Performance Analysis of MC-CDMA for Rayleigh fading Channel

For wireless communication system multipath fading is a common problem specially in urban areas where a large number of buildings reflects the radio signals which results in interference amongst the reflected signals which causes the multipath fading effect since its selective by nature some spectrum at some specific location cancels out hence the receive signal losses some part of their information this abruptly increases the BER of communication system in slight movement of receiver, this paper specially analyzes the BER performance under Rayleigh fading channel conditions of MC-CDMA (Multicarrier Code Division Multiple Access) in presence of AWGN (Additive White Gaussian Noise) for different number of subcarrier, different number of users, and different path gains system analysis is performed by simulating the MC-CDMA using MATLAB program, and finally the paper also presents a comparison between simulated results. Keywords: MC-CDMA (Multicarrier Code Division Multiple Access), AWGN (Additive White Gaussian Noise), Rayleigh fading

Using Interprofessional Collaboration to Reduce CLABSI Rates in an Intensive Care Setting

Background: Central line associated bloodstream infections (CLABSI) are preventable hospital-acquired infections associated with increased morbidity and mortality, and cost. CLABSIs are the most expensive healthcare associated infection (HAI) with a cost upwards of $90,000 per infection. This cost does not account for increased length of stay or future readmissions. The criteria used to define CLABSIs in an acute care setting is based on the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) definitions. An infection window period (IWP) is used to review infection criteria to meet the surveillance definition. This is defined as a 7 day period, which includes the 3 calendar days before and after the first positive diagnostic test (Table 1). If no secondary sources are identifiable as a cause of the bloodstream infection (BSI) within the IWP, it will qualify as a CLABSI based on the NHSN definition. Healthcare organizations are encouraged to adhere to evidence based central line (CL) insertion and maintenance practices to reduce infection, which include: Adherence to hand hygiene practices Insertion bundles Maintenance bundles Removal of CL when they are no longer indicated Despite improved compliance with these infection prevention interventions, the surgical intensive care unit (SICU) at Henry Ford Hospital (HFH) continued to experience high CLABSI rates in 2019 and 2020. Aims: Using an interprofessional proactive approach, this project\u27s goal was to reduce the number of NHSN reportable CLABSIs by identifying at risk patients and clinically assessing for alternative infection sources. Methods: An interprofessional team formed to better understand the occurrence of CLABSI on the surgical intensive care unit (SICU). The team included: Unit Medical Director Infection Prevention Specialist Clinical Nurse Specialist Multiple opportunities were identified when reviewing root cause analysis data: Care team documentation Assessments for alternative infection. Verification of blood culture indication following HFH Blood Culture Stewardship Guidelines IRB approval and a waiver of informed consent were obtained. The interprofessional team (Figure 1): Completed daily chart audits on patients with central access Screened patients for blood culture collection and result status Verified blood culture indication using the HFH Blood Culture Stewardship Guidelines Established an IWP and reviewed medical record for infection source once blood cultures were collected Shared findings with interprofessional team via secure messaging Communicated potential gaps with the patient care teams, which included collaborative efforts regarding the treatment plan and proper documentation of clinical findings This proactive approach ensured supporting evidence was present to meet NHSN definitions for secondary BSI to avoid CLABSIs This quasi experimental retrospective study compared data from the pre intervention period (January 2019 to January 2021) to the intervention period (March 2021 to December 2022): CLABSI rate per 1,000 CL days Blood culture order rate per 1,000 CL days CL utilization ratio per 1,000 patient days Standardized infection ratio The t test was used to compare the continuous variables and was determined statistically significant if P \u3c 0.05. All analyses were performed using IBM SPSS Statistics (Version 29; Armonk, NY). Results: After implementation, the interprofessional team identified alternative sources of bloodstream infection in 37 patients (17 in 2021 and 20 in 2022) with qualifying central access and positive blood culture. When comparing pre and post intervention periods, significant reductions were made (see Table 2). This included an 82$1.6 million difference in healthcare costs. Discussion: This project demonstrates that an interpersonal team reviewing potential CLABSIs and identifying alternative sources of BSI can decrease CLABSI rates, improve patient management and lead to better outcomes. In addition to being a safe and effective approach, this intervention had the additional benefit of cost savings for the health system. Healthcare institutions should consider implementing this intervention to reduce unnecessary CLABSI rates, as well as cost.https://scholarlycommons.henryford.com/nursresconf2023/1001/thumbnail.jp

SERUM HOMOCYSTEINE AS A RISK FACTOR FOR STROKE: A PROSPECTIVE STUDY FROM A RURAL TERTIARY CARE CENTRE

Objective: Stroke is one of the leading causes of mortality and long-term disability in both developed and developing countries. Serum homocysteine level is one of the emerging modifiable risk factors for atherosclerosis which may result into a cerebrovascular accident. This study was designed to study the association of Serum Homocysteine level with the development of acute stroke at a rural tertiary care centre in North India.Methods: The present study was a prospective cross-sectional study conducted in the Department of Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. The study population included 100 patients presenting with Stroke (either ischemic or hemorrhagic) in the indoor and outdoor facilities in the Department of Medicine. 50 age and sex-matched healthy individuals were taken as controls. Serum total Homocysteine level was measured in all the cases and controls.Results: Majority of the patients suffered from ischemic stroke (78%), while only 22% patients had hemorrhagic stroke. The mean Serum Homocysteine level in stroke patients (19.88±8.78 μmol/l) was significantly higher than in controls (10.48±4.39 μmol/l) (p<0.01). In a subgroup analysis, stroke patients with a positive history of smoking had significantly higher homocysteine level as compared to non-smokers (p<0.05).Conclusion: Increased level of Serum Homocysteine is significantly associated with risk of cerebrovascular accident, which is independent of the risk attributed to traditional risk factors.Â

Para vaginal dermoid cyst: a rare occurrence

Dermoid cyst (cystic teratoma) showing well differentiated derivatives of all three germs cell layers, is a benign germ cell tumour. Ovaries remain the commonest site. Paravaginal dermoid cyst is a rare occurrence. Pre-operative diagnosis is usually difficult in majority of cases. They constitute less than 4% of all extragonadal teratomas. A 28-year old, P2L2 female presented with paravaginal cyst, 10×10cms, non-tender, soft swelling, cystic in consistency occupying posterior and left part of rectovaginal septum. Trans vaginal excision of cyst under regional anaesthesia done. Cyst was ruptured while excision showing putty material with tuft of hairs. A retrospective diagnosis of mature teratoma/paravaginal dermoid cyst was made on histopathological examination. Paravaginal dermoid cyst, a benign cystic teratoma is a very rare occurrence. Transvaginal excision of dermoid cyst under anaesthesia remains treatment of choice. Retrospective diagnosis on histopathological examination remains confirmatory as it may be missed on sonography if teeth are not present in dermoid cyst

Aggressive angiomyxoma of vagina: a rare entity

Aggressive angiomyxoma a soft tissue tumor arising in the pelvis and perineal regions of women in reproductive age group is a rare entity. It is slow growing locally aggressive myxoid mesenchymal tumor, with a marked tendency to local recurrence. Preoperative clinical diagnosis is usually difficult due to absence of diagnostic features as well as rarity of the disease. We describe a case of aggressive angiomyxoma of vagina in a 47-year-old para 4 woman with multiple fibromyoma (upto 22-week size of pregnant uterus) with 10*10 cms posterior vaginal cyst. Total abdominal hystrectomy with surgical excision of vaginal wall cyst done. A retrospective diagnosis-Aggressive Angiomyxoma of the vagina was made after histological confirmation. Surgical excision with wide margins and long term follow up remains treatment of choice

Elevated serum CA 19-9 levels in dermoid cyst: a predictor of ovarian torsion and tissue necrosis?

Dermoid cyst (mature cystic teratoma) with well differentiated derivatives of all the three-germ cell layer is a benign tumour with ovaries being the commonest site. Dermoid cyst accounts for more than half of ovarian tumours in girls below 20 years of age. 80% of dermoid cyst are seen in reproductive age group between 20-40 years. Size of dermoid cyst usually varies between 5-10 cm and it may be bilateral in 10% of cases. Malignant transformation is very rare occurrence only in 1-3% cases, however torsion may occur in 15% of dermoid cyst. Carbohydrate antigen or cancer antigen 19-9 is usually raised in gastrointestinal tumours, pancreatic malignancy, pseudocyst of pancreas. However, it may be raised in some other malignancies and benign condition like torsion of dermoid cyst. Authors report an unusual case of torsion large dermoid cyst with tissue necrosis along with significantly elevates levels of serum CA 19-9. A 30-year-old P1L1 female presented with chief complaint of heaviness and pain lower abdomen and loss of five kilogram weight for last three months. A provisional diagnosis of dermoid was made. Serum CA 19-9 level were 1126 IU significantly raised. An exploratory laparotomy done under regional anaesthesia. A large demoid cyst 12*10 cm with torsion and areas of gangrene in ovarian tissue was seen replacing left ovary. Large and small intestine, stomach, pancreas were explored to rule out any pathology. Histopathology confirmed diagnosis of mature cystic teratoma. There was significant fall in serum Ca 19-9 levels to 247 U/ml two weeks after surgery and levels returned to normal limit six weeks after surgery

Intra-household evaluations of alcohol abuse in men with depression and suicide in women: A cross-sectional community-based study in Chennai, India.

BACKGROUND: Harmful effects of alcohol abuse are well documented for drinkers, and adverse effects are also reported for the physical and emotional well-being of family members, with evidence often originating from either drinkers or their families in clinic-based settings. This study evaluates intra-household associations between alcohol abuse in men, and depression and suicidal attempts in women, in community-based settings of Chennai, India. METHODS: This community-based cross-sectional study of chronic disease risk factors and outcomes was conducted in n = 259 households and n = 1053 adults (aged 15 years and above) in rural and urban Chennai. The Alcohol Use Disorder Identification Test (AUDIT) score was used to classify alcohol consumption into 'low-risk', 'harmful', 'hazardous' and 'alcohol dependence' drinking and the Patient Health Questionnaire (PHQ-9) score to classify depression as 'mild', 'moderate', 'moderate-severe' and 'severe'. Multivariate logistic regression models estimated the association of depression in women with men's drinking patterns in the same household. RESULTS: A significant 2.5-fold increase in any depression (PHQ-9 ≥ 5) was observed in men who were 'alcohol-dependent' compared to non-drinkers (OR = 2.53; 95% CI: 1.26, 5.09). However, there was no association between men's drinking behavior and depression in women of the same household, although suicidal attempts approached a significant dose-response relationship with increasing hazard-level of men's drinking (p = 0.08). CONCLUSION: No significant intra-household association was observed between men's alcohol consumption and women's depression, though an increasing (non-significant) trend was associated with suicidal attempts. Complex relationships between suicidal attempts and depression in women and male abusive drinking require further exploration, with an emphasis on intra-household mechanisms and pathways

Study of the clinical spectrum of AUB (FIGO AUB Systems) and women’s attitude towards its management at Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India

Background: AUB has significant impact on quality of life of women related to health specially in developing countries including India. FIGO AUB systems are universally accepted. Aim was to study the clinical spectrum of AUB according to the FIGO AUB systems and women’s attitude towards its management.Methods: Cross sectional prospective study was carried out in the department of Obstetrics and Gynaecology, ANMMCH, Gaya, a tertiary care center, among women of 15-55 years age groups having complain related to abnormal uterine bleeding, for 1 year from 1st May 2019 to 30th April 2020 on 1000 patients. Data was collected and analyzed by percentage and proportions.Results: Prevalence of AUB was maximum among 15-30 years age group of patients (46.80%). Most of the patients belong to lower (62.5%) class, rural area (68%) and were anaemic (62.5%). Ovulatory dysfunction (55%) was most common cause for AUB, maximum patients choose surgical management (hysterectomy) but after counselling, most of them shifted to medical management.Conclusions: This study suggests more conservative approach for management of AUB and emphasizes the importance of awareness for clinical spectrum of AUB among women so that they can be self-motivated for early treatment and unnecessary hysterectomy can be avoided

Medical student’s perception and feed-back on virtual classes during COVID-19 pandemic: a multi-centric questionnaire based study

Introduction: The quick turn to online platforms from contact learning during COVID-19 remained challenging for both teachers as well for students. This study was done with the aim to know the perception and feed back of under-graduate medical students on virtual classes during the pandemic. Material & Methods: This was a cross-sectional questionnaire based multi-centric study.  Questionnaire in the form of Google form was distributed to the undergraduate medical students from various MBBS professionals studying in various medical colleges across North India. The completed questionnaire was collected and data was analyzed. Results: 40% students were from government, 52% from private medical colleges and 8% from AIIMS/ SGPGI. Majority of students were using mobile (63.7%) for e learning, using 4G internet (70.6%). Mostly the private medical colleges (73%) and only 4.5% government colleges were conducting the live video classes. Rest of them was providing the soft copy of the study material to the students. Based on the feedback by the students, about one third of the students (36.7%) appreciated the online platform in the current scenario as well for future in the combination with traditional classroom teaching. Discussion: The e-learning was the need of the hour as every day is important for a medical student and the learning has to be uninterrupted. Although helpful, e-learning alone is a far cry from face‐to‐face interaction between students and teachers. Finding the right balance of class-room teaching combined with e-learning should become the norm for future students.   &nbsp