One of the most import things that humans have developed through evolution is the ability to comm... more One of the most import things that humans have developed through evolution is the ability to communicate through each other by means of language. This is essential for exchanging ideas and expressions. Hearing impaired people uses signs to communicate with others. There is no universal language as every country has its own spoken language so every country has their own dialect of sign language and in India they use Indian Sign Language (ISL).This application will help the person with and without the imparities to communicate with each other. The system consists of two stages. First stage is to capture gestures from real time video. Second stage is to map these gestures into equivalent Indian sign language text output.
TECHNO REVIEW Journal of Technology and Management
In India's current economic situation, women's entrepreneurship is gaining traction. It h... more In India's current economic situation, women's entrepreneurship is gaining traction. It has been hailed as a significant step forward in the country's fight against poverty. In India, there is a list of successful businesses in both the social and monetary spheres. They are doing a fantastic job. The growing presence of women in the business world as entrepreneurs has resulted in a shift in the country's business and monetary development sector qualities. Women-led groups are doing an outstanding job in the public light encouraging others and expanding job opportunities across the country. Regardless, a manageable growth of women business visionaries is required to advance a reasonable development in the country. This study develops a model that addresses the various elements that are essential for the development of women business visionaries in India. What India requires is a well-organized, all-encompassing technique in which the general people and the government ...
Journal of the American Academy of Child & Adolescent Psychiatry, 2017
Conclusions: Findings of this project suggest that the SPARC program was effective in improving a... more Conclusions: Findings of this project suggest that the SPARC program was effective in improving adherence to follow-up treatment and reducing future suicide attempts among high-risk suicidal youth by providing evidence-based care that was widely accepted by patients and families.
International Journal of Contemporary Pediatrics, 2021
The clinical manifestations of newborn infections vary and include subclinical infection, mild to... more The clinical manifestations of newborn infections vary and include subclinical infection, mild to severe manifestations of focal or systemic infection and rarely, congenital syndromes resulting from in utero infection. The timing of exposure, inoculum size, immune status and virulence of the etiologic agent influence the expression of disease. Maternal infection that is the source of transplacental fetal infection is often undiagnosed during pregnancy because the mother was either asymptomatic or had nonspecific signs and symptoms at the time of acute infection.
The goal of structure optimization is to decrease total mass of hydraulic press while assuring ad... more The goal of structure optimization is to decrease total mass of hydraulic press while assuring adequate stiffness. Structural optimization tools and computer simulations have gained the paramount importance in industrial applications as a result of innovative designs, reduced weight and cost effective products. A method of structure optimization for hydraulic press is proposed in order to reduce mass while assuring adequate stiffness. Key geometric parameters of plates which have relatively larger impacts on mass and stiffness are extracted as design variables. In order to research relationship between stiffness, mass and design variables, common batch file is built by CREO and analysis is done in ANSYS. Top plate , movable plate and column design and analysis done.
Journal of the American Academy of Child & Adolescent Psychiatry, 2018
Objectives: This study created a simple 10-item scale based on a clinical interview that can prov... more Objectives: This study created a simple 10-item scale based on a clinical interview that can provide indirect evidence of inflammation and explore its relationship with depression. Methods: Prospective review of Rating Scale for Inflammatory Depression (RSID) was conducted at Children's Medical Center by consultationliaison (CL) service as part of clinical interview over 12 months (December 2016-December 2017). Severity of depression was measured by Quick Inventory of Depressive Symptomatology (QIDS). Cronbach's alpha, exploratory factor analysis (EFA), principal component analysis (PCA), and regression analysis were used to analyze results. Analysis was completed on 74 patients. A Varimax orthogonal rotation was used to aid in interpretability. Results: Sample group was composed of 83 patients, predominantly white (54%) and female (66%), ages 12-17 years (mean age ¼ 15 years). Questions were categorized in 3 groups: 1) assessment of the presence of allergy symptoms or medication for allergy/inflammation; 2) assessment of stress level, obesity, poor sleep, and physical activity; and 3) assessment of the presence of gastrointestinal symptoms, dental problems, and diet. Secondary analysis was performed using linear regression with 3 composite scores based on the factors found in the EFA as independent and QIDS score as dependent variable. PCA (including Kaiser-Meyer-Olkin, eigenvalue, and a Varimox orthogonal rotation) revealed 3 components that had eigenvalues greater than 1, which explained 20.38, 15.34, and 13.85% of the total variance, respectively. The 3-component solution explained 49.58% of the total variance. Statistically significant depression scores were associated with second component (N ¼ 74, t ¼ 2.683, p ¼ 0.009). Regression analysis was conducted as a predictor of depression scores; we found significant relationship between second component (stress, sleep, weight, physical activity) and depression scores. Conclusions: In its preliminary state, the findings of the RSID scale are not reliable (a ¼ 0.56). Reliability is low because our scale looks at different components not relating to each other well. Although these components do not measure one single variable, they are still clinically relevant as they point toward some degree of underlying inflammation. A future goal is to improve the scale by revising questions and possibly adding biological markers of inflammation.
Background: Familial haemophagocytic lymphohistiocytosis (FHL) is a rare autosomal recessive diso... more Background: Familial haemophagocytic lymphohistiocytosis (FHL) is a rare autosomal recessive disorder of immune dysregulation associated with uncontrolled T cell and macrophage activation and hypercytokinaemia. The incidence of FHL is 0$12/100,000 children born per year, with a male to female ratio of 1:1. Mutations of PRF1 gene have been identified in FHL-2 patients, and it is the commonest gene defect causing FHL. Patients with severe perforin deficiency usually present within 1 st year of life and severe clinical manifestations. Material and methods: Medical records of 15 patients (total 108 HLH patients, 65 were primary) of diagnosed perforin deficiency were reviewed and analysed for the age of presentation and diagnosis, clinical features, laboratory findings and course of disease. Results: Our study had 6 females and 9 males with history of consanguinity in 2 patients; 2 patients had a history of sibling death. The mean age of presentation and diagnosis was 2.3 years (range-1 month-16 years). Out of 15, 9 had early presentation within 1 st 6 months of life and had a fatal outcome. There were 5 patients with unusual manifestations in the form of kala azar, low IgA with history of repeated infections, enteric fever, Hodgkins disease and SOJIA. All patients presented with HLH. Commonest manifestation was fever (100%), hepatosplenomegaly (100%), anemia (66%), convulsions (33%) and rash (33%). Laboratory investigations showed anemia (100%), thrombocytopenia (66%), liver function abnormalities (55%) and among HLH markers there was hyperferritinemia (88%), hypertriglyceridemia (75%), hypofibrinogenemia (55%) and hemophagocytes (55%). All 15 patients had abnormal perforin expression on NK cell by flow cytometry, confirmed by genetic mutation in 2 patients and 1 patient in addition had abnormal GRA expression on cell culture. All patients were started on HLH protocol, 9(60%) patients expired during induction, 3 were lost to follow-up, 2 are currently on protocol and 1 is asymptomatic. Conclusion: This study shows that perforin deficiency causing FHLH has an early and severe presentation with high mortality. Screening for perforin and granzyme deficiency should be carried out for all patients with HLH.
1ST INTERNATIONAL CONFERENCE ON ADVANCES IN MECHANICAL ENGINEERING AND NANOTECHNOLOGY (ICAMEN 2019), 2019
With the ever increasing world population and hence the more and more use of vehicles and automob... more With the ever increasing world population and hence the more and more use of vehicles and automobiles, environmental pollution is rapidly increasing and has become one of the major challenges of the century. Also the fossil fuel reserves are limited and these are being rapidly exhausted, thus energy security for the future generations is another key concern. Thus scholars around the world are looking for alternative fuels which could be substituted for these fossil fuels and also do not pollute the environment. The most appropriate solution is the widespread use of the resources that nature provides and which could be replenished. It is imperative that, as soon as possible, we find and exploit these new sources of energy. In this context, biomass will play a crucial role in the transition from fossil to renewable fuels. Biomass is renewable, available in large quantities, and helps to recycle the carbon already released into the atmosphere. Ethanol is the most prominent natural resource, when produced from sugarcane and cane. Added to petrol, ethanol is used as a fuel in a large number of countries, and for this reason is considered one of the most viable options to reduce the excessive reliance on fossil fuels. This study investigates the effects of ethanol-blended gasoline on emissions characteristics of a single-cylinder Spark Ignition (SI) Engine for different compression ratios. The three blends (E5, E10, E15) were prepared in the laboratory. No modifications on the engine and its parts have been made. Moreover, no major problems like knocking were encountered during the engine operation. The emission tests were measured using an exhaust gas analyser and smoke-meter. The experimental results proved that the blending increased brake thermal efficiency more than a sole fuel, such as gasoline. The emission tests found that the CO emissions slightly decreased, while HC increased moderately whereas CO2 and NOx appreciably increased. Experimentation concludes that use of ethanol can effectively help in fossil fuel compensation and can improve the emission characteristics as well.
HERD: Health Environments Research & Design Journal, 2012
Objective:Sound levels, staff perceptions, and patient outcomes were evaluated during a year-long... more Objective:Sound levels, staff perceptions, and patient outcomes were evaluated during a year-long hospital renovation project on the floor above a neonatal intensive care unit (NICU).Background:Construction noise may be detrimental to NICU patients and healthcare professionals. There are no comprehensive studies evaluating the impact of hospital construction on sound levels, staff, and patients.Methods:Prospective observational study comparing sound measures and patient outcomes before, during, and after construction. Staff were surveyed about the construction noise, and hospital employee satisfaction scores are reported.Results:Equivalent sound levels were not significantly higher during construction. Most staff members (89%) perceived the renovation period as louder, and 83% reported interruptions of their work. Patient outcomes were the same or more positive during construction. Very low birth weight (VLBW infants were less likely to require 24+ hours' mechanical ventilation ...
BACKGROUND Antipsychotic drug use in children has doubled from 2001 to 2007 with concomitant incr... more BACKGROUND Antipsychotic drug use in children has doubled from 2001 to 2007 with concomitant increase in obesity. Second-generation antipsychotic (SGA) medication use is associated with weight gain, metabolic derangements, and blood sugar and lipid abnormalities in children. The American Psychiatric Association and the American Diabetes Association have recommended metabolic monitoring guidelines for patients using SGA. STUDY QUESTION The study objective was to investigate and compare metabolic monitoring for SGA medications in psychiatry (PSY), and pediatrics and family medicine [primary care providers (PCP)] outpatient clinics of a university medical center. STUDY DESIGN This is a retrospective study of 149 charts of patients newly prescribed with SGA, ages 5-18 years, from their initial visit in the outpatient clinics. MEASURES AND OUTCOMES Compliance with recommended metabolic monitoring was evaluated for initial and subsequent clinic visits. Parameters included body mass index, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile. RESULTS Of the 149 charts, 110 patients were in PSY and 39 in PCP. The parameter most regularly monitored was body mass index (baseline: PSY 88.3%, PCP 97.4%; 12 weeks: PSY 86.4%, PCP 85.0%; and 24 weeks: PSY 91.8%, PCP 100%). Fasting plasma glucose (baseline: PSY 18.9%, PCP 25.6% and 12 weeks: PSY 8.6%, PCP 10.0%) and fasting lipid profile (baseline: PSY 12.7%, PCP 25.6% and 12 weeks: PSY 7.0%, PCP 10.0%) had low completions rates. No difference was seen in metabolic monitoring by sex or ethnic group. CONCLUSIONS Metabolic monitoring rate of child and adolescent patients on SGAs was low overall. No statistically significant differences were seen between psychiatry and PCP except a significantly higher rate of fasting plasma glucose level monitoring at baseline among PCP. Limitations to the study include the small sample size obtained for the period investigated and insufficient documentation in some electronic charts. Extending the period studied may increase the statistical significance of the data.
inheritance. CGD is characterized by neutrophils and monocytes capable of normal chemotaxis, inge... more inheritance. CGD is characterized by neutrophils and monocytes capable of normal chemotaxis, ingestion and degranulation, but unable to kill catalase-positive microorganisms due to defects in one of the 5 major subunits of NADPH oxidase. Method and material: The medical records of 38 patients diagnosed with CGD were reviewed and analysed with respect to demographic data, age at presentation and diagnosis, clinical features, laboratory investigations, organisms isolated, treatment & prophylaxis given and clinical course. Results: Our study had 28 males and 10 females with 13 having history of consanguinity. Their mean age at presentation and diagnosis was 1.32yr and 2.5yr respectively. The most common manifestations at presentation were failure to thrive (100%) and lymphadenopathy (100%) followed by hepatomegaly (72%) and splenomegaly (48%). The commonest infection was pneumonia (84%) followed by abscesses (55%) involving lungs, liver, subcutaneous tissue; osteomyelitis (15%); urinary tract infections; otitis media and CNS infections. Organisms isolated from blood, stool and pus of infected lesions included bacteria-Mycobacterium tuberculae (50%), Staphylococci (24%), Klebsiella (16%) and fungi-Aspergillus (13%), Candida (26%). Biopsies done in 36% patients from lymph node, skin, lung and liver showed non caseating granulomatous inflammation. Diagnosis was based on reduced nitroblue tetrazolium test (NBT) between 0-5% in all patients and confirmed by dihydrorhodamine (DHR) assay in 84% patients. 18 families were screened. All patients received antibiotics, 80% received AKT, 76% received Antifungals and all received antifungal and antibacterial prophylaxis. 4 patients have succumbed to the illness and 13 patients are lost to follow-up. 7 patients inherited CGD in an X-linked recessive fashion. Genetic mutation analysis has been done in 22 patients. Conclusion: CGD is a not uncommon in India.
inheritance. CGD is characterized by neutrophils and monocytes capable of normal chemotaxis, inge... more inheritance. CGD is characterized by neutrophils and monocytes capable of normal chemotaxis, ingestion and degranulation, but unable to kill catalase-positive microorganisms due to defects in one of the 5 major subunits of NADPH oxidase. Method and material: The medical records of 38 patients diagnosed with CGD were reviewed and analysed with respect to demographic data, age at presentation and diagnosis, clinical features, laboratory investigations, organisms isolated, treatment & prophylaxis given and clinical course. Results: Our study had 28 males and 10 females with 13 having history of consanguinity. Their mean age at presentation and diagnosis was 1.32yr and 2.5yr respectively. The most common manifestations at presentation were failure to thrive (100%) and lymphadenopathy (100%) followed by hepatomegaly (72%) and splenomegaly (48%). The commonest infection was pneumonia (84%) followed by abscesses (55%) involving lungs, liver, subcutaneous tissue; osteomyelitis (15%); urinary tract infections; otitis media and CNS infections. Organisms isolated from blood, stool and pus of infected lesions included bacteria-Mycobacterium tuberculae (50%), Staphylococci (24%), Klebsiella (16%) and fungi-Aspergillus (13%), Candida (26%). Biopsies done in 36% patients from lymph node, skin, lung and liver showed non caseating granulomatous inflammation. Diagnosis was based on reduced nitroblue tetrazolium test (NBT) between 0-5% in all patients and confirmed by dihydrorhodamine (DHR) assay in 84% patients. 18 families were screened. All patients received antibiotics, 80% received AKT, 76% received Antifungals and all received antifungal and antibacterial prophylaxis. 4 patients have succumbed to the illness and 13 patients are lost to follow-up. 7 patients inherited CGD in an X-linked recessive fashion. Genetic mutation analysis has been done in 22 patients. Conclusion: CGD is a not uncommon in India. The commonest mode of presentation was Pneumonia, skin and subcutaneous abscesses, lymphadenitis and osteomyelitis. Mycobacteria, Staphylococcus Aureus, Klebsiella, Aspergillus, Candida, and Gram negative bacilli were the commonest organism isolated in our series. Infection with Aspergillus, Burkholderia Cepacia, Serratia Marcescens, Nocardia should prompt work up for CGD. All children with CGD should be given routine chemoprophylaxis with Septran and Itraconazole. Families should be screened and counselled during future conceptions.
(BENTA) disease characterized by excessive B cell lymphocytosis presenting in early childhood, wi... more (BENTA) disease characterized by excessive B cell lymphocytosis presenting in early childhood, with associated splenomegaly and lymphadenopathy. BENTA disease is genetically defined by germ line-encoded, heterozygous GOF mutations in CARD11. CARD11 is expressed primarily in lymphocytes and functions as a scaffold molecule that bridges engagement of the antigen receptor. Phenotyping reveals accumulation of both immature transitional and mature naïve polyclonal B cells, while T cell fall within normal pediatric ranges. BENTA patients exhibit several hallmarks of primary immunodeficiency with Sino pulmonary and ear infections other "opportunistic" viral infections with insufficient humeral immune responses in response to polysaccharide-based vaccines. Conclusion: BENTA disease represents different spectrum of ALPS disorder with similar presentation but different molecular mechanism and lack of typical feature of autoimmune phenomenon. Also traditional test DNT not useful for a diagnosis of BENTA disease hence to diagnose such a disease precise molecular tests are require if clinical background firmly suggestive of disease.
Journal of the American Academy of Child & Adolescent Psychiatry, 2016
The goals of this session are to determine the impact of the Affordable Care Act (ACA) on the num... more The goals of this session are to determine the impact of the Affordable Care Act (ACA) on the number of children and adolescents presenting to emergency room with mental health problems and to understand the differences in the demographic and clinical characteristics of the patients before and after the implementation of ACA. Methods: A retrospective review was conducted on patients between ages 5 and 18 years who presented to Children's Medical Center of Dallas with mental health problems in 2011 (before the implementation of ACA) and 2014 (after implementation of ACA). Several demographic (age, gender, race, ethnicity, insurance) and clinical (presenting complaint, history of psychiatric treatment) characteristics were compared before and after the implementation of ACA. Statistical analysis was conducted using Chi-square values. Results: Patients (N ¼ 833) were seen in the emergency department in 2011, whereas 1,401 were seen in 2014, an increase of almost 40 percent. Of the patients who presented in 2011, 65 percent had commercial insurance and 29 percent had public insurance compared with 2014 where 49 percent had commercial insurance and 29 percent had public insurance. The proportion of Hispanic patients with public insurance was 29 and 46 percent in 2011 and 2014, respectively (P ¼ 0.00006). Of the Caucasian patients who came in 2011, 68 percent had commercial insurance and 53 percent had public insurance compared with 2014 where 16 percent commercial insurance and 69 percent had public insurance (P < 0.00001). Significant difference has also been observed in the number of patients who had been treated before the emergency department presentation: 36.9 percent in 2011 and 63.1 percent in 2014. Conclusions: The number of patients presenting to the emergency department has significantly increased (almost 40 percent) between 2011 and 2014, suggesting that a higher number of patients sought mental health treatment. After the implementation of ACA, the number of patients with public insurance also went up significantly, which was independent of race and ethnicity. An increase was noted in the number of patients who had a history of previous psychiatric treatment in 2014 compared with 2011. Although the sample size group of this study is relatively small, these findings suggest that the ACA could have been a major factor in the increasing number of patients seeking mental health treatments.
Journal of the American Academy of Child & Adolescent Psychiatry, 2016
Objectives: The goals of this session are as follows: 1) deduce statistics on school violence; 2)... more Objectives: The goals of this session are as follows: 1) deduce statistics on school violence; 2) understand the impact of incorporating violence risk assessment with the help of Structured Assessment for Violence Risk in Youth (SAVRY) among children and adolescents struggling with mental illnesses; and 3) understand the clinical correlation of SAVRY and comparison of rating scores, grades, and clinical findings. Methods: A retrospective chart review of the subsample group of Telemedicine Wellness Intervention Triage and Referral (TWITR) participants, who were screened using SAVRY, was conducted. The comparison of clinical variables (from psychiatric assessments and rating scales) with risk assessment determined by SAVRY was made. Results: Patients (n ¼ 33) identified from the TWITR Project were screened using the SAVRY tool. Of these patients, 45 percent were male, and 55 percent were female. Thirty-nine percent of patients were rated low, 42 percent were rated moderate, and 18 percent were rated high on the SAVRY scale. A significantly higher number of males among the patients rated high compared to those who rated low on SAVRY (63 percent vs. 9 percent, P ¼ 0.008). The average age of the sample group was 14 years in all of the three rating categories of the SAVRY. The most common diagnoses among all three groups were major depression, mood dysregulation, and conduct disorder. Patients who were rated high on SAVRY also had higher average scores in other rating scales such as the Mood and Feelings Questionnaire (25 percent vs. 38 percent), Loneliness Questionnaire (39 percent vs. 53 percent), and Hopelessness Questionnaire (7 percent vs. 9 percent). The difference in the average grades also was seen among the patients who were rated high on SAVRY compared to those who were rated low (76 percent vs. 82 percent). Conclusions: Majority of patients who scored moderate and high on SAVRY had significant mood disturbances and feelings of hopelessness and loneliness. Effective psychopharmacological and psychotherapeutic interventions are available to address these symptoms. This suggests that early detection of these findings can provide them with appropriate mental health treatment and possibly prevent adverse outcomes. Use of SAVRY in routine psychiatric assessment can help identify youths at risk for violence, and it can help them to devise appropriate treatment strategies. However, more research in this area is warranted to obtain more evidence.
(BENTA) disease characterized by excessive B cell lymphocytosis presenting in early childhood, wi... more (BENTA) disease characterized by excessive B cell lymphocytosis presenting in early childhood, with associated splenomegaly and lymphadenopathy. BENTA disease is genetically defined by germ line-encoded, heterozygous GOF mutations in CARD11. CARD11 is expressed primarily in lymphocytes and functions as a scaffold molecule that bridges engagement of the antigen receptor. Phenotyping reveals accumulation of both immature transitional and mature naïve polyclonal B cells, while T cell fall within normal pediatric ranges. BENTA patients exhibit several hallmarks of primary immunodeficiency with Sino pulmonary and ear infections other "opportunistic" viral infections with insufficient humeral immune responses in response to polysaccharide-based vaccines. Conclusion: BENTA disease represents different spectrum of ALPS disorder with similar presentation but different molecular mechanism and lack of typical feature of autoimmune phenomenon. Also traditional test DNT not useful for a diagnosis of BENTA disease hence to diagnose such a disease precise molecular tests are require if clinical background firmly suggestive of disease.
One of the most import things that humans have developed through evolution is the ability to comm... more One of the most import things that humans have developed through evolution is the ability to communicate through each other by means of language. This is essential for exchanging ideas and expressions. Hearing impaired people uses signs to communicate with others. There is no universal language as every country has its own spoken language so every country has their own dialect of sign language and in India they use Indian Sign Language (ISL).This application will help the person with and without the imparities to communicate with each other. The system consists of two stages. First stage is to capture gestures from real time video. Second stage is to map these gestures into equivalent Indian sign language text output.
TECHNO REVIEW Journal of Technology and Management
In India's current economic situation, women's entrepreneurship is gaining traction. It h... more In India's current economic situation, women's entrepreneurship is gaining traction. It has been hailed as a significant step forward in the country's fight against poverty. In India, there is a list of successful businesses in both the social and monetary spheres. They are doing a fantastic job. The growing presence of women in the business world as entrepreneurs has resulted in a shift in the country's business and monetary development sector qualities. Women-led groups are doing an outstanding job in the public light encouraging others and expanding job opportunities across the country. Regardless, a manageable growth of women business visionaries is required to advance a reasonable development in the country. This study develops a model that addresses the various elements that are essential for the development of women business visionaries in India. What India requires is a well-organized, all-encompassing technique in which the general people and the government ...
Journal of the American Academy of Child & Adolescent Psychiatry, 2017
Conclusions: Findings of this project suggest that the SPARC program was effective in improving a... more Conclusions: Findings of this project suggest that the SPARC program was effective in improving adherence to follow-up treatment and reducing future suicide attempts among high-risk suicidal youth by providing evidence-based care that was widely accepted by patients and families.
International Journal of Contemporary Pediatrics, 2021
The clinical manifestations of newborn infections vary and include subclinical infection, mild to... more The clinical manifestations of newborn infections vary and include subclinical infection, mild to severe manifestations of focal or systemic infection and rarely, congenital syndromes resulting from in utero infection. The timing of exposure, inoculum size, immune status and virulence of the etiologic agent influence the expression of disease. Maternal infection that is the source of transplacental fetal infection is often undiagnosed during pregnancy because the mother was either asymptomatic or had nonspecific signs and symptoms at the time of acute infection.
The goal of structure optimization is to decrease total mass of hydraulic press while assuring ad... more The goal of structure optimization is to decrease total mass of hydraulic press while assuring adequate stiffness. Structural optimization tools and computer simulations have gained the paramount importance in industrial applications as a result of innovative designs, reduced weight and cost effective products. A method of structure optimization for hydraulic press is proposed in order to reduce mass while assuring adequate stiffness. Key geometric parameters of plates which have relatively larger impacts on mass and stiffness are extracted as design variables. In order to research relationship between stiffness, mass and design variables, common batch file is built by CREO and analysis is done in ANSYS. Top plate , movable plate and column design and analysis done.
Journal of the American Academy of Child & Adolescent Psychiatry, 2018
Objectives: This study created a simple 10-item scale based on a clinical interview that can prov... more Objectives: This study created a simple 10-item scale based on a clinical interview that can provide indirect evidence of inflammation and explore its relationship with depression. Methods: Prospective review of Rating Scale for Inflammatory Depression (RSID) was conducted at Children's Medical Center by consultationliaison (CL) service as part of clinical interview over 12 months (December 2016-December 2017). Severity of depression was measured by Quick Inventory of Depressive Symptomatology (QIDS). Cronbach's alpha, exploratory factor analysis (EFA), principal component analysis (PCA), and regression analysis were used to analyze results. Analysis was completed on 74 patients. A Varimax orthogonal rotation was used to aid in interpretability. Results: Sample group was composed of 83 patients, predominantly white (54%) and female (66%), ages 12-17 years (mean age ¼ 15 years). Questions were categorized in 3 groups: 1) assessment of the presence of allergy symptoms or medication for allergy/inflammation; 2) assessment of stress level, obesity, poor sleep, and physical activity; and 3) assessment of the presence of gastrointestinal symptoms, dental problems, and diet. Secondary analysis was performed using linear regression with 3 composite scores based on the factors found in the EFA as independent and QIDS score as dependent variable. PCA (including Kaiser-Meyer-Olkin, eigenvalue, and a Varimox orthogonal rotation) revealed 3 components that had eigenvalues greater than 1, which explained 20.38, 15.34, and 13.85% of the total variance, respectively. The 3-component solution explained 49.58% of the total variance. Statistically significant depression scores were associated with second component (N ¼ 74, t ¼ 2.683, p ¼ 0.009). Regression analysis was conducted as a predictor of depression scores; we found significant relationship between second component (stress, sleep, weight, physical activity) and depression scores. Conclusions: In its preliminary state, the findings of the RSID scale are not reliable (a ¼ 0.56). Reliability is low because our scale looks at different components not relating to each other well. Although these components do not measure one single variable, they are still clinically relevant as they point toward some degree of underlying inflammation. A future goal is to improve the scale by revising questions and possibly adding biological markers of inflammation.
Background: Familial haemophagocytic lymphohistiocytosis (FHL) is a rare autosomal recessive diso... more Background: Familial haemophagocytic lymphohistiocytosis (FHL) is a rare autosomal recessive disorder of immune dysregulation associated with uncontrolled T cell and macrophage activation and hypercytokinaemia. The incidence of FHL is 0$12/100,000 children born per year, with a male to female ratio of 1:1. Mutations of PRF1 gene have been identified in FHL-2 patients, and it is the commonest gene defect causing FHL. Patients with severe perforin deficiency usually present within 1 st year of life and severe clinical manifestations. Material and methods: Medical records of 15 patients (total 108 HLH patients, 65 were primary) of diagnosed perforin deficiency were reviewed and analysed for the age of presentation and diagnosis, clinical features, laboratory findings and course of disease. Results: Our study had 6 females and 9 males with history of consanguinity in 2 patients; 2 patients had a history of sibling death. The mean age of presentation and diagnosis was 2.3 years (range-1 month-16 years). Out of 15, 9 had early presentation within 1 st 6 months of life and had a fatal outcome. There were 5 patients with unusual manifestations in the form of kala azar, low IgA with history of repeated infections, enteric fever, Hodgkins disease and SOJIA. All patients presented with HLH. Commonest manifestation was fever (100%), hepatosplenomegaly (100%), anemia (66%), convulsions (33%) and rash (33%). Laboratory investigations showed anemia (100%), thrombocytopenia (66%), liver function abnormalities (55%) and among HLH markers there was hyperferritinemia (88%), hypertriglyceridemia (75%), hypofibrinogenemia (55%) and hemophagocytes (55%). All 15 patients had abnormal perforin expression on NK cell by flow cytometry, confirmed by genetic mutation in 2 patients and 1 patient in addition had abnormal GRA expression on cell culture. All patients were started on HLH protocol, 9(60%) patients expired during induction, 3 were lost to follow-up, 2 are currently on protocol and 1 is asymptomatic. Conclusion: This study shows that perforin deficiency causing FHLH has an early and severe presentation with high mortality. Screening for perforin and granzyme deficiency should be carried out for all patients with HLH.
1ST INTERNATIONAL CONFERENCE ON ADVANCES IN MECHANICAL ENGINEERING AND NANOTECHNOLOGY (ICAMEN 2019), 2019
With the ever increasing world population and hence the more and more use of vehicles and automob... more With the ever increasing world population and hence the more and more use of vehicles and automobiles, environmental pollution is rapidly increasing and has become one of the major challenges of the century. Also the fossil fuel reserves are limited and these are being rapidly exhausted, thus energy security for the future generations is another key concern. Thus scholars around the world are looking for alternative fuels which could be substituted for these fossil fuels and also do not pollute the environment. The most appropriate solution is the widespread use of the resources that nature provides and which could be replenished. It is imperative that, as soon as possible, we find and exploit these new sources of energy. In this context, biomass will play a crucial role in the transition from fossil to renewable fuels. Biomass is renewable, available in large quantities, and helps to recycle the carbon already released into the atmosphere. Ethanol is the most prominent natural resource, when produced from sugarcane and cane. Added to petrol, ethanol is used as a fuel in a large number of countries, and for this reason is considered one of the most viable options to reduce the excessive reliance on fossil fuels. This study investigates the effects of ethanol-blended gasoline on emissions characteristics of a single-cylinder Spark Ignition (SI) Engine for different compression ratios. The three blends (E5, E10, E15) were prepared in the laboratory. No modifications on the engine and its parts have been made. Moreover, no major problems like knocking were encountered during the engine operation. The emission tests were measured using an exhaust gas analyser and smoke-meter. The experimental results proved that the blending increased brake thermal efficiency more than a sole fuel, such as gasoline. The emission tests found that the CO emissions slightly decreased, while HC increased moderately whereas CO2 and NOx appreciably increased. Experimentation concludes that use of ethanol can effectively help in fossil fuel compensation and can improve the emission characteristics as well.
HERD: Health Environments Research & Design Journal, 2012
Objective:Sound levels, staff perceptions, and patient outcomes were evaluated during a year-long... more Objective:Sound levels, staff perceptions, and patient outcomes were evaluated during a year-long hospital renovation project on the floor above a neonatal intensive care unit (NICU).Background:Construction noise may be detrimental to NICU patients and healthcare professionals. There are no comprehensive studies evaluating the impact of hospital construction on sound levels, staff, and patients.Methods:Prospective observational study comparing sound measures and patient outcomes before, during, and after construction. Staff were surveyed about the construction noise, and hospital employee satisfaction scores are reported.Results:Equivalent sound levels were not significantly higher during construction. Most staff members (89%) perceived the renovation period as louder, and 83% reported interruptions of their work. Patient outcomes were the same or more positive during construction. Very low birth weight (VLBW infants were less likely to require 24+ hours' mechanical ventilation ...
BACKGROUND Antipsychotic drug use in children has doubled from 2001 to 2007 with concomitant incr... more BACKGROUND Antipsychotic drug use in children has doubled from 2001 to 2007 with concomitant increase in obesity. Second-generation antipsychotic (SGA) medication use is associated with weight gain, metabolic derangements, and blood sugar and lipid abnormalities in children. The American Psychiatric Association and the American Diabetes Association have recommended metabolic monitoring guidelines for patients using SGA. STUDY QUESTION The study objective was to investigate and compare metabolic monitoring for SGA medications in psychiatry (PSY), and pediatrics and family medicine [primary care providers (PCP)] outpatient clinics of a university medical center. STUDY DESIGN This is a retrospective study of 149 charts of patients newly prescribed with SGA, ages 5-18 years, from their initial visit in the outpatient clinics. MEASURES AND OUTCOMES Compliance with recommended metabolic monitoring was evaluated for initial and subsequent clinic visits. Parameters included body mass index, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile. RESULTS Of the 149 charts, 110 patients were in PSY and 39 in PCP. The parameter most regularly monitored was body mass index (baseline: PSY 88.3%, PCP 97.4%; 12 weeks: PSY 86.4%, PCP 85.0%; and 24 weeks: PSY 91.8%, PCP 100%). Fasting plasma glucose (baseline: PSY 18.9%, PCP 25.6% and 12 weeks: PSY 8.6%, PCP 10.0%) and fasting lipid profile (baseline: PSY 12.7%, PCP 25.6% and 12 weeks: PSY 7.0%, PCP 10.0%) had low completions rates. No difference was seen in metabolic monitoring by sex or ethnic group. CONCLUSIONS Metabolic monitoring rate of child and adolescent patients on SGAs was low overall. No statistically significant differences were seen between psychiatry and PCP except a significantly higher rate of fasting plasma glucose level monitoring at baseline among PCP. Limitations to the study include the small sample size obtained for the period investigated and insufficient documentation in some electronic charts. Extending the period studied may increase the statistical significance of the data.
inheritance. CGD is characterized by neutrophils and monocytes capable of normal chemotaxis, inge... more inheritance. CGD is characterized by neutrophils and monocytes capable of normal chemotaxis, ingestion and degranulation, but unable to kill catalase-positive microorganisms due to defects in one of the 5 major subunits of NADPH oxidase. Method and material: The medical records of 38 patients diagnosed with CGD were reviewed and analysed with respect to demographic data, age at presentation and diagnosis, clinical features, laboratory investigations, organisms isolated, treatment & prophylaxis given and clinical course. Results: Our study had 28 males and 10 females with 13 having history of consanguinity. Their mean age at presentation and diagnosis was 1.32yr and 2.5yr respectively. The most common manifestations at presentation were failure to thrive (100%) and lymphadenopathy (100%) followed by hepatomegaly (72%) and splenomegaly (48%). The commonest infection was pneumonia (84%) followed by abscesses (55%) involving lungs, liver, subcutaneous tissue; osteomyelitis (15%); urinary tract infections; otitis media and CNS infections. Organisms isolated from blood, stool and pus of infected lesions included bacteria-Mycobacterium tuberculae (50%), Staphylococci (24%), Klebsiella (16%) and fungi-Aspergillus (13%), Candida (26%). Biopsies done in 36% patients from lymph node, skin, lung and liver showed non caseating granulomatous inflammation. Diagnosis was based on reduced nitroblue tetrazolium test (NBT) between 0-5% in all patients and confirmed by dihydrorhodamine (DHR) assay in 84% patients. 18 families were screened. All patients received antibiotics, 80% received AKT, 76% received Antifungals and all received antifungal and antibacterial prophylaxis. 4 patients have succumbed to the illness and 13 patients are lost to follow-up. 7 patients inherited CGD in an X-linked recessive fashion. Genetic mutation analysis has been done in 22 patients. Conclusion: CGD is a not uncommon in India.
inheritance. CGD is characterized by neutrophils and monocytes capable of normal chemotaxis, inge... more inheritance. CGD is characterized by neutrophils and monocytes capable of normal chemotaxis, ingestion and degranulation, but unable to kill catalase-positive microorganisms due to defects in one of the 5 major subunits of NADPH oxidase. Method and material: The medical records of 38 patients diagnosed with CGD were reviewed and analysed with respect to demographic data, age at presentation and diagnosis, clinical features, laboratory investigations, organisms isolated, treatment & prophylaxis given and clinical course. Results: Our study had 28 males and 10 females with 13 having history of consanguinity. Their mean age at presentation and diagnosis was 1.32yr and 2.5yr respectively. The most common manifestations at presentation were failure to thrive (100%) and lymphadenopathy (100%) followed by hepatomegaly (72%) and splenomegaly (48%). The commonest infection was pneumonia (84%) followed by abscesses (55%) involving lungs, liver, subcutaneous tissue; osteomyelitis (15%); urinary tract infections; otitis media and CNS infections. Organisms isolated from blood, stool and pus of infected lesions included bacteria-Mycobacterium tuberculae (50%), Staphylococci (24%), Klebsiella (16%) and fungi-Aspergillus (13%), Candida (26%). Biopsies done in 36% patients from lymph node, skin, lung and liver showed non caseating granulomatous inflammation. Diagnosis was based on reduced nitroblue tetrazolium test (NBT) between 0-5% in all patients and confirmed by dihydrorhodamine (DHR) assay in 84% patients. 18 families were screened. All patients received antibiotics, 80% received AKT, 76% received Antifungals and all received antifungal and antibacterial prophylaxis. 4 patients have succumbed to the illness and 13 patients are lost to follow-up. 7 patients inherited CGD in an X-linked recessive fashion. Genetic mutation analysis has been done in 22 patients. Conclusion: CGD is a not uncommon in India. The commonest mode of presentation was Pneumonia, skin and subcutaneous abscesses, lymphadenitis and osteomyelitis. Mycobacteria, Staphylococcus Aureus, Klebsiella, Aspergillus, Candida, and Gram negative bacilli were the commonest organism isolated in our series. Infection with Aspergillus, Burkholderia Cepacia, Serratia Marcescens, Nocardia should prompt work up for CGD. All children with CGD should be given routine chemoprophylaxis with Septran and Itraconazole. Families should be screened and counselled during future conceptions.
(BENTA) disease characterized by excessive B cell lymphocytosis presenting in early childhood, wi... more (BENTA) disease characterized by excessive B cell lymphocytosis presenting in early childhood, with associated splenomegaly and lymphadenopathy. BENTA disease is genetically defined by germ line-encoded, heterozygous GOF mutations in CARD11. CARD11 is expressed primarily in lymphocytes and functions as a scaffold molecule that bridges engagement of the antigen receptor. Phenotyping reveals accumulation of both immature transitional and mature naïve polyclonal B cells, while T cell fall within normal pediatric ranges. BENTA patients exhibit several hallmarks of primary immunodeficiency with Sino pulmonary and ear infections other "opportunistic" viral infections with insufficient humeral immune responses in response to polysaccharide-based vaccines. Conclusion: BENTA disease represents different spectrum of ALPS disorder with similar presentation but different molecular mechanism and lack of typical feature of autoimmune phenomenon. Also traditional test DNT not useful for a diagnosis of BENTA disease hence to diagnose such a disease precise molecular tests are require if clinical background firmly suggestive of disease.
Journal of the American Academy of Child & Adolescent Psychiatry, 2016
The goals of this session are to determine the impact of the Affordable Care Act (ACA) on the num... more The goals of this session are to determine the impact of the Affordable Care Act (ACA) on the number of children and adolescents presenting to emergency room with mental health problems and to understand the differences in the demographic and clinical characteristics of the patients before and after the implementation of ACA. Methods: A retrospective review was conducted on patients between ages 5 and 18 years who presented to Children's Medical Center of Dallas with mental health problems in 2011 (before the implementation of ACA) and 2014 (after implementation of ACA). Several demographic (age, gender, race, ethnicity, insurance) and clinical (presenting complaint, history of psychiatric treatment) characteristics were compared before and after the implementation of ACA. Statistical analysis was conducted using Chi-square values. Results: Patients (N ¼ 833) were seen in the emergency department in 2011, whereas 1,401 were seen in 2014, an increase of almost 40 percent. Of the patients who presented in 2011, 65 percent had commercial insurance and 29 percent had public insurance compared with 2014 where 49 percent had commercial insurance and 29 percent had public insurance. The proportion of Hispanic patients with public insurance was 29 and 46 percent in 2011 and 2014, respectively (P ¼ 0.00006). Of the Caucasian patients who came in 2011, 68 percent had commercial insurance and 53 percent had public insurance compared with 2014 where 16 percent commercial insurance and 69 percent had public insurance (P < 0.00001). Significant difference has also been observed in the number of patients who had been treated before the emergency department presentation: 36.9 percent in 2011 and 63.1 percent in 2014. Conclusions: The number of patients presenting to the emergency department has significantly increased (almost 40 percent) between 2011 and 2014, suggesting that a higher number of patients sought mental health treatment. After the implementation of ACA, the number of patients with public insurance also went up significantly, which was independent of race and ethnicity. An increase was noted in the number of patients who had a history of previous psychiatric treatment in 2014 compared with 2011. Although the sample size group of this study is relatively small, these findings suggest that the ACA could have been a major factor in the increasing number of patients seeking mental health treatments.
Journal of the American Academy of Child & Adolescent Psychiatry, 2016
Objectives: The goals of this session are as follows: 1) deduce statistics on school violence; 2)... more Objectives: The goals of this session are as follows: 1) deduce statistics on school violence; 2) understand the impact of incorporating violence risk assessment with the help of Structured Assessment for Violence Risk in Youth (SAVRY) among children and adolescents struggling with mental illnesses; and 3) understand the clinical correlation of SAVRY and comparison of rating scores, grades, and clinical findings. Methods: A retrospective chart review of the subsample group of Telemedicine Wellness Intervention Triage and Referral (TWITR) participants, who were screened using SAVRY, was conducted. The comparison of clinical variables (from psychiatric assessments and rating scales) with risk assessment determined by SAVRY was made. Results: Patients (n ¼ 33) identified from the TWITR Project were screened using the SAVRY tool. Of these patients, 45 percent were male, and 55 percent were female. Thirty-nine percent of patients were rated low, 42 percent were rated moderate, and 18 percent were rated high on the SAVRY scale. A significantly higher number of males among the patients rated high compared to those who rated low on SAVRY (63 percent vs. 9 percent, P ¼ 0.008). The average age of the sample group was 14 years in all of the three rating categories of the SAVRY. The most common diagnoses among all three groups were major depression, mood dysregulation, and conduct disorder. Patients who were rated high on SAVRY also had higher average scores in other rating scales such as the Mood and Feelings Questionnaire (25 percent vs. 38 percent), Loneliness Questionnaire (39 percent vs. 53 percent), and Hopelessness Questionnaire (7 percent vs. 9 percent). The difference in the average grades also was seen among the patients who were rated high on SAVRY compared to those who were rated low (76 percent vs. 82 percent). Conclusions: Majority of patients who scored moderate and high on SAVRY had significant mood disturbances and feelings of hopelessness and loneliness. Effective psychopharmacological and psychotherapeutic interventions are available to address these symptoms. This suggests that early detection of these findings can provide them with appropriate mental health treatment and possibly prevent adverse outcomes. Use of SAVRY in routine psychiatric assessment can help identify youths at risk for violence, and it can help them to devise appropriate treatment strategies. However, more research in this area is warranted to obtain more evidence.
(BENTA) disease characterized by excessive B cell lymphocytosis presenting in early childhood, wi... more (BENTA) disease characterized by excessive B cell lymphocytosis presenting in early childhood, with associated splenomegaly and lymphadenopathy. BENTA disease is genetically defined by germ line-encoded, heterozygous GOF mutations in CARD11. CARD11 is expressed primarily in lymphocytes and functions as a scaffold molecule that bridges engagement of the antigen receptor. Phenotyping reveals accumulation of both immature transitional and mature naïve polyclonal B cells, while T cell fall within normal pediatric ranges. BENTA patients exhibit several hallmarks of primary immunodeficiency with Sino pulmonary and ear infections other "opportunistic" viral infections with insufficient humeral immune responses in response to polysaccharide-based vaccines. Conclusion: BENTA disease represents different spectrum of ALPS disorder with similar presentation but different molecular mechanism and lack of typical feature of autoimmune phenomenon. Also traditional test DNT not useful for a diagnosis of BENTA disease hence to diagnose such a disease precise molecular tests are require if clinical background firmly suggestive of disease.
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