Quality Index Research Articles

Functional and vascular neuroimaging in maritime pilots with long-term sleep disruption.

The mechanism underlying the possible causal association between long-term sleep disruption and Alzheimer's disease remains unclear Musiek et al. 2015. A hypothesised pathway through increased brain amyloid load was not confirmed in previous work in our cohort of maritime pilots with long-term work-related sleep disruption Thomas et al. Alzheimer's Res Ther 2020;12:101. Here, using functional MRI, T2-FLAIR, and arterial spin labeling MRI scans, we explored alternative neuroimaging biomarkers related to both sleep disruption and AD: resting-state network co-activation and between-network connectivity of the default mode network (DMN), salience network (SAL) and frontoparietal network (FPN), vascular damage and cerebral blood flow (CBF). We acquired data of 16 maritime pilots (56 ± 2.3years old) with work-related long-term sleep disruption (23 ± 4.8 working years) and 16 healthy controls (59 ± 3.3years old), with normal sleep patterns (Pittsburgh Sleep Quality Index ≤ 5). Maritime pilots did not show altered co-activation in either the DMN, FPN, or SAL and no differences in between-network connectivity. We did not detect increased markers of vascular damage in maritime pilots, and additionally, maritime pilots did not show altered CBF-patterns compared to healthy controls. In summary, maritime pilots with long-term sleep disruption did not show neuroimaging markers indicative of preclinical AD compared to healthy controls. These findings do not resemble those of short-term sleep deprivation studies. This could be due to resiliency to sleep disruption or selection bias, as participants have already been exposed to and were able to deal with sleep disruption for multiple years, or to compensatory mechanisms Mentink et al. PLoS ONE. 2021;15(12):e0237622. This suggests the relationship between sleep disruption and AD is not as strong as previously implied in studies on short-term sleep deprivation, which would be beneficial for all shift workers suffering from work-related sleep disruptions.

Water quality assessment for aquacultivation in Quang Ngai city, Quang Ngai province

Aquatic product development and growth are significantly influenced by the water supply used for aquaculture. Evaluating the water quality available for this activity is vital since Quang Ngai city has been a major hub for the growth of aquaculture in Quang Ngai province. Twelve surface water quality parameters were monitored and analyzed at eight sampling points in the river basins of An Nghia and Tinh Khe communes from May to September 2023. The Water Quality Index (WQI) was calculated, and methods including Principal Component Analysis (PCA), calculation of environmental variable weights based on principal components (PC), and Pearson correlation were used to assess the correlation of the investigated factors. In the river basin of An Nghia and Tinh Khe communes, 12 criteria for the assessment of surface water quality were tracked and examined using 8 sampling locations between May and September in 2023. The degree of linkage was assessed using principal component analysis (PCA), weighting environmental factors based on principal components (PC), and Pearson correlation. The water quality index (WQI) was calculated between the factors of the research. The findings show that: (1) The parameters exceeded the permitted limit: DO, Alkalinity, NH4+, TP, Vibrio SPP, Coliform, TOC, and TN. The two metrics with the greatest levels of pollution among them are Vibrio SPP and NH4+. The WQI index ranges from 52-74 and is within the average water quality range (51-75); (2) PCA analysis reveals that only the first two principal components, PC1 and PC2 can account for 74.39% of the variance, with NH4+ (0.089) having the highest weight; (3) NH4+ and Vibrio SPP content have a strong correlation (r = 0.95), indicating that both of these parameters can be used to evaluate water quality in the study area in general.

Effects of Jin's three-needles therapy combined with low-frequency repetitive transcranial magnetic stimulation on sleep disorders and EEG in children with spastic cerebral palsy

To investigate the effects of Jin's three-needles therapy combined with low-frequency repetitive transcranial magnetic stimulation (rTMS) on sleep disorders and EEG activity in children with spastic cerebral palsy (CP). By using stratified randomization method, 100 children of spastic CP with sleep disorders were randomly assigned to a control group and an observation group, with 50 cases in each group. The patients in the control group were treated with medication, comprehensive rehabilitation training, and low-frequency rTMS, while the patients in the observation group were treated with Jin's three-needles therapy in addition to the interventions given to the control group. Acupoints selected included temporal three needles, brain three needles, intelligence three needles, four spirits needles, and bilateral Ganshu (BL 18), Shenshu (BL 23), Shenmai (BL 62), and Zhaohai (KI 6). Treatment was given once daily, five times a week, for 12 weeks. The Pittsburgh sleep quality index (PSQI) and children's sleep habits questionnaire (CSHQ) scores, modified Ashworth grade, Peabody developmental motor scales-2 (PDMS-2) score, and relative power values of δ, θ, β1, and β2 frequency bands in EEG were observed before and after treatment in both groups. Treatment safety was also evaluated. Compared before treatment, PSQI and CSHQ scores were decreased in both groups after treatment (P<0.05), with lower scores in the observation group than the control group (P<0.05). The modified Ashworth grade showed improvement (P<0.05), with better results in the observation group (P<0.05). PDMS-2 scores were increased in all dimensions (P<0.05), with higher scores in the observation group (P<0.05). Relative power values of δ and θ frequency bands in EEG were decreased (P<0.05), with lower values in the observation group (P<0.05), while relative power values of β1 and β2 frequency bands were increased (P<0.05), with higher values in the observation group (P<0.05). Children in both groups did not occurred obvious adverse reactions. Jin's three-needles therapy combined with low-frequency rTMS can effectively improve sleep disorders, spasticity and motor function, regulate EEG activity in children with spastic CP and sleep disorder, and have good safety.

Combined fractional CO2 laser with topical tioconazole versus Q-switched Nd-YAG laser in the treatment of onychomycosis; a randomized comparative trial.

Treatment of onychomycosis includes topical and systemic agents. However, prolonged use of oral treatment could cause adverse effects and topical antifungal agents have limited penetration. To compare the clinical efficacy and the safety of fractional CO2 laser combined with topical tioconazole nail solution versus Q-switched 1064 Nd: YAG laser in the treatment of fingernail onychomycosis. This randomized comparative clinical trial was conducted on 13 patients (47 nails) with fingernail onychomycosis. Patients were randomized to receive either fractional CO2 laser combined with topical tioconazole or Q-Switched Nd: YAG 1064nm laser every 2 weeks for 3 months followed by a 1-month follow up assessment. Onychomycosis severity index (OSI) score, Dermatology life Quality Index (DLQI) score, patient satisfaction score, dermoscopic evaluation and KOH examination were used for assessment of improvement. OSI showed improvement after treatment in both arms (from 16.17 to 10.92 in fractional CO2 arm (p = 0.026) and 23.13 to 22.43 (p = 0.92)). When comparing both groups OSI score significantly reduced in the fractional CO2 laser combined with tioconazole more than the Q-switched laser group (p = 0.002). The mean DLQI score significantly improved in both groups but no statistically significant difference between the two groups. Significant improvement in patient satisfaction score was noted in both groups. Mycological cure using KOH examination was detected in both groups (44.4% in the CO2 group and 56.5% in the Q-switched group) with no significant difference (P value < 0.05). Ruin pattern keratosis found to be the most dermoscopic pattern to be associated with poor OSI score improvement. Fractional CO2 laser combined with topical tioconazole is more efficient in treatment of onychomycosis than Q-Switched Nd: YAG 1064nm laser group as regards clinical improvement but both have comparable effect on mycological cure. Their use as adjuvant treatment rather than alone is recommended to ensure mycological cure in onychomycosis.

Prevalence and determinants of poor sleep quality among patients of diabetes mellitus: A tertiary hospital based cross sectional study

Background: The effects of diabetes on sleep quality are pronounced and have a cause-effect relationship. The major aim of this study was to check for the prevalence of poor sleep quality and associated factors among patients of diabetes mellitus in Pakistan as every 1 in 4th individual is suffering from diabetes in Pakistan. Materials and Methods: A hospital based cross-sectional study was conducted on diagnosed patients of diabetes mellitus from September 2023 to March 2024 using Pittsburgh Sleep Quality Index (PSQI). SPSS v.27 was used for data analysis. Frequencies, percentages for sample characteristics and means for PSQI were calculated. Chi-square and spearman were run for association and correlations respectively. Risk factors were predicted using binary logistic regression. Results: 384 responses were collected with 12 excluded. The prevalence of poor sleepers came out to be 82% and poor sleep was significantly associated and correlated with increasing age, poor glycemic control, and metformin as well as income, education and duration of diabetes respectively. Presence of comorbidities and uncontrolled diabetes were the only associated risk factors. Conclusions: Pakistani population with diabetes mellitus have an extremely high rate of poor sleep quality which should be addressed by adding sleep quality-oriented guidelines in the management of diabetes.

Spatiotemporal Dynamics of Water Quality: Long-Term Assessment Using Water Quality Indices and GIS

The severe contamination of groundwater supplies in rural areas is a global problem that requires strict environmental measures. Related to this, one of the most important challenges at present is the elimination of local sources of pollution. Therefore, this research examined the local water quality changes following the construction of the sewerage network, under the framework of long-term monitoring (2011–2022) in Báránd, Hungary, using water quality indices and GIS (Geographic Information System) techniques. In order to understand the purification processes and spatial and temporal changes, three periods were determined: the pre-sewerage period (2011–2014), the transitional period (2015–2018), and the post-sewerage period (2019–2022). Forty monitoring wells were included in the study, ensuring complete coverage of the municipality. The results revealed a high level of pollution in the area in the pre-sewerage period. Based on the calculated indices, an average of 80% of the wells were ranked in categories 4–5, indicating poor water quality, while less than 8% were classified in categories 1–2, indicating good water quality. No significant purification process was detected in the transitional period. However, marked changes were observed in the post-sewerage period as a result of the elimination of local sources of pollution. In the post-sewerage period, the number of monitoring wells ranked as excellent and good increased significantly. Additionally, the number of wells assigned to category 5 decreased markedly, compared to the reference period. The significant difference between the three periods was confirmed by the Wilcoxon test as well (p &lt; 0.05). Based on interpolated maps, it was found that, in the post-sewerage period, an increasing section of the settlement had good or excellent water quality. In addition to an assessment of long-term tendencies, the annual fluctuations in the water quality of the wells were also examined. This showed that the purification processes do not occur in a linear pattern but are influenced by various factors (e.g., precipitation). Our results highlight the importance of protecting and improving groundwater resources in municipal areas and the relevance of long-term monitoring of water adequate management policy.

Abstract 4122679: Associations Between Recent and Cumulative Lifetime Cannabis Use and Sleep Health in Middle-Aged Adults: 35-Year Insights from the Coronary Artery Risk Development in Young Adults (CARDIA) and CARDIA Sleep Studies

Background: Cannabis use has become common, but its effects on sleep health—an important contributor to cardiovascular health—remain poorly understood. We investigated associations between recent and cumulative lifetime cannabis use and objective and subjective sleep measures in middle-aged adults. Method: We assessed recent cannabis use (last 30 days) repeatedly from young adulthood (age 18-30 at baseline in 1985-86) to middle age (after 35 years) in the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) study. Cumulative lifetime cannabis use (1 year = 365 days of use) was estimated by summing days of use during follow-up. At Year 35 (Y35), we obtained objective sleep measures (duration, efficiency, fragmentation, wake after sleep onset [WASO]) via 7-day wrist actigraphy from CARDIA Sleep Ancillary Study II. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Robust regression models adjusted for Y35 age, sex, race, education, cumulative cigarette smoking, alcohol use, other substance use, physical activity, body mass index, sleep medication, and comorbidities. We also examined race, sex, and cigarette smoking status differences in associations. Result: Of 571 participants, mean age was 61.9 years; 65% were female, and 35% Black. Means (SD) for sleep duration, efficiency, fragmentation, WASO, and PSQI were 6.9 (1.1) hours, 90.5 (4.2)%, 20.6 (7.6)%, 43.5 (20.9) minutes, and 6.1 (3.6) scores, respectively. At Y35, 13.8% reported recent cannabis use, 56% reported former use, mean (SD) cumulative use was 1.6 (4.4) years. With adjustment, recent cannabis use was associated with longer sleep duration, lower efficiency, and higher WASO; former cannabis use was associated with longer sleep duration (Table). Compared to those with cumulative cannabis exposure years in the first quartile, fourth quartile users had longer sleep duration, lower efficiency, and higher WASO (β/p-value: 0.3/0.01, -1.2/0.01, and 8.9/&lt;.001, respectively). PSQI was not associated with recent or cumulative cannabis use. Associations were similar across race, sex, and cigarette smoking status. Conclusion: Recent and cumulative lifetime cannabis use is associated with longer sleep duration and poorer sleep quality in objective, but not subjective, measures. Further longitudinal studies are needed to identify interventions aimed at improving sleep health and promoting cardiovascular health in cannabis users.

Intra-class switch among interleukin-17 inhibitors for the treatment of plaque psoriasis: a single-center experience

Psoriasis is a chronic immune-mediated disease primarily affecting the skin. The most common subtype is plaque psoriasis, which can affect any body area, with a predilection for the knees, elbows, scalp, lumbosacral region, and genitalia. The European guidelines adopted in Italy recommend systemic therapies for moderate-to-severe psoriasis, defined by a Psoriasis Area and Severity Index (PASI) ≥ 10, Dermatology Life Quality Index (DLQI) ≥ 10, and/or Body Surface Area (BSA) ≥ 10. Over the past two decades, the development of biological agents has revolutionized psoriasis management, targeting specific cytokines such as TNF-α, IL-23, and IL-17. Among these, ixekizumab, secukinumab, brodalumab, and bimekizumab are approved for the treatment of moderate-to-severe plaque psoriasis. However, some patients require switching therapy because of primary/secondary ineffectiveness or side effects. We retrospectively analyzed 20 patients who had switched from one anti-IL-17 drug to another, assessing both safety and effectiveness. 70% of patients was represented by males, with a median age of 49.5 years. The most frequent comorbidities were arterial hypertension and hypercholesterolemia. Effectiveness was evaluated in terms of a 90% (PASI90) and 100% (PASI100) reduction in PASI compared to baseline at 16 and 52 weeks. Before switching to the current IL-17 inhibitor, seven patients had failed at least two biologics. Thirteen patients experienced a loss of effectiveness after more than 6 months (secondary ineffectiveness), whereas the other seven never showed improvement with the previous drug (primary ineffectiveness). Fourteen patients completed at least one year of follow-up. Two patients were lost during the follow-up, while four more are currently still under treatment without having completed the established temporal cut-off. Two patients switched to bimekizumab, nine to brodalumab, and nine to ixekizumab. At baseline, the median PASI was 10 (IQR 4.5). After 16 weeks, the median PASI decreased to 2 (IQR 5.5), and after one year, it was 1 (IQR 2). Eight patients (40%) and six patients (30%) achieved PASI 90 and PASI 100 at 16 weeks, respectively. After one year, sustained effectiveness was observed with PASI 90 (57.1%), PASI 100 (35.7%), and PASI ≤ 2 (78.6%). No serious adverse events or discontinuations due to adverse events were observed during the study period. Our study confirms the safety and effectiveness of intraclass switching among IL-17 antagonists, highlighting that an inter-class switch can be a valid option when patients fail to respond or lose effectiveness with an IL-17 inhibitor. However, further larger and longer studies are needed for a deeper understanding.

Groundwater Quality Prediction and Analysis Using Machine Learning Models and Geospatial Technology

The most prominent source of drinking water is groundwater, followed by lakes and reservoirs. Hydrological parameters like temperature, dissolved oxygen, pH, conductivity, ORP, and turbidity often change due to waste dumping into natural drinking water sources, particularly in densely populated areas. As a result, the water quality must be tested before public consumption to ensure healthy living in society. This research collected water samples from 129 wells in the Kanchipuram district in Tamil Nadu, India. An efficient integrated machine-learning-based prediction model has been proposed and modeled to determine the groundwater quality index (GQI). Several machine learning models were used to predict the water’s quality, including the naïve Bayes model, the KNN classifier, and the XGBoost classifier. Water quality predictions in 2024 were made using a combination of classification algorithms and models based on long short-term memory (LSTM) neural networks. The projected water quality characteristics were analyzed using geographical information system (GIS) technology to better understand and visualize the results. The XGBoost classifier model outperforms prior findings in the literature, with an accuracy of roughly 94.6%. The classification and prediction model was validated using collected and tested current data samples from a selected well. The findings were accurate within the 5% error range, promoting sustainability.

Association of plant and animal protein intake with sleep quality and quality of life in hemodialysis patients: a multicenter cross-sectional study

BackgroundThe current study aimed to evaluate the association between the intake of plant-based protein, animal-based protein, total protein, and the ratio of plant to animal protein with sleep quality and quality of life in patients undergoing hemodialysis.MethodsIn this cross-sectional study, 479 adult patients undergoing dialysis for a minimum of 3 months were included. The dietary intake was calculated using information from a validated 168-item semi-quantitative food frequency questionnaire. Quality of life (QOL) was assessed using the Kidney Disease Quality of Life Short Form (KDQOL-SF 1.3). and the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality.ResultsIn this study, the mean age of the participants was 58.18 years (± 14.25 years), with the majority being male (58.2%). After adjusting for potential confounders, significant positive associations were observed between total protein intake (β = 0.12, p = 0.03) and quality of life (QOL). Conversely, there were significant negative associations between the ratio of plant to animal protein intake (β = −0.94, p &amp;lt; 0.01) and QOL. Furthermore, significant negative associations were found between total protein intake (β = −0.02, p &amp;lt; 0.05) and animal protein intake (β = −0.19, p &amp;lt; 0.05) with poor sleep quality. Additionally, there were significant positive associations between the ratio of plant to animal protein intake (β = 0.188, p &amp;lt; 0.05) and poor sleep quality.ConclusionIncreased consumption of animal protein is associated with improved sleep quality and Quality of Life (QOL) in patients undergoing hemodialysis (HD). Further research, especially prospective studies, is required to confirm these associations.

Unilateral cochlear implantation in elderly patients: assessment of the auditory and non-auditory functions of patients

Introduction. One of the few ways to rehabilitate profound hearing loss in elderly patients is cochlear implantation. A number of studies have been published assessing the effect of unilateral cochlear implantation on cognitive function in elderly patients, but the results have been mixed.Aim. Evaluation of the impact of unilateral cochlear implantation on auditory and non-auditory functions in elderly patients.Materials and methods. The study included 50 elderly and senile patients (mean age 67.16 ± 3.5 years). RBANS-H, HI-MoCA tests were used to assess cognitive function. Quality of life, depression and anxiety levels were assessed by HADS, SF-36. Auditory function was assessed by pure tone audiometry, speech audiometry, SSQ, HISQUI19.Results. The study showed improvement in cognitive function in patients with and without residual hearing. There was also an improvement in quality of life, a decrease in depression and anxiety in both study groups. When assessing the auditory function, statistically significant differences between the study groups remained during the study for the sound quality indicator (SSQ test), while other parameters did not have a statistically significant difference at the end of the study. In addition, the study did not reveal a statistically significant effect of vestibular dysfunction on cognitive function in patients.Conclusions. Unilateral CI as a method of rehabilitation of profound impairments of auditory function in elderly and senile patients has demonstrated its high effectiveness.

Multi-Omics Analysis Uncovers the Mechanism for Enhanced Organic Acid Accumulation in Peach (Prunus persica L.) Fruit from High-Altitude Areas

The early-ripening peach industry has undergone rapid development in the Panxi region of the Sichuan Basin in recent years. However, after the introduction of some new peach varieties to the high-altitude peach-producing areas in Panxi, the titratable acid content in peach fruit has significantly increased. This study compared the fruit quality indicators of early-ripening peach varieties cultivated in Xide County (a high-altitude peach-producing area) and Longquanyi District (a low-altitude peach-producing area) in Sichuan Province and analyzed the differences in organic acid metabolism by combining primary metabolomic and transcriptomic approaches. The results showed that the ‘Zhongtaohongyu’ fruit from the high-altitude peach-producing area had a much higher accumulation of malic acid and, accordingly, a significantly higher organic acid content than the other samples. The lower annual average temperature and stronger ultraviolet radiation in high-altitude peach-producing areas may lead to the increased expression of genes (PpNAD-ME1, PpNADP-ME3, and PpPEPC1) in the organic acid synthesis pathway and the decreased expression of genes (PpACO2, PpNAD-MDH2/3/4/5, and PpPEPCK2) in the organic acid degradation pathway in peach fruit, ultimately resulting in the accumulation of more organic acids. Among them, the downregulation of the key genes PpNAD-MDH3/4/5 involved in malic acid metabolism may be the main reason for the higher malic acid accumulation in peach fruit from high-altitude peach-producing areas. Overall, this study elucidates the mechanism by which environmental factors enhance the accumulation of organic acids in peach fruit from high-altitude peach-producing areas from a multi-omics perspective, as well as providing a theoretical basis for screening key genes involved in organic acid metabolism in peach fruit.

Design of optimum spacecraft reorientation control with a combined criteria of quality based on the quaternions

Specifical original problem of attitude controlling for spacecraft was proposed in this paper. Problem of optimal rotation from a known initial state in a prescribed spatial orientation was studied in detail (turnaround time is not fixed). Design of optimal program of reorientation is based on new indicator of quality that combines energy costs including the contribution of controlling torques and integral of rotary energy (in a known proportion) and reorientation time; presence of duration factor bounds time of rotation finish. To construct an optimal control of angular momentum changing, quaternionic method and the maximum principle were applied. Differential equation that relates spacecraft angular momentum and quaternion of spacecraft orientation is a base to obtain analytic solution to a problem. We reveal the properties of optimum control program analytically, and study key features of optimum motion in details. Also, we write the formalized equations, mathematical formulas to design optimal law for change of spacecraft’s angular momentum. Analytic relations and equations are given for finding the optimal solution. Control law (in as explicit dependence between phase variables and con-trolling variables has been formulated. Main relations determining optimum values of parameters for rotation control algorithm were given. The closed-form law for rotation was obtained for dynamically symmetric solids. Numerical example as well as results of mathematical modeling of spacecraft motion that formed using optimum control are presented. This data as addition to the made theoretic descriptions shows reorientation process (in virtual form) and demonstrates practical feasibility of the developed control method. A designed algorithm for optimal control of rotation improves an efficiency of attitude system, and originates more economical performing of space vehicle during its flight along orbit.

Quality Management in Spanish Community Pharmacy: Implementation of ISO 9001.

Spanish community pharmacy has been incorporating some methods and approaches in the evaluation and improvement of quality, with the ISO 9001 standard being the most used reference. The experience of a community pharmacy in Spain is presented. The pharmacy implemented a management system based on the ISO 9001 standard in 2020, using the Deming cycle with the aim of enhancing the quality of pharmaceutical care. The results obtained in the processes over the following 2 years are also presented. The ISO 9001 standard was reviewed to ensure compliance. The Quality Management System control documentation was updated and included the following documents: quality manual, process map, operational processes and procedures, quality indicators and incident records. The pharmacy has planned and implemented a process of monitoring, measurement, analysis of results and continuous improvement for operational, strategic and support processes during the time period of the study. The main operational processes were associated with a set of indicators which permitted to know the results obtained, analyse deviations and implement improvements. The planning and development of the project encompassed approximately 1 year and involved several key stages: (1) diagnosis and assessment of quality situation, (2) analysis of processes, (3) preparation of documentation, (4) implementation of the Quality Management System, (5) internal audit, (6) monitoring of activities and continuous improvement, (7) follow-up audit by the certifying body, (8) obtaining the ISO 9001:2015 quality certificate. The planned schedule was adhered and the documents were successfully drafted. In total, eight operational processes, nine support processes and six strategic processes were reviewed and included in the Quality Management System. Twenty indicators were established to monitor and analyse the performance of these processes. During audits, deviations in the system or nonconformances were identified and analysed. In the first year of system implementation, five nonconformances were identified, decreasing to two in the subsequent two periods. In 2020, three improvement actions were implemented with the objective of: (1) implementing a medication reconciliation service, (2) developing a medication dose adjustment service for polymedicated patients, and (3) implementing a service to measure and improve inhalation technique in patients using inhalers. The implementation of a methodology based on the ISO 9001 standard has facilitated: (1) Integrating process management as a regular working methodology, (2) A focus on the continuous improvement of services, (3) Achieving recognition of the staff efforts and involvement.

Application of mathematical models on efficiency evaluation and intervention of medical institutions in China.

BACKGROUND: The efficiency of medical services directly impacts the economic burden of healthcare, making it crucial to analyze the input-output efficiency of various types of medical institutions. However, while hospitals had been extensively analyzed for their efficiency, other types of medical institutions had received limited attention in this regard. METHODS: In this study, we employed data envelopment analysis (DEA) methods based on time series and internal benchmarks to autonomously assess the efficiency of 18 distinct categories of healthcare facilities in China over the past decade. The verification was conducted through the utilization of the critical incident technique (CIT). Additionally, we utilized the Delphi process (AHP) method to evaluate suppliers of medical consumables, implemented a multi-population genetic algorithm for managing these consumethod and analytic hierarchymables efficiently, and applied stakeholder theory to manage medical personnel efficiency. RESULTS: Our findings indicated that medical institutions capable of providing clinical services exhibited higher levels of efficiency compared to those unable to do so. Multiple indicators suggested redundancy within these institutions. Notably, comprehensive benefit evaluation revealed that clinical laboratory had performed poorly over the past decade. We selected an inefficient medical institution for intervention in reagent management and the work efficiency of medical staff. After implementing the Delphi method and multi-population genetic algorithm for consumable replenishment, the reagent cost was reduced by 40%, 39% and 31% respectively in each of the three experimental groups, compared to the control group. By applying stakeholder theory and process reengineering methods, we were able to shorten quality control management time for medical staff in the experimental group by 41min per day, reduce clinical service time by 25min per day, and extend rest time by 70min per day, while the quality indicators were all meeting the targets. CONCLUSION: By employing various mathematical models as described above, we were able to reduce costs associated with medical consumables and enhance medical personnel work efficiency without compromising quality objectives.

Letter to the editor: Quality indicators and the safety profile of endoscopic intervention in patients with bleeding esophageal varices.

Letter to the editor: Quality indicators and the safety profile of endoscopic intervention in patients with bleeding esophageal varices.

Trends in Anti-Mullerian Hormone levels among Women attending Fertility Clinic in the UAE.

Background: Anti-Müllerian hormone (AMH) is widely recognised as the gold standard for assessing ovarian reserve. It is also utilised to predict ovarian response during controlled ovarian stimulation in assisted reproductive technology (ART) and is key indicator of oocyte yield, embryo quality, embryo euploidy, and live birth rates.

Effect of Motivation, Training and Work Discipline on Employee Performance: The Case of CV. Bumi Angkasa Sejahtera South Sumatera

This study examines the effect of motivation, training, and work discipline on employee performance at CV. Bumi Angkasa Sejahtera South Sumatra. The object of the study is CV Bumi Angkasa Sejahtera South Sumatra. Address Jalan Tanjung Sari I, Jl. Sapta Marga No. 1A, Bukit Sangkal, Kec. Kalidoni, Palembang City, South Sumatra 30114. This study is a causal associative study using a quantitative approach. The dependent variable is performance, with indicators of work quality, work quantity, and responsibility. The independent variables are motivation, training, and work discipline. The indicators of motivation are the need for security, the need to feel belonging, and the need for self-esteem. The training indicators are participants, materials, and objectives. The indicators of work discipline are obedience to time rules, company regulations, and rules of conduct at work. The population used in this study were all CV Bumi Angkasa Sejahtera South Sumatra employees, totaling 135 people, and the sample consisted of 100 respondents. The method used in data collection was a questionnaire, The analysis model used was multiple linear regression. The result reveals that motivation, training, and work discipline positively and significantly affect CV employee performance. Bumi Angkasa Sejahtera South Sumatera

Efficiency of International Law Mechanisms for Human Rights Protection in Education

Objectives. The study deals with international law mechanisms for human rights protection in education. The aim of the study is to analyse and evaluate the effectiveness of international law mechanisms for human rights protection in education. Theoretical Framework: The theoretical basis of the research was made up of the scientific works of scientists, quality and qualitative indicators of research, and the regulatory and legal framework. Methods: The research employed the method of comparison, visual graphic methods, a set of methods of processing, comprehension and interpretation of information. Results and Discussion: The study established the most common types of violations in the field of education, in particular: violation of the right of national minorities to education; impossibility of choosing the language of instruction; failure to provide inclusive education; discrimination against people with mental illness. Specific manifestations of the effectiveness of international law mechanisms for the human rights protection in the field of education are singled out, in particular: increasing public awareness and transparency of government activity, etc. Research Implications: The study gave grounds to draw the conclusions regarding the difficulty of proving the existence of violations in education. Attention is drawn to the subjectivity of the European Court of Human Rights (ECHR) and the ambiguous interpretation of norms enshrined in international legal acts. Originality/Value: The research is original, based on official data and the author's own conclusions, and has practical significance.

Hydrochemical characterization and sustainability assessment of Ismailia canal water, Eastern Nile Delta, Egypt: implications for human health and environmental safety

Surface freshwater systems globally face severe stresses due to overpopulation and associated waste. The Ismailia Canal, a crucial freshwater source in the eastern Nile Delta, Egypt, serves multiple purposes and is endangered by various environmental activities. This study characterizes the canal’s water using physicochemical parameters to evaluate its suitability for different uses. Water samples were collected twice in winter and summer seasons of the year 2018 from eight sites distributed along the course of Ismailia Canal. A comprehensive chemical analysis of the samples was carried out. Water chemistry was graphically and statistically assessed. Water qualities were evaluated using WHO guidelines, water quality index (WQI), Pollution indices of metals (PIm) and long- and short-term effect of trace elements on irrigation. Results show that the water is slightly alkaline and moderately hard, with higher salinity in winter than summer. Major cations and anions are higher in winter, whereas NO₃ is higher in summer. The canal water is primarily of the Ca(Mg)-HCO₃ type, influenced mainly by rock-water interactions. While most physicochemical parameters meet drinking water standards, Al, Sb, As, Cd, Fe, Pb, and Tl exceed limits, with significant impacts from Al and Tl year-round, and seasonal impacts from As, Pb, Cd, and Fe. For irrigation, water quality is generally unaffected in winter, but Mo and Se have slight impacts in summer for long-term use. This research is vital for informing sustainable water management practices, which are crucial for Egypt’s research initiatives, economic stability, and environmental sustainability.