A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study.

Background: The effectiveness of mobile technology to improve medication adherence via customized Short Messaging Service (SMS) reminders for stroke has not been tested in resource poor areas. We designed a randomized controlled trial to test the effectiveness of SMS on improving medication adherence in stroke survivors in Pakistan. Methods: This was a parallel group, assessor-blinded, randomized, controlled, superiority trial. Participants were centrally randomized in fixed block sizes. Adult participants on multiple medications with access to a cell phone and stroke at least 4 weeks from onset (Onset as defined by last seen normal) were eligible. The intervention group, in addition to usual care, received reminder SMS for 2 months that contained a) Personalized, prescription tailored daily medication reminder(s) b) Twice weekly health information SMS. The Health Belief Model and Social Cognitive theory were used to design the language and content of messages. Frontline SMS software was used for SMS delivery. Medication adherence was self-reported and measured on the validated Urdu version of Morisky Medication Adherence Questionnaire. Multiple linear regression was used to model the outcome against intervention and other covariates. Analysis was conducted by intention-to-treat principle. Results: Two hundred participants were enrolled. 38 participants were lost to follow-up. After 2 months, the mean medication score was 7.4 (95 % CI: 7.2–7.6) in the intervention group while 6.7 (95 % CI: 6.4–7.02) in the control group. The adjusted mean difference (Δ) was 0.54 (95 % CI: 0.22–0.85). The mean diastolic blood pressure in the intervention group was 2.6 mmHg (95 % CI; −5.5 to 0.15) lower compared to the usual care group. Conclusion: A short intervention of customized SMS can improve medication adherence and effect stroke risk factors like diastolic blood pressure in stroke survivors with complex medication regimens living in resource poor areas

Effects of exercise on sleep spindles in Parkinson's disease

BackgroundIn a randomized, controlled trial, we showed that high-intensity rehabilitation, combining resistance training and body-weight interval training, improves sleep efficiency in Parkinson's disease (PD). Quantitative sleep EEG (sleep qEEG) features, including sleep spindles, are altered in aging and in neurodegenerative disease.ObjectiveThe objective of this post-hoc analysis was to determine the effects of exercise, in comparison to a sleep hygiene, no-exercise control group, on the quantitative characteristics of sleep spindle morphology in PD.MethodsWe conducted an exploratory post-hoc analysis of 24 PD participants who were randomized to exercise (supervised 3 times/week for 16 weeks) versus 26 PD participants who were assigned to a sleep hygiene, no-exercise control group. At baseline and post-intervention, all participants completed memory testing and underwent polysomnography (PSG). PSG-derived sleep EEG central leads (C3 and C4) were manually inspected, with rejection of movement and electrical artifacts. Sleep spindle events were detected based on the following parameters: (1) frequency filter = 11–16 Hz, (2) event duration = 0.5–3 s, and (3) amplitude threshold 75% percentile. We then calculated spindle morphological features, including density and amplitude. These characteristics were computed and averaged over non-rapid eye movement (NREM) sleep stages N2 and N3 for the full night and separately for the first and second halves of the recording. Intervention effects on these features were analyzed using general linear models with group x time interaction. Significant interaction effects were evaluated for correlations with changes in performance in the memory domain.ResultsA significant group x time interaction effect was observed for changes in sleep spindle density due to exercise compared to sleep hygiene control during N2 and N3 during the first half of the night, with a moderate effect size. This change in spindle density was positively correlated with changes in performance on memory testing in the exercise group.ConclusionsThis study is the first to demonstrate that high-intensity exercise rehabilitation has a potential role in improving sleep spindle density in PD and leading to better cognitive performance in the memory domain. These findings represent a promising advance in the search for non-pharmacological treatments for this common and debilitating non-motor symptom

A Lightweight Elliptic-Elgamal-Based Authentication Scheme for Secure Device-to-Device Communication

Device-to-Device (D2D) is a major part of 5G that will facilitate deployments with extended coverage where devices can act as users or relays. These relays normally act as decode and forward relays (semi-intelligent devices) with limited computational and storage capabilities. However, introducing such a technology, where users can act as relays, presents a wide range of security threats, in particular, rogue relay devices or man in the middle attacks (M-I-T-M). Second, passing fewer control messages is always advisable when considering authenticity and secrecy. To mitigate M-I-T-M and to reduce communication costs, this paper presents a lightweight elliptic-ElGamal-based authentication scheme using PKI (FHEEP) in D2D communication. Pollard’s rho and Baby Step, Giant Step (BSGS) methods are used to evaluate the authenticity and secrecy of our proposed scheme. The communication cost is calculated based on the comparative analysis indicating that our proposed scheme outperforms the baseline protocol. The proposed scheme can be used for any infrastructure architecture that will enhance the security of any D2D settings with better performance

A Dynamic Application-Partitioning Algorithm with Improved Offloading Mechanism for Fog Cloud Networks

This paper aims to propose a new fog cloud architecture that performs a joint energy-efficient task assignment (JEETA). The proposed JEETA architecture utilizes the dynamic application-partitioning algorithm (DAPTS), a novel algorithm that efficiently decides and switches the task to be offloaded or not in heterogeneous environments with minimal energy consumption. The proposed scheme outperforms baseline approaches such as MAUI, Think Air and Clone Cloud in many performance aspects. Results show that for the execution of 1000 Tasks on fog, mobile offloaded nodes, JEETA consumes the leas, i.e., 23% of the total energy whereas other baseline approaches consume in between 50–100% of the total energy. Results are validated via real test-bed experiments and trice are driven efficient simulations

Bank maturity, income diversification, and bank stability

The purpose of this research is to examine the influence of bank life cycle or bank maturity on income diversification (ID) and stability. In addition, this research investigates the ID relationship with bank stability. Drawing on the dynamic resource-based view and modern portfolio theory, this research examines the influence of a paramount internal factor i.e. bank life cycle or bank maturity on income diversification (ID) and stability consequence. Data were collected from the Pakistani’s commercial banks’ financial statements over the period 2005 to 2019. This research relied on the fixed effect and generalized method of moments (GMM) model to empirically test the proposed relationships. Core findings of the research reveal that bank maturity leads to enhanced ID and ID strongly influences the bank stability consequence, moreover, research findings are robust to use different measures of bank stability and GMM estimation techniques. To the authors’ best knowledge, this research is the first to report specific evidence about bank maturity as an internal driver of income diversification and stability and advances the literature seeking to understand the determinants of ID. This research also shows managers to recognize the importance of internal drivers to diversify effectively into non-interest income, and how such an effective ID translates into stability consequence

Effectiveness Of Double J Stent With Extracorporeal Shockwave Lithotripsy: An Analysis Of Stone-Free Rates

Introduction: Preservation of renal function and integrity is of profound importance and therefore renders stent-related symptoms a secondary concern. The usage of DJ stent is known for decades to support stone removal, this study aims to assess the effect of DJ stent after extracorporeal shock wave lithotripsy for stone removal and DJ stent-related complications in adult patients. Methods: This is a prospective, comparative study, Patients were selected after being diagnosed with established radiological evidence of a single radio-opaque stone ≤ 2 cm. The presence of the visible radio-opaque shadow post-procedure indicated residual stones and negative results. Primary follow-up was recommended after 2 weeks post-procedure and participants were inquired about all the anticipated complications, data was entered on SPSS version 23.0 for analysis. The chi-square test was applied to assess the significance and a p-value ≤ 0.05 was deemed significant for our results. Results: The sample size of the study was 150, sorted equally into two separated groups categorized by presence and absence of DJ stent after ESWL, stone size was almost similar to avoid any confounding factor with the mean value of 1.24 ± 0.2 in group A and 1.6 ± 0.1 in group B, with a p-value of 0.05. Hematuria was categorized within mild 6(4%) & 7(4.6%), moderate 6(4%) & 5(3.3%) while gross hematuria was reported in 1(0.6%) & 2(1.3%) in group A and B respectively. Conclusion: This study concluded that using a DJ stent with ESWL does not help in the stone passage or improve stone-free rates of stone removal after breaking the calculi with shockwave lithotripsy