A study of factors delaying hospital arrival and predictors of mortality in patients presenting to emergency department with Stroke: A developing state scenario

Background: Thrombolytic therapy for acute ischemic stroke has recently become available in India but its success depends on initiating the treatment in the narrow therapeutic time window. There is commonly a delay of several hours before patients with acute stroke seek medical attention. Materials and Methods: A prospective study was conducted to assess the factors influencing this delay in admission of acute stroke cases. 134cases (101 males, 33 females) of acute stroke that arrived within 72 hours at our hospital casualty were recruited. A standardized structured questionnaire was given to patients or their attendants. Results: The median time to casualty arrival was 9 hours with 13.4% cases arriving within 3 hours and 36.5 % cases within 6 hours. Distances from hospital, referral, belief in myths and alternate medicine and low threat perception of symptoms of stroke were independent factors associated with delay in arrival. Living in city, day time onset, urgency shown by attendant, availability of transport and presence of family history were associated with early arrival. There was no correlation with patients' or attendants' sex, educational status, history of previous stroke or transient ischemic attack, subtype or severity of stroke, time of stroke and availability of transport. 134 patients (65.7% were from rural population, 55.22%-smokers, 46.76%-alcoholics) with mean (SD) age of 53.83+/-18.02years [significantly lower in females (mean difference=9.73years p=0.002)], were admitted and diagnosed to have stroke. 87.3% had first episode of stroke and 12.7 had more than one episode of stroke. ICF rate was 26.1%. ICF rate has no relation with age (p=0.516), sex (p=0.460), number of episodes (0.795), underlying hypertension (p=0.905). Odds of diabetics dying were 12 times higher than non-diabetics. Inpatient mortality was also significantly higher in smokers compared with non-smokers (p=0.004), in patients with right-sided compared with left-sided hemiplegic (p=0.029) and who couldn’t afford computed tomography (CT) scan (p=0.007). Kaplan Meier curve in Image-1 shows the survival following admission to emergency ward. Conclusion: Adequate measures need to be taken to improve the public awareness of stroke and the role of local doctors. Our study has shown that active smokers, involvement of the right side and non performance of CT were independent predictors of mortality which have not been shown earlier. Also, we found that diabetes mellitus is independent predictor of mortality in stroke, which has been seen in earlier studies too

A study of factors delaying hospital arrival and predictors of mortality in patients presenting to emergency department with stroke: A developing state scenario

Background: Thrombolytic therapy for acute ischemic stroke has recently become available in India but its success depends on initiating the treatment in the narrow therapeutic time window. There is commonly a delay of several hours before patients with acute stroke seek medical attention. Materials and Methods: A prospective study was conducted to assess the factors influencing this delay in admission of acute stroke cases. 134cases (101 males, 33 females) of acute stroke that arrived within 72 hours at our hospital casualty were recruited. A standardized structured questionnaire was given to patients or their attendants. Results: The median time to casualty arrival was 9 hours with 13.4% cases arriving within 3 hours and 36.5 % cases within 6 hours. Distances from hospital, referral, belief in myths and alternate medicine and low threat perception of symptoms of stroke were independent factors associated with delay in arrival. Living in city, day time onset, urgency shown by attendant, availability of transport and presence of family history were associated with early arrival. There was no correlation with patients' or attendants' sex, educational status, history of previous stroke or transient ischemic attack, subtype or severity of stroke, time of stroke and availability of transport. 134 patients (65.7% were from rural population, 55.22%-smokers, 46.76%-alcoholics) with mean (SD) age of 53.83+/-18.02years [significantly lower in females (mean difference=9.73years p=0.002)], were admitted and diagnosed to have stroke. 87.3% had first episode of stroke and 12.7 had more than one episode of stroke. ICF rate was 26.1%. ICF rate has no relation with age (p=0.516), sex (p=0.460), number of episodes (0.795), underlying hypertension (p=0.905). Odds of diabetics dying were 12 times higher than non-diabetics. Inpatient mortality was also significantly higher in smokers compared with non-smokers (p=0.004), in patients with right-sided compared with left-sided hemiplegic (p=0.029) and who couldn’t afford computed tomography (CT) scan (p=0.007). Kaplan Meier curve in Image-1 shows the survival following admission to emergency ward. Conclusion: Adequate measures need to be taken to improve the public awareness of stroke and the role of local doctors. Our study has shown that active smokers, involvement of the right side and non performance of CT were independent predictors of mortality which have not been shown earlier. Also, we found that diabetes mellitus is independent predictor of mortality in stroke, which has been seen in earlier studies too

Why do you need to tie me down? Reflecting back on a significant dynamic of turmoil in intimacy

Lo scopo di questo articolo \ue8 illustrare la dinamica dell'avversione a conoscere nell'intimit\ue0 delle relazioni familiare quale il fattore psicologico che innesta una clima emotivo di aggressivit\ue0 latente. Applicando la metodologia dell'osservazione partecipe e neutrale si \ue8 riscontrato che la frustrazione nei figli per l'incomprensione emotiva ha sortito una lieve forma di timidezza che ha reso complicato il processo di familiarizzazione con l'osservatrice. Nel tempo i figli hanno dimostrato ostilit\ue0 nei confronti dell'osservatrice la quale divenne il ricettacolo della gelosia e dell'invidia negata dal gruppo familiare. Questo studio rivela che la non elaborazione di emozioni forti crea la condizione per sortire pretesti di libero sfogo dell'aggressivit\ue0

Affine-Invariant Outlier Detection and Data Visualization

A wealth of data is generated daily by social media websites that is an essential component of the Big Data Revolution. In many cases, the data is anonymized before being disseminated for research and analysis. This anonymization process distorts the data so that some essential characteristics are lost which may not be captured by methods that are not robust against such transformations. In this paper we propose novel algorithms, for two-dimensional data, for a recently discovered statistical data analysis measure, the Ray Shooting Depth (RSD) that provides an affineinvariant ranking of data points. In addition, we prove some complexity results and illustrate some of the desirable properties of RSD via comparisons with other similar notions. We develop an open-source data visualization tool based on RSD, and show its applications in distribution estimation, outlier detection, and 2D tolerance-region construction

To compare the accuracy of prayer\u27s sign and mallampatti test in predicting difficult intubation in diabetic patients

Objective: To determine the accuracy of Prayer\u27s sign and Mallampatti test in predicting difficult endotracheal intubation in diabetic patients. Methods: The cross-sectional study was performed at Aga Khan University Hospital, Karachi, over a period from January 2009 to April 2010, and comprised 357 patients who required endotracheal intubation for elective surgical procedures. Prayer\u27s sign and Mallampatti tests were performed for the assessment of airway by trained observers. Ease or difficulty of laryngoscopy after the patient was fully anaesthetised with standard technique were observed and laryngoscopic view of first attempt was rated according to Cormack-Lehan grade of intubation. SPSS 15 was used for statistical analysis. Results: Of the 357 patients, 125(35%) were classified as difficult to intubate. Prayer\u27s sign showed significantly lower accuracy, positive and negative predictive values than Mallampatti test. The sensitivity of Prayer\u27s sign was lower 29.6 (95% Confidence Interval, 21.9-38.5) than Mallampatti test 79.3 (95% confidence interval, 70.8-85.7) while specificity of both the tests was not found to be significantly different. Conclusion: Prayer\u27s sign is not acceptable as a single best bedside test for prediction of difficult intubation

Practices in Library Staff Development: A case study of Pakistan Academy for Rural Development (PARD) Library

This study has been conducted to judge and document the initiatives taken for staff development at the library of Pakistan Academy for Rural Development (PARD) to enhance the performance of its employees for effective service delivery. This study also documents the visible change in professional improvement of library staff before and after such initiatives. The paper describes each initiative with explanation and practically applied examples showing its output and results. This is an observational study where the data was collected through personal interviews, table-talks with employees, and annual Performance Evaluation Reports (PERs)of the subjects. Current and retrospective staff of PARD library have participated in this study and provided their candid feedback. The library job, unlike other jobs, is isolated and is limited to perform one-type of job description. Therefore, the library staff are not openly exposed to avail staff development opportunities. The study concludes that techniques (discussed in this paper and practically executed) are useful to develop competencies of library staff in order to be more fruitful. Annual Performance Evaluation Reports, individual interview results, and users’ feedback on overall library performance is evident to shows that staffs, have benefited both personally and professionally from such activities. Staff development activities taken at PARD library has not only developed the skills at individual level but also contributed to achieve the organizational goals. This paper presents original viewpoint by the authors based on the observation, interviews and examining the performance evaluation report of the subject population. A kind of first ever study conducted on development of library staff in Pakistan

The Relationship between Iron Deficiency Anemia and the Incidence of Febrile Convulsions

OBJECTIVES To determine the role of iron deficiency anemia in patients with febrile convulsions in the 06 to 60 months in a tertiary care hospital.METHODOLOGY This cross-sectional study was undertaken at Ayub Teaching Hospital, Abbottabad, from January 2020 to February 2022. Patients with typical and atypical febrile seizures were recruited for the study, while patients with neurodegenerative diseases, meningoencephalitis, epilepsy, trauma, nephritic syndrome, and hypertensive seizures were excluded from the study. Iron deficiency was identified concerning a complete blood count. The data were analyzed in SPSS version 21, and the significance value was kept at < 0.005.RESULTSIn the present study, 102 patients were enrolled. The mean age of the sample was 15 months, with an age range of 6-54 months. The male-to-female ratio was 2:1. The mean haemoglobin (HB) of the sample observed was 9.9±1.9, mean corpuscular volume (MCV) 73±13, red cell distribution width (RDW) 16±7.9 white cell count (WBC) 12.9±7.1 and platelets of 312±180. The use of cow milk in febrile seizures was 41%, and only 33% of parents were unaware of proper milk dilution. CONCLUSION We concluded that patients with atypical febrile seizures and those with seizures more than once have a significantly higher degree of iron deficiency anemia than those with typical febrile seizures. Moreover, the group with prolonged seizures has severe anemia compared to the group with brief seizures

Scalable Approximation Algorithm for Network Immunization

The problem of identifying important players in a given network is of pivotal importance for viral marketing, public health management, network security and various other fields of social network analysis. In this work we find the most important vertices in a graph G = (V;E) to immunize so as the chances of an epidemic outbreak is minimized. This problem is directly relevant to minimizing the impact of a contagion spread (e.g. flu virus, computer virus and rumor) in a graph (e.g. social network, computer network) with a limited budget (e.g. the number of available vaccines, antivirus software, filters). It is well known that this problem is computationally intractable (it is NP-hard). In this work we reformulate the problem as a budgeted combinational optimization problem and use techniques from spectral graph theory to design an efficient greedy algorithm to find a subset of vertices to be immunized. We show that our algorithm takes less time compared to the state of the art algorithm. Thus our algorithm is scalable to networks of much larger sizes than best known solutions proposed earlier. We also give analytical bounds on the quality of our algorithm. Furthermore, we evaluate the efficacy of our algorithm on a number of real world networks and demonstrate that the empirical performance of algorithm supplements the theoretical bounds we present, both in terms of approximation guarantees and computational efficiency

A featureless approach for object detection and tracking in dynamic environments

One of the challenging problems in mobile robotics is mapping a dynamic environment for navigating robots. In order to disambiguate multiple moving obstacles, state-of-art techniques often solve some form of dynamic SLAM (Simultaneous Localization and Mapping) problem. Unfortunately, their higher computational complexity press the need for simpler and more efficient approaches suitable for real-time embedded systems. In this paper, we present a ROS-based efficient algorithm for constructing dynamic maps, which exploits the spatial-temporal locality for detecting and tracking moving objects without relying on prior knowledge of their geometrical features. A two-prong contribution of this work is as follows: first, an efficient scheme for decoding sensory data into an estimated time-varying object boundary that ultimately decides its orientation and trajectory based on the iteratively updated robot Field of View (FoV); second, lower time-complexity of updating the dynamic environment through manipulating spatial-temporal locality available in the object motion profile. Unlike existing approaches, the snapshots of the environment remain constant in the number of moving objects. We validate the efficacy of our algorithm on both V-Rep simulations and real-life experiments with a wide array of dynamic environments. We show that the algorithm accurately detects and tracks objects with a high probability as long as sensor noise is low and the speed of moving objects remains within acceptable limits