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BACKGROUND: Understanding expectations of the patients towards the quality of services that hospitals providing is very important in quality in healthcare. With every health care organization claiming its services to be the best, benchmarking and comparing them to ascertain the real best is very difficult but much required in this competitive world. Patients have a varied need depending upon the resources and criticality of disease. The aim of the study was to identify the factors linked with patient's expectations contributing to the quality of the service delivered by the hospital. MATERIALS AND METHODS: Multi-speciality hospitals were visited to survey indoor and outdoor patients of different age groups. Omega coefficient and Cronbach α test were used to test the questionnaire's validity and reliability. The factor analysis technique was used to identify factors determining patient expectations. The SERVQUAL framework was used to categorize evaluation criteria. RESULTS: The resultant factors show variations in prioritizing service demands by the patients. Such a system would enable the patients to select a hospital capable of delivering best quality services. CONCLUSION: This study identifies the factors that contribute in delivering high quality service by the hospital. It gives a futuristic view to design a framework for evaluating the quality of the service delivered by a hospital.

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A facile hydrothermal synthesis route was explored to obtain various nanostructures of Co oxide for applications in electrocatalytic water-splitting. The effect of reaction time and metal precursor ions on the morphology of synthesized nanostructures was studied in detail with the aid of a scanning electron microscope. By systematic optimization of the synthesis parameters, Co oxide nanostructures with single dimensionality were obtained in the form of 0D nanoparticles (NPs), 1D nanowires (NWs), 2D nanosheets (NSs) and 3D nanocrystals (NCs). The effectiveness of the developed nanostructures towards oxygen evolution reaction (OER) was studied and a promising OER activity was recorded for all the samples. Amongst all the developed catalysts, Co(OH)2 NPs showed the lowest overpotential of 339 mV to achieve a current density of 10 mA cm-2, which is even lower than that of noble-metal oxides such as the commercial RuO2 catalyst (370 mV). The specific effect of different parameters such as BET surface area, phase, crystallographic orientation of surface lattice planes, electroactive surface area and surface active species on the OER performance was studied. It was found that the Co3O4 phase is more active for the OER, compared to the Co(OH)2 phase. However, Co(OH)2 NPs showed the best OER performance owing to their higher BET surface area, thereby underlining the significance of the catalyst surface area. The effect of the number of active surface atoms was demonstrated by estimating the electroactive surface area of all Co3O4 nanostructures. It was also shown that the formation of CoO2 species (Co(IV)) on the surface is more beneficial for the OER as compared to the formation of CoOOH species (Co(III)). Finally, the robustness of the developed Co3O4 nanostructures was established by performing a recycling test for the OER (1000 cycles) and the observed change in the catalytic activity was correlated with morphological variation.

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BACKGROUND: Hemi-agenesis of thyroid is a rare congenital condition with the clinical significance lying only in cases where the remnant tissue is affected by a pathology mandating removal of the gland. Henceforth, the hemi-thyroidectomy technically becomes a total thyroidectomy with a need for long term thyroid replacement therapy. CASE SUMMARY: We present a series of three cases noted over a period of two years where preoperative imaging evaluation confirmed the developmental abnormality. Further presence of a thyroid nodule in each of these cases posed a specific clinical situation whereby characterization of nodule appeared mandatory for a rational management involving life-long thyroid replacement therapy due to an 'apparent total thyroidectomy', if the remnant gland is removed. Ultrasound TI-RADS is a new system for evidence based sub-classification of thyroid nodules enabling both the surgeon and patient to take a streamlined decision about the overall approach for management. CONCLUSION: Prospective nodule characterization based on the thyroid image reporting and data system (TI-RADS), enables the surgeon to decide the treatment strategy sparing the patient of the cost and morbidity associated with long term thyroid replacement therapy.

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INTRODUCTION: Most of the adrenal masses are discovered incidentally by imaging techniques for reasons unrelated to adrenal diseases. Treatment is based on various factors such as, nature of adrenal mass, age of presentation, size of tumor, and the functional status of tumor. We report a series of 14 consecutive cases of adrenal tumors treated in a single surgical unit in our hospital. AIM: The aim of this study was to evaluate the clinical profile and outcome of treatment of adrenal tumors treated in a surgical unit. MATERIALS AND METHODS: It is a retrospective study data of 14 cases of adrenal tumors treated in a single surgical unit in University Hospital over 10 years have been analyzed. Various parameters such as gender, age, size of tumor, functional status, histopathology, type of management, and outcome have been reviewed. RESULTS: A total of 14 patients with adrenal masses were seen over a 10 year period (1997-2006). All were referred cases, either from endocrinology or medicine wards. There were seven female and seven male patients. Mean age of patients was 48.6 years (range 14-60 years). Mean size of tumor was 8.0 cm (5.9 cm for benign tumors and 9.7 cm for malignant tumors). There were six cases of adrenal carcinoma, four cases of adrenal myelolipoma, two cases of pheochromocytoma, and one each case of adrenal hyperplasia and histoplasmosis. There were only two functional tumors. All, except two malignant cases were treated operatively. A total of 5 year survival was 100% in benign cases and 27% in malignant tumors. CONCLUSION: Adrenal tumors need to be assessed for their functional status and malignant potential prior to treatment. Surgical excision is usually curative for benign lesion. Among malignant tumors the benefits of surgery depend on local extent and metastatic status of tumors.

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Sphincter of Oddi disorder (SOD) is a part of functional gastrointestinal disorder which is a non-calculous obstructive disorder. This disease is more common in middle-aged women with a prevalence of around 1.5% but in patients with post-cholecystectomy syndrome (PCS) the prevalence rate is markedly higher (9-55%). This high variability maybe attributed to lack of uniformity in patient selection criteria, definition of SOD, and the diagnostic method used. Abdominal pain is the most common symptom occurring due to obstruction at the SO leading to ductal hypertension, ischemia from spastic contraction and hypersensitivity of papilla. Clinical diagnosis of SOD can be achieved by Rome III criteria. Various classifications are used (Milwaukee billiary and modified Milwaukee group classification) for billiary and pancreatic SOD. Not a single non-invasive method is diagnostic. Sphincter of Oddimanometry (SOM) is the gold standard method for evaluating and deciding the management of an SOD patient. The symptomatic relief rate varies from 55% to 95%, so risk-benefit ratio should be evaluated with each patient.

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OBJECTIVE: To report the use of trypan blue staining of the filtering bleb to assess its functional status in eyes undergoing phacoemulsification after trabeculectomy. SUBJECTS AND METHODS: This retrospective study was conducted at a tertiary eye care centre in North India and studied 33 eyes of 33 patients ( with previously operated trabeculectomy), who underwent phacoemulsification. Trypan blue dye (0.06%) was used to stain the anterior capsule. After completion of phacoemulsification, the staining of the trabeculectomy bleb was noted as diffuse, patchy, minimal or no staining. RESULTS: Of the 33 eyes, 13 had diffuse staining (39.4%, mean IOP = 9.3 ± 2.2 mm Hg), 7 (21.2%, mean IOP= 15.5 ± 1.8 mm Hg) had patchy staining, 4 had minimal staining (12.1%, mean IOP= 17.5 ± 0.5mm Hg) and nine (27.3%, mean IOP= 19.3 ± 1.6 mm Hg) had no staining. These staining patterns were labeled as groups 1 - 4 respectively. Statistical analysis showed that the difference between the IOPs in Group 1 - 2 and between Group 2 - 3 was not significant statistically (p=0.682 and 0.665 respectively). However the differences between the IOPs between Groups 1 - 3, 1 - 4, 2 - 4, and 3 - 4 were found to be highly significant statistically (p less than 0.0005). CONCLUSIONS: Trypan blue dye can be used to test the amount of sub conjunctival filtration in eyes undergoing phacoemulsification cataract surgery.

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AIM: This study investigated the levels of Apurinic/Apyrimidinic Endonuclease (APEX1) in gallbladder carcinoma (CaGB) tissue and co-related these levels with various clinicopathological parameters. PATIENTS AND METHODS: Twenty cases of CaGB and cholelithiasis were included in the study. Western blot analysis of APEX1 protein was performed using actin as the reference point. Densitometric analysis and the integrated density value (IDV) of APEX1 protein samples were determined. The ratio of IDV of APEX1/actin was determined. RESULTS: The mean IDV ratio of APEX1 in CaGB was 0.63±0.33 and 0.45±0.19 in cholelithiasis. The mean IDV ratio of a variant of APEX1 (ΔAPEX1) in CaGB was 0.50±0.09, whereas it was 0.40±0.16 in cholelithiasis. Calculating the mean IDV ratio of total APEX (APEX1+ΔAPEX1) in CaGB was 1.13±0.31 whereas in cholelithiasis, 0.85±0.23. The differences were statistically significant (p<0.05). CONCLUSION: A significant correlation was found between the relative expressions of APEX1 in cancer as compared to that in cholelithiasis patients. There was significant association between APEX1 expression and perineural invasion. A variant of APEX1 correlated with tumor infiltration. Hence APEX1 may be of use as a prognostic marker in patients with CaGB.

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The genetic regulatory network responds dynamically to perturbations in the intracellular and extracellular environments of an organism. The GAL system in the yeast Saccharomyces cerevisiae has evolved to utilise galactose as an alternative carbon and energy source, in the absence of glucose in the environment. This work contains a modified dynamic model for GAL system in S. cerevisiae, which includes a novel mechanism for Gal3p activation upon induction with galactose. The modification enables the model to simulate the experimental observation that in absence of galactose, oversynthesis of Gal3p can also induce the GAL system. Subsequently, the model is related to growth on galactose and glucose in a structured manner. The growth-related models are validated with experimental data for growth on individual substrates as well as mixed substrates. Finally, the model is tested for its prediction of a variety of known mutant behaviours. The exercise shows that the authors' model with a single set of parameters is able to capture the rich behaviour of the GAL system in S. cerevisiae. [Includes supplementary material].

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Distribution of cesium in large negative ion beam sources to be operational in ITER, is presently based on the use of three or more cesium ovens, which operate simultaneously and are controlled remotely. However, use of multiple Cs ovens simultaneously is likely to pose difficulties in operation and maintenance of the ovens. An alternate method of Cs delivery, based on a single oven distribution system is proposed as one which could reduce the need of simultaneous operation of many ovens. A proof of principle experiment verifying the concept of a multinozzle distributor based Cs oven has been carried out at Institute for Plasma Research. It is also observed that the Cs flux is not controlled by Cs reservoir temperature after few hours of operation but by the temperature of the distributor which starts behaving as a Cs reservoir.

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Biological systems respond appropriately to a variety of environments thus representing complex systems with rich physiological behaviour. Quantitative models can be used to identify the design components that result in the system complexity. In this work, the tryptophan system of Escherichia coli that synthesises tryptophan internally when faced with starvation in a rapid manner and shuts off the synthesis sluggishly when the cells are exposed to a medium replete with tryptophan has been discussed. The evolved regulatory design is capable of providing such an asymmetric response that represents an appropriate behaviour to ensure survival. The tryptophan system uses three distinct regulatory mechanisms namely genetic regulation, transcriptional attenuation and enzyme inhibition to achieve its goals. It has been shown that genetic repression and attenuation are the only active regulatory mechanisms during moderate and severe starvation. However, as the degree of starvation increases, repression is relieved prior to attenuation. The analysis also shows that enzyme inhibition does not play a role under severe starvation and plays a marginal role in increasing the rate of repression when the cells are exposed to well-fed conditions. Finally, we use tools from linear systems theory to rationalise the above observations based on the poles and zeros of an approximated linear system.

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In many industrial processes, the most desirable variables to control are measured infrequently off-line in a quality control laboratory. In these situations, use of advanced control or optimization techniques requires use of inferred measurements generated from correlations. For well-understood processes, the structure of the correlation as well as the choice of inputs may be known a priori. However, many industrial processes are too complex and the appropriate form of the correlation and choice of input measurements are not obvious. Here, process knowledge, operating experience, and statistical methods play an important role in development of correlations. This paper describes a systematic approach to the development of nonlinear correlations for inferential measurements using neural networks. A three-step procedure is proposed. The first step consists of data collection and preprocessing. Next, the process variables are subjected to simple statistical analyses to identify a subset of measurements to be used in the inferential scheme. The third step involves generation of the inferential scheme. We demonstrate the methodology by inferring the ASTM 95% endpoint of a petroleum product using data from a domestic US refinery.

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