Detection of Sleep Disordered Breathing in Patients Hospitalized with Congestive Heart Failure

OBJECTIVES: The purpose of this study was to evaluate the plethysmographic signal-derived oxygen desaturation index (ODI) as an inpatient screening strategy to identify sleep-disordered breathing (SDB) in patients with congestive heart failure (CHF). BACKGROUND: SDB is highly prevalent among patients hospitalized with CHF but is widely underdiagnosed. We evaluated overnight photoplethysmography as a possible screening strategy for hospitalized patients with CHF. METHODS: Consecutively admitted heart failure patients with high clinical suspicion of SDB and ODI ≥5 were offered outpatient polysomnography (PSG), which was completed within 4 weeks of discharge. PSG was considered positive if the apnea hypoxia index (AHI) was ≥5. A Bland-Altman plot was used to assess agreement between ODI and AHI. Receiver-operator characteristics were determined for ODI ≥5 and AHI ≥5. RESULTS: A screening questionnaire identified 246 of 282 consecutive patients with positive symptoms for SDB. Of these patients, 105 patients were offered further evaluation and 86 had ODI ≥5 (mean ODI 17 ± 17). Among these 86 patients, 68 underwent outpatient PSG within 4 weeks of discharge. PSG showed that 64 (94%) had SDB, with a mean AHI of 28. Inpatient ODI correlated well with PSG-derived AHI. The area under the curve was 0.82 for AHI ≥5. The Bland-Altman plot revealed no major bias. Matthew\u27s correlation coefficient revealed that the optimal cut-off for ODI is 5. CONCLUSIONS: Screening hospitalized patients with heart failure using targeted inpatient ODI identifies a cohort of patients with a high prevalence of SDB. Our screening strategy provides a potentially cost-effective method for early detection and treatment of SDB

Experimental research to Optimize Process Parameters in Machining of Non Conducting Material with hybrid non conconventional machining

Among all non conventional micro machining, electrochemical discharge machining ECDM is having high quality of material removal rate with zero residual stress. This machining has been accepted as a highly modern technology in micromachining. In this paper an effort has been done on micro drilling of glass using electrochemical discharge machining ECDM . A fixed tool and a step down transformer have been used to support the steady machining to increase the accuracy of work piece. The input parameters used in this experiment are voltage, concentration of electrolyte, enter electrode gap and ratio of area of electrode. MRR has been investigated over the input parameters. Feed rate and electrolyte temperature has been made constant of 3µm sec and 30°c respectively. Taguchi method is used to optimize the effect of the process parameters on MRR. The signal to noise S N ratio and the ANOVA analysis are employed to find the contributions of input parameters. Vikrant Sharma | Sunil Kumar "Experimental research to Optimize Process Parameters in Machining of Non Conducting Material with hybrid non conconventional machining" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-1 | Issue-4 , June 201

Herd Behavior in Financial Markets

This paper provides an overview of the recent theoretical and empirical research on herd behavior in financial markets. It looks at what precisely is meant by herding, the causes of herd behavior, the success of existing studies in identifying the phenomenon, and the effect that herding has on financial markets. Copyright 2001, International Monetary Fund

Reading the acts and lives of performers in Mughal Persian texts

Examining materials from early modern and contemporary North India and Pakistan, Tellings and Texts brings together seventeen first-rate papers on the relations between written and oral texts, their performance, and the musical traditions these performances have entailed. The contributions from some of the best scholars in the field cover a wide range of literary genres and social and cultural contexts across the region. The texts and practices are contextualized in relation to the broader social and political background in which they emerged, showing how religious affiliations, caste dynamics and political concerns played a role in shaping social identities as well as aesthetic sensibilities. By doing so this book sheds light into theoretical issues of more general significance, such as textual versus oral norms; the features of oral performance and improvisation; the role of the text in performance; the aesthetics and social dimension of performance; the significance of space in performance history and important considerations on repertoires of story-telling

Role of ‘corporate persistence’ and ‘environmental support’ in building breakthrough capability: Empirical investigation of Samsung’s initiatives in memory and microwave oven business

It is now an incontrovertible fact that capabilities are the source of competitive advantage. However, the process through which firms build capabilities over a period of time is only partially understood. Concepts like learning, resource combination, and co-evolution can be categorized as enablers as they support capability formation. On the other hand, concepts like inertia and path dependence can be categorized as restrictors as they constrain the process of capability formation. Combined together, while these concepts hint in the right direction, there is a need to have concepts that explain the process of capability formation holistically. An endeavour towards this objective would require taking into account the role of internal and external events. This paper builds concepts of ‘corporate persistence’ and ‘environmental support’ to explain their role in building breakthrough capability by examining major events in the evolution of two mega high technology business belonging to the Samsung group.