Low use of statins and other coronary secondary prevention therapies in primary and secondary care in India.

ObjectiveTo determine the frequency of use of pharmacotherapy with aspirin, beta blocker, statin, and angiotensin-converting enzyme (ACE) inhibitor in patients with stable coronary heart disease (CHD) among physicians at different levels of health care in Rajasthan state, India.MethodsPhysicians practicing at tertiary hospitals and clinics at tertiary, secondary and primary levels were contacted. Prescriptions of CHD patients were audited and descriptive statistics reported.ResultsWe evaluated 2,993 prescriptions (tertiary hospital discharge 711, tertiary 688, secondary 1,306, and primary 288). Use of aspirin was in 2,713 (91%) of prescriptions, beta blockers 2,057 (69%), ACE inhibitors or angiotensin receptor blockers (ARBs) 2,471 (82%), and statins 2,059 (69%). Any one of these drugs was prescribed in 2,991 (100%), any two in 2,880 (96%), any three in 1,740 (58%), and all four in 1,062 (35.5%) (P < 0.001). As compared to tertiary hospital, prescriptions at tertiary, secondary, and primary levels were lower: aspirin (96% vs 95%, 91%, 67%), beta blockers (80% vs 62%, 66%, 70%), statins (87% vs 82%, 62%, 21%): two drugs (98% vs 96%, 98%, 85%), three drugs (75% vs 58%, 55%, 28%), or four drugs (54% vs 44%, 28%, 7%) (P < 0.01). Use of ACE inhibitors/ARBs was similar while nitrates (43% vs 23%, 43%, 70%), dihydropyridine calcium channel blockers (12% vs 15%, 30%, 47%), and multivitamins (6% vs 26%, 37%, 47%) use was more in secondary and primary care.ConclusionsThere is suboptimal use of various evidence-based drugs (aspirin, beta blockers, ACE inhibitors, and statins) for secondary prevention of CHD in India

Levels of protein C and soluble thrombomodulin in critically ill patients with acute kidney injury: a multicenter prospective observational study.

Endothelial dysfunction contributes to the development of acute kidney injury (AKI) in animal models of ischemia reperfusion injury and sepsis. There are limited data on markers of endothelial dysfunction in human AKI. We hypothesized that Protein C (PC) and soluble thrombomodulin (sTM) levels could predict AKI. We conducted a multicenter prospective study in 80 patients to assess the relationship of PC and sTM levels to AKI, defined by the AKIN creatinine (AKI Scr) and urine output criteria (AKI UO). We measured marker levels for up to 10 days from intensive care unit admission. We used area under the curve (AUC) and time-dependent multivariable Cox proportional hazard model to predict AKI and logistic regression to predict mortality/non-renal recovery. Protein C and sTM were not different in patients with AKI UO only versus no AKI. On intensive care unit admission, as PC levels are usually lower with AKI Scr, the AUC to predict the absence of AKI was 0.63 (95%CI 0.44-0.78). The AUC using log10 sTM levels to predict AKI was 0.77 (95%CI 0.62-0.89), which predicted AKI Scr better than serum and urine neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C, urine kidney injury molecule-1 and liver-fatty acid-binding protein. In multivariable models, PC and urine NGAL levels independently predicted AKI (p=0.04 and 0.02) and PC levels independently predicted mortality/non-renal recovery (p=0.04). In our study, PC and sTM levels can predict AKI Scr but are not modified during AKI UO alone. PC levels could independently predict mortality/non-renal recovery. Additional larger studies are needed to define the relationship between markers of endothelial dysfunction and AKI

A Study of The Geographical Information System (GIS) based Energy Station Identification and Frequency Analysis Using ETA

The energy corporation entity recently pays maximum attention to the environmental and social safe guards associated with its operations. In developing countries mainly suffers to balance the gap between generation and demand for effective operation by the energy utilities. An inadequate transmission capacity, non-uniform location of energy stations may lead to worst consequences when the occurrences of fault and may end up with black out. To overcome the above situation and to improve the stability of such system, In this research proposes a Geographical Information System (GIS) based identification of location of the uncertainty power stations and also a technique called Islanding Scheme to protect the severely affected system by measuring its frequency parameters. The severely disturbed large interconnected power system is divided into number of subsystems with two or more generating buses feeding its nearby loads by disintegrating the tie lines. The sample 50 bus test case system taken from Tamilnadu Electricity Board (TNEB), INDIA to analyze and simulate the results using Electrical Transient Analyzer Program (ETAP) and Geographical Information System (GIS). In this paper, ETAP and GIS effective software tools used for identify the energy station in various locations and analyzing the frequency status of different buses for better operation in electric utilities and thus ensure better management, enhance the improved stability by mapping the data and outage management

Evidence for HIV-1 cure after CCR5Δ32/Δ32 allogeneic haemopoietic stem-cell transplantation 30 months post analytical treatment interruption: a case report

Background The ‘London Patient’ (IciS-36) underwent allogeneic stem cell transplantation with cells lacking the expression of CCR5 (CCR5Δ32/Δ32) and remission was reported at 18 months. Here we present longer term data including sampling from diverse HIV-1 reservoir sites. Methods Ultra-sensitive plasma, semen and cerebrospinal fluid (CSF) viral load assays were used to detect HIV-1 RNA. In gut biopsies and lymph node tissue cell-copy number, total HIV-1 DNA levels were quantified in multiple replicates using droplet digital PCR (ddPCR) and real time qPCR. Furthermore, presence of intact proviral DNA was analyzed using multiplex ddPCR targeting the packaging signal (psi) and env. Intracellular cytokine staining was used to measure HIV-1 specific T cell responses. Detuned and low avidity antibody assays were used to measure the humoral response to HIV-1. We predicted the probability of rebound using a previously-developed mathematical model and inference approach. Findings HIV-1 viral load in plasma has remained undetectable using an assay with detection limit of 1 copy/ml up to 29 months. The most recent CD4 count was 430 cells per µL (20.3%). There was a very low level positive signal for HIV-1 DNA in peripheral CD4 memory cells. Semen viral load was undetectable in both plasma (LLD 99% probability of cure with 90% donor chimerism. Interpretation The ‘London Patient’ has been in HIV remission for 29 months with no detectable replication-competent virus in blood, CSF, intestinal tissue, or lymphoid tissue. Donor chimerism has been maintained at 99% in peripheral T cells. We conclude that this represents HIV-1 cure

A declining CD4 count and diagnosis of HIV-associated Hodgkin lymphoma: do prior clinical symptoms and laboratory abnormalities aid diagnosis?

BACKGROUND: The incidence of Hodgkin lymphoma (HL) among HIV-infected individuals remains unchanged since the introduction of combination antiretroviral therapy (cART). Recent epidemiological data suggest that CD4 count decline over a year is associated with subsequent diagnosis of HL. In an era of economic austerity monitoring the efficacy of cART by CD4 counts may no longer be required where CD4 count>350 cells/µl and viral load is suppressed (350 may not have delayed diagnosis

DFQIoV: Design of a Dynamic Fan-Shaped-Clustering Model for QoS-aware Routing in IoV Networks

Internet of Vehicles (IoV) is a steadily growing field of research that deals with highly ad-hoc wireless networks. These networks require design of high-speed & high-efficiency routing models, that can be applied to dynamically changing network scenarios. Existing models that perform this task are highly complex and require larger delays for estimation of dynamic routes. While, models that have faster performance, do not consider comprehensive parameters, which limits their applicability when used for large-scale network scenarios. To overcome these limitations, this text proposes design of a novel dynamic fan-shaped clustering model for QoS-aware routing in IoV networks. The model initially collects network information sets including node positions, & energy levels, and combines them with their temporal packet delivery & throughput performance levels. These aggregated information sets are processed via a hybrid bioinspired fan shaped clustering model, that aims at optimization of routing performance via deployment of dynamic clustering process. The model performs destination-aware routing process which assists in reducing communication redundances. This is done via a combination of Elephant Herding Optimization (EHO) with Particle Swarm Optimization (PSO), which integrates continuous learning for router level operations. The integrated model is able to reduce communication delays by 5.9%, while improving energy efficiency by 8.3%, throughput by 4.5%, and packet delivery performance by 1.4% under different network scenarios. Due to which the proposed model is capable of deployment for a wide variety of dynamic network scenarios

ENHANCED REVERSIBLE IMAGE DATA HIDING BASED ON BLOCK HISTOGRAM SHIFTING AND PADHM

Due to the enhanced digital media on the web, information security and privacy protection issue have attracted the eye of information communication. Information hiding has become a subject of sizable im-portance. Currently each day there's very big drawback of information hacking into the networking space. There is variety of techniques offered within the trade to over-come this drawback. So, information hiding within the encrypted image is one in all the solutions, however the matter is that the original cover can't be losslessly recov-ered by this system. That’s why recently; additional and additional attention is paid to reversible information concealing in encrypted pictures however this technique drawback low hardiness. A completely unique technique is planned by reserving for embedding information be-fore encoding of the image takes place with the offered algorithmic rule. Currently the authentic person will hide the information simply on the image to produce authen-tication. The transmission and exchange of image addi-tionally desires a high security .This is the review paper regarding this reversible information hiding algorithms obtainable. As a result, because of histogram enlarge-ment and bar graph shifting embedded message and also the host image may be recovered dead. The embedding rate is enhanced and PSNR magnitude relation using novel technique

Virological outcomes of second-line protease inhibitor-based treatment for human immunodeficiency virus type 1 in a high-prevalence rural South African setting: a competing-risks prospective cohort analysis

Background. Second-line antiretroviral therapy (ART) based on ritonavir-boosted protease inhibitors (bPIs) represents the only available option after first-line failure for the majority of individuals living with human immunodeficiency virus (HIV) worldwide. Maximizing their effectiveness is imperative. Methods. This cohort study was nested within the French National Agency for AIDS and Viral Hepatitis Research (ANRS) 12249 Treatment as Prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa. We prospectively investigated risk factors for virological failure (VF) of bPI-based ART in the combined study arms. VF was defined by a plasma viral load >1000 copies/mL ≥6 months after initiating bPI-based ART. Cumulative incidence of VF was estimated and competing risk regression was used to derive the subdistribution hazard ratio (SHR) of the associations between VF and patient clinical and demographic factors, taking into account death and loss to follow-up. Results. One hundred one participants contributed 178.7 person-years of follow-up. Sixty-five percent were female; the median age was 37.4 years. Second-line ART regimens were based on ritonavir-boosted lopinavir, combined with zidovudine or tenofovir plus lamivudine or emtricitabine. The incidence of VF on second-line ART was 12.9 per 100 person-years (n = 23), and prevalence of VF at censoring was 17.8%. Thirteen of these 23 (56.5%) virologic failures resuppressed after a median of 8.0 months (interquartile range, 2.8-16.8 months) in this setting where viral load monitoring was available. Tuberculosis treatment was associated with VF (SHR, 11.50 [95% confidence interval, 3.92-33.74]; P < .001). Conclusions. Second-line VF was frequent in this setting. Resuppression occurred in more than half of failures, highlighting the value of viral load monitoring of second-line ART. Tuberculosis was associated with VF; therefore, novel approaches to optimize the effectiveness of PI-based ART in high-tuberculosis-burden settings are needed

PGP Implementation with modified 3DE

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An Approach for Solving Multiple Travelling Salesman Problem using Ant Colony Optimization

Ant Colony Optimization (ACO) is a heuristic algorithm which has been proven a successful technique and applied to a number of combinatorial optimization (CO) problems. The traveling salesman problem (TSP) is one of the most important combinatorial problems. Multiple traveling salesman problem (MTSP) is a typical computationally complex combinatorialOptimization problem, which is an extension of the famous traveling salesman problem (TSP). The paper proposed an approach to show how the ant colony optimization (ACO) can be applied to the MTSP with ability constraint. There are several reasons for the choice of the TSP as the problem to explain the working of ACO algorithms: it is an important NP-hard optimization problem that arises in several applications; it is a problem to which ACO algorithms are easily applied; it is easily understandable, so that the algorithm behavior is not obscured by too many technicalities; and it is a standard test bed for new algorithmic ideas as a good performance on the TSP is often taken as a proof of their usefulness. Keywords— Ant colony optimization, Traveling salesman proble