cell membranes, ultimately inducing cell death. However, the understanding of IRE's impact beyond the initiation of focal cell death in tumor tissue remains limited. In this study, we demonstrate that IRE triggers a unique mix of cell death pathways and orchestrates a shift in the local tumor microenvironment driven, in part, by reducing the myeloid-derived suppressor cell (MDSC) and regulatory T cell populations and increasing cytotoxic T lymphocytes and neutrophils. We further show that IRE drives induce cell cycle arrest at the G0/G1 phase in vitro and promote inflammatory cell death pathways consistent with pyroptosis and programmed necrosis in vivo. IRE-treated mice exhibited a substantial extension in progression-free survival. However, within a span of 14 days, the tumor immune cell populations reverted to their pre-treatment composition, which resulted in an attenuation of the systemic immune response targeting contralateral tumors and ultimately resulting in tumor regrowth. Mechanistically, we show that IRE augments IFN-γ signaling, resulting in the up-regulation of the PD-L1 checkpoint in pancreatic cancer cells. Together, these findings shed light on potential mechanisms of tumor regrowth following IRE treatment and offer insights into co-therapeutic targets to improve treatment strategies. [ABSTRACT FROM AUTHOR]

This study presents a numerical analysis for point contact Elasto-hydrodynamic lubrication EHL. The oils used are (0W-30 and 10W-40) as lubricants. The pressure and film-thickness profiles for point contact EHL are evaluated. The aims of this study are to estimate the effect of oil’s temperature on friction force, coefficient of friction and load carrying capacity. By using FORTRAN program, the Forward-iterative method is used, to solve two dimensional (2D) EHL problem. The viscosity is updating in the solution by using Roeland’s model. After the convergence of pressure is done, the friction force, friction power losses, and friction coefficient are calculated. The temperature used ranges from (-20 to 120 oC). The results showed the film-thickness decreases with the increasing of temperature. Though the maximum pressure is not affected, only the pressure distribution and profile are changed, inlet pressure decreases and the pressure profile tends towards a hertzian (dry contact) one. The friction force and the coefficient of friction decrease with the increasing of temperature.

The paper aim to developing of Seaweed Jelly industry value chain model that can increase sustainable value added. Detail purpose of this paper are designing initial model, constucting development model,and then calculates the amount of value added projectionthat can be accepted from the development model of Seaweed Jelly industry value chain. The research was conducted in the coastal area of Muna Regency of Southeast Sulawesi Province, ie Lasunapa Village, Gonebalano Village, and Lagasa Village, where 50 respondents were assigned to each village through purposive sampling technique, The analysis used is Activity Based Costing (ABC), Focus Group Discussion (FGD), and Hayami Method. The paper finding showed that; (1) there is an increase of product value added from Rp. 29,050,-/kg on the initial model, to Rp. 33,250,-/kg on thedevelopment model resulting in an increase in profit from Rp. 9,050,-/kg on the initial model to Rp. 13,250,-/kg on the development model; (2) there is an increase of profit margin from Rp. 54.000,-/kg on the initial model to Rp. 59,500,-/kg on the development model. This research does not carry out a deep analysis of the institutional industry, so that the future needs to be done institutional model development of the seaweed jelly industry. The paper include implication for the increasing productivity and community welfare. The paper includes implications for the cost reduction and increase value added of seaweed jelly industry. This paper resulting an development model and value added projection from that development model.

Agribusiness institutions have a strategic role in the development and management of superior commodities in Indonesia. The existence of agribusiness institutions is expected to strengthen the bargaining position of agribusiness actors and increase commodity competitiveness. This reason makes most groups of agribusiness actors to form institutions in order to maintain the sustainability of the businesses. However, several established agribusiness institutions have not been able to overcome the problems faced, such as; high economic disparity between farmers and other related economic actors, weak market access, and low production continuity so that the existence of agribusiness institutions still cannot give an impact on improving the economic status of the society and reducing poverty. The urgency of this study is to develop seaweed agribusiness institutions in Southeast Sulawesi that are able to improve institutional performance and have an impact on added value, wider market, and product selling prices. This study used a balance scorecard method to improve the institutional performance of seaweed agribusiness by which it has not been maximally implemented in overcoming the problems faced. The problems in questions are in the context of developing and managing seaweed agribusiness. Based on the performance recapitulation results of learning and growth perspectives on seaweed agribusiness institutions in Lea-Lea District of Baubau City, it shows that the level of productivity and the level of job satisfaction have sufficient score so that this indicator has a score of 3 (good). The results indicate that, in general, the performance of learning and growth perspectives on seaweed agribusiness institutions in Lea-Lea District of Baubau City is still sufficient or not in the category of excellent.

This paper deals with Matlab simulation of Long Term Evolution system (Lte) to show data rate of the uplink layer from user equipment toward the tower with respect to the size of Desecrate Fourier Transform process (DFT) which will be increased from 2 to the size of Inverse Desecrate Fourier Transform process (IDFT). Also it shows the way of using Cyclic Prefix technique (CP) in Lte system and its types which effect on the data rate for uplink layer. Finally the results will show the value of Lte system data rate for different types of modulation and Cyclic Prefix which will be for many types of system bandwidth individually, and it will show the minimum and maximum values of (DFT) process size with the midpoint which is the best one.