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Coronary artery disease (CAD) is reported as one of the most common sources of death all over the world. The presence of stenosis (plaque) in the coronary arteries results in the restriction of blood supply, leading to myocardial infarction. The current study investigates the influence of multi stenosis on hemodynamic properties in a patient-specific left coronary artery.

A three-dimensional model of the patient-specific left coronary artery was reconstructed based on computed tomography (CT) scan images using MIMICS-20 software. The diseased model of the left coronary artery was investigated, having the narrowing of 90% and 70% of area stenosis (AS) at the left anterior descending (LAD) and left circumflex (LCX), respectively.

The results indicate that the upstream region of stenosis experiences very high pressure for 90% AS during the systolic period of the cardiac cycle. The pressure drops maximum as the flow travels into the stenotic zone, and the high flow velocities were observed across the 90% AS. The higher wall shear stresses occur at the stenosis region, and it increases with the increase in the flow rate. It is found that the maximum wall shear stress across 90% AS is at the highest risk for rupture. A recirculation region immediately after the stenosis results in the further development of stenosis.

The current study provides evidence that there is a strong effect of multi-stenosis on the blood flow in the left coronary artery.

Monocytes are a leukocytes’ subset that plays an important role in immunity. Protein kinase B (AKT) is involved in monocytes' survival, proliferation and differentiation. Using phorbol 12-myristate 13-acetate (PMA) as an inducer for cell line U937 differentiation into macrophage-like cells may be used as a model for cancer cell therapy or other biomedical research studies. The authors investigated the Akt1 signaling pathway's involvement with PMA as a differentiating agent and survival in the U937 cell line.

PMA was utilized to stimulate the differentiation of the U937 cell line into macrophage-like cells at a concentration of 10 nM. Akt1-phosphorylated Serine 473, Bad-phosphorylated Serine 136 and Caspase9-phosphorylated Serine 196 were tested by flow cytometry for the involvement of the Akt1 signaling pathway during differentiation in addition to the expression of CD14, CD206 and CD83. DNA cell cycle variation analysis was done using PI staining and cell viability and apoptosis detection using Annexin V and PI flow cytometry.

There was a decrease in phosphorylated Akt1 and Bad activation and an increase in Caspase9 activation, with an increase in surface markers CD14, CD206 and CD83 acquired by PMA-differentiated cells. DNA cell cycle analysis revealed cell accumulation in the G2/M phase and fewer cells in the S phase of PMA-induced U937. Apoptosis induction for Ly294002 or Wortmannin-inhibited cells and part of PMA-induced cells were detected.

These results may be used to create a model for biomedical research studies and advance the understanding of the mechanism involving differentiation of the U937 cell line.

Joule heating effect is a pervasive phenomenon in electro-osmotic flow because of the applied electric field and fluid electrical resistivity across the microchannels. Its effect in electro-osmotic flow field is an important mechanism to control the flow inside the microchannels and it includes numerous applications.

This research article details the numerical investigation on alterations in the profile of stream wise velocity of simple Couette-electroosmotic flow and pressure driven electro-osmotic Couette flow by the dynamic viscosity variations happened due to the Joule heating effect throughout the dielectric fluid usually observed in various microfluidic devices.

The advantages of the Joule heating effect are not only to control the velocity in microchannels but also to act as an active method to enhance the mixing efficiency. The results of numerical investigations reveal that the thermal field due to Joule heating effect causes considerable variation of dynamic viscosity across the microchannel to initiate a shear flow when EDL (Electrical Double Layer) thickness is increased and is being varied across the channel.

This research work suggest how joule heating can be used as en effective mechanism for flow control in microfluidic devices.

Enormous amount of biomedical wastes (BMW) produced everyday across the world. Management of BMW depends on adherence to protocol. BMW management at generation point, definitely, depends upon the awareness, attitudes and practises of health-care staff, the purpose of this study will assess the awareness, attitude and practise regarding different aspects of BMW.

An observational with appropriate checklists, and a cross-sectional study, involving questionnaires, was conducted during 7-24 January 2016. The existing system of BMW management, funds, resources, etc., knowledge, attitude and practises about BMW were assessed amongst 273 health-care workers in selected public health-care institutes of Karnataka.

Of 273 study participants, majority (54%) of them have not received any training pertaining to BMW. The results showed a poor level of knowledge and awareness of BMW management amongst health-care personnel. Merely, 43% of the participants correctly knew the categorization of BMW and its disposal in proper colour-coded bins/bags. Awareness is very poor amongst the lower age group, male participants, lab-technicians/pharmacists and supporting staff. Doctors were good at theoretical knowledge such as rules, legislation and public-health importance of BMW management than the practical aspects such as categorization and colour-coding. Further, the attitude of health-care staff is favourable about BMW. Immunization for hepatitis-B was very poor amongst waste handlers (43%).

As the awareness and practise regarding BMW management were poor across different health-care staff there is a need to conduct periodic training and regular monitoring with special focus on the proper use of personal protective equipment. Further, precautionary immunization should be provided, especially waste handlers and sanitary workers.

Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.

A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.

Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.

The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.

Computer vision for automated analysis of cells and tissues usually include extracting features from images before analyzing such features via various machine learning and machine vision algorithms. The purpose of this work is to explore and demonstrate the ability of a Convolutional Neural Network (CNN) to classify cells pictured via brightfield microscopy without the need of any feature extraction, using a minimum of images, improving work-flows that involve cancer cell identification.

The methodology involved a quantitative measure of the performance of a Convolutional Neural Network in distinguishing between two cancer lines. In their approach, they trained, validated and tested their 6-layer CNN on 1,241 images of MDA-MB-468 and MCF7 breast cancer cell line in an end-to-end fashion, allowing the system to distinguish between the two different cancer cell types.

They obtained a 99% accuracy, providing a foundation for more comprehensive systems.

Value can be found in that systems based on this design can be used to assist cell identification in a variety of contexts, whereas a practical implication can be found that these systems can be deployed to assist biomedical workflows quickly and at low cost. In conclusion, this system demonstrates the potentials of end-to-end learning systems for faster and more accurate automated cell analysis.

This paper aims to explore how the cross-fertilization of knowledge and technologies in EU-funded research projects, including serious games and gamification, is influenced by the following variables: multidisciplinarity, knowledge base and organizations (number and diversity). The interrelation of actors and projects form a network of innovation. The largest contribution to cross-fertilization comes from the multidisciplinary nature of projects and the previous knowledge and technology of actors. The analysis draws on the understanding of how consortia perform as an innovation network, what their outcomes are and what capabilities are needed to reap value.

All the research projects including serious games and/or gamification, funded by the EU-Horizon 2020 work programme, have been analyzed to test the hypotheses in this paper. The study sample covers the period between 2014 and 2016 (June), selecting the 87 research projects that comprised 519 organizations as coordinators and participants, and 597 observations – because more organizations participate in more than one project. The data were complemented by documentary and external database analysis.

To create cross-fertilization of knowledge and technologies, the following emphasis should be placed on projects: partners concern various disciplines; partners have an extensive knowledge base for generating novel combinations and added-value technologies; there is a diverse typology of partners with unique knowledge and skills; and there is a limited number of organizations not too closely connected to provide cross-fertilization.

First, the database sample covers a period of 30 months. The authors’ attention was focused on this period because H2020 prioritized for the first time the serious games and gamification with two specific calls (ICT-21–14 and ICT-24–16) and, second, for the explosion of projects including these technologies in the past years (Adkins, 2017). These facts can be understood as a way to push the research to higher technology readiness levels (TRLs) and introducing the end-user in the co-creation and co-development along the value chain. Second, an additional limitation makes reference to the European focus of the projects, missing strong regional initiatives not identified and studied.

This paper has attempted to explore and define theoretically and empirically the characteristics found in the cross-fertilization of collaborative research projects, emphasizing which variables, and how, need to be stimulated to benefit more multidisciplinary consortia and accelerate the process of innovation.

The paper contributes to the discussion on valuation in organization studies and strategic management literature. The nascent literature on valuation practices has examined established markets where producers and consumers are known and rivalry in the market is a given. Furthermore, previous research has operated with a narrow meaning of value as either a financial profit or a subjective consumer preference. Such a narrow view on value is problematic and insufficient for studying the interlacing of innovation and value creation in emerging technoscientific business domains.

The authors present an empirical study about value creation in an emerging technoscience business domain formed around personalized medicine and digital health data.

The results of this analysis show that in a technoscientific domain, valuation of innovations is multiple and malleable, entails pursuing attractiveness in collaboration and partnerships and is performative, and due to emphatic future orientation, values are indefinite and promissory.

As research implications, this study shows that valuation practices in an emerging technoscience business domain focus on defining the potential economic value in the future and attracting partners as probable future beneficiaries. Commercial value upon innovation in an embryonic business milieu is created and situated in valuation practices that constitute the prospective market, the prevalent economic discourse, and rationale. This is in contrast to an established market, where valuation practices are determined at the intersection of customer preferences and competitive arenas where suppliers, producers, service providers and new entrants to the market present value propositions.

The study findings extend discussion on valuation from established business domains to emerging technoscience business domains which are in a “pre-competition” phase where suppliers, customers, producers and their collaborative and competitive relations are not yet established.

As managerial implications, this study provides insights into health innovation stakeholders, including stakeholders in the public, private and academic sectors, about the ecosystem dynamics in a technoscientific innovation. Such insight is useful in strategic decision-making about ecosystem strategy and ecosystem business model for value proposition, value creation and value capture in an emerging innovation domain characterized by collaborative and competitive relations among stakeholders. To business managers, the findings of this study about valuation practices are useful in strategic decision-making about ecosystem strategy and ecosystem business model for value proposition, value creation and value capture in an emerging innovation domain characterized by collaborative and competitive relations among stakeholders. To policy makers, this study provides an in-depth analysis of an overall business ecosystem in an emerging technoscience business that can be propelled to increase the financial investments in the field. As a policy implication, this study provides insights into the various dimensions of valuation in technoscience business to policy makers, who make governance decisions to guide and control the development of medical innovation using digital health data.

This study's results expand previous theorizing on valuation by showing that in technoscientific innovation all types of value created – scientific, clinical, social or economic – are predominantly promissory. This study complements the nascent theorizing on value creation and valuation practices of technoscientific innovation.

The goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length of Hospital Stay (LOS).

The methodology used to improve the quality of the hospitalization process and patient management was Lean Thinking. Therefore, the Lean tools (Value stream map and Ishikawa diagram) were used to identify waste and inefficiencies, improving the process with the implementation of corrective actions. The data was collected through personal observations, patient interviews, brainstorming and from printed medical records of 151 patients undergoing oral cancer surgery in the period from 2006 to 2018.

The authors identified, through Value Stream Map, waste and inefficiencies during preoperative activities, consequently influencing preoperative LOS, considered the best performance indicator. The main causes were identified through the Ishikawa diagram, allowing reflection on possible solutions. The main corrective action was the introduction of the pre-hospitalization service. A comparative statistical analysis showed the significance of the solutions implemented. The average preoperative LOS decreased from 4.90 to 3.80 days (−22.40%) with a p-value of 0.001.

The methodology allowed to highlight the improvement of the patient hospitalization process with the introduction of the pre-hospitalization service. Therefore, by adopting the culture of continuous improvement, the flow of hospitalization was redrawn. The benefits of the solutions implemented are addressed to the patient in terms of lower LOS and greater service satisfaction and to the hospital for lower patient management costs and improved process quality. This article will be useful for those who need examples on how to apply Lean tools in healthcare.

This paper aims to investigate the role that Italian third sector organizations have in the process of social and administrative categorization of newly arrived migrants living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/Aids) or hepatitis b. In Italy, free access to health is provided to all migrants and residence permits for medical treatment is granted for migrants living with a “serious illness” since the 1990s. The case of HIV/Aids and hepatitis b shows how this political openness, however, clashes with the tightening of migration policies.

The study is based on ethnographic research conducted between 2014 and 2016 within an associative centre that deals with the socio-health care of newly arrived migrants in Rome. In addition to the participant observations, the study is based in semi-structured interviews conducted with 10 health-care providers (nurses, health-care assistants and socio-cultural mediators) and doctors and with 22 migrants coming from Sub-Saharan Africa and living with HIV/AIDS (10) and hepatitis b (12).

In Italy, the two infections have been identified as top diseases among migrant populations in the country but if HIV/Aids is always considered as a “serious illness”, hepatitis b is considered as a public health priority only in the case of a treatment prescription. These aspects have an important impact on the interactions between medical and social professionals and migrants affected by HIV/AIDS and hepatitis b, contributing differently to the creation of legal categories assigned to migrants.

The case of HIV/Aids and hepatitis b shows how the political openness of the public health system, clashes with the tightening of migration policies and analyse the role of the third sector has in this issue.