Enhancing Private Healthcare Effectiveness in Lagos State, Nigeria: An Overview of the Effect of Quality Improvement Initiatives and Implications for Sustainable Healthcare Delivery

Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.

Research and Implementation for License Plate Recognition Based on Improved Projection Algorithm

This paper analyzes and dissertates the discrete wavelet transform and improved projection algorithm in four kernel stages （image preprocessing, license plate localization, character segmentation, license plate recognition, i.e.） of license plate recognition system in detail. At last, it gives some conclusions and suggestions on future research.

Instantaneous solitons and fractal solitons for a (2+1)-dimensional nonlinear system

By an improved projective equation approach and a linear variable separation approach, a new family of exact solutions of the （2＋1）-dimensional Broek-Kaup system is derived. Based on the derived solitary wave solution and by selecting appropriate functions, some novel localized excitations such as instantaneous solitons and fractal solitons are investigated.

National trends in resection of the distal pancreas

AIM:To investigate national trends in distal pancreatectomy(DP) through query of three national patient care databases.METHODS:From the Nationwide Inpatient Sample(NIS,2003-2009),the National Surgical Quality Improvement Project(NSQIP,2005-2010),and the Surveillance Epidemiology and End Results(SEER,2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal pancreatectomy.Utilization of laparoscopy was defined in NIS by the International Classification of Diseases,Ninth Revision correspondent procedure code;and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology codes.In SEER,patients were identified by the International Classification of Diseases for Oncology,Third Edition diagnosis codes and the SEER Program Code Manual,third edition procedure codes.We analyzed the databases with respect to trends of inpatient outcome metrics,oncologic outcomes,and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative resection.RESULTS:NIS,NSQIP and SEER identified 4242,2681 and 11 082 DP resections,respectively.Overall,laparoscopy was utilized in 15%(NIS) and 27%(NSQIP).No significant increase was seen over the course of the study.Resection was performed for malignancy in 59%(NIS) and 66%(NSQIP).Neither patient Body mass index nor comorbidities were associated with operative approach(P = 0.95 and P = 0.96,respectively).Mortality(3% vs 2%,P = 0.05) and reoperation(4% vs 4%,P = 1.0) was not different between laparoscopy and open groups.Overall complications(10% vs 15%,P < 0.001),hospital costs [44 741 dollars,interquartile range(IQR) 28 347-74 114 dollars vs 49 792 dollars,IQR 13 299-73 463,P = 0.02] and hospital length of stay(7 d,IQR 4-11 d vs 7 d,IQR 6-10,P < 0.001) were less when laparoscopy was utilized.One and two year survival after resection for malignancy were unchanged over the course of the study(ductal adenocarinoma 1-year 63.6% and 2-year 35.1%,P = 0.53;intraductal papillary mucinous neoplasm and nueroendocrine 1-year 90% and 2-year 84%,P = 0.25).The majority of resections were performed in teaching hospitals(77% NIS and 85% NSQIP),but minimally invasive surgery(MIS) was not more likely to be used in teaching hospitals(15% vs 14%,P = 0.26).Hospitals in the top decile for volume were more likely to be teaching hospitals than lower volume deciles(88% vs 43%,P < 0.001),but were no more likely to utilize MIS at resection.Complication rate in teaching and the top decile hospitals was not significantly decreased when compared to non-teaching(15% vs 14%,P = 0.72) and lower volume hospitals(14% vs 15%,P = 0.99).No difference was seen in the median number of lymph nodes and lymph node ratio in N1 disease when compared by year(P = 0.17 and P = 0.96,respectively).CONCLUSION:There appears to be an overall underutilization of laparoscopy for DP.Centralization does not appear to be occurring.Survival and lymph node harvest have not changed.

Localized Excitations of （2＋1）-Dimensional Korteweg-de Vries System Derived from a Periodic Wave Solution

With the aid of an improved projective approach and a linear variable separation method, new types of variable separation solutions （including solitary wave solutions, periodic wave solutions, and rational function solutions） with arbitrary functions for （2＋1）-dimensional Korteweg-de Vries system are derived. Usually, in terms of solitary wave solutions and rational function solutions, one can find some important localized excitations. However, based on the derived periodic wave solution in this paper, we find that some novel and significant localized coherent excitations such as dromions, peakons, stochastic fractal patterns, regular fractal patterns, chaotic line soliton patterns as well as chaotic patterns exist in the KdV system as considering appropriate boundary conditions and/or initial qualifications.

Complex Wave Excitations in Generalized Broer-Kaup System

Starting from an improved projective method and a linear variable separation approach, new families of variable separation solutions （including solltary wave solutlons, periodic wave solutions and rational function solutions） with arbitrary functions [or the （2＋ 1）-dimensional general/zed Broer-Kaup （GBK） system are derived. Usually, in terms of solitary wave solutions and/or rational function solutions, one can find abundant important localized excitations. However, based on the derived periodic wave solution in this paper, we reveal some complex wave excitations in the （2＋1）-dimensional GBK system, which describe solitons moving on a periodic wave background. Some interesting evolutional properties for these solitary waves propagating on the periodic wave bactground are also briefly discussed.

SOME IMPROVED PROJECTED QUASI-NEWTON ALGORITHMS AND THEIR CONVERGENCE Ⅱ.LOCAL CONVERGENCE RATE AND NUMERICAL TESTS

For the improved two-sided projected quasi-Newton algorithms, which were presented in PartI, we prove in this paper that they are locally one-step or two-step superlinearly convergent. Numerical tests are reported thereafter. Results by solving a set of typical problems selectedfrom literature have demonstrated the extreme importance of these modifications in making Nocedal& Overton's original methon practical. Furthermore, these results show that the improved algoritnmsare very competitive in comparison with some highly praised sequential quadratic programmingmethods.

SOME IMPROVED PROJECTED QUASI-NEWTON ALGORITHMS AND THEIR CONVERGENCE Ⅰ.METHODS AND GLOBAL BEHAVIOR

In this paper we improve the two versions of the two-sided projected quasi-Newton method-onewas proposed by Nocedal & Overton in [1] and the other was discussed in our previous paper, byintroducing three different merit functions to make inexact one-dimensional searches. It is shown that these improved quasi-Newton algorithms have gained global convergence propertywhich is not possessed by the original two algorithms.

Multi-angle Face Detection Based on DP-Adaboost

Although important progresses have been already made in face detection,many false faces can be found in detection results and false detection rate is influenced by some factors,such as rotation and tilt of human face,complicated background,illumination,scale,cloak and hairstyle.This paper proposes a new method called DP-Adaboost algorithm to detect multi-angle human face and improve the correct detection rate.An improved Adaboost algorithm with the fusion of frontal face classifier and a profile face classifier is used to detect the multi-angle face.An improved horizontal differential projection algorithm is put forward to remove those non-face images among the preliminary detection results from the improved Adaboost algorithm.Experiment results show that compared with the classical Adaboost algorithm with a frontal face classifier,the textual DP-Adaboost algorithm can reduce false rate significantly and improve hit rate in multi-angle face detection.