A Stochastic Approach To Reconstruct Gamma Ray Burst Lightcurves

Gamma-Ray Bursts (GRBs), being observed at high redshift (z = 9.4), vital to cosmological studies and investigating Population III stars. To tackle these studies, we need correlations among relevant GRB variables with the requirement of small uncertainties on their variables. Thus, we must have good coverage of GRB light curves (LCs). However, gaps in the LC hinder the precise determination of GRB properties and are often unavoidable. Therefore, extensive categorization of GRB LCs remains a hurdle. We address LC gaps using a 'stochastic reconstruction,' wherein we fit two pre-existing models (Willingale 2007; W07 and Broken Power Law; BPL) to the observed LC, then use the distribution of flux residuals from the original data to generate data to fill in the temporal gaps. We also demonstrate a model-independent LC reconstruction via Gaussian Processes. At 10% noise, the uncertainty of the end time of the plateau, its correspondent flux, and the temporal decay index after the plateau decreases, on average, by 33.3% 35.03%, and 43.32%, respectively for the W07, and by 33.3%, 30.78%, 43.9% for the BPL. The slope of the plateau decreases by 14.76% in the BPL. After using the Gaussian Process technique, we see similar trends of a decrease in uncertainty for all model parameters for both the W07 and BPL models. These improvements are essential for the application of GRBs as standard candles in cosmology, for the investigation of theoretical models and for inferring the redshift of GRBs with future machine learning analysis.Comment: 20 pages, 6 tables, 11 figure

Acute Effect of Selective Yogic Exercises on Brainstem Auditory Evoked Potentials in Stable Chronic Obstructive Pulmonary Disease Patients

Background: Chronic obstructive pulmonary disease (COPD) is presently regarded as a multi-system disorder. A decrease oxygen transport to brain in these patients alters spontaneous brain activity. Yoga plays a vital role in complementary management of the disease. Brainstem auditory evoked potentials (BAEP) reflect neuronal activity along the auditory pathway up to the midbrain. Thus, we aimed to assess the effects of short-term yogic exercises in BAEP in stable COPD patients. Methods: This one group pretest – posttest observational study enrolled 50 stable patients with COPD. Steps of yogic exercises which included bhujangasana (snake pose), nadisodhana pranayama (alternate nostril breathing), swana pranayama (panting dog breathing) and ajapa-japa meditation (constant awareness of breathing) were taught to subjects by yoga instructor and given rest for 15 minutes. Then, BAEP latencies were recorded. After recording subjects performed the 20-25 minutes of yogic exercises as per the instructions, immediately after the completion, BAEP latencies were recorded. Thereafter, subjects were allowed to have rest for 10-15 minutes recording was done again. Results: Latency of BAEP wave I (1.78 ± 0.50 vs 1.99 ± 0.49 ms, p=0.006) and wave II (2.91 ± 0.32 vs 2.99 ± 0.30 ms, p=0.006) significantly decreased immediately after yoga, compared to baseline in right ear. Similarly, latency of wave II (2.77 ± 0.42 vs 2.92 ± 0.46 ms, p=0.005) and wave V (5.72 ± 0.32 vs 5.91 ± 0.37 ms, p=0.017) significantly decreased immediately after yoga, compared to baseline in left ear. However, latency of wave IV (5.51 ± 0.32 vs 5.34 ± 0.40 ms, p=0.042) increased significantly after the rest of 30 minutes, compared to immediately after yoga in right ear. Conclusions: Enhancement of neuronal transmission along the auditory pathway up to the midbrain was seen immediately after yogic exercises, which returned back to the baseline after 30 mins of rest

Self-management practice, associated factors and its relationship with health literacy and patient activation among multi-morbid COPD patients from rural Nepal

2020 The Author(s). Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive and debilitating condition that affects individuals\u27 quality of life. COPD self-management and supports provided by carers is key to the quality of life people living with COPD. Health literacy (HL) and Patient Activation (PA) are main drivers of self-management practices (SMPs). However, their contribution remains to be fully explored. This study aimed to examine the level of self-management practices, and the relationship with socio-demographic factors, HL and PA among multi-morbid COPD patients from rural Nepal. Methods: This is a cross-sectional study conducted between July 2018 and January 2019. Patients completed a survey, including Self-management Practices questionnaire (SMPQ), five domains of the Health Literacy Questionnaire (HLQ), and Patient Activation Measure (PAM). The relationship between HL, PAM, and SMPs was examined using univariate statistics. Multivariable analysis was conducted to identify the factors associated with SMPs. Results: A total of 238 patients responded to the study. The mean score of SMPQ was 45.31(SD = 9.00). The HLQ and PAM scores were positively correlated with the total score of SMPQ. Low level of SMPs were found to be positively associated with being uneducated (β = - 0.43, p =.001), having a low family income (β = - 5.22, p =.002), and, negatively associated with the presence of more than one co-morbidity (β = 3.58, p = 0.007) after controlling for other socio-demographic variables in the multivariable analysis. Conclusion: The overall SMPs among this sample of Nepalese with COPD were low. Our findings highlight the need to implement a self-management intervention program involving patient activation and health literacy-focused activities for COPD, creating a support system for patients from low-income families and low education

Levels and determinants of health literacy and patient activation among multi-morbid COPD people in rural Nepal: Findings from a cross-sectional study

BACKGROUND: Health literacy (HL) and patient activation (PA) are necessary foundations to engage patients in self-management intervention. Each concept plays a unique role in improving access to the effective self-management of chronic disease. In this cross-sectional study, we examined the levels and determinants of HL and PA among the multi-morbid COPD patients in Nepal. METHODS: We conducted interviews with a simple random sample of 238 multi-morbid COPD people from July 2018 to January 2019. The questionnaire included sociodemographic profiles, five domains of the Health Literacy Questionnaire (HLQ), 13-item Patient Activation Measure (PAM) and patient\u27s illness perception by Brief Illness Perception Questionnaire (BIPQ). Multivariable logistic regression was used to examine the associations. RESULTS: Most people with COPD had low health levels across each of the five domains of the HLQ. The proportion of people with low literacy level across each of the domains was: (i) feeling understood and supported by healthcare providers (79.0%), (ii) having sufficient information to manage my own health (76.5%), (iii) social support for health (77.3%), (iv) ability to find the good health information (75.2%), and (v) understand the health information well enough to know what to do (74.8%), respectively. The majority of patients also reported low levels of patient activation (level 1: 81.5%; level 2: 11.8%), with only 6.7% (level 3: 5%; level 4: 1.7%) reported higher patient activation level. We found significant associations between poor HL levels in the HLQ domains and having no education, being female or from Indigenous and Dalits communities, and having a monthly family income of less than USD176. Having no education and poor illness perception were significantly associated with poor activation level on PAM scale. CONCLUSION: A high proportion of multi-morbid COPD peoples had low levels of HL and were less activated than what would be required to self-manage COPD. These were in turn associated with socioeconomic factors and poor illness perception. The findings from this study are being used to design a COPD self-management program tailored to the low health literate population

Facilitators and barriers to the self-management of COPD: A qualitative study from rural Nepal

Author(s) (or their employer(s)) 2020. Objective: To understand the facilitators and barriers to the self-management of chronic obstructive pulmonary disease (COPD) in rural Nepal. Settings: Community and primary care centres in rural Nepal. Participants: A total of 14 participants (10 people with COPD and 4 health care providers) were interviewed. Primary and secondary outcome measure(s): People with COPD and healthcare provider\u27s experience of COPD self-management in rural Nepal. Results: Facilitators and barriers affecting COPD self-management in Nepal operated at the patient-family, community and service provider levels. People with COPD were found to have a limited understanding of COPD and medications. Some participants reported receiving inadequate family support and described poor emotional health. At the community level, widespread use of complementary and alternative treatment was found to be driven by social networks and was used instead of western medicine. There were limited quality controls in place to monitor the safe use of alternative treatment. While a number of service level factors were identified by all participants, the pertinent concerns were the levels of trust and respect between doctors and their patients. Service level factors included patients\u27 demands for doctor time and attention, limited confidence of people with COPD in communicating confidently and openly with their doctor, limited skills and expertise of the doctors in promoting behavioural change, frustration with doctors prescribing too many medicines and the length of time to diagnose the disease. These service level factors were underpinned by resource constraints operating in rural areas. These included inadequate infrastructure and resources, limited skills of primary level providers and lack of educational materials for COPD. Conclusions: The study findings suggest the need for a more integrated model of care with multiple strategies targeting all three levels in order to improve the self-management practices among people with COPD

Air due to Glue: Spontaneous Pneumothorax in a Young Adult with Glue Sniffing

Solvent abuse, as inhalant specially, in the form of low cost adhesives like dendrite is common in low income countries among children and the teens. This habit is often a stepping stone to harder drugs. The neurological and neuropsychological effects of solvent abuse are well explored. But the respiratory effects are often overlooked. In this report, we present a case of a 19 year old gentleman, with regular history of sniffing of commercial “glue” compounds. This patient presented with right sided chest pain and chest x-ray showed a right sided pneumothorax. The pulmonary barotrauma, possibly due to increased intra-alveolar pressure, during the sniffing process can lead to alveolar rupture and in turn, pneumothorax. In the absence of other risk factors for Pneumothorax, the link between inhalant abuse and respiratory complications has to be explored in patients with history of such abuse

Implementation, effectiveness and monitoring of telemedicine program in Bhutanese refugees camp in Eastern Nepal

Background: Telemedicine, a part of Medical Informatics used to consult patients from remote places either via videoconferencing or transferring data and resources via the Store and Forward method, makes the quality of healthcare in low-and middle-income countries more efficient, cost-effective, and accessible. The objectives of this study were to determine its effects on the health of refugees and its efficacy in terms of referrals and cost reduction for healthcare service providers among Bhutanese refugees in eastern Nepal. Methods: This was a cross-sectional study done retrospectively from the records of patient data of Bhutanese refugees from AMDA, Damak, and prospectively by asking the questionnaire to the healthcare providers of Beldangi PHC of AMDA, Damak. Results: The total percentage of patients that were seen via teleconsultation in the primary center was 58% male and 42% females, whereas from the secondary center, males were 43% and females constituted 57%. The referral rate from those primary centers and secondary centers were decreased to 31% and 39%, respectively, from 72% and 61% from previous records. The budget expenditure was also decreased to 13.65% from 29.41%. Conclusions: Telemedicine is beneficial in those types of refugee camps where there are chains of referring patients from primary health centers to tertiary care centers via secondary healthcare centers. As it not only decreased the referral rate but also save the budget expenditure, which are needed when referring those patients to other centers.</p

Outcomes Bronchoscopic Evaluation in A University Hospital

Introduction: Study of clinical profile of the patients and diagnostic yield of the selected bronchoscopic procedures gives us important information in clinical decision making and better patient care. There are hardly very few studies regarding these entities. Therefore, we decided to study clinical characteristics and outcomes of the patients who underwent bronchoscopic evaluation in our setting. Methods: This was a cross-sectional study the consecutive patients who underwent bronchoscopy from 1st May 2013- 30th April 2015 in division of pulmonary, critical care and sleep medicine. The main procedure performed was bronchoalveolar lavage. Results: The mean age was 54.71 years with 76 (76%) males. Recurrent hemoptysis in 58 (58%) patients were the commonest indication. Total 95 (95%) patients have chest X-ray abnormalities. The commonest bronchoscopic finding was bronchiectasis 23 (23%) of patients followed by chronic bronchitis in 18 (18%) and endobronchial tuberculosis in 16 (16%). Total 10 (71%) of the 14 bronchoscopically suspected lung cancer patients have intraluminal lesions. Bronchoalveolar lavage culture for tuberculosis showed growth in 46 (46%), positive for malignancy in 7 (7%) positive Ziehl Neelson stain for tuberculosis in 6 (6%). Conclusions: Bronchoscopic evaluation of patients with pulmonary diseases gives us a lot of information that may help us in better patient care and bronchoalveolar lavage has high diagnostic yield in diagnosing pulmonary tuberculosis. Keywords: bronchoalveolar lavage;clinical profile;fiberoptic bronchoscopy. | PubMe

Levels and determinants of health literacy and patient activation among multi-morbid COPD people in rural Nepal: Findings from a cross-sectional study.

BACKGROUND:Health literacy (HL) and patient activation (PA) are necessary foundations to engage patients in self-management intervention. Each concept plays a unique role in improving access to the effective self-management of chronic disease. In this cross-sectional study, we examined the levels and determinants of HL and PA among the multi-morbid COPD patients in Nepal. METHODS:We conducted interviews with a simple random sample of 238 multi-morbid COPD people from July 2018 to January 2019. The questionnaire included sociodemographic profiles, five domains of the Health Literacy Questionnaire (HLQ), 13-item Patient Activation Measure (PAM) and patient's illness perception by Brief Illness Perception Questionnaire (BIPQ). Multivariable logistic regression was used to examine the associations. RESULTS:Most people with COPD had low health levels across each of the five domains of the HLQ. The proportion of people with low literacy level across each of the domains was: (i) feeling understood and supported by healthcare providers (79.0%), (ii) having sufficient information to manage my own health (76.5%), (iii) social support for health (77.3%), (iv) ability to find the good health information (75.2%), and (v) understand the health information well enough to know what to do (74.8%), respectively. The majority of patients also reported low levels of patient activation (level 1: 81.5%; level 2: 11.8%), with only 6.7% (level 3: 5%; level 4: 1.7%) reported higher patient activation level. We found significant associations between poor HL levels in the HLQ domains and having no education, being female or from Indigenous and Dalits communities, and having a monthly family income of less than USD176. Having no education and poor illness perception were significantly associated with poor activation level on PAM scale. CONCLUSION:A high proportion of multi-morbid COPD peoples had low levels of HL and were less activated than what would be required to self-manage COPD. These were in turn associated with socioeconomic factors and poor illness perception. The findings from this study are being used to design a COPD self-management program tailored to the low health literate population

Varicella pneumonia in an immunocompetent child: A case report

Varicella-zoster virus (VZV) is a type of herpes virus that causes varicella (primary infection) and herpes zoster/shingles (due to reactivation of latent infection). Usually a benign and a self-limited illness, the illness sometimes can result in severe complications in both immunocompetent and immunocompromised persons. Varicella Pneumonia as a complication of herpes zoster is a rare event, with reports primarily concerning immunocompromised individuals. Here we report a 14-year-old female who developed a secondary bacterial infection of the skin lesions and varicella pneumonia associated with VZV infection. The patient presented with multiple painful vesicles that later turned into pustular lesions over the right cheek with erosions and hemorrhagic crusting. Swelling involving the right half of both upper and lower lips was present. She developed a fever, cough, and shortness of breath after two days of the presence of vesico-pustular lesions. A diagnosis of Pneumonia was made based on symptoms of fever and cough and findings on chest x-ray. This case highlights, though rare, varicella pneumonia has a high rate of respiratory failure, but early diagnosis with prompt administration of antiviral medications can improve outcomes