Differential Subordinations Involving Generalized Bessel Functions

In this paper our aim is to present some subordination and superordination results, by using an operator, which involves the normalized form of the generalized Bessel functions of first kind. These results are obtained by investigating some appropriate classes of admissible functions. We obtain also some sandwich-type results and we point out various known or new special cases of our main results.Comment: 15 pages, accepted in Bulletin of the Malaysian Mathematical Sciences Societ

Consequences of a medical emergency among emergency room patients

Objective: To study the consequences of a medical emergency among Emergency Room patients, at a teaching hospital in Karachi, Pakistan. Design: A questionnaire-based survey Settings: Emergency Room of Aga Khan University Hospital in Karachi, Pakistan. Main outcome measures: Consequences of a medical emergency in terms of impact on employment, financial position, family life, social life, recreational life, self-confidence and psyche. Results: A hundred patients were surveyed. Emergency Room patients feel that they will not have a major impact on their job or employment, as a result of the medical emergency but it will have adverse financial consequences. The respondents in our study perceive the consequence of the medical emergency to have a variable impact on their family life, social life, recreation life and self-confidence. It is important to note with concern that a major impact on ìPsycheî is expected by the emergency room patients, as a result of a medical emergencyConclusion: We have documented the consequences of a medical emergency among Emergency Room patients, with implications for medical practice and policy makers on healt

Healing during physician-patient consultation

OBJECTIVE: To determine the patient perceptions regarding healing during a physician-patient consultation. DESIGN: A questionnaire-based survey. PLACE AND DURATION OF STUDY: Family Practice Center of the Aga Khan University Hospital, Karachi, Pakistan, in June 2004. PATIENTS AND METHODS: A questionnaire was designed that included the demographic profile of patients comprising age, gender, education and occupation as well as questions in line with the study objective. It was administered to 111 patients, visiting outpatient department of the hospital. Participants were explained the study objective, a written consent was taken and full confidentiality was assured. RESULTS: The mean age of the study population was 27.86 years. Majority of the subjects were males with 68% having graduate or more education. A physician-patient consultation has healing properties for patients and physicians, according to 99 (89%) and 67 (65%) respondents respectively, with 65 (58%) having had experienced healing during the consultation process. The competence of a physician, individual attention given by a physician and a cool and calm attitude of a physician, were reported to increase healing in a physician-patient consultation according to 34 (30%), 32 (29%) and 13 (11%) respondents respectively. The unhelpful physician behavior, incorrect diagnosis and physician\u27s rude and arrogant attitude were reported to decrease healing according to 42 (37%), 15 (14%) and 14 (13%) respondents respectively. CONCLUSION: The study shows that a majority of the patients believe a physician-patient consultation has healing properties on its own, based on healing potential in the consultation process itself. Physicians must try to find ways to improve their ability to act as healers during consultation with patients

Patient expectations from an emergency medical service

BACKGROUND: Patient expectation survey at the Emergency Medical Services can improve patient satisfaction. A need was established to conduct such a survey in order to recommend its use as a quality improvement tool. METHODS: The study was conducted on patients visiting the Emergency Medical Services, Aga Khan University, Karachi. A questionnaire was used to collect information on the demographic profile, and expectations of patients. The ethical requirements for conducting the study were met. RESULTS: A hundred patients were surveyed. The majority was relatively young, married men and women, well educated and better socio-economically placed. The majority of the patients expected a waiting time and a consultation time of less than 30 minutes and 20 minutes, respectively. The majority of respondents expected and agreed to be examined by a trainee but there were reluctant to be examined by the students. There was an expectation that the consultant will examine patients and not advice the attending team over the phone. The majority of the patients expected intravenous fluid therapy. There was a desire to have patient attendant present during the consultation process. The majority of the patients expected to pay less than three thousand rupees for the visit. An expectation exists for investigations and hospitalization. Involvement of patients in decisions concerning their treatment and written feedback on their visit was expected. CONCLUSIONS: We have documented the need and value of patient expectation survey at the Emergency Medical Services department. The use of such a tool is recommended in order to improve the satisfaction levels of patients visiting such facilities

Global transcript and phenotypic analysis of yeast cells expressing Ssa1, Ssa2, Ssa3 or Ssa4 as sole source of cytosolic Hsp70-Ssa chaperone activity.

BACKGROUND: Cytosolic Hsp70 is a ubiquitous molecular chaperone that is involved in responding to a variety of cellular stresses. A major function of Hsp70 is to prevent the aggregation of denatured proteins by binding to exposed hydrophobic regions and preventing the accumulation of amorphous aggregates. To gain further insight into the functional redundancy and specialisation of the highly homologous yeast Hsp70-Ssa family we expressed each of the individual Ssa proteins as the sole source of Hsp70 in the cell and assessed phenotypic differences in prion propagation and stress resistance. Additionally we also analysed the global gene expression patterns in yeast strains expressing individual Ssa proteins, using microarray and RT-qPCR analysis. RESULTS: We confirm and extend previous studies demonstrating that cells expressing different Hsp70-Ssa isoforms vary in their ability to propagate the yeast [PSI+] prion, with Ssa3 being the most proficient. Of the four Ssa family members the heat inducible isoforms are more proficient in acquiring thermotolerance and we show a greater requirement than was previously thought, for cellular processes in addition to the traditional Hsp104 protein disaggregase machinery, in acquiring such thermotolerance. Cells expressing different Hsp70-Ssa isoforms also display differences in phenotypic response to exposure to cell wall damaging and oxidative stress agents, again with the heat inducible isoforms providing better protection than constitutive isoforms. We assessed global transcriptome profiles for cells expressing individual Hsp70-Ssa isoforms as the sole source of cytosolic Hsp70, and identified a significant difference in cellular gene expression between these strains. Differences in gene expression profiles provide a rationale for some phenotypic differences we observed in this study. We also demonstrate a high degree of correlation between microarray data and RT-qPCR analysis for a selection of genes. CONCLUSIONS: The Hsp70-Ssa family provide both redundant and variant-specific functions within the yeast cell. Yeast cells expressing individual members of the Hsp70-Ssa family as the sole source of Ssa protein display differences in global gene expression profiles. These changes in global gene expression may contribute significantly to the phenotypic differences observed between the Hsp70-Ssa family members

Abstract 219: Use of Machine Learning Models to Identify Atherosclerotic Cardiovascular Disease Patients at Very High Risk for Future Events in a Multi-state Health Care System

Background: In the 2018 AHA/ACC Blood Cholesterol Guideline, it is recommended that ASCVD patients be classified as very high-risk (VHR) vs not-VHR (NVHR) to guide treatment decisions. This has important implications for ezetimibe and PCSK9 inhibitor eligibility. We aimed to develop a tool that could assist in more easily identifying VHR patients based on machine learning (ML) techniques. This approach offers a powerful, assumption-free alternative to conventional methods, such as logistic regression, to identify potential interactions among risk factors while incorporating the hierarchy of interaction among variables. Method: We used EHR-derived ICD-10 codes to identify patients within our health system with ASCVD. VHR was defined by ≥2 major ASCVD events (ACS ≤12 months, history of MI \u3e12 months, ischemic stroke, or symptomatic PAD) or 1 major ASCVD event and ≥2 high-risk conditions (age ≥65, diabetes, hypertension, smoking, heterozygous familial hypercholesterolemia, CKD, CHF, persistently elevated LDL-C ≥100 mg/dl, or prior CABG/PCI). Patients not meeting these criteria were classified as NVHR. We randomly assigned patients into a training set and a testing set. Classification and regression tree (CART) modeling was performed on the training set and validated on the testing set. The results were compared with a random forest model. Variables in both models included age, sex, race, ethnicity, and each of the VHR criteria above. The primary outcome for both models was VHR classification. Performance of the two models were compared using area under the curve (AUC). Result: A total of 180,669 ASCVD patients were identified in 2018: 104,123 (58%) were VHR and 76,546 (42%) were NVHR. Mean age and sex were 73.1±11.9 years, 55% male and 70.1±13.4 years, 54% male for the VHR and NVHR groups, respectively. Half the population was randomly selected as the training dataset (n=90,334) and the other half was used as the testing dataset (n=90,335). Both CART and random forest models identified recent ACS, ischemic stroke, hypertension, PAD, and history of MI as the top five predictors of VHR status. Ninety-six percent of patients with recent ACS were classified as VHR. Among patients with no recent ACS, 95% were classified as VHR if they had a stroke and hypertension. Among patients with no ACS or stroke, 89% were classified as VHR if they had PAD. Finally, among patients with no ACS, stroke or PAD, 90% were classified as VHR if they had a history of MI. The misclassification rate of the CART model on the testing set was 4.3%. The AUC for the CART and random forest models was 0.949 and 0.968, respectively. Conclusion: Both ML methods were highly predictive of VHR status among those with ASCVD. Use of this approach affords a simplified means to drive clinical decision making at the point of care

Climate Change and Future Long Term Trends of Rainfall at North-eastern Part of Iraq

Iraq is facing water shortage problem despite the presence of the Tigris and Euphrates Rivers. In this research, long rainfall trends up to the year 2099 were studied in Sulaimani city northeast Iraq to give an idea about future prospects. The medium high (A2) and medium low B2 scenarios have been used for purpose of this study as they are more likely than others scenarios, that beside the fact that no climate modeling canter has performed GCM (global climate model) simulations for more than a few emissions scenarios (HadCM3 has only these two scenarios) otherwise pattern scaling can be used for generating different scenarios which entail a huge uncertainty. The results indicate that the average annual rainfall shows a significant downward trend for both A2 and B2 scenarios. In addition, winter projects increase/decrease in the daily rainfall statistics of wet days, the spring season show very slight drop and no change for both scenarios. However, both summer and autumn shows a significant reduction in maximum rainfall value especially in 2080s while the other statistics remain nearly the same. The extremes events are to decrease slightly in 2080s with highest decrease associated with A2 scenario. This is due to the fact that rainfall under scenario A2 is more significant than under scenario B2. The return period of a certain rainfall will increase in the future when a present storm of 20 year could occur once every 43 year in the 2080s. An increase in the frequency of extreme rainfall depends on several factors such as the return period, season of the year, the period considered as well as the emission scenario used

The Energy Loss of a Heavy Quark Moving in a Viscous Fluid

To study the rate of energy and momentum loss of a heavy quark in QGP, specifically in the hydrodynamic regime, we use fluid/gravity duality and construct a perturbative procedure to find the string solution in gravity side. We show that by this construction the drag force exerted on the quark can be computed perturbatively, order by order in a boundary derivative expansion. At ideal order, our result is just the drag force exerted on a moving quark in thermal plasma with thermodynamics variables promoted to become local functions of space and time. Furthermore, we apply this procedure to a transverse quark in Bjorken flow and compute the first-derivative corrections, namely the viscous corrections, to the drag force.Comment: 33 pages, 6 figures, references added v5: Some correction

On the Beaming of Gluonic Fields at Strong Coupling

We examine the conditions for beaming of the gluonic field sourced by a heavy quark in strongly-coupled conformal field theories, using the AdS/CFT correspondence. Previous works have found that, contrary to naive expectations, it is possible to set up collimated beams of gluonic radiation despite the strong coupling. We show that, on the gravity side of the correspondence, this follows directly (for arbitrary quark motion, and independently of any approximations) from the fact that the string dual to the quark remains unexpectedly close to the AdS boundary whenever the quark moves ultra-relativistically. We also work out the validity conditions for a related approximation scheme that proposed to explain the beaming effect though the formation of shock waves in the bulk fields emitted by the string. We find that these conditions are fulfilled in the case of ultra-relativistic uniform circular motion that motivated the proposal, but unfortunately do not hold for much more general quark trajectories.Comment: 1+33 pages, 2 figure