Multi-objective Optimization of water resources in real time based on integration of NSGA-II and support vector machines.

One of the management strategies of water resources systems is the combination of simulation and optimization models to achieve the optimal policies of reservoir operation in the form of specific optimization. This study utilizes an integration of the NSGA-II multi-objective algorithm and WEAP simulator model so that the first objective is to maximize the reliability of providing the needs in front of the second goal, i.e., to minimize the drawdown the water table at the end of the operation time. The dam rule curve or the amount of released volume from the reservoir is optimized to supply downstream uses in these conditions. However, in certain optimizations, the optimal solutions cannot be generalized to other possible inputs to the reservoir, and if the inflow to the reservoirs changes, the obtained optimal solutions are no longer efficient and the system must be re-optimized in the form of an optimizer algorithm. Therefore, to solve this problem, a new method is extended on the basis of the combination of the support vector machine and NSGA-II algorithm for optimal real-time operation of the system. The results demonstrate that the average error rate of optimal rules derived from support vector machines is less than 2.5% compared to the output of the NSGA-II algorithm in the verification step, which indicates the efficiency of this method in predicting the optimal pattern of the dam rule curve in real time. In this structure, based on the inflow to the reservoir, the volume of water storage in the reservoir and changes in the reservoir storage (at the beginning of the month) and the downstream demands of the current month, the optimal release amount can be achieved in real time. Therefore, the developed support vector machine has the ability to provide optimal operation policies based on new data of the inflow to the dam in a way that allows us optimally manage the system in real time.

Impact of Medical TV Shows on the Surgical Knowledge of Non-Healthcare Students of Lahore, Pakistan.

Purpose: A popular genre of television shows is medical dramas. Although the primary objective of watching these shows is entertainment, acquiring medical knowledge is a passive by-product. Surgical procedures constitute a large part of the storyline of these shows. This could either serve as a source of medical knowledge or provide false information, the effect being especially important in individuals with no prior medical exposure. This study assesses the impact medical TV shows can have on the surgical knowledge of non-healthcare students and the difference in knowledge between different demographic groups (among those with relatives in the medical community and those without). Methods: A cross-sectional study was conducted among the non-healthcare students of Lahore, Pakistan. A self-administered questionnaire was used containing socio-demographic factors (age, gender, educational discipline), history, and hours of medical TV shows watched. It also contained ten questions each with a score of 1 to assess surgical knowledge. Data were analyzed using SPSS v.26. Results: Among the 1097 respondents, 450 (41%) had a history of watching medical TV shows. The majority, 319 (29.1%), had seen these shows for < 24 hours. The mean score of all respondents was 5.79 out of a maximum score of 10. Respondents with a history of watching medical TV shows were more knowledgeable than those who did not (p < 0.001). Similarly, respondents with a history of watching more hours of medical TV shows were more knowledgeable than those who watched for a lesser number of hours (p < 0.001). Respondents with relatives in the healthcare profession were also more knowledgeable than those without (p = 0.049). Conclusion: If properly developed, while maintaining their primary entertainment value, medical TV shows can also be used as efficient learning tools. Quality controls must also be applied to minimize the risk of false information.

Prevalence and predictors of using complementary and alternative medicine among diabetic patients in Taif city, Saudi Arabia.

BACKGROUND: Saudi Arabia has the second-highest rate of diabetes in the Middle East. Herbal treatment is the most used complementary and alternative therapy among Saudi diabetic patients. Little is known about the use of complementary and alternative medicine among diabetic patients who reside in Taif city. METHOD: This study evaluated the magnitude and correlates of complementary and alternative medicine (CAM) use among diabetic patients attending diabetic clinics and primary healthcare in two governmental hospitals, namely, Prince Mansour Military Hospital (PMMH) and National Gourd Hospital (NGH) in Taif city. RESULTS: CAM prevalence was 33.7%, of whom 87.3% did not consult a doctor before use and 43.2% had more than one source of information while 62.7% used more than one CAM method. Around 49.2% reported that it is very useful, and 72.9% did not notice any side effect from its use. In addition, 47.5% would recommend CAM to other diabetic patients. All (100%) reported using bitter apple, 66.1% reported using cinnamon, 55.1% used ginger, 35.6% took fenugreek, and 21.2% reported using Garlic as an only CAM. Female gender, family history, diabetic complications, and longer duration of diabetes were associated with the increased use of CAM. DISCUSSION AND CONCLUSION: CAM use by diabetic patients in Taif is prevalent. Health education and the safe use of CAM is much needed. Appropriate efforts from the government to integrate CAM into conventional diabetes treatment should be considered.

Arranging blood for elective thyroid surgeries: dilemma continues in the developing world.

BACKGROUND: Cross matched blood is frequently ordered based on a subjective anticipation of blood loss for a procedure. Excessive blood arrangement and wastage overburdens the blood bank in terms of work load and storage of blood, increases cost of medical care and results in injudicious use of a limited resource. The aim of this short report is to assess the current practice for arranging cross matched blood in elective thyroid surgeries by comparing cross match to blood transfused ratio. FINDINGS: Medical records for all patients from January 2009 to December 2014 undergoing thyroid surgery were retrieved and reviewed through electronic health information management system (HIMS). A total of 91 patients were included in the study, out of which 18 (19.7%) were male and 73 (80.2%) were female. A total of 107 units of blood were arranged and only 9 were transfused. 47 patients underwent a total thyroidectomy, while 44 underwent a hemithyroidectomy. The cross match to transfusion ratio came out to be 11.88. CONCLUSIONS: Routine arrangement of cross matched blood is not required in elective thyroid surgeries. All institutions should have a maximum blood ordering schedule planned for elective procedures, and blood products should be arranged accordingly to avoid unnecessary cross matching.

Effect of bupivacaine soaked gauze in postoperative pain relief in laparoscopic cholecystectomy: a prospective observational controlled trial in 120 patients.

BACKGROUND: Symptomatic gallstone disease is one of the most common problem attended by a general surgeon. The application of minimally invasive surgical techniques for the removal of gallbladder is now an accepted and preferred method for treating this condition. The avoidance of a subcostal incision and minimal bowel handling leads to decreased postoperative pain, early returning to function and overall shorter duration of hospital stay. Nevertheless, patients do have significant postoperative pain, and newer techniques to further reduce this pain are the subject of many ongoing studies. Many intraoperative techniques for reducing postoperative pain have been described. The current practice at many institutions, including ours, is to discharge the patient on the first postoperative day on oral analgesics. Better control of postoperative pain may help establishing laparoscopic cholecystectomy as a day care procedure in selected patients. The aim of this study is to determine the effect of 0.5 % bupivacaine soaked oxidized regenerated cellulose surgical versus normal saline soaked surgical applied at the gallbladder bed on postoperative mean pain score after laparoscopic cholecystectomy for symptomatic gallstones. PATIENTS AND METHODS: Patients scheduled for laparoscopic cholecystectomy were enrolled in the study after meeting the inclusion criteria. Relevant history was taken and clinical examination was done. Necessary investigations were carried out. All patients were divided to receive either 0.5 % bupivacaine soaked surgicel or normal saline soaked surgicel after laparoscopic cholecystectomy with each group having equal number of patients. The pain score was measured with a visual analogue scale (VAS) at 4, 12 and 24 h after the procedure in both groups. All data was recorded on performa and SPSS-19 was used for analysis. RESULTS: The demographic characteristic of the two groups has shown that studied patients were matched as regarding gender, age, weight, ASA status and duration of surgery. Post-operative abdominal pain was significantly lower in bupivacaine Group than Saline group. This difference was reported from 4 h till 12 h post-operatively. Bradycardia, Hypotension and Urinary retention were the most common perioperative symptoms reported, with an incidence of 28.3 % in the saline Group and 15 % in the bupivacaine group with no significant differences. Evaluation of postoperative details such as oral intake, time to walk and length of hospital stay revealed that bupivacaine group reported better outcomes as compared to saline group. CONCLUSION: Placing bupivacaine soaked surgicel has been shown to decrease the mean postoperative pain score in patients. No significant complication was noticed with the use of surgicel. Because adequate pain control requires intravenous medications, additional methods for pain control need to be studied before laparoscopic cholecystectomy can be routinely performed as a day care case.

Membrane fouling and performance evaluation of conventional membrane bioreactor (MBR), moving biofilm MBR and oxic/anoxic MBR.

In this study, three laboratory scale submerged membrane bioreactors (MBRs) comprising a conventional MBR (C-MBR), moving bed MBR (MB-MBR) and anoxic-oxic MBR (A/O-MBR) were continuously operated with synthesized domestic wastewater (chemical oxygen demand, COD = 500 mg/L) for 150 days under similar operational and environmental conditions. Kaldnes(®) plastic media with 20% dry volume was used as a biofilm carrier in the MB-MBR and A/O-MBR. The treatment performance and fouling propensity of the MBRs were evaluated. The effect of cake layer formation in all three MBRs was almost the same. However, pore blocking caused a major difference in the resultant water flux. The A/O-MBR showed the highest total nitrogen and phosphorus (PO4-P) removal efficiencies of 83.2 and 69.7%, respectively. Due to the high removal of nitrogen, fewer protein contents were found in the soluble and bound extracellular polymeric substances (EPS) of the A/O-MBR. Fouling trends of the MBRs showed 12, 14 and 20 days filtration cycles for C-MBR, MB-MBR and A/O-MBR, respectively. A 25% reduction of the soluble EPS and a 37% reduction of the bound EPS concentrations in A/O-MBR compared with C-MBR was a major contributing factor for fouling retardation and the enhanced filtration capacity of the A/O-MBR.

Performance evaluation and bacterial characterization of membrane bioreactors.

A bench-scale conventional membrane bioreactor (C-MBR), a moving bed membrane bioreactor (MB-MBR) and an anoxic/oxic membrane bioreactor (A/O-MBR), operating under similar feed, environmental and operating conditions, were each evaluated for their treatment performance and bacterial diversity. MBRs were compared for the removal of organics (COD) and nutrients (N and P) while pure culture techniques were employed for bacterial isolation and an API 20E kit was used to identify the isolates. Pseudomonas aeruginosa, selected as a representative of denitrifying microorganisms, was isolated only from the A/O-MBR using Citrimide Agar. Using PCR, the nitrifying bacteria Nitrosomonas europaea was detected only in the MB-MBR. On the other hand, Nitrobacter winogradskyi was detected in all three reactors. Addition of media and maintenance of a lesser DO resulted in the highest TN removal in the A/O-MBR as compared to the C-MBR and the MB-MBR, whereas better nitrification was observed in the MB-MBR than in the C-MBR.

How do emergency departments in England process the results of laboratory investigations?

AIMS: To determine how emergency departments in England process laboratory investigation results, to identify risk, and to note examples of good practice. METHODS: A telephone survey was conducted, and data were entered anonymously into Excel spreadsheets. Fisher's exact test was used to test the independence of pairs of variables. RESULTS: Data were collected from 167 out of 193 (87%) emergency departments in England. The majority had nurse-requested blood tests. There was a statistical association between nurse-requesting and failure by the clinician seeing the patient to check results. Fourteen (8%) departments did not allow patients to leave until all their results were available. A senior doctor did a second 'safety' check of results in 83 (50%) departments. Many respondents were able to give examples of patients who had been recalled to hospital after a second check. Only a minority of departments had information systems that could identify high-risk patients. CONCLUSION: A second 'safety' check by an experienced consultant, associate specialist or middle grade doctor identifies error. This is time-consuming, but could be supported and simplified by using intelligently designed information systems.

Improving operation notes to meet British Orthopaedic Association guidelines.

INTRODUCTION: Operation notes are an important part of medical records for clinical, academic and medicolegal reasons. This study audited the quality of operative note keeping for total knee replacements against the standards set by the British Orthopaedic Association (BOA). PATIENTS AND METHODS: A prospective review of all patients undergoing total knee replacement at a district general hospital over 8 months. Data recorded were compared with those required by the BOA good-practice guidelines. Change in practice was implemented and the audit cycle completed. Data were statistically analysed. RESULTS: A total of 129 operation notes were reviewed. There was a significant improvement in the mean number of data points recorded from 9.6 to 13.1. The least well recorded data were diagnosis, description of findings, alignment and postoperative flexion range. All had a significant improvement except description of findings. The operating surgeon writing the note improved from 56% to 67%. Detailed postoperative instructions also improved in quality. CONCLUSIONS: Surgeon education and the use of a checklist produce better quality total knee replacement operation notes in line with BOA guidelines. Further improvements may be made by making the data points part of the operation note itself.