Cardiovascular risk in first degree relatives of patients with premature coronary heart disease

Context: In most parts of the United Kingdom current cardiac services neglect assessment and primary prevention of cardiovascular disease in first degree relatives of patients with proven premature coronary heart disease. First degree relatives are at a higher risk than the general population by virtue of shared lifestyle risk and genetic factors to index cases. Objectives: This study aimed to identify first degree relatives of patients with proven coronary heart disease and assess their cardiovascular risk, using various cardiovascular risk assessment tools. We also aimed to assess the effectiveness of cardiovascular risk reduction services on the cardiovascular risk of the individual. Design, Setting, and Participation: A qualitative study was conducted at Sandwell Hospital. 43 participants aged 18- 74years were recruited. Results: The mean age of the cohort was 42(±4). 66% were under the age of 40years. At the baseline appointment 30% of the cohort, had a systolic blood pressure greater than 140mmHg, mean 140(±14.8) mmHg and 28% had a diastolic blood pressure greater than 90mmHg, mean 94(±2.12) mmHg. 82% of south Asians had a BMI greater than 23 Kg/m2. 63% of non south Asians had a BMI greater than <25 Kg/m2. 37%. 61% of the cohort’s total cholesterol was greater than 5mmol/l, mean 7.1(±1.8) mmol/l. 64% had triglycerides greater than 2.0mmol/l, mean 2.75(±0.49) mmol/l. The high density lipoprotein for males, 11% had a level greater than less than 1.0mmol/l, mean 1.2(±0.2) mmol/l, 4% of females had a level less than 1.2mmol/l, mean 1.4(±1) mmol/l. The cardiovascular tools QRISK, ETHRISK CVD, Framingham CVD identified over 10% of the cohort as high risk at the baseline appointment, and at the review appointment there was no change using QRISK. However, ETHRISK CVD and Framingham CVD demonstrated a risk reduction in the cohort. The tools varied in their selection of high risk, moderate risk and low risk. ETHRISK CHD and Framingham CHD and BNF identified 7% as high risk. Referral to specialist services was initiated with 14% referred for investigations, 21% commenced on medication or was altered. 12% of smokers were referred to a smoking cessation services. 25% referred to weight management service. 32% were referred to Cardiologist or Lipidologist. 19% referred to exercise on prescription. Conclusions: The study identified risk factors in individuals who would not conventionally access the current National Health Service Health Checks programme and should therefore be seen as complementary to NHS Health Checks. 66% were under the age of 40years who accessed the service. This population would not be able to access the systematic Health Checks programme provided by the National Health Service. This study therefore, illustrates the benefits of providing a tailored service for young individual’s potentially high risk and susceptible to premature CVD. This service enabled first degree relatives to choose a healthier lifestyle to reduce their risk of cardiovascular event in the future

Teaching Effectiveness of Secondary School Teachers in Relation to Demographic Factors

This paper has been published in Peer-reviewed International Journal "Remarking An Analisation" P: ISSN NO.: 2394-0344, E: ISSN NO.: 2455-0817 VOL-3* ISSUE-7* (Part-1) October- 2018 http://www.socialresearchfoundation.com/upoadreserchpapers/5/235/230928105053ranjitkaur.pdf Publisher : Social Research Foundation, Kanpur (SRF International

Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study

18% of the world's population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have not been available so far for all major diseases and risk factors. Thus, we aimed to estimate the disease burden and risk factors in every state of India as part of the Global Burden of Disease (GBD) Study 2016

Selective solvomercuration of dienes: Synthesis of olefinic mercuric chlorides, iodides and hydroxides

574-578One pot selective solvomercuration of dienes using mercuric acetate in dry MeOH followed by, in situ, treatment with NaCl or KI or sodium hydroxide or mercurinium intermediate at 0oC afford the olefinic mercuric chlorides, iodides and hydroxides, respectively

A convenient methodology for demercuration of organomercurials by Na/MeOH — Synthesis of ethers

327-328Monoenes and dienes upon treatment with mercuric acetate in dry methanol, followed by demercuration with Na in methanol at 0°C, give ethers in good yields. The coagulation of mercury makes this a simple and convenient work-up process for such reactions

A new greedy search method for the design of digital IIR filter

A new greedy search method is applied in this paper to design the optimal digital infinite impulse response (IIR) filter. The greedy search method is based on binary successive approximation (BSA) and evolutionary search (ES). The suggested greedy search method optimizes the magnitude response and the phase response simultaneously and also finds the lowest order of the filter. The order of the filter is controlled by a control gene whose value is also optimized along with the filter coefficients to obtain optimum order of designed IIR filter. The stability constraints of IIR filter are taken care of during the design procedure. To determine the trade-off relationship between conflicting objectives in the non-inferior domain, the weighting method is exploited. The proposed approach is effectively applied to solve the multiobjective optimization problems of designing the digital low-pass (LP), high-pass (HP), bandpass (BP), and bandstop (BS) filters. It has been demonstrated that this technique not only fulfills all types of filter performance requirements, but also the lowest order of the filter can be found. The computational experiments show that the proposed approach gives better digital IIR filters than the existing evolutionary algorithm (EA) based methods

Real Coded Genetic Algorithm for Design of IIR Digital Filter with Conflicting Objectives

A solution methodology for the design of digital infinite impulse response (IIR) filter considering multiple conflicting objectives has been proposed. The nucleus of the method is that multiple objectives can be attuned suitably, to optimize the performance in pass bands, stop bands and transition bands of IIR digital filters. The proposed method uses multiobjective optimization approach for designing stable IIR filter using real-coded genetic algorithm (RCGA). Digital IIR filters are designed by minimizing magnitude response and phase response simultaneously, using weighted sum approach. The value of weights are searched using RCGA along with filter coefficients thus assigning different weight vector to each individual population thereby finding multiple pareto-optimal solutions in one simulation run. The order of the filter is controlled by a control gene whose value is also optimized along with the filter coefficients to obtain optimum order of designed IIR filter. The computational experiments show that the proposed approach gives better digital IIR filters than the existing genetic algorithm based methods

Real Coded Genetic Algorithm for Design of IIR Digital Filter with Conflicting Objectives

Abstract: A solution methodology for the design of digital infinite impulse response (IIR) filter considering multiple conflicting objectives has been proposed. The nucleus of the method is that multiple objectives can be attuned suitably, to optimize the performance in pass bands, stop bands and transition bands of IIR digital filters. The proposed method uses multiobjective optimization approach for designing stable IIR filter using real-coded genetic algorithm (RCGA). Digital IIR filters are designed by minimizing magnitude response and phase response simultaneously, using weighted sum approach. The value of weights are searched using RCGA along with filter coefficients thus assigning different weight vector to each individual population thereby finding multiple pareto-optimal solutions in one simulation run. The order of the filter is controlled by a control gene whose value is also optimized along with the filter coefficients to obtain optimum order of designed IIR filter. The computational experiments show that the proposed approach gives better digital IIR filters than the existing genetic algorithm based methods

Postoperative outcomes following trabeculectomy and nonpenetrating surgical procedures: a 5-year longitudinal study

Li Jiang, Scott Eaves, Navpreet Dhillon, Punithawathy Ranjit Ophthalmology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK Purpose: To assess and compare the long-term postoperative outcomes of trabeculectomy (TE), phacotrabeculectomy (PTE), and viscocanalostomy (VC) and to correlate postoperative intraocular pressure (IOP) with visual outcome.Patients and methods: This retrospective cohort observational study included 520 eyes which underwent TE with mitomycin C (MMC) (n=205), PTE with MMC (n=189), and VC &plusmn; combined cataract surgery and MMC (n=126) to control IOP between June 2010 and June 2014 by a single surgeon. Complete success was defined as postoperative IOP &lt;20 mmHg, and qualified success with IOP &lt;20 mmHg with single topical agent. Cases requiring more than one topical agent and/or repeat surgery were considered as failure. Mixed linear regression models were constructed to determine estimated predictive values of demographic data, topical prescriptions, baseline and postoperative IOP, and optical assessment (ie, best-corrected visual acuity and mean deviation) profile.Results: Follow-up ranged from 12 to 66 months (mean 26 months). At last follow-up, 139 (93.9%), 118 (91.5%), and 98 (94.2%) eyes achieved complete success in TE, PTE, and VC groups, respectively (p=0.0007). Failure rates were 2.7%, 3.9%, and 2.9% following TE, PTE, and VC, respectively (p=0.0052). The between-group difference of mean IOP reduction was greater in the short term (p=0.0002). Good postoperative IOP control correlates to optical outcomes reflected by best-corrected visual acuity and mean deviation following TE (&beta; = -4.7577, p=0.0384) and PTE (&beta; = -4.5083, p=0.02741).Conclusion: Significant association was observed between good postoperative IOP control and optical outcome. TE remains the more effective surgical intervention for sustained lowering of IOP. Most complications were transient and self-limiting. Keywords: traveculectomy, viscocanalostomy, intraocular pressure, postoperative outcom