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The Operating Room Scheduling (ORS) problem is the task of assigning patients to operating rooms (ORs), taking into account different specialties, lengths, and priority scores of each planned surgery, OR session durations, and the availability of beds for the entire length of stay (LOS) both in the Intensive Care Unit (ICU) and in the wards. A proper solution to the ORS problem is of primary importance for the healthcare service quality and the satisfaction of patients in hospital environments. In this paper we first present a solution to the problem based on Answer Set Programming (ASP). The solution is tested on benchmarks with realistic sizes and parameters, on three scenarios for the target length on 5-day scheduling, common in small–medium-sized hospitals, and results show that ASP is a suitable solving methodology for the ORS problem in such setting. Then, we also performed a scalability analysis on the schedule length up to 15 days, which still shows the suitability of our solution also on longer plan horizons. Moreover, we also present an ASP solution for the rescheduling problem, that is, when the offline schedule cannot be completed for some reason. Finally, we introduce a web framework for managing ORS problems via ASP that allows a user to insert the main parameters of the problem, solve a specific instance, and show results graphically in real time.
Cutaneous Leishmaniasis (CL) is considered a neglected tropical disease which in Pakistan can now be considered as a growing public health problem. The exact figures on the magnitude of the disease are lacking both at the national and regional level and only a few health centres are available for diagnosis of CL. The present study was designed to identify the epidemiology of CL infection from August 2018 to December 2019 and to assess clinical aspects of CL in Baluchistan Province of Pakistan. A total of 4072 clinically suspected CL cases were analysed statistically. The highest number of CL cases were reported in May, followed by April, January and then July, February and June and the lowest number of cases were observed in March and November. The highest prevalence rate was found in males where 38% of reported cases were aged 0–9 years. The majority (24.4%) of lesions were found on the hands followed by the face in which cheeks, ears and nose were the effected organs. About 50% of the participants have single lesion while 14% of the participants had two and nearly 3% of the participants have six lesions. The atypical clinical presentations were observed in Baluchistan and common unusual presentations were lupus erythematosus. The study findings suggest that more epidemiological studies and health education campaigns are needed for the population awareness regarding CL in Baluchistan. It is recommended that risk factors should be evaluated to establish control and management strategies to prevent disease at the individual and community level.
Flavanones are found specifically and abundantly in citrus fruits. Their beneficial effect on vascular function is well documented. However, little is known about their cellular and molecular mechanisms of action in vascular cells. The goal of the present study was to identify the impact of flavanone metabolites on endothelial cells and decipher the underlying molecular mechanisms of action. We investigated the impact of naringenin and hesperetin metabolites at 0·5, 2 and 10 μm on monocyte adhesion to TNF-α-activated human umbilical vein endothelial cells (HUVEC) and on gene expression. Except hesperetin-7-glucuronide and naringenin-7-glucuronide (N7G), when present at 2 μm, flavanone metabolites (hesperetin-3′-sulphate, hesperetin-3′-glucuronide and naringenin-4′-glucuronide (N4′G)) significantly attenuated monocyte adhesion to TNF-α-activated HUVEC. Exposure of both monocytes and HUVEC to N4′G and N7G at 2 μm resulted in a higher inhibitory effect on monocyte adhesion. Gene expression analysis, using TaqMan Low-Density Array, revealed that flavanone metabolites modulated the expression of genes involved in atherogenesis, such as those involved in inflammation, cell adhesion and cytoskeletal organisation. In conclusion, physiologically relevant concentrations of flavanone metabolites reduce monocyte adhesion to TNF-α-stimulated endothelial cells by affecting the expression of related genes. This provides a potential explanation for the vasculoprotective effects of flavanones.
Introduction: The tobacco epidemic is surging in developing countries. While the determinants of tobacco use are well known, it is less certain whether they are similar in developed and developing countries. This has important ramifications for the implementation of interventions locally. This qualitative study explored the determinants and importance of context on tobacco use in Pakistan. Methods: Focus group discussions were conducted in two districts with doctors, nurses and patients from local tuberculosis clinics. Results: Peer influence, social acceptability, affordability and visibility of tobacco, public understanding and personal perception of risks influence tobacco use. Individual factors, such as personal curiosity, adversity and stress, also affected tobacco uptake and use. Patients were willing to pay for effective cessation treatment provided the costs were comparable to their expenditure on tobacco. Discussion: Factors such as peer and social influences are similar to those reported elsewhere. However, local variations exist in the degree of sociocultural acceptability, visibility of tobacco use, public understanding of risks and individual situational factors that influence tobacco use. Patients are prepared to pay for treatment, but there are gender differences in what can be afforded. For tobacco cessation interventions to be effective, local adaptations are essential to ensure cultural and contextual appropriateness.
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