Search results for: Sneha Ambwani
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 19

Search results for: Sneha Ambwani

19 EEG and ABER Abnormalities in Children with Speech and Language Delay

Authors: Bharati Mehta, Manish Parakh, Bharti Bhandari, Sneha Ambwani

Abstract:

Speech and language delay (SLD) is seen commonly as a co-morbidity in children having severe resistant focal and generalized, syndromic and symptomatic epilepsies. It is however not clear whether epilepsy contributes to or is a mere association in the pathogenesis of SLD. Also, it is acknowledged that Auditory Brainstem Evoked Responses (ABER), besides used for evaluating hearing threshold, also aid in prognostication of neurological disorders and abnormalities in the hearing pathway in the brainstem. There is no circumscribed or surrogate neurophysiologic laboratory marker to adjudge the extent of SLD. The current study was designed to evaluate the abnormalities in Electroencephalography (EEG) and ABER in children with SLD who do not have an overt hearing deficit or autism. 94 children of age group 2-8 years with predominant SLD and without any gross motor developmental delay, head injury, gross hearing disorder, cleft lip/palate and autism were selected. Standard video Electroencephalography using the 10:20 international system and ABER after click stimulus with intensities 110 db until 40 db was performed in all children. EEG was abnormal in 47.9% (n= 45; 36 boys and 9 girls) children. In the children with abnormal EEG, 64.5% (n=29) had an abnormal background, 57.8% (n=27) had presence of generalized interictal epileptiform discharges (IEDs), 20% (n=9) had focal epileptiform discharges exclusively from left side and 33.3% (n=15) had multifocal IEDs occurring both in isolation or associated with generalised abnormalities. In ABER, surprisingly, the peak latencies for waves I, III & V, inter-peak latencies I-III & I-V, III-V and wave amplitude ratio V/I, were found within normal limits in both ears of all the children. Thus in the current study it is certain that presence of generalized IEDs in EEG are seen in higher frequency with SLD and focal IEDs are seen exclusively in left hemisphere in these children. It may be possible that even with generalized EEG abnormalities present in these children, left hemispheric abnormalities as a part of this generalized dysfunction may be responsible for the speech and language dysfunction. The current study also emphasizes that ABER may not be routinely recommended as diagnostic or prognostic tool in children with SLD without frank hearing deficit or autism, thus reducing the burden on electro physiologists, laboratories and saving time and financial resources.

Keywords: ABER, EEG, speech, language delay

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18 A Survey on Various Technique of Modified TORA over MANET

Authors: Shreyansh Adesara, Sneha Pandiya

Abstract:

The mobile ad-hoc network (MANET) is an important and open area research for the examination and determination of the performance evolution. Temporary ordered routing algorithm (TORA) is adaptable and distributed MANET routing algorithm which is totally dependent on internet MANET Encapsulation protocol (IMEP) for the detection of the link and sensing of the link. If IMEP detect the wrong link failure then the network suffer from congestion and unnecessary route maintenance. Thus, the improvement in link detection method of TORA is introduced by various methods on IMEP by different perspective from different person. There are also different reactive routing protocols like AODV, TORA and DSR has been compared for the knowledge of the routing scenario for different parameter and using different model.

Keywords: IMEP, mobile ad-hoc network, protocol, TORA

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17 An Investigation of Sustainability: Scope of Eco Denim Fashion

Authors: Sneha Bhatnagar, Sachin Bhatnagar

Abstract:

Denim presently is the most widely accepted textile product and shows its hold even in future with its growing popularity. Denim today is no longer restricted to only a pair of jeans but has diversified in all different product categories. Although denim is considered as an expression of youth and demonstrates durability and comfort, denim raises issues of sustainability. Through an exploratory research, the researcher aims at addressing the possibilities of denim fashion promoting environmental sustainability by means of creativity, awareness, recycle and artisan appreciation. It also touches on how eco conscious fashion brands involve in development in terms of ideation and modification of denim as a fabric or product into diversified sustainable fashion. In conclusion, it is shown that blue denim fashion continues to evolve and shows eventual transformation in becoming green denim in future, nurturing values of both quality and sustainability.

Keywords: arts, craft, creativity, denim, fashion, recycle, sustainability

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16 Relationship between Stress and Personality in Young Adults

Authors: Sneha Sadana

Abstract:

Human beings are unique and so are their reactions towards varied stimuli. This study focuses on the impact personality has on how one deals with stressful situations. It can be intriguing to know how big of an impact our personality has on the way we react and how it is wired in us to respond to things in a particular manner all because of our personality and the traits which make us who we are. The study was done on 150 college going students, 75 males and 75 females mainly from Ahmedabad, India pursuing a variety of different streams and subjects. The questionnaire consists of two standardized questionnaires which measure stress and personality. The Student Stress Scale by Manju Agarwal evaluates stress of subjects and the big five personality locator by Norman.
The findings showed that there exists a positive relationship between stress and neuroticism and an inverse relationship between stress and sociability, stress and openness, stress and agreeableness and stress and conscientiousness.
And on doing a further comparative analysis on personality types of the same sample it was found out that females were more agreeable, followed by conscientiousness, sociability, openness, and neuroticism. In males, however, it was observed that males were more agreeable, followed by conscientiousness, neuroticism, sociability, and openness

Keywords: college students, personality, stress, theories of personality

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15 Influence of Grain Shape, Size and Grain Boundary Diffusion on High Temperature Oxidation of Metal

Authors: Sneha Samal, Iva Petrikova, Bohdana Marvalova

Abstract:

Influence of grain size, shape and grain boundary diffusion at high temperature oxidation of pure metal is investigated as the function of microstructure evolution in this article. The oxidized scale depends on the geometrical parameter of the metal-scale system and grain shape, size, diffusion through boundary layers and influence of the contamination. The creation of the inner layer and the morphological structure develops from the internal stress generated during the growth of the scale. The oxidation rate depends on the cation and anion mobile transport of the metal in the inward and outward direction of the diffusion layer. Oxidation rate decreases with decreasing the grain size of the pure metal, whereas zinc deviates from this principle. A strong correlation between the surface roughness evolution, grain size, crystalline properties and oxidation mechanism of the oxidized metal was established.

Keywords: high temperature oxidation, pure metals, grain size, shape and grain boundary

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14 Tracing Back the Bot Master

Authors: Sneha Leslie

Abstract:

The current situation in the cyber world is that crimes performed by Botnets are increasing and the masterminds (botmaster) are not detectable easily. The botmaster in the botnet compromises the legitimate host machines in the network and make them bots or zombies to initiate the cyber-attacks. This paper will focus on the live detection of the botmaster in the network by using the strong framework 'metasploit', when distributed denial of service (DDOS) attack is performed by the botnet. The affected victim machine will be continuously monitoring its incoming packets. Once the victim machine gets to know about the excessive count of packets from any IP, that particular IP is noted and details of the noted systems are gathered. Using the vulnerabilities present in the zombie machines (already compromised by botmaster), the victim machine will compromise them. By gaining access to the compromised systems, applications are run remotely. By analyzing the incoming packets of the zombies, the victim comes to know the address of the botmaster. This is an effective and a simple system where no specific features of communication protocol are considered.

Keywords: bonet, DDoS attack, network security, detection system, metasploit framework

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13 Early Detection of Lymphedema in Post-Surgery Oncology Patients

Authors: Sneha Noble, Rahul Krishnan, Uma G., D. K. Vijaykumar

Abstract:

Breast-Cancer related Lymphedema is a major problem that affects many women. Lymphedema is the swelling that generally occurs in the arms or legs caused by the removal of or damage to lymph nodes as a part of cancer treatment. Treating it at the earliest possible stage is the best way to manage the condition and prevent it from leading to pain, recurrent infection, reduced mobility, and impaired function. So, this project aims to focus on the multi-modal approaches to identify the risks of Lymphedema in post-surgical oncology patients and prevent it at the earliest. The Kinect IR Sensor is utilized to capture the images of the body and after image processing techniques, the region of interest is obtained. Then, performing the voxelization method will provide volume measurements in pre-operative and post-operative periods in patients. The formation of a mathematical model will help in the comparison of values. Clinical pathological data of patients will be investigated to assess the factors responsible for the development of lymphedema and its risks.

Keywords: Kinect IR sensor, Lymphedema, voxelization, lymph nodes

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12 Groundwater Level Prediction Using hybrid Particle Swarm Optimization-Long-Short Term Memory Model and Performance Evaluation

Authors: Sneha Thakur, Sanjeev Karmakar

Abstract:

This paper proposed hybrid Particle Swarm Optimization (PSO) – Long-Short Term Memory (LSTM) model for groundwater level prediction. The evaluation of the performance is realized using the parameters: root mean square error (RMSE) and mean absolute error (MAE). Ground water level forecasting will be very effective for planning water harvesting. Proper calculation of water level forecasting can overcome the problem of drought and flood to some extent. The objective of this work is to develop a ground water level forecasting model using deep learning technique integrated with optimization technique PSO by applying 29 years data of Chhattisgarh state, In-dia. It is important to find the precise forecasting in case of ground water level so that various water resource planning and water harvesting can be managed effectively.

Keywords: long short-term memory, particle swarm optimization, prediction, deep learning, groundwater level

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11 Catalytic Decomposition of High Energy Materials Using Nanoparticles of Copper Chromite

Authors: M. Sneha Reddy, M. Arun Kumar, V. Kameswara Rao

Abstract:

Chromites are binary transition metal oxides with a general formula of ACr₂O₄, where A = Mn²⁺, Fe²⁺, Co²⁺, Ni²⁺, and Cu²⁺. Chromites have a normal-type spinel structure with interesting applications in the areas of applied physics, material sciences, and geophysics. They have attracted great consideration because of their unique physicochemical properties and tremendous technological applications in nanodevices, sensor elements, and high-temperature ceramics with useful optical properties. Copper chromite is one of the most efficient spinel oxides, having pronounced commercial application as a catalyst in various chemical reactions like oxidation, hydrogenation, alkylation, dehydrogenation, decomposition of organic compounds, and hydrogen production. Apart from its usage in chemical industries, CuCr₂O₄ finds its major application as a burn rate modifier in solid propellant processing for space launch vehicles globally. Herein we synthesized the nanoparticles of copper chromite using the co-precipitation method. The synthesized nanoparticles were characterized by XRD, TEM, SEM, BET, and TG-DTA. The synthesized nanoparticles of copper chromites were used as a catalyst for the thermal decomposition of various high-energy materials.

Keywords: copper chromite, coprecipitation method, high energy materials, catalytic thermal decomposition

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10 Advancing in Cricket Analytics: Novel Approaches for Pitch and Ball Detection Employing OpenCV and YOLOV8

Authors: Pratham Madnur, Prathamkumar Shetty, Sneha Varur, Gouri Parashetti

Abstract:

In order to overcome conventional obstacles, this research paper investigates novel approaches for cricket pitch and ball detection that make use of cutting-edge technologies. The research integrates OpenCV for pitch inspection and modifies the YOLOv8 model for cricket ball detection in order to overcome the shortcomings of manual pitch assessment and traditional ball detection techniques. To ensure flexibility in a range of pitch environments, the pitch detection method leverages OpenCV’s color space transformation, contour extraction, and accurate color range defining features. Regarding ball detection, the YOLOv8 model emphasizes the preservation of minor object details to improve accuracy and is specifically trained to the unique properties of cricket balls. The methods are more reliable because of the careful preparation of the datasets, which include novel ball and pitch information. These cutting-edge methods not only improve cricket analytics but also set the stage for flexible methods in more general sports technology applications.

Keywords: OpenCV, YOLOv8, cricket, custom dataset, computer vision, sports

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9 Surfactant Free Synthesis of Magnetite/Hydroxyapatite Composites for Hyperthermia Treatment

Authors: M. Sneha, N. Meenakshi Sundaram

Abstract:

In recent times, magnetic hyperthermia is used for cancer treatment as a tool for active targeting of delivering drugs to the targeted site. It has a potential advantage over other heat treatment because there is no systemic buildup in organs and large doses are possible. The aim of this study is to develop a suitable magnetic biomaterial that can destroy the cancer cells as well as induce bone regeneration. In this work, the composite material was synthesized in two-steps. First, porous iron oxide nano needles were synthesized by hydrothermal process. Second, the hydroxyapatite, were synthesized from natural calcium (i.e., egg shell) and inorganic phosphorous source using wet chemical method. The crystalline nature is confirmed by powder X-ray diffraction analysis (XRD). Thermal analysis and the surface area of the material is studied by Thermo Gravimetric Analysis (TGA), Brunauer-Emmett and Teller (BET) technique. Scanning electron microscope (SEM) images show that the particles have nanoneedle-like morphology. The magnetic property is studied by vibrating sample magnetometer (VSM) technique which confirms the superparamagnetic behavior. This paper presents a simple and easy method for synthesis of magnetite/hydroxyapatite composites materials.

Keywords: iron oxide nano needles, hydroxyapatite, superparamagnetic, hyperthermia

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8 Exaptive Urbanism: Evolutionary Biology and the Regeneration of Mumbai’s Dhobighat

Authors: Piyush Bajpai, Sneha Pandey

Abstract:

Mumbai’s Dhobighat, 150 year old largest open laundry in the world, is the true live-work place and only source of income for some of Mumbai’s highest density ‘urban poor’ residents. The regeneration of Dhobighat, due to its ultra prime location and complex socio-political culture has been a complex issue. This once flourishing urban industrial core has been degrading for the past several decades mainly due to the decline of the open laundry business, the site’s over burdened infrastructure and conflicting socio-political and economic forces. The phenomena of ‘exaptation’ or ‘co-option’ has been observed by evolutionary biologists as a process responsible for producing highly tenacious and resilient offsprings within a species. The reddish egret uses its wings to cast shadow in shallow waters to attract small fish and hunt them. An unrelated feature used opportunistically to produce a very favorable result. How can this idea of co-option be applied to resolve the complex issue of Dhobighat’s regeneration? Our paper proposes a new methodology/approach for the regeneration of Dhobighat through the lens of evolutionary biology. Forces and systems (social, political, economic, cultural and ecological) that seem conflicting or unrelated by nature are opportunistically transformed into symbiotic and complimentary relationships that produce an inclusive, resilient and holistic solution for the regeneration of Dhobighat.

Keywords: urban regeneration, exaptation, resilience, Dhobighat, Mumbai

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7 Identification and Characterization of Genes Expressed in Diseased Condition Silkworms (Bombyx mori): A Systematic Investigation

Authors: Siddharth Soni, Gourav Kumar Pandey, Sneha Kumari, Dev Mani Pandey, Koel Mukherjee

Abstract:

The silkworm Bombyx mori is a commercially important insect, but a major roadblock in silk production are silkworm diseases. Flacherie is one of the diseases of the silkworm, that affects the midgut of the 4th and 5th instar larvae and eventually makes them lethargic, stop feeding and finally result in their death. The concerned disease is a result of bacterial and viral infection and in some instances a combination of both. The present study aims to identify and study the expression level of genes in the flacherie condition. For the said work, total RNA was isolated from the infected larvae at their most probable infectious instar and cDNA was synthesized using Reverse Transcriptase PCR (RT-PCR). This cDNA was then used to amplify disease relalted genes whose expression levels were checked using quantitaive PCR (qPCR) using the double delta Ct method. Cry toxin receptors like APN and BtR-175, ROS mediator Dual Oxidase are few proteins whose genes were overexpressed. Interestingly, pattern recognition receptors (PRRs) C-type lectins' genes were found to be downregulated. The results explain about the strong expression of genes that can distinguish the concerned protein in the midgut of diseased silkworm and thereby aiding knowledge in the field of inhibitor designing research.

Keywords: Bombyx mori, flacherie disease, inhibitor designing, up and down regulation

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6 Myosin-Driven Movement of Nanoparticles – An Approach to High-Speed Tracking

Authors: Sneha Kumari, Ravi Krishnan Elangovan

Abstract:

This abstract describes the development of a high-speed tracking method by modification in motor components for nanoparticle attachment. Myosin motors are nano-sized protein machines powering movement that defines life. These miniature molecular devices serve as engines utilizing chemical energy stored in ATP to produce useful mechanical energy in the form of a few nanometre displacement events leading to force generation that is required for cargo transport, cell division, cell locomotion, translated to macroscopic movements like running etc. With the advent of in vitro motility assay (IVMA), detailed functional studies of the actomyosin system could be performed. The major challenge with the currently available IVMA for tracking actin filaments is a resolution limitation of ± 50nm. To overcome this, we are trying to develop Single Molecule IVMA in which nanoparticle (GNP/QD) will be attached along or on the barbed end of actin filaments using CapZ protein and visualization by a compact TIRF module called ‘cTIRF’. The waveguide-based illumination by cTIRF offers a unique separation of excitation and collection optics, enabling imaging by scattering without emission filters. So, this technology is well equipped to perform tracking with high precision in temporal resolution of 2ms with significantly improved SNR by 100-fold as compared to conventional TIRF. Also, the nanoparticles (QD/GNP) attached to actin filament act as a point source of light coffering ease in filament tracking compared to conventional manual tracking. Moreover, the attachment of cargo (QD/GNP) to the thin filament paves the way for various nano-technological applications through their transportation to different predetermined locations on the chip

Keywords: actin, cargo, IVMA, myosin motors and single-molecule system

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5 Adolescent Sleep Hygiene Scale and Adolescent Sleep Wake Scale: Factorial Analysis and Validation for Indian Population

Authors: Sataroopa Mishra, Mona Basker, Sneha Varkki, Ram Kumar Pandian, Grace Rebekah

Abstract:

Background: Sleep deprivation is a matter of public health importance among adolescents. We used adolescent sleep wake scale and adolescent sleep hygiene scale to determine the sleep quality and sleep hygiene respectively of school going adolescents in Vellore city of India. The objective of the study was to do factorial analysis of the scales and validate it for use in local population. Methods: Observational questionnaire based cross sectional study. Setting: Community based school survey in a semi-urban setting in three schools in Vellore city. Data collection: Non probability sample was collected form students studying in standard 9 and 11. Students filled Adolescent Sleep Wake scale (ASWS) and Adolescent Sleep Hygiene Scale (ASHS) translated into vernacular language. Data Analysis: Exploratory Factorial Analysis was used to see the factor loading of various components of the two scales. Confirmatory factorial analysis is subsequently planned for assessing the internal validity of the scales.Results: 557 adolescents were included in the study of 12 – 17 years old. Exploratory factorial analysis of adolescent sleep hygiene scale indicated significant factor loading for 18 items from 28 items originally devised by the authors and has been reconstructed to four domains instead of 9 domains in the original scale namely sleep stability, cognitive – emotional, Physiological - bed time routine - behavioural arousal factor (activites before bedtime and during bed time), Sleep environment (lighting and bed sharing). Factorial analysis of Adolescent sleep wake scale showed factor loading of 18 items out of 28 items in original scale reconstructed into 5 aspects of sleep quality. Conclusions: The factorial analysis gives a reconstructed scale useful for the local population. Further a confirmatory factorial analysis has been subsequently planned to determine the internal consistency of the scale for local population.

Keywords: factorial analysis, sleep hygiene, sleep quality, adolescent sleep scale

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4 Facile Surfactant-Assisted Green Synthesis of Stable Biogenic Gold Nanoparticles with Potential Antibacterial Activity

Authors: Sneha Singh, Abhimanyu Dev, Vinod Nigam

Abstract:

The major issue which decides the impending use of gold nanoparticles (AuNPs) in nanobiotechnological applications is their particle size and stability. Often the AuNPs obtained biomimetically are considered useless owing to their instability in the aqueous medium and thereby limiting the widespread acceptance of this facile green synthesis procedure. So, the use of nontoxic surfactants is warranted to stabilize the biogenic nanoparticles (NPs). But does the surfactant only play a role in stabilizing by being adsorbed to the NPs surface or can it have any other significant contribution in synthesis process and controlling their size as well as shape? Keeping this idea in mind, AuNPs were synthesized by using surfactant treated (lechate) and untreated (cell lysate supernatant) Bacillus licheniformis cell extract. The cell extracts mediated reduction of chloroauric acid (HAuCl 4) in the presence of non-ionic surfactant, Tween 20 (TW20), and its effect on the AuNPs stability was studied. Interestingly, the surfactant used in the study served as potential alternative to harvest cellular enzymes involved in bioreduction process in a hassle free condition. The surfactants ability to solubilize/leach membrane proteins and simultaneously stabilizing the AuNPs could have advantage from process point of view as it will reduce the time and economics involve in the nanofabrication of biogenic NPs. The synthesis was substantiated with UV-Vis spectroscopy, Dynamic light scattering study, FTIR spectroscopy, and Transmission electron microscopy. The Zeta potential of AuNPs solutions was measured routinely to corroborate the stability observations recorded visually. Highly stable, ultra-small AuNPs of 2.6 nm size were obtained from the study. Further, the biological efficacy of the obtained AuNPs as potential antibacterial agent was evaluated against Bacilllus subtilis, Pseudomonas aeruginosa, and Escherichia coli by observing the zone of inhibition. This potential of AuNPs of size < 3 nm as antibacterial agent could pave way for development of new antimicrobials and overcoming the problems of antibiotics resistance

Keywords: antibacterial, bioreduction, nanoparticles, surfactant

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3 Alphabet Recognition Using Pixel Probability Distribution

Authors: Vaidehi Murarka, Sneha Mehta, Dishant Upadhyay

Abstract:

Our project topic is “Alphabet Recognition using pixel probability distribution”. The project uses techniques of Image Processing and Machine Learning in Computer Vision. Alphabet recognition is the mechanical or electronic translation of scanned images of handwritten, typewritten or printed text into machine-encoded text. It is widely used to convert books and documents into electronic files etc. Alphabet Recognition based OCR application is sometimes used in signature recognition which is used in bank and other high security buildings. One of the popular mobile applications includes reading a visiting card and directly storing it to the contacts. OCR's are known to be used in radar systems for reading speeders license plates and lots of other things. The implementation of our project has been done using Visual Studio and Open CV (Open Source Computer Vision). Our algorithm is based on Neural Networks (machine learning). The project was implemented in three modules: (1) Training: This module aims “Database Generation”. Database was generated using two methods: (a) Run-time generation included database generation at compilation time using inbuilt fonts of OpenCV library. Human intervention is not necessary for generating this database. (b) Contour–detection: ‘jpeg’ template containing different fonts of an alphabet is converted to the weighted matrix using specialized functions (contour detection and blob detection) of OpenCV. The main advantage of this type of database generation is that the algorithm becomes self-learning and the final database requires little memory to be stored (119kb precisely). (2) Preprocessing: Input image is pre-processed using image processing concepts such as adaptive thresholding, binarizing, dilating etc. and is made ready for segmentation. “Segmentation” includes extraction of lines, words, and letters from the processed text image. (3) Testing and prediction: The extracted letters are classified and predicted using the neural networks algorithm. The algorithm recognizes an alphabet based on certain mathematical parameters calculated using the database and weight matrix of the segmented image.

Keywords: contour-detection, neural networks, pre-processing, recognition coefficient, runtime-template generation, segmentation, weight matrix

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2 Significance of Architectural Conservation Today, For a Better Tomorrow

Authors: Sneha Manjunath

Abstract:

Architecture is a continuous process of evolution that keeps changing and evolving through time and gives rise to various design solutions based on the purpose of change and the present function of the space. This evolution in design has been happening for a long time and hence a variety of climate-responsive, context-responsive and human-responsive developments in habitats are witnessed. India has been one of the hot spots for the conservation of heritage and architecture. Buildings ranging from Indus-valley civilization to modern contemporary dwellings have all evolved in one or the other way. Various historical sites such as Hampi in Karnataka, Taj Mahal in Agra and various temples in Southern India are identified and preserved under the Archeological Survey of India. The main objective of such preservation is to help in protecting, preserving and keeping it intact for the future. Study of such heritage-rich buildings and building techniques helps us in understanding the psychology, lifestyle and socio-cultural impacts it had on the complete urban fabric that developed in a region. It also gives an insight into the occupation, economic status and religious beliefs that gave rise to a pattern in an urban form that was more inclusive and appropriate as per the need of the users. Today’s generation draws various inspirations from history with respect to space planning, building services such as lighting, ventilation and sanitation systems and elevation treatments. It is important to know and understand the importance of certain urban planning techniques used to develop ancient towns or cities in a radial pattern, square pattern, or checkered pattern depending on the need of the administrative set-up of the respective town or city. It is believed that every element of design undergoes evolution and it is important for a designer to know, respect and develop the same for the future so as to acknowledge and conserve every aspect of heritage that has been a backbone in urban form generation even today. Hampi in the Karnataka state of India is a very good example of how the monuments and dwellings from 14th Century still stand strong. Temples from North India, such as Kedarnath Temple, survived heavy floods because of their building techniques. Such building materials and construction techniques are to be revived and reused for a better perspective towards space planning in urbanized cities.

Keywords: architecture, urban form, heritage, town planning

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1 A Digital Health Approach: Using Electronic Health Records to Evaluate the Cost Benefit of Early Diagnosis of Alpha-1 Antitrypsin Deficiency in the UK

Authors: Sneha Shankar, Orlando Buendia, Will Evans

Abstract:

Alpha-1 antitrypsin deficiency (AATD) is a rare, genetic, and multisystemic condition. Underdiagnosis is common, leading to chronic pulmonary and hepatic complications, increased resource utilization, and additional costs to the healthcare system. Currently, there is limited evidence of the direct medical costs of AATD diagnosis in the UK. This study explores the economic impact of AATD patients during the 3 years before diagnosis and to identify the major cost drivers using primary and secondary care electronic health record (EHR) data. The 3 years before diagnosis time period was chosen based on the ability of our tool to identify patients earlier. The AATD algorithm was created using published disease criteria and applied to 148 known AATD patients’ EHR found in a primary care database of 936,148 patients (413,674 Biobank and 501,188 in a single primary care locality). Among 148 patients, 9 patients were flagged earlier by the tool and, on average, could save 3 (1-6) years per patient. We analysed 101 of the 148 AATD patients’ primary care journey and 20 patients’ Hospital Episode Statistics (HES) data, all of whom had at least 3 years of clinical history in their records before diagnosis. The codes related to laboratory tests, clinical visits, referrals, hospitalization days, day case, and inpatient admissions attributable to AATD were examined in this 3-year period before diagnosis. The average cost per patient was calculated, and the direct medical costs were modelled based on the mean prevalence of 100 AATD patients in a 500,000 population. A deterministic sensitivity analysis (DSA) of 20% was performed to determine the major cost drivers. Cost data was obtained from the NHS National tariff 2020/21, National Schedule of NHS Costs 2018/19, PSSRU 2018/19, and private care tariff. The total direct medical cost of one hundred AATD patients three years before diagnosis in primary and secondary care in the UK was £3,556,489, with an average direct cost per patient of £35,565. A vast majority of this total direct cost (95%) was associated with inpatient admissions (£3,378,229). The DSA determined that the costs associated with tier-2 laboratory tests and inpatient admissions were the greatest contributors to direct costs in primary and secondary care, respectively. This retrospective study shows the role of EHRs in calculating direct medical costs and the potential benefit of new technologies for the early identification of patients with AATD to reduce the economic burden in primary and secondary care in the UK.

Keywords: alpha-1 antitrypsin deficiency, costs, digital health, early diagnosis

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