Reduction of Switches and DC Sources in Cascaded Multilevel Inverter

Harmonics and increasing number of switches and DC sources for increasing level is the major issue in the cascaded multilevel inverter for the application of medium and high voltage power system applications. In this paper several new techniques are used to reduce the switches and DC sources, which overcome the disadvantages of cascaded multilevel inverter. The THD values for various levels (seven & nine) are compared with and without PWM technique

25-Hydroxy vitamin-D, obesity, and associated variables as predictors of breast cancer risk and tamoxifen benefit in NSABP-P1.

Observational studies suggest that host factors are associated with breast cancer risk. The influence of obesity, vitamin-D status, insulin resistance, inflammation, and elevated adipocytokines in women at high risk of breast cancer is unknown. The NSABP-P1 trial population was used for a nested case-control study. Cases were drawn from those who developed invasive breast cancer and controls selected from unaffected participants (≤4 per case) matched for age, race, 5 year Gail score, and geographic location of clinical center as a surrogate for latitude. Fasting serum banked at trial enrolment was assayed for 25-hydroxy vitamin-D (25OHD), insulin, leptin (adipocytokine), and C-reactive protein (CRP, marker of inflammation). Logistic regression was used to test for associations between study variables and the risk of invasive breast cancer. Two hundred and thirty-one cases were matched with 856 controls. Mean age was 54, and 49% were premenopausal. There were negative correlations for 25OHD with body mass index (BMI), insulin, CRP, and leptin. BMI ≥ 25 kg/m(2) was associated with higher breast cancer risk (odds ratio [OR] 1.45, p = 0.02) and tamoxifen treatment was associated with lower risk (OR = 0.44, p < 0.001). Suboptimal 25OHD (<72 nmol/l) did not influence breast cancer risk (OR = 1.06, p = 0.76). When evaluated as continuous variables, 25OHD, insulin, CRP, and leptin levels were not associated with breast cancer risk (all p > 0.34). In this high risk population, higher BMI was associated with a greater breast cancer risk. Serum levels of 25OHD, insulin, CRP, and leptin were not independent predictors of either breast cancer risk or tamoxifen benefit

Understanding Patients’ Meal Experiences through Staff’s Role: Study on Malaysian Public Hospitals

Background: One way to improve hospital food provision is certainly by understanding the management of hospital foodservices, but there is limited detailed information about staff roles in food provision in many hospitals around the world. Objective: The hospital meal experience of patients, a part of the services provided by hospitals, is becoming important. Therefore, the role of various hospital staff members was studied through their behavior, attitudes, and practices so as to understand how the foodservice system works to address patients’ food consumption. Methods: This qualitative research used the convenient sampling method. Data was collected by interviewing twenty hospital employees with different job scopes (nurses, doctors, dietitians, foodservice managers, and directors of hospital foodservices) in 6 public hospitals. Results: Themes such as providing familiar food, food as the motivational factor for consumption, empathy shown by staff, and influences of the eating environment were identified using content analysis. Conclusion: The viewpoints and experiences of key stakeholders facilitated the understanding of various factors involved in the provision of hospital food which affect patients’ decisions to accept and consume food

Patients Emotions during Meal Experience: Understanding through Critical Incident Technique

Background and Objectives: It was established that eating experience may affect patients emotionally. Acknowledging the role and understanding the basis of patients’ emotions in their food consumption may assist in identifying their nutritional status as well as their satisfaction with foodservice. To date, there are limited studies focusing on patients’ food-related emotional experiences. Hence the present study sought to explore the issue using a qualitative approach. Methods: The study was conducted in three Malaysian public hospitals, two of which from rural and one from urban areas. Information about aspects of the hospital food experience was gathered using semi-structured interview method. A total of 29 patients who felt well enough to provide information about the hospital food were identified with the help of the head nurses. Patients were recruited based on the concept of data saturation. The interview was implemented based on Critical Incident Technique (CIT), which enables systematic extraction of information from the wealth of data in the stories told by the interviewees about things which have happened to them. Data were analysed using content analysis method. Findings: Patients were found toexperience emotions including frustration, interest, enjoyment, hostility, shame, boredom, sadness, anger, surprise and satisfaction in relation to food provision. The frequency of incidents eliciting negative emotions (56.7%) was higher than that of positive incidents (43.3%). Frustration, interest, and enjoyment were the most frequently reported emotions. Conclusions: Our study highlights emotion as an important aspect of patients’ food consumption, and lays a ground for incorporation of food-related emotion into hospital services and patient management research. Our study also indicated the CIT to be effective and credible in elucidating hidden patients’ emotions, which encourages its application in future relevant studies

Weak ferromagnetism in non-centrosymmetric BiPd 4K superconductor

We report synthesis of non-centrosymmetric BiPd single crystal by self flux method. The BiPd single crystal is crystallized in monoclinic structure with the P21 space group. Detailed SEM (Scanning Electron Microscopy) results show that the crystals are formed in slab like morphology with homogenous distribution of Bi and Pd. The magnetic susceptibility measurement confirmed that the BiPd compound is superconducting below 4K. Further, BiPd exhibits weak ferromagnetism near the superconducting transition temperature in isothermal magnetization (MH) measurements. The temperature dependent electrical resistivity also confirmed that the BiPd single crystal is superconducting at Tc=4K. Magneto transport measurements showed that the estimated Hc2(0) value is around 7.0kOe. We also obtained a sharp peak in heat capacity Cp(T) measurements at below 4K due to superconducting ordering. The normalized specific-heat jump, DC/{\gamma}Tc, is 1.52, suggesting the BiPd to be an intermediate BCS coupled superconductor. The pressure dependent electrical resistivity shows the Tc decreases with increasing applied pressure and the obtained dTc/dP is -0.62K/Gpa.Comment: 11 pages Text+Fig

Fetal and maternal outcome following expectant management of severe pre-eclampsia remote from term

Background: Expectant management of severe preeclampsia, remote from term is often a difficult decision. Maternal and foetal complications may occur while trying to achieve a more favourable perinatal outcome. We wanted to find out the foetal and maternal outcomes of expectant management in these women.Methods: A prospective cohort study was conducted at Government Medical College, Thrissur, India between May 2013 and April 2015. Women with severe preeclampsia remote from term, who were admitted, managed expectantly and delivered in our hospital during the study period, were recruited. The study subjects were grouped into: Group A (between 28 weeks and 31 weeks 6 days) and Group B (between 32 weeks and 33 weeks 6 days). A structured proforma was used to collect demographic and clinical details. The maternal and foetal outcomes were noted.Results: There were 4786 deliveries during the study period. Among them 76 (1.58% of total deliveries) women with severe preeclampsia between 28 weeks and 33-week 6 days gestation on expectant management were included in the study. The mean duration of expectant management was 7.92 days in group A (27 women) and 6.67 days in group B (49 women). Most women required termination of pregnancy for foetal distress (36.8%). HELLP syndrome and imminent eclampsia were the maternal complications that occurred. Perinatal loss was significantly more in Group A when compared to Group B.Conclusions: Expectant management of women with severe preeclampsia remote from term, especially between 32weeks and 33weeks 6 days, with antenatal corticosteroids and close monitoring, seems a reasonable option in developing countries

Comparison of the Sequential Organ Failure Assessment (SOFA) and Quick SOFA Scores in Predicting in-Hospital Mortality among Adult Critical Care Patients with Suspected Infection

Introduction: Sepsis is global health priority and the leading cause of death in critical care. The SEPSIS 3 criteria introduced in 2016 is the latest tool in diagnosing sepsis. It uses SOFA and qSOFA scores in place of the SIRS criteria for better ability to predict mortality in patients with suspected infections. The performance of these scores in critical care units outside high-income countries remains largely unknown. Methods: We compared the performance of SOFA and qSOFA in predicting the in-hospital mortality of an adult critical care unit in Kenya. We conducted a retrospective review of all patients admitted to the critical care units with suspected infection between 1 January 2017 and 31 December 2017. A standardized electronic data collection tool was be used to collect demographic, clinical and outcome data on the participants. Area under the receiver operating characteristic curves (AUROC) with 95% confidence intervals was used to compare SOFA and qSOFA. Results: We enrolled 450 patients with a mean age of 56 years [SD ± 19.10] and 57.60% were male. Majority of the patients, 352 (78.20%), presented through the emergency department. Pneumonia was the commonest source of infection 293 (65.10%). There were 92 deaths (mortality rate of 20.44%). The majority of patients, 371 (82.44%) manifested a SOFA score of ≥ 2 and 190 (42.22%) had a qSOFA score of ≥ 2. SOFA score was superior in predicting in hospital mortality compared to qSOFA with an AUROC = 0.799 [0.752-0.846] vs. 0.694 [0.691-0.748, P \u3c 0.001]. Conclusion: A SOFA score of two or more is better than qSOFA score in predicting in-hospital mortality among adult critical care patients with suspected infection. This finding suggests that SOFA is an appropriate tool in the initial diagnosis sepsis in critical care setting in a developing country

Chorioangioma with pre-eclampsia and IUGR: a case report

Chorioangioma is a non-trophoblastic benign tumour of the placenta, arising from the primitive chorionic mesenchyme with an estimated incidence of 0.6% diagnosed antenatal on ultrasound imaging. Small chorioangiomas are often asymptomatic with a frequency of about 1%, giant chorioangiomas more than >5 cm in diameter, are rare seen in 1:3500 to 1:16000 births and are associated with maternal and fetal complications. We report a case of 23-year-old, primigravida 36.4 weeks of gestation with pre-eclampsia with asymmetrical intrauterine growth restriction (IUGR), ultrasound suggestive of large placental chorioangioma 8×6.8 cm. This patient despite having large tumour and being diagnosed late at 35 weeks had a favourable maternal and fetal outcome. Histopathology confirmed the diagnosis

The 'Healthy Passport' intervention with older people in an English urban environment:effects of incentives and peer-group organisers in promoting healthy living

This paper reports the evaluation of the effectiveness of incentives (viz. points and prizes) and of peer-group organisers ('older people's champions') in the outcomes of a health-improvement programme for people aged 50 + years in a multi-ethnic district of the West Midlands, England. Health promotion activities Were provided, and adherence, outcome variables and barriers to adherence were assessed over six months, using a `passport' format. Those aged in the fifties and of Asian origin Were under represented, but people of Afro-Caribbean origin were well represented and proportionately most likely to stay in the project. Those of greater age and With more illness were most likely to drop out. There were significant improvements in exercise, diet and the uptake of influenza vaccines and eyesight tests, but slighter improvements in wellbeing. Positive outcomes related to the incentives and to liking the format. The number of reported barriers was associated with lower involvement and lack of change, as was finding activities too difficult, the level of understanding, and transport and mobility problems, but when these were controlled, age did not predict involvement. Enjoying the scheme was related to positive changes, and this was associated with support from the older people's champions