User Perception of Library Services in Public Libraries in Western Tamilnadu with special reference to Salem District: a Case Study

Public libraries are always called ‘People’s University’ as it provides education to all and to improve Information literacy, empowerment, and cultural heritage. Public libraries facilitate variety of services to the user community. This study has made an attempt to investigate the current trends of user perception in terms of library services and availability of resources in public libraries in western Tamilnadu particularly in District Central Public Library at Salem. This study tired to focus to evaluate regarding the gender and age wise distribution, Marital status and Educational qualifications, Occupation wise distribution, and Membership status, Residence wise distribution, Availability of library resources, Frequency of Library visit, and Time spent in Library, Purpose of visiting the Library, Information search pattern, Level of satisfaction about Journals / Magazines, and Level of satisfaction regarding Internet services, and Opinion about overall library services etc. For data analysis, a total number of 200 well designed questionnaires were selected and distributed to the user community who are coming to Salem district public library. Out of 200 samples, we received only 186 dully filled questionnaires were returned. Further, the data has been worked out with relevant statistical tools such as simple percentage and average and so on

User Perception of Library Services in Public Libraries in Western Tamilnadu with special reference to Salem District: a Case Study

Public libraries are always called ‘People’s University’ as it provides education to all and to improve Information literacy, empowerment, and cultural heritage. Public libraries facilitate a variety of services to the user community. This study has made an attempt to investigate the current trends of user perception in terms of library services and availability of resources in public libraries in western Tamilnadu particularly in District Central Public Library at Salem. This study tried to focus to evaluate regarding the gender and age wise distribution, Marital status and Educational qualifications, Occupation wise distribution, and Membership status, Residence wise distribution, Availability of library resources, Frequency of Library visit, and Time spent in Library, Purpose of visiting the Library, Information search pattern, Level of satisfaction about Journals / Magazines, and Level of satisfaction regarding Internet services, and Opinion about overall library services etc. For data analysis, a total number of 200 well-designed questionnaires were selected and distributed to the user community who are coming to Salem district public library. Out of 200 samples, we received only 186 dully filled questionnaires were returned. Further, the data has been worked out with relevant statistical tools such as simple percentage and average and so on

Inphase Opposed Phase Imaging of Bone Marrow Differentiating Neoplastic Lesions from Non Neo Plastic Lesions.

Magnetic resonance (MR) imaging has become preferred Over other imaging modalities in evaluating disease in the bone marrow. The bone marrow represents 5% of body weight and consists of Hematopoietic components (40% fat, and 40% water, and 20%protein) and lipomatous components (80% fat, 15% water, 5% protein) with a Variable trabecular bone lattice. Bone marrow is a richly vascularised, Dynamic and highly responsive system that is prominently targeted in Many physiologic and pathologic processes. It is a non invasive Technique complements bone marrow aspirations and biopsies by Sampling a large volume of bone marrow and by providing information That aids the diagnosis, staging, and follow-up of hematologic Malignancies. Conventionally, bone marrow is examined by means of bone marrow aspiration biopsy or trephinement of the posterior iliac crest. Both techniques provide a localized view of the state of the marrow and may be subject to sampling errors when used in disorders known to affect the marrow focally. An objective and non invasive method of assessing and characterizing bone marrow would be a useful clinical adjunct to bone marrow aspiration and trephinement. Examination of the bone marrow has traditionally been provided by biopsy or aspiration approaches or by relatively insensitive or Non-specific techniques such as scintigraphy, radiography or computed Tomography. MR, with its multifaceted imaging and quantitative capabilities, has found wide application in the assessment of the Bone Marrow, both on a research and clinical basis. Each of the various mR pulse sequences, ranging from Spin-echo(se), and short ti inversion recovery (stir) to more advanced chemical shift techniques (opposed phase) offers unique opportunities to detect, assess and quantify the many processes affecting the bone marrow. These processes include age-related marrow Conversion and reconversion, hematologic disorders, diffuse and focal Neoplastic processes, storage and marrow packing disorders, ischemic and hyperaemic conditions, traumatic and infectious processes, toxic Exposures, and metabolic bone disorders such as osteoporosis. The Age-related patterns of hemateopoietic tissue regression from the Appendicular skeleton and the progressive conversion of marrow in the Axial skeleton are well documented. Variable reconversion patterns, particularly well defined with Opposed phase sequences have been observed. Non-neoplastic Hematologic conditions, ranging from hemolytic anemia with myeloid Hyperplasia and reconversion to aplastic anemia with myeloid depletion, Have been widely investigated with various MR techniques. Marrowbased Neoplastic processes, both diffuse and focal, have also been Extensively studied with MR. AIM & OBJECTIVES : Neoplastic and non neoplastic lesions in the bone marrow may have similar signal intensity on conventional MR imaging sequences. Purpose of this study is whether inphase opposed phase imaging can helps to differentiate neoplastic and non neoplastic lesions of bone marrow (ii) To assess sensitivity and specificity of inphase opposed phase imaging in Differentiating neoplastic and non neoplastic lesions of bone marrow. CONCLUSION: In-phase/opposed-phase imaging helpful in differentiating Neoplastic lesions from non neoplatic lesions of bone marrow. Furthermore, it may be an early indicator of response to treatment after radiation therapy to the spine .In-phase and opposed phase imaging sequences performed rapidly and just it adds only 4-5 minutes to total imaging time. In phase Opposed phase imaging has ability to demonstrate small amounts fat and fat- water mixture is the strongest advantage of this technique both quantitative and visual interpretation appear equally accurate for assessment of focal marrow abnormalities. either can be used. Thus allowing for rapid interpretation from visual assessment. TB spondylitis (non neoplastic lesion) included in this study shows high relative SIR . signal intensity in TB spondylitis depending on the degree of infiltration of fatty marrow by inflammatory cellular elements. So use of in phase opposed phase imaging in infection should be evaluated more. In-phase/opposed-phase imaging is fast , most sensitive. Easly interpretable and useful sequence, in differentiating Neoplastic lesions from non neoplatic lesions of bone marrow

Outcomes of Adult Patients with Small Body Size Supported with a Continuous-Flow Left Ventricular Assist Device

There is insufficient data on patients with small body size to determine if this should be considered a risk factor for continuous-flow left ventricular assist device (CF-LVAD) support. We sought to evaluate survival outcomes, adverse events, and functional status of CF-LVAD patients with body surface area (BSA) <1.5 m2 in a large national registry. Adults with BSA < 1.5 m2 (n = 128) implanted with a HeartMate II (HMII)-LVAD from the Interagency Registry for Mechanically Assisted Circulatory Support registry from April 2008 to December 2012 formed this cohort. Outcomes were compared with HMII bridge to transplant (BTT) and destination therapy (DT) post approval studies. The majority of patients were female (n = 106, 83%). A total of 64% (n = 82) were implanted for BTT and 36% (n = 46) for DT. The median BSA (range) was 1.44 (1.19–1.49) and 1.45 (1.25–1.49) m2 for BTT and DT, respectively. Overall survival 1 year post implant was 81% ± 5% for BTT and 84% ± 6% for DT. The most common adverse events for BTT and DT patients were bleeding (0.91, 0.88 events/patient year) and driveline infection (16%, 0.28 events/patient year). Six months post implantation, 87% of BTT and 77% of DT patients were New York Heart Association functional class I or II. Post implant survival, functional status improvement, and adverse event profile for adult BTT and DT HMII patients with BSA < 1.5 m2 are favorable and comparable with outcomes published in the overall patient population

The incidence, risk factors, and outcomes associated with late right-sided heart failure in patients supported with an axial-flow left ventricular assist device

BACKGROUND: Early right-sided heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with increased mortality, but little is known about patients who develop late RHF (LRHF). We evaluated the incidence, risk factors, and clinical impact of LRHF in patients supported by axial-flow LVADs. METHODS: Data were analyzed from 537 patients enrolled in the HeartMate II (HM II; Thoratec/St. Jude) destination therapy clinical trial. LRHF was defined as the development of clinical RHF accompanied by the need for inotropic support occurring more than 30 days after discharge from the index LVAD implant hospitalization. Clinical variables, quality of life, rehospitalizations, and survival were compared between patients with and without LRHF. RESULTS: LRHF developed in 41 patients (8%), with a median time to LRHF of 480 days. A higher preoperative blood urea nitrogen and increased central venous pressure-to-pulmonary capillary wedge pressure ratio were independent predictors of LRHF. The Michigan and HMII RHF risk scores were both associated with an increased likelihood of LRHF (p < 0.05). Patients with LRHF had worse quality of life according to the Kansas City Cardiomyopathy Questionnaire (61 ± 26 vs 70 ± 21; p < 0.05), poorer functional capacity by 6-minute walk distance (275 ± 189 m vs 312 ± 216 m; p < 0.05), and more rehospitalizations (6 vs 3; p < 0.001). LRHF was associated with decreased survival (p < 0.001). CONCLUSIONS: LRHF is an important complication in patients with LVADs and is associated with worse quality of life, reduced functional capacity, more frequent hospitalizations, and worse survival compared with those without LRHF

Early intervention for lactate dehydrogenase elevation improves clinical outcomes in patients with the HeartMate II left ventricular assist device: Insights from the PREVENT study

BACKGROUND: Hemolysis, assessed by elevated serum lactate dehydrogenase (LDH), is strongly associated with HeartMate II pump thrombosis (PT). However, it is unknown whether early intervention for elevated LDH circumvents the risk of serious PT requiring pump exchange. We sought to evaluate the relationship between elevated LDH and clinical outcomes, the effectiveness of early medical intervention, and risk factors for elevated LDH. METHODS: We studied 268 patients in the prospective, multicenter PREVENT study who had 2 or more LDH measurements at ≥30 days post-implant. Elevated LDH was defined as LDH ≥2.5× upper limit of normal (ULN) for 2 consecutive measurements. RESULTS: Fourteen percent of patients had elevated LDH. Stroke-free survival at 6 months was lower in patients with elevated LDH vs patients with normal LDH (83 ± 6% vs 93 ± 2%, p = 0.035). Elevated LDH resolved without intervention in 19% of patients, with intensified medical therapy in 43% and required surgical intervention in 38%. For patients receiving only medical therapy, survival was 94 ± 6% at 6 months post-treatment. In this subgroup, resolution of symptoms with intensified medical therapy was sustained in 15 of 16 patients, with PT occurring in 1 patient at 171 days after initial treatment for elevated LDH (202 days post-implant). Early medical intervention at moderately elevated LDH (2.5× to 3.2× ULN), as compared with higher levels (>3.2× ULN), led to more sustained resolution of symptoms without subsequent PT or need for surgical intervention (91% vs 26% at 6 months post-treatment, p = 0.002). CONCLUSIONS: Early medical intervention can successfully resolve moderate LDH elevations (2.5× to 3.2× ULN) with a low incidence of death or PT at 6 months post-treatment

PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management: The PREVENT multi-center study

BACKGROUND: Recommended structured clinical practices including implant technique, anti-coagulation strategy, and pump speed management (PREVENT [PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management] recommendations) were developed to address risk of early (<3 months) pump thrombosis (PT) risk with HeartMate II (HMII; St. Jude Medical, Inc. [Thoratec Corporation], Pleasanton, CA). We prospectively assessed the HMII PT rate in the current era when participating centers adhered to the PREVENT recommendations. METHODS: PREVENT was a prospective, multi-center, single-arm, non-randomized study of 300 patients implanted with HMII at 24 participating sites. Confirmed PT (any suspected PT confirmed visually and/or adjudicated by an independent assessor) was evaluated at 3 months (primary end-point) and at 6 months after implantation. RESULTS: The population included 83% men (age 57 years ± 13), 78% destination therapy, and 83% Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profile 1-3. Primary end-point analysis showed a confirmed PT of 2.9% at 3 months and 4.8% at 6 months. Adherence to key recommendations included 78% to surgical recommendations, 95% to heparin bridging, and 79% to pump speeds ≥9,000 RPMs (92% >8,600 RPMs). Full adherence to implant techniques, heparin bridging, and pump speeds ≥9,000 RPMs resulted in a significantly lower risk of PT (1.9% vs 8.9%; p < 0.01) and lower composite risk of suspected thrombosis, hemolysis, and ischemic stroke (5.7% vs 17.7%; p < 0.01) at 6 months. CONCLUSIONS: Adoption of all components of a structured surgical implant technique and clinical management strategy (PREVENT recommendations) is associated with low rates of confirmed PT

User Perception of Library Services in Public Libraries in Western Tamilnadu with special reference to Salem District: a Case Study

Public libraries are always called ‘People’s University’ as it provides education to all and to improve Information literacy, empowerment, and cultural heritage. Public libraries facilitate a variety of services to the user community. This study has made an attempt to investigate the current trends of user perception in terms of library services and availability of resources in public libraries in western Tamilnadu particularly in District Central Public Library at Salem. This study tried to focus to evaluate regarding the gender and age wise distribution, Marital status and Educational qualifications, Occupation wise distribution, and Membership status, Residence wise distribution, Availability of library resources, Frequency of Library visit, and Time spent in Library, Purpose of visiting the Library, Information search pattern, Level of satisfaction about Journals / Magazines, and Level of satisfaction regarding Internet services, and Opinion about overall library services etc. For data analysis, a total number of 200 well-designed questionnaires were selected and distributed to the user community who are coming to Salem district public library. Out of 200 samples, we received only 186 dully filled questionnaires were returned. Further, the data has been worked out with relevant statistical tools such as simple percentage and average and so on

User Perception of Library Services in Public Libraries in Western Tamilnadu with special reference to Salem District: a Case Study

Public libraries are always called ‘People’s University’ as it provides education to all and to improve Information literacy, empowerment, and cultural heritage. Public libraries facilitate variety of services to the user community. This study has made an attempt to investigate the current trends of user perception in terms of library services and availability of resources in public libraries in western Tamilnadu particularly in District Central Public Library at Salem. This study tired to focus to evaluate regarding the gender and age wise distribution, Marital status and Educational qualifications, Occupation wise distribution, and Membership status, Residence wise distribution, Availability of library resources, Frequency of Library visit, and Time spent in Library, Purpose of visiting the Library, Information search pattern, Level of satisfaction about Journals / Magazines, and Level of satisfaction regarding Internet services, and Opinion about overall library services etc. For data analysis, a total number of 200 well designed questionnaires were selected and distributed to the user community who are coming to Salem district public library. Out of 200 samples, we received only 186 dully filled questionnaires were returned. Further, the data has been worked out with relevant statistical tools such as simple percentage and average and so on