Bed blockers: A study on the elderly patients in a teaching hospital in India

A cross-sectional study of in-patients over the age of 60 years was conducted at district McGann Hospital, Shimoga on patients who were classified as bed blockers. Level of dependency and cognitive function of these patients were assessed using Barthel scale and Abbreviated mental test (AMT) respectively. Median age of the study population was 67 years; majority of them were men. Most of them were admitted in the medical ward and the median time to be labeled as bed blocker was 32 days. These bed blockers were a weak group of patients with an average 3.1 pathology per case. Majority of them suffered from neurological disorders and cardiovascular disease. High level of dependence was noted with a mean Barthel score of 29.68 (Range 0 -100). Low levels of cognitive function was also noted among these patients with a mean AMT of 4.76 (Range 0 -10).These findings demonstrate that the bed blockers in McGann hospital suffer not only from genuine health problems but also have a high dependency level in activities of daily living which hamper their discharge to the community. Community based rehabilitation using an intersectoral approach may help at least the less dependent to return home

A study on stenting in coronary bifurcation lesions

Background: Lesions at coronary bifurcations represent a challenging area in interventional cardiology. Treating bifurcation lesions involves weighing the risk of side-branch closure and the need for additional stent, sometimes requiring complex techniques. There are no specific guidelines established in choosing a one-stent versus a two-stent technique for a bifurcation lesion. The decision is highly dependent on its anatomic configuration and operator preference and expertise.Methods:  Twenty patients of coronary artery bifurcation disease, most of them are double vessel disease with bifurcation coronary lesions planned for bifurcation stenting are included in the study. All the twenty patients’ risk factors, angiographic profile, and the technique used for bifurcation stenting are noted. Different stenting techniques are used for bifurcation stenting. Patients clinical follow up at three months, six months and at nine months done. Depending on the clinical symptoms patients are subjected for coronary angiogram. Results: Patients with complex stenting techniques (T stenting, SKS, & Crush) when compared to simple (provisional stenting) showed increased MACE during nine month follow up.Conclusions: The general consensus is that for bifurcation lesions without high risk features, the default approach of one stent PCI with provisional angioplasty plus stent is appropriate. For bifurcation lesions with high risk features, two stent techniques may be safer due to protection and treatment of the SB vessel. When coronary bifurcation lesions are treated with a systematic 2-stent technique results in higher rates of major adverse cardiovascular events on follow up at 9 months.                                                     

Genetic determinants of response and adverse effects following vitamin K antagonist oral anticoagulants

Background: Vitamin K antagonist anticoagulants (warfarin/acenocoumarol) are commonly used anticoagulants that require careful clinical management to balance the risks of over anticoagulation and bleeding with those of under anticoagulation and clotting. Genetic variants of the enzyme that metabolizes vitamin K antagonist anticoagulant, cytochrome P-450 2C9 (CYP2C9), and of a key pharmacologic target of vitamin K antagonists anticoagulant, vitamin K epoxide reductase (VKORC1), contribute to differences in patients' responses to various anticoagulant doses. Methods: In thirty patients on oral vitamin K antagonist anticoagulant therapy, presented with either clotting manifestations (valve thrombosis, pulmonary embolism and DVT) or prolonged INR/bleeding manifestations, we assessed CYP2C9 genotypes, VKORC1 haplotypes, clinical characteristics, response to therapy (as determined by the international normalized ratio [INR]), and bleeding events.Results: Of the thirty patients, thirteen patients INR was high and four patients presented with major bleeding and four with minor bleeding manifestations. Out of thirteen patients with high INR, ten patients showed CYP2C9 polymorphism (*1/*3 and *2/*3) of poor metabolizer genotype. Most of the high INR patients were recently started on oral vitamin K antagonist anticoagulant. Most patients presented with clotting manifestations with below therapeutic INR are noncompliant with anticoagulants.Conclusions: The results of this study suggest that the CYP2C9 polymorphisms are associated with an increased risk of over anticoagulation and of bleeding events among patients on vitamin K antagonists’ anticoagulant setting.  Screening for CYP2C9 variants may allow clinicians to develop dosing protocols and surveillance techniques to reduce the risk of adverse drug reactions in patients receiving vitamin K antagonist anticoagulants. However the cost-effectiveness of genotyping of patients must be considered.                

Sustainable utilization of discarded foundry sand and crushed brick masonry aggregate in the production of lightweight concrete

Nowadays, there is a considerable shortage in the availability of river sand and natural stone aggregate for the construction activities all around the globe and the way out is being worked out by the use of discarded foundry sand and crushed brick masonry aggregate for construction purposes. In the present study, river sand was partly replaced by the discarded foundry sand procured from steel moulding industries and the crushed brick masonry aggregate was used as coarse aggregate for the production of lightweight concrete. The experimental program involved casting of six distinct mixes with 0%, 20%, 40%, 60%, 80% & 100% replacement of fine aggregate by discarded foundry sand. The mechanical and durability properties of the lightweight concrete were assessed for each of the six diverse blends. Even though the 80% and 100% replacement mixes were found to be less dense than the rest of the mix, the blend of 40% replacement acquired desirable mechanical and durability properties when compared to that of all other mixes. The optimum replacement level of the discarded foundry sand by mass to the river sand was 40%. The lightweight concrete produced by utilizing crushed brick masonry aggregate and discarded foundry sand (40% substitution level) can be employed in all major structural lightweight construction aspects and is ideally suited for sloped roof slabs and making architectural or decorative concrete blocks

Investigation of concrete produced using recycled aluminium dross for hot weather concreting conditions

Aluminium dross is a by-product obtained from the aluminium smelting process. Currently, this dross is processed in rotary kilns to recover the residual aluminium, and the resultant salt cake is sent to landfills. The present study investigates the utilization of recycled aluminium dross in producing concrete, which is suitable for hot weather concreting condition. The primary objectives of the experimental study are to examine the feasibility of using concrete blended with recycled aluminium dross under hot weather concreting situations and then to evaluate the strength and durability aspects of the produced concrete. From the experimental results it is observed that the initial setting time of the recycled aluminium dross concrete extended by about 30 minutes at 20% replacement level. This property of recycled aluminium dross concrete renders it to be suitable for hot weather concreting conditions. Based on the results obtained, the replacement of cement with 20% of Al dross yields superior mechanical and durability characteristics

Are non-brain stem-dead cardiac donors acceptable donors?

BACKGROUND: The deleterious effects of brainstem death (BSD) on donor cardiac function and endothelial integrity have been documented previously. Domino cardiac donation (heart of a heart-lung recipient transplanted into another recipient) is a way to avoid the effects of brainstem death and may confer both short- and long-term benefits to allograft recipients. METHODS: This study evaluates short- and long-term outcome in heart recipients of BSD donors (cadaveric) as compared with domino hearts explanted from patients who underwent heart-lung transplantation. RESULTS: Patients having undergone cardiac transplantation between April 1989 and August 2001 at Papworth Hospital were included (n = 571). Domino donor hearts were used in 81 (14%) of these cases. The pre-operative transpulmonary gradient was not significantly different between the two groups (p = 0.7). There was no significant difference in 30-day mortality (4.9% for domino vs 8.6% for BSD, p = 0.38) or in actuarial survival (p = 0.72). Ischemic time was significantly longer in the BSD group (p < 0.001). Acute rejection and infection episodes were not significantly different (p = 0.24 vs: 0.08). Relative to the BSD group, the risk (95% confidence interval) of acute rejection in the domino group was 0.89 (0.73 to 1.08). Similarly, the relative risk of infection was 0.78 (0.59 to 1.03). The 5-year actuarial survival rates (95% confidence interval) were 78% (69% to 87%) and 69% (65% to 73%) in the domino and BSD groups respectively. Angiography data at 2 years were available in 50 (62%) and 254 (52%) patients in the domino and BSD groups, respectively. The rates for 2-year freedom from cardiac allograft vasculopathy (CAV) were 96% (91% to 100%) and 93% (90% to 96%), respectively. CONCLUSION: Despite the lack of endothelial cell activation after brainstem death and a shorter ischemic time, the performance of domino donor hearts was similar to that of BSD donor hearts. This may indicate a similar pathology (i.e., endothelial cell activation) in the domino donors

Visually estimated ejection fraction by two dimensional and triplane echocardiography is closely correlated with quantitative ejection fraction by real-time three dimensional echocardiography

<p>Abstract</p> <p>Background</p> <p>Visual assessment of left ventricular ejection fraction (LVEF) is often used in clinical routine despite general recommendations to use quantitative biplane Simpsons (BPS) measurements. Even thou quantitative methods are well validated and from many reasons preferable, the feasibility of visual assessment (eyeballing) is superior. There is to date only sparse data comparing visual EF assessment in comparison to quantitative methods available. The aim of this study was to compare visual EF assessment by two-dimensional echocardiography (2DE) and triplane echocardiography (TPE) using quantitative real-time three-dimensional echocardiography (RT3DE) as the reference method.</p> <p>Methods</p> <p>Thirty patients were enrolled in the study. Eyeballing EF was assessed using apical 4-and 2 chamber views and TP mode by two experienced readers blinded to all clinical data. The measurements were compared to quantitative RT3DE.</p> <p>Results</p> <p>There were an excellent correlation between eyeballing EF by 2D and TP vs 3DE (r = 0.91 and 0.95 respectively) without any significant bias (-0.5 ± 3.7% and -0.2 ± 2.9% respectively). Intraobserver variability was 3.8% for eyeballing 2DE, 3.2% for eyeballing TP and 2.3% for quantitative 3D-EF. Interobserver variability was 7.5% for eyeballing 2D and 8.4% for eyeballing TP.</p> <p>Conclusion</p> <p>Visual estimation of LVEF both using 2D and TP by an experienced reader correlates well with quantitative EF determined by RT3DE. There is an apparent trend towards a smaller variability using TP in comparison to 2D, this was however not statistically significant.</p

Analyse multidimensionnelle interactive de résultats de simulation (aide à la décision dans le domaine de l'agroécologie)

Dans cette thèse, nous nous sommes intéressés à l'analyse des données de simulation issues du modèle agro-hydrologique TNT. Les objectifs consistaient à élaborer des méthodes d'analyse des résultats de simulation qui replacent l'utilisateur au coeur du processus décisionnel, et qui permettent d'analyser et d'interpréter de gros volumes de données de manière efficace. La démarche développée consiste à utiliser des méthodes d'analyse multidimensionnelle interactive. Tout d'abord, nous avons proposé une méthode d'archivage des résultats de simulation dans une base de données décisionnelle (i.e. entrepôt de données), adaptée au caractère spatio-temporel des données de simulation produites. Ensuite, nous avons suggéré d'analyser ces données de simulations avec des méthodes d'analyse en ligne (OLAP) afin de fournir aux acteurs des informations stratégiques pour améliorer le processus d'aide à la prise de décision. Enfin, nous avons proposé deux méthodes d'extraction de skyline dans le contexte des entrepôts de données afin de permettre aux acteurs de formuler de nouvelles questions en combinant des critères environnementaux contradictoires, et de trouver les solutions compromis associées à leurs attentes, puis d'exploiter les préférences des acteurs pour détecter et faire ressortir les données susceptibles de les intéresser. La première méthode EC2Sky, permet un calcul incrémental et efficace des skyline en présence de préférences utilisateurs dynamiques, et ce malgré de gros volumes de données. La deuxième méthode HSky, étend la recherche des points skyline aux dimensions hiérarchiques. Elle permet aux utilisateurs de naviguer le long des axes des dimensions hiérarchiques (i.e. spécialisation / généralisation) tout en assurant un calcul en ligne des points skyline correspondants. Ces contributions ont été motivées et expérimentées par l'application de gestion des pratiques agricoles pour l'amélioration de la qualité des eaux des bassins versants agricoles, et nous avons proposé un couplage entre le modèle d'entrepôt de données agro-hydrologiques construit et les méthodes d'extraction de skyline proposées.This thesis concerns the analysis of simulation data generated by the agrohydrological model TNT. Our objective is to develop analytical methods for massive simulation results. We want to place the user at the heart of the decision-making process, while letting him handle and analyze large amounts of data in a very efficient way. Our first contribution is an original approach N-Catch, relying on interactive multidimensional analysis methods for archiving simulation results in a decisional database (i.e. data warehouse) adapted to the spatio-temporal nature of the simulation data. In addition, we suggest to analyze the simulation data with online analytical methods (OLAP) to provide strategic information for stakeholders to improve the decision making process. Our second contribution concern two methods for computing skyline queries in the context of data warehouses. These methods enable stakeholders to formulate new questions by combining conflicting environmental criteria, to find compromise solutions associated with their expectations, and to exploit the stakeholder preferences to identify and highlight the data of potential interest. The first method EC2Sky, focuses on how to answer efficiently and progressively skyline queries in the presence of several dynamic user preferences despite of large volume of data. The second method HSky, extends the skyline computation to hierarchical dimensions. It allows the user to navigate along the dimensions hierarchies (i.e. specialize / generalize) while ensuring the online computation of associated skylines. Finally, we present the application of our proposals for managing agricultural practices to improve water quality in agricultural watersheds. We propose a coupling between the agro-hydrological data warehouse model N-Catch and the proposed skyline computation methods.RENNES1-Bibl. électronique (352382106) / SudocSudocFranceF

Development Discourse and Practice: Alternatives and New Directions from Postcolonial Perspectives

Development and aid programs, such as those aimed at promoting economic growth and prosperity in ‘Third World’ nations and transition economies, often arise out of Western and neo-liberal policy ideologies and practices. These programs may, in some cases, provide useful guidelines for restructuring institutional structures and governance mechanisms in nations that have long struggled with poverty, economic instability, health crises, and social and political turmoil. However, a growing number of critical voices are raising concerns over the guiding assumptions and inclusiveness of these policies and programs in their aims to promote economic development and social well-being in non-Western nations. We join these critical perspectives by way of postcolonial frameworks to highlight some of the problematic assumptions and oversights of development programs, while offering new alternatives and directions. By doing so, we contribute to organizational theorizing in a global context, as postcolonial insights provide much needed engagement with international aid policies and programs, as well as development organizations and institutions. To accomplish this, we offer a historical perspective on development, present a critique of the policies and practices guiding many aid programs, and conclude with suggestions emanating from postcoloniality