Role of rivaroxaban in the management of atrial fibrillation: insights from clinical practice.

© 2018 Vimalesvaran et al. This work is published and licensed by Dove Medical Press Limited.Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and it leads to significant morbidity and mortality, predominantly from ischemic stroke. Vitamin K antagonists, mainly warfarin, have been used for decades to prevent ischemic stroke in AF, but their use is limited due to interactions with food and other drugs, as well as the requirement for regular monitoring of the international normalized ratio. Rivaroxaban, a direct factor Xa inhibitor and the most commonly used non-vitamin K oral anticoagulant, avoids many of these challenges and is being prescribed with increasing frequency for stroke prevention in non-valvular AF. Randomized controlled trial (RCT) data from the ROCKET-AF(Rivaroxaban once daily oral direct Factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation) trial have shown rivaroxaban to be non-inferior to warfarin in preventing ischemic stroke and systemic embolism and to have comparable overall bleeding rates. Applicability of the RCT data to real-world practice can sometimes be limited by complex clinical scenarios or multiple comorbidities not adequately represented in the trials. Available real-world evidence in non-valvular AF patients with comorbidities - including renal impairment, acute coronary syndrome, diabetes mellitus, malignancy, or old age - supports the use of rivaroxaban as safe and effective in preventing ischemic stroke in these subgroups, though with some important considerations required to reduce bleeding risk. Patient perspectives on rivaroxaban use are also considered. Real-world evidence indicates superior rates of drug adherence with rivaroxaban when compared with vitamin K antagonists and with alternative non-vitamin K oral anticoagulants - perhaps, in part, due to its once-daily dosing regimen. Furthermore, self-reported quality of life scores are highest among patients compliant with rivaroxaban therapy. The generally high levels of patient satisfaction with rivaroxaban therapy contribute to overall favorable clinical outcomes.Peer reviewedFinal Published versio

A Study to Evaluate the Effectiveness of Doula Care on Pain, Anxiety and Labor Outcome among Parturient in Selected Hospitals of Theni District

BACKGROUND OF THE STUDY: The main aim or goal of perinatal care is a family-centered approach. Many of the hospitals in the developed countries allow family members to be present during labor. Labor support has appeared in increasing numbers of official and legal documents as well as national and global initiatives. WHO also emphasized that the psychosocial care for women in labor is essential and should be based on a holistic perspective that encourages family-centered care that involves women in decision making. Aim of the study was to evaluate the effectiveness of doula care on pain, anxiety and labor outcome among parturient in selected hospitals of Theni district. METHODOLOGY: A quantitative approach using a quasi experimental (post test) only design was applied to this study. The study was conducted in Holy redeemer maternity hospital, Theni among 200 primi parturient, (100 in the control group and 100 in the interventional group) who were selected by non probability convenience sampling technique. Data collection was based on interview technique and observation method. The tools used in this study were demographic variables, standardized numerical pain rating scale, standardized state anxiety scale, and self developed questionnaire on labor outcome. Data was collected from December 2013 to February 2015, at Holy redeemer hospital, Theni, after obtaining permission and ethical clearance from the concerned authorities. The participant’s written consent was obtained. First 100 parturient were selected conveniently to the control group and the next 100 to the interventional group. Interventional group underwent doula care (Researcher acted as doula) along with routine care from latent phase of 1st stage of labor till immediate postpartum period.(until 1 hr after delivery ). The researcher assessed the level of pain, anxiety during late active phase of first stage labor, and labor outcome was assessed during labor and immediate post partum period. Control group underwent hospital routine care, pain and anxiety were assessed during late active phase of first stage of labor, and labor outcome observed during labor and immediate post partum period. The researcher taught about doula care to the control group to practice for future delivery. The Conceptual Framework for the present study was based on Roy’s adaptation theory (1984). Data were analyzed by descriptive and inferential statistics. RESULTS: There was a notable decrease in level of pain (15.8%, t=6.16) anxiety (10.8%, t=6.01) and improvement in the level of labor outcome (13.2%, t= 7.60) at p < 0.001 level in the interventional group as compared with the control group. Findings on correlation coefficient indicated that pain, anxiety and labor outcome were moderately related to each other among parturient in the interventional and control group Age of the parturient, type of work, history of complications, weight of the parturient had significant association with level of pain among parturient in the interventional group. Age of the parturient, type of family, gestational weeks of parturient and history of complications had significant association with level of anxiety among parturient in the interventional group. Age of the parturient, Type of work, gestational weeks of parturient and history of complications, history of abortion had significant association with level of labor outcome among parturient in the interventional group. CONCLUSION: The findings imply that adding doula care with routine care was found to be effective in reducing the pain, anxiety and in improving the labor outcome among primi parturient during labor. None of the parturient in the study reported adverse effects to doula care. Doula care filled the gap between the parturient and midwives

LIVE ENERGY METER READING - CONTINUOUS MONITORING AND ANALYSIS USING THINGSPEAK

The current energy meters do not provide any provision to monitor continuous reading about our electricity consumption. Even the provision for automatic billing system is inefficient. Recently developed automatic meter systems uses the GSM modem for transferring the data from the user to provider over particular time through SMS. It has several disadvantages that the cost of the SMS is comparatively high and does not provide continuous monitoring. However, the designed energy meter uses GPRS to transfer the data continuously. When compared to SMS facility, the cost of GPRS is low at continuous monitoring. There is no need for a person to visit every home at the end of the month for checking the unit consumption. In recent years, the numbers of smartphones and computer users have increased drastically. The users can view their current energy meter reading through the web link thingspeak.com and also pay their Electric bills through the internet. The users and providers can also monitor their energy meters online, and they are also given an option of paying the bill online. Using this system, the users will be aware of the electricity usage in his/her home. Even the provider can remotely cut the supply of the user who is not paying electricity bill in time by visiting their host page. Once the bill is paid the provider can resume the power supply. With some modifications, we can track the energy consumption of any industrial plants, offices, educational institutions, and corporates companies and hence this system may help them to save the power consumption to a greater extent

Popular matchings with two-sided preferences and one-sided ties

We are given a bipartite graph $G = (A \cup B, E)$ where each vertex has a preference list ranking its neighbors: in particular, every $a \in A$ ranks its neighbors in a strict order of preference, whereas the preference lists of $b \in B$ may contain ties. A matching $M$ is popular if there is no matching $M'$ such that the number of vertices that prefer $M'$ to $M$ exceeds the number of vertices that prefer $M$ to~$M'$. We show that the problem of deciding whether $G$ admits a popular matching or not is NP-hard. This is the case even when every $b \in B$ either has a strict preference list or puts all its neighbors into a single tie. In contrast, we show that the problem becomes polynomially solvable in the case when each $b \in B$ puts all its neighbors into a single tie. That is, all neighbors of $b$ are tied in $b$'s list and $b$ desires to be matched to any of them. Our main result is an $O(n^2)$ algorithm (where $n = |A \cup B|$) for the popular matching problem in this model. Note that this model is quite different from the model where vertices in $B$ have no preferences and do not care whether they are matched or not.Comment: A shortened version of this paper has appeared at ICALP 201

User Selection and Pairing for Future Power Domain Non-Orthogonal Multiple Access (PD-NOMA) using Deep Learning Techniques

The next-generation wireless networks and communications such as 5G/6G offers various benefits such as low latency, high data rates, and improvement in user numbers with increased base station capacity and quality of service. These advantages are obtained from the increasing receiver complexity through the non-orthogonal multiple access (NOMA) of users. It is the promising radio access approach used to enhance next-generation wireless communications. Among the techniques of NOMA such as power and code domain, this paper concentrates on power domain NOMA. The user in the network for transmission is selected using a deep learning approach called deep neural network (DNN).&nbsp; This user selection results are the training data and the loss function is modified for the selection of users that could meet the constraint the selected user cannot be in both strong and weak groups. The user aggregation/user pairing among the sub-channels is performed through the exhaustive analysis using particle swarm optimization (PSO). The usage of DNN-PSO enables the transmitter and required minimum uplink and downlink transmitting power and guaranteed for Quality of Service of each user. The simulation and comprehensive statistical evaluation are performed with the comparative analysis of energy efficiency and maximum achievable rate with the given spectrum efficiency (SE) of PD-NOMA. The proposed model ensures reduced latency, increased throughput, less energy, achievable data rate, user fairness and increased reliability and quality of service

FORCED OSCILLATION FOR A CLASS OF FRACTIONAL PARABOLIC PARTIAL DIFFERENTIAL EQUATIONS

We investigate the oscillation of class of time fractional partial dierential equationof the formfor (x; t) 2 R+ = G; R+ = [0;1); where is a bounded domain in RN with a piecewisesmooth boundary @ ; 2 (0; 1) is a constant, D +;t is the Riemann-Liouville fractional derivativeof order of u with respect to t and is the Laplacian operator in the Euclidean N- space RNsubject to the Neumann boundary conditionWe will obtain sucient conditions for the oscillation of class of fractional partial dierentialequations by utilizing generalized Riccatti transformation technique and the integral averagingmethod. We illustrate the main results through examples

Covid – 19: Impact On The Indian Economy

The onset of COVID-19, the global economy is set to undergo a sharp double-dip recession. As many international agencies have already forecasted, the global growth could be -3 per cent in 2020, which is a decline of about 6 percentage points from the baseline projection of positive 3 per cent growth with no pandemic. Such swings in growth forecasts are unprecedented, and this is due to both health scare with lots of deaths and infections and also due to the lockdown of a major part of the global economy. Added to this, the pandemic appears to be more severe in the industrialized economy. While the forecasts for 2021 suggest a sharp rebound, the trends suggest that the world may need to endure this for a longer period than expected. Unlike the global economy, Indian economy was already in a slowdown phase before the pandemic affected and there were expectations that the economy is on a recovery path. But, with the COVID-19 such hopes are not only dented rather down turn turning out to be much deeper. There are various forecasts that suggest a sharper slowdown. Some forecasts even suggest a negative growth, which was not heard in the past five decades. With the lockdown and with increasing infections, the uncertainty in the economy has increased manifolds. There are also discussions about the shapeoftherecovery–VorUorW. But, in our view, the most probabilistic recovery could see an elongated U shape

Enhancement of Writeback Caching by changes in flush and its parameters

Achievement of high performance in computing or accessing of data is the aim of any system. Reduction of access time to a particular data which is present in the device is very important for the enhancement in the performance. Caching is implemented to do the same. The group of cache device and the virtual device is made as a cache group to enhance the performance of the system. The system may not be on the same condition different instances of time. There will always be a variation in io rates of the application, which is not utilized for the full extent. These differences in the io rates can be utilized effectively for the enhancement of the performance of the system. When the system is idle of with less io then the system will force the flush so that the inconsistency of data is reduced. When the system is being bombarded with io then less threads are given for the flush io. These variations in the threads assigned for the implementation of flush io will enhance the overall performance of the system

Zone Based Multi-Path Disjoint Routing In Manet Using Zbmdr Protocol

A MANET (Mobile Ad hoc Network) is an accumulation of wireless mobile nodes which are autonomous and can dynamically self-organize that creates aprovisional network topology. Numerouspossible applications of MANETs necessitate group communications among several nodes, which is supported by multicasting. In a dynamic environment, it is difficult to maintain group membership management, which is a challenging task to implement robust and scalable multicast routing. For that reason, a novel Zone Based Multipath Disjoint Routing (ZBMDR) is proposed. The proposed ZBMDR is disjoint at the zones which can establish multiple zone disjoint routes between the source and the destination network zones which help to develop the network lifetime and also to reduce the congestion and communication overhead. The proposed ZBMDR protocol is simulated using the NS-2 (NS-2.39) and the experimental results are presented