Improving Knowledge of the Importance of Adhering to Anticoagulation Therapy among Patients with Atrial fibrillation to Reduce Stroke Risk: A Quality Improvement Project.

Abstract Background: It is reported that more than 795,000 people in the United States suffer from stroke, and almost 87% suffer from ischemic strokes. Stroke impacts the patient\u27s condition causing adverse effects such as paralysis, weakness, lack of proper balancing, excessive fatigue, and pain, affecting the quality of life. Atrial fibrillation is the leading cause of strokes, and they are usually provided with anticoagulant therapy, which helps prevent blood clots. However, the patient faces difficulty adhering to the treatment process, resulting in stroke and recurrent hospitalization. This quality improvement project (QIP) aimed to improve the Knowledge of Patients with Atrial Fibrillation to help Adherence to Use Anticoagulation to Reduce Stroke Risk in the inpatient setting. Methods: A survey was designed for the pre-and post-intervention. The survey consisted of 4 demographic and 21 knowledge questions on knowledge and treatment of atrial fibrillation and patient knowledge about the importance of anticoagulation. Fourteen participants completed the pre-survey, the educational session, and the post-survey. A 15-minute evidence-based educational session was conducted in the inpatient setting. The survey results indicated improvement in the knowledge question responses after the 15-minute educational session. Knowledge scores from the pre-and post-survey were compared, which were statistically significant. It is reinforced that an educational intervention can improve the knowledge of the importance of anticoagulation in stroke prevention in patients with atrial fibrillation can be improved. Results: Knowledge scores from the pre- and post-surveys were compared, which were statistically significant based on the p-value. Conclusion: These findings indicated that educating patients with atrial fibrillation on the importance of anticoagulation in healthcare can decrease their stroke risk

Evaluate the Effectiveness of Pranayama on Educational Stress among Adolescents in Selected School at Kanyakumari District

Aim: The objective of the current study was to assess the effectiveness of pranayama on educational stress among adolescents. Methods: In a quasi-experimental one-group pretest and posttest design, adolescents between the ages of 12 and 18 were selected using a purposive sampling technique. The self-structured demographic variables and the Educational Stress Scale for Adolescents (ESSA) (Sun J, 2011) were used to assess the pre and post-test levels of educational stress. A structured interview schedule was used to assess the adolescents' level of educational stress. Following the pre-test, samples were given daily pranayama training in a calm and quiet environment. The Pranayama procedure took about 30 minutes to complete. A post-test was performed three months after the intervention. Results: Among the 95 adolescents who participated in the study, the pre-test stress levels were mild (15.8%), moderate (45.3%), and severe (38.9%). The same was reduced in the posttest, with mild being 77.8% and moderate being 22.1%. The severe stress was null. There was a significant difference in educational stress levels before and after Pranayama training (t=27.707; p<.0001). The adolescents' mean score of educational stress before and after Pranayama was 56.7 and 31.4, respectively. The mean reduction was 25.4±8.9. There was a significant association between age, gender, grades, and internet usage; 6.0, 7.3, 11.8 and 13.866, respectively, at P>0.05. The results discovered that pre-educational stress was decreased after Pranayama training. Conclusion: Educational stress is inevitable for school-age adolescents in today's highly competitive world. In accordance with the study findings, Pranayama practice reduces stress, as evidenced by a significant reduction in educational stress. Keywords: Educational Stress, Stress, Adolescents, Pranayama DOI: 10.7176/JHMN/102-07 Publication date:September 30th 2022

Micro Vascular Reconstruction of Maxilla using Free Fibula Flap

AIM: The purpose of the study was to evaluate the aesthetic and functional outcome after free fibula flap reconstruction for maxillary defects. OBJECTIVES: The long term outcome is evaluated in the following manner, 1. Fibula as a suitable reconstruction method for maxillary defects. 2. Patient satisfaction In terms of functional and aesthetic satisfaction at donor and recipient site. (annexure). 3. Wound infection and dehiscence. 4. Donor site morbidity. MATERIALS & METHODS: 3 patients were included in the study. Two patients were secondarily reconstructed due to post traumatic defect and mucormycosis, and third patient was primarily reconstructed after resection for squamous cell carcinoma. RESULTS: All the three patients had an improvement in speech and aesthetically acceptable results. One patient had wound dehiscence in the recipient site; one patient had pain in donor site for 3 weeks while walking downstairs. No difficulty in deglutition in any patients. CONCLUSION: Low donor site morbidity, acceptable aesthetic and functional outcome recommends micro vascularized free fibula flap to be considered as one of the ideal option for maxillary reconstruction. It improves the quality of life by improving the speech and swallowing

Microphone Array Speech Enhancement Via Beamforming Based Deep Learning Network

In general, in-car speech enhancement is an application of the microphone array speech enhancement in particular acoustic environments. Speech enhancement inside the moving cars is always an interesting topic and the researchers work to create some modules to increase the quality of speech and intelligibility of speech in cars. The passenger dialogue inside the car, the sound of other equipment, and a wide range of interference effects are major challenges in the task of speech separation in-car environment. To overcome this issue, a novel Beamforming based Deep learning Network (Bf-DLN) has been proposed for speech enhancement. Initially, the captured microphone array signals are pre-processed using an Adaptive beamforming technique named Least Constrained Minimum Variance (LCMV). Consequently, the proposed method uses a time-frequency representation to transform the pre-processed data into an image. The smoothed pseudo-Wigner-Ville distribution (SPWVD) is used for converting time-domain speech inputs into images. Convolutional deep belief network (CDBN) is used to extract the most pertinent features from these transformed images. Enhanced Elephant Heard Algorithm (EEHA) is used for selecting the desired source by eliminating the interference source. The experimental result demonstrates the effectiveness of the proposed strategy in removing background noise from the original speech signal. The proposed strategy outperforms existing methods in terms of PESQ, STOI, SSNRI, and SNR. The PESQ of the proposed Bf-DLN has a maximum PESQ of 1.98, whereas existing models like Two-stage Bi-LSTM has 1.82, DNN-C has 1.75 and GCN has 1.68 respectively. The PESQ of the proposed method is 1.75%, 3.15%, and 4.22% better than the existing GCN, DNN-C, and Bi-LSTM techniques. The efficacy of the proposed method is then validated by experiments

Clinical and coronary angiographic correlation of patients with unstable Angina.

INTRODUCTION : UA is a clinical syndrome caused by atherosclerotic plaque rupture and thrombosis within a coronary artery . It is defined as angina that is new onset or abruptly increased in intensity ,duration or frequency within the past 60 days. It may present as rest angina,new onset severe angina or increasing angina .Initial evaluation includes risk stratification based on history ,clinical exam , ECG , cardiac enzymes . Among patients with UA who undergo angiogram ,85% will have significant CAD. CABG confers a survival benefit in patients with > 50% LM stenosis or triple vessel disease with LV dysfunction, Importantly patients with no significant lesions at angiography benefit from reorientation of their management.Symptomatic patients with normal coronaries may have significant atherosclerosis by IVUS secondary to coronary artery remodeling AIM : 1. Risk stratification based on clinical history & presentation, ECG, Enzymes, 2. To Correlate the clinical profile with Coronary angiographic profile 3. To identify the high risk predictors for early intervention MATERIALS AND METHODS : Study design : Observational and Cross sectional StudyStudy population:Unstable angina patients admitted for coronary angiogram in cardiology ward GRH, Madurai. Inclusion Criteria Patients admitted with a history of chest pain diagnosed as unstable angina and subsequently underwent CAG in cardiology ward. RESULTS AND CONCLUSION : Unstable angina commonly affects the age group 45-60yrs in both sexes. 30% of patients in our study was women. Women have normal coronaries compared to men in patients with unstable angina, (30% vs 20%) which suggests a different patho physiological mechanism for their symptoms which leads to difficulty in making a firm diagnosis of UA. Smoking, diabetes, Hyperlipidemia, Hypertension are major risk factors for unstable angina in this study Braunwald class III angina (Rest angina) predicted severity of lesion ( left main & triple vessel disease) in our study. Patients who had High TIMI risk scoring had more severe coronary lesions compared to low TIMI risk score which helps in risk stratification and early intervention. Significant ST-T changes in ECG predicted more extensive disease which helps in decision making regarding treatment strategy (conservative vs invasive) aVR ST elevation in background of unstable angina predicts left main disease &Triple vessel disease in our study which helps risk stratification and early intervention. ECHO evidence of LV dysfunction predicted Triple vessel disease /LM disease. Out of the 100 pts who underwent coronary angiogram in our study 27 pts had Single Vessel disease ( type A lesions predominantly) 24 pts had two Vessel disease .( type B lesions predominantly) 26% had three vessel disease. (type B lesions predominantly) 14 patients had Left Main Coronary artery disease. 23 patients had normal or insignificant coronary artery lesions. 9 patients had thrombus containing lesion who had rest angina, out of whom 6 patients had SVD and 3 patients had multivessel disease. 3 patients had total occlusion with TIMI ‘0’ flow

One year study of Transverse and Vertical Diameter of the Orbit as a parameter in sex determination of human skull: June 2005 - May 2006

INTRODUCTION : In view of certain amount of, uncertainity the sex differentiation of skull, it is thought to make out another parameter. As previous experience revealed certain amount of variants of orbital height between both sexes, it is thought that this parameter may be investigated. Hence this work. REVIEW OF LITERATURE : The literature of this subject is reviewed. Broca studied orbital index for race differentiation but did not mention of the sex difference. Wincler reported on the estimation of age difference through orbital index but he too did not mention sex difference. Pearson studied the orbital index of males but did not observe on the females. This work aims to study the sex differentiation with the help of orbital index. MATERIAL AND METHODS : For this work, the orbital measurements of 96 male and 62 female adult Cadavers were taken. The instrument used is a sliding calipers. The dead bodies belong to the anatomy, and forensic medicine kept in mortuary. Not much destruction is made to the bodies while taking the measurements. Orbital height : It measures the straight distance between the upper and lower margins of the orbital cavity, taken at right angle to the orbital breadth. Orbital breadth : It measures the straight distance between maxillo frontal (mf) and ecto conchion (ecto, Ecto conchion (ect) must be marked before the measurement. The diameter should out the orbital cavity in almost to equal halves. Care has been taken while selecting the specimens that there are no deformaties or diseases of the orbits present. The age of the individuals are also noted. After taking the measurements, they have been studied in a statistical data in sex wise and age wise groups. All the results have been tabulated and graphically represented. The values obtained are critically studied. Conclusions and recommendations were made on the results this obtained. OBSERVATION : The average orbital breadth of males and females was found to be 33.15 and 33.83mm respectively. The average orbital height of males and females was found to be 26.45 and 30.06mm respectively. This difference of orbital height in statistically found to be significant (P < 0.01). CONCLUSION : It has been observed that an orbital index of 89 and above conclusively proves a female sex without any error. An orbital index of 85 to 88 is conclusive proof of a female sex with a nominal range of error of 1%. An orbital index of 73 and below is conclusively to be that of a male with-out any error. These conclusions have been found to be statistically highly significant. LIMITATIONS : The limitations of this work may be (a) a small sample – segregated geographical distribution and (b) little more probable error for dry bones. SUGGESTIONS : It is suggested that a bigger sample may be taken, the work may be continued at different geographical areas and on dry bones. This study has brought out a simple, easy and clear parameter for conclusive sex differentiation of skull

A comparative study on morphometric and meristic characters of Nemipterus japonicus (Bloch, 1791) in the coasts of India

A total of 200 threadfin bream Nemipterus japonicus was collected from Chennai in the east coast and Kochi in the west coast during January to February 2013 and studied for their morphometric and meristic characters. In total, 21 characters were analyzed out of which 3 characters namely dorsal, ventral and anal fins were not considered since they were unaltered. The findings indicate that 91% of the total variation in the data can be accounted for by three clusters. Small values of 1-R**2 ratio for the three clusters obtained indicate good clustering. The small values of p (≤0.0001) indicate that there are significant differences in the variables of Chennai and Kochi data which are shown through MANOVA. This might depict that the fish of Chennai and Kochi might be of 2 different stocks. Moreover, the study has also aided in identifying the importance of regular monitoring of stock assessment and the biology of commercially important fishes

Computational tracking of Parkinsonian motor fluctuations in a real-world setting: a case study

Digital biomarkers based on accurate tracking of motor behaviour can provide a cost-effective, objective, and robust measure for Parkinson’s Disease progression, changes in care needs, and the effect of interventions. Markerless motion capture technology offers a promising approach for running it in the home. This technology uses depth sensors to capture movement unobtrusively and generate objective and quantifiable movement features. Here we present a 4-month long case study during which the patient visits our lab every month to perform mobility tasks and daily living tasks. Our data suggest accurate tracking of symptom fluctuations during both task types. This is a promising proof-of-concept towards passive tracking in-the-home of Parkinsonian symptom fluctuations

Studies on the Release of Metabolic Intermediates And/or Endproducts During Wastewater Purification by Activated Sludge

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