Search results for: Tiruvengala Padma
20 Deep Excavations with Embedded Retaining Walls - Diaphragm Walls
Authors: Sowmiyaa V. S., Tiruvengala Padma, Dhanasekaran B.
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Due to urbanization, traffic congestion, air pollution and fuel consumption underground metros are constructed in urban cities nowadays. These metros reduce the commutation time and makes the daily transportation in urban cities hassle free. To construct the underground metros deep excavations are to be carried out. These excavations should be supported by an appropriate earth retaining structures to provide stability and to prevent deformation failures. The failure of deep excavations is catastrophic and hence appropriate caution need to be carried out during design and construction stages. This paper covers the construction aspects, equipment, quality control, design aspects of one of the earth retaining systems the Diaphragm Walls.Keywords: underground metros, diaphragm wall, quality control of diaphragm wall, design aspects of diaphragm wall
Procedia PDF Downloads 10019 Monitoring the Change of Padma River Bank at Faridpur, Bangladesh Using Remote Sensing Approach
Authors: Ilme Faridatul, Bo Wu
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Bangladesh is often called as a motherland of rivers. It contains about 700 rivers among all these the Padma River is one of the largest rivers of Bangladesh. The change of river bank and erosion has become a common environmental natural hazard in Bangladesh. The river banks are under intense pressure from natural processes such as erosion and accretion as well as anthropogenic processes such as urban growth and pollution. The Padma River is flowing along ten districts of Bangladesh among all these Faridpur district is most vulnerable to river bank erosion. The severity of the river erosion is so high that each year a thousand of populations become homeless and lose their agricultural lands. Though the Faridpur district is most vulnerable to river bank erosion no specific research has been conducted to identify the changing pattern of river bank along this district. The outcome of the research may serve as guidance to prepare river bank monitoring program and management. This research has utilized integrated techniques of remote sensing and geographic information system to monitor the changes from 1995 to 2015 at Faridpur district. To discriminate the land water interface Modified Normalized Difference Water Index (MNDWI) algorithm is applied and on screen digitization approach is used over MNDWI images of 1995, 2002 and 2015 for river bank line extraction. The extent of changes in the river bank along Faridpur district is estimated through overlaying the digitized maps of all three years. The river bank lines are highlighted to infer the erosion and accretion and the changes are calculated. The result shows that the middle of the river is gaining land through sedimentation and the both side river bank is shifting causing severe erosion that consequently resulting the loss of farmland and homestead. Over the study period from 1995 to 2015 it witnessed huge erosion and accretion that played an active role in the changes of the river bank.Keywords: river bank, erosion and accretion, change monitoring, remote sensing
Procedia PDF Downloads 32518 On the Analysis of Pseudorandom Partial Quotient Sequences Generated from Continued Fractions
Authors: T. Padma, Jayashree S. Pillai
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Random entities are an essential component in any cryptographic application. The suitability of a number theory based novel pseudorandom sequence called Pseudorandom Partial Quotient Sequence (PPQS) generated from the continued fraction expansion of irrational numbers, in cryptographic applications, is analyzed in this paper. An approach to build the algorithm around a hard mathematical problem has been considered. The PQ sequence is tested for randomness and its suitability as a cryptographic key by performing randomness analysis, key sensitivity and key space analysis, precision analysis and evaluating the correlation properties is established.Keywords: pseudorandom sequences, key sensitivity, correlation, security analysis, randomness analysis, sensitivity analysis
Procedia PDF Downloads 59017 Morpheme Based Parts of Speech Tagger for Kannada Language
Authors: M. C. Padma, R. J. Prathibha
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Parts of speech tagging is the process of assigning appropriate parts of speech tags to the words in a given text. The critical or crucial information needed for tagging a word come from its internal structure rather from its neighboring words. The internal structure of a word comprises of its morphological features and grammatical information. This paper presents a morpheme based parts of speech tagger for Kannada language. This proposed work uses hierarchical tag set for assigning tags. The system is tested on some Kannada words taken from EMILLE corpus. Experimental result shows that the performance of the proposed system is above 90%.Keywords: hierarchical tag set, morphological analyzer, natural language processing, paradigms, parts of speech
Procedia PDF Downloads 29616 Analysis and Design of Single Switch Mosfet Dimmer for AC Driven Lamp
Authors: S.Pandeeswari, Raju Padma
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In this paper a new solution to implement and control single-stage electronic ballast based on the integration of a buck-boost power factor correction stage and a half bridge resonant inverter is presented. The control signals are obtained using the inverter resonant current by means of a saturable transformer. Core saturation is used to control the required dead time between the control pulses on both switches. The turn-on time of one of the inverter switches is controlled to provide proper cathode preheating during the lamp ignition process. No special integrated circuits are required to control the ballast and the total number of components is minimized. Analysis and basic design of phase cut dimmer.Keywords: MOSFET dimmer, PIC 16F877A, voltage regulator, bridge rectifier
Procedia PDF Downloads 37915 Design and Development of Automatic Onion Harvester
Authors: P. Revathi, T. Mrunalini, K. Padma Priya, P. Ramya, R. Saranya
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During the tough times of covid, those people who were hospitalized found it difficult to always convey what they wanted to or needed to the attendee. Sometimes the attendees might also not be there. In that case, the patients can use simple hand gestures to control electrical appliances (like its set it for a zero watts bulb)and three other gestures for voice note intimation. In this AI-based hand recognition project, NodeMCU is used for the control action of the relay, and it is connected to the firebase for storing the value in the cloud and is interfaced with the python code via raspberry pi. For three hand gestures, a voice clip is added for intimation to the attendee. This is done with the help of Google’s text to speech and the inbuilt audio file option in the raspberry pi 4. All the 5 gestures will be detected when shown with their hands via a webcam which is placed for gesture detection. A personal computer is used for displaying the gestures and for running the code in the raspberry pi imager.Keywords: onion harvesting, automatic pluging, camera, raspberry pi
Procedia PDF Downloads 19814 Detection of Adulterants in Milk Using IoT
Authors: Shaik Mohammad Samiullah Shariff, Siva Sreenath, Sai Haripriya, Prathyusha, M. Padma Lalitha
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The Internet of Things (IoT) is the emerging technology that has been utilized to extend the possibilities for smart dairy farming (SDF). Milk consumption is continually increasing due to the world's growing population. As a result, some providers are prone to using dishonest measures to close the supply-demand imbalance, such as adding adulterants to milk. To identify the presence of adulterants in milk, traditional testing methods necessitate the use of particular chemicals and equipment. While efficient, this method has the disadvantage of yielding difficult and time-consuming qualitative results. Furthermore, same milk sample cannot be tested for other adulterants later. As a result, this study proposes an IoT-based approach for identifying adulterants in milk by measuring electrical conductivity (EC) or Total Dissolved Solids (TDS) and PH. In order to achieve this, an Arduino UNO microcontroller is used to assess the contaminants. When there is no adulteration, the pH and TDS values of milk range from 6.45 to 6.67 and 750 to 780ppm, respectively, according to this study. Finally, the data is uploaded to the cloud via an IoT device attached to the Ubidot web platform.Keywords: internet of things (IoT), pH sensor, TDS sensor, EC sensor, industry 4.0
Procedia PDF Downloads 7813 Investigation of Roll-Off Factor in Pulse Shaping Filter on Maximal Ratio Combining for CDMA 2000 System
Authors: G. S. Walia, H. P. Singh, D. Padma
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The integration of wide variety of communication services is made possible with invention of 3G technology. Code Division Multiple Access 2000 operates on various RF channel bandwidths 1.2288 or 3.6864 Mcps (1x or 3x systems). It is a 3G system which offers high bandwidth and wireless broadband services but its efficiency is lowered due to various factors like fading, interference, scattering, absorption etc. This paper investigates the effect of diversity (MRC), roll off factor in Root Raised Cosine (RRC) filter for the BPSK and QPSK modulation schemes. It is possible to transmit data with minimum Inter symbol Interference and within limited bandwidth with proper pulse shaping technique. Bit error rate (BER) performance is analyzed by applying diversity technique by varying the roll off factor for BPSK and QPSK. Roll off factor reduces the ISI and diversity reduces the Fading.Keywords: CDMA2000, root raised cosine, roll-off factor, ISI, diversity, interference, fading
Procedia PDF Downloads 40712 Microbial Fuel Cells in Waste Water Treatment and Electricity Generation
Authors: Rajalaxmi N., Padma Bhat, Pooja Garag, Pooja N. M., V. S. Hombalimath
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Microbial fuel cell (MFC) is the advancement of science that aims at utilizing the oxidizing potential of bacteria for wastewater treatment and production of bio-hydrogen and bio-electricity. Salt-bridge is the economic alternative to highly priced proton-exchange membrane in the construction of a microbial fuel cell. This paper studies the electricity generating capacity of E.coli and Clostridium sporogenes in microbial fuel cells (MFCs). Unlike most of MFC research, this targets the long term goals of renewable energy production and wastewater treatment. In present study the feasibility and potential of bioelectricity production from different wastewater was observed. Different wastewater was primarily treated which were confirmed by the COD tests which showed reduction of COD. We observe that the electricity production of MFCs decreases almost linearly after 120 hrs. The sewage wastewater containing Clostridium sporogenes showed bioelectricity production up to 188mV with COD removal of 60.52%. Sewage wastewater efficiently produces bioelectricity and this also helpful to reduce wastewater pollution load.Keywords: microbial fuel cell, bioelectricity, wastewater, salt bridge, COD
Procedia PDF Downloads 53711 Analysis of Interpolation Factor in Pulse Shaping Filter on MRC for CDMA 2000 Systems
Authors: Pankaj Verma, Gagandeep Singh Walia, Padma Devi, H. P. Singh
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Code Division Multiple Access 2000 operates on various RF channel bandwidths 1.2288 or 3.6864 Mcps. CDMA offers high bandwidth and wireless broadband services but the efficiency gets decreased because of many interfering factors like fading, interference, scattering, diffraction, refraction, reflection etc. To reduce the spectral bandwidth is one of the major concerns in modern day technology and this is achieved by pulse shaping filter. This paper investigates the effect of diversity (MRC), interpolation factor in Root Raised Cosine (RRC) filter for the QPSK and BPSK modulation schemes. It is made possible to send information with minimum inter symbol interference and within limited bandwidth with proper pulse shaping technique. Bit error rate (BER) performance is analyzed by applying diversity technique by varying the interpolation factor for Binary Phase Shift Keying (BPSK) and Quadrature Phase Shift Keying (QPSK). Interpolation factor increases the original sampling rate of a sequence to a higher rate and reduces the interference and diversity reduces the fading.Keywords: CDMA2000, root raised cosine, roll off factor, ISI, diversity, interference, fading
Procedia PDF Downloads 47510 Analysis of Bed Load Sediment Transport Mataram-Babarsari Irrigation Canal
Authors: Agatha Padma Laksitaningtyas, Sumiyati Gunawan
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Mataram Irrigation Canal has 31,2 km length, is the main irrigation canal in Special Region Province of Yogyakarta, connecting Progo River on the west side and Opak River on the east side. It has an important role as the main water carrier distribution for various purposes such as agriculture, fishery, and plantation which should be free from sediment material. Bed Load Sediment is the basic sediment that will make the sediment process on the irrigation canal. Sediment process is a simultaneous event that can make deposition sediment at the base of irrigation canal and can make the height of elevation water change, it will affect the availability of water to be used for irrigation functions. To predict the amount of drowning sediments in the irrigation canal using two methods: Meyer-Peter and Muller’s Method which is an energy approach method and Einstein Method which is a probabilistic approach. Speed measurement using floating method and using current meters. The channel geometry is measured directly in the field. The basic sediment of the channel is taken in the field by taking three samples from three different points. The result of the research shows that by using the formula Meyer -Peter Muller get the result of 60,75799 kg/s, whereas with Einsten’s Method get result of 13,06461 kg/s. the results may serve as a reference for dredging the sediments on the channel so as not to disrupt the flow of water in irrigation canal.Keywords: bed load, sediment, irrigation, Mataram canal
Procedia PDF Downloads 2289 Gloria Naylor's Linden Hills: A Fine Description of Burdens and Misguided Notions of the Middle Black Community
Authors: Kalluru Maheswaramma, Putta Padma
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This study makes an attempt to demonstrate the wondrous world of the upwardly middle black community in Gloria Naylor’s Linden Hills. Gloria Naylor’s first novel The Women of Brewster Place is about the working class and Linden Hills about middle-class Black America. Naylor believes their serenity that is lost in the middle or working class black people as they move into the upper patriarchal society. Naylor challenges the different forms of superiority, homophobia, and chauvinism, interracial bias, and the like, which plague a community so significantly trying to be acceptable in the larger white community. In an ironic twist, Naylor creates characters that recognize their desire for a solid black community but who in reality ignore blackness and negate any emergent sign of its development. Linden Hills is an expose of the wealthy and spiritually dissolute upper class. Linden Hills is an examination of an upper-middle-class African American community in which women are largely exploited or invisible and in which men have, in the course of upward mobility, sacrificed their racial identity and their essence. Linden Hills is a social world, which includes firm stratification, false values, and an immobilizing impact on its residents. Touching a brief note upon the origin and development of African American Literature as well a note on the chosen writer and her works, the paper proceeds to depict the middle-class black community of Linden Hills.Keywords: gloria naylor, linden hills, African American community, the middle black community
Procedia PDF Downloads 5648 Immunity Boosting and Balanced Diet Prevents Viral Infections with Special Emphasis on COVID-19
Authors: K. R. Padma, K. R. Don
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Background and aims: A balanced nutritional diet is essential in maintaining immunity and for deterrence as well as desisting of viral infections. Nevertheless, currently, very less information is available online regarding nutrition consumption during the period of coronavirus infection, i.e. (COVID-19). In our systematic review article, we portrayed and aimed to evaluate evidence from various previous clinical trials, which was based on nutritional interventions for viral diseases and given a concise overview. Methods: A systematic search was carried out employing 3 key medical databases: PubMed®, Web of Science®, and SciVerse Scopus®. Studies were performed and evaluated suitable if clinical trials in humans, appropriate immunological parameters on viral and respiratory infections, need to perform. Basic Clinical trials on nutritional vitamins, minerals, nutraceuticals as well as probiotics were included. Results: We have explored 10 review articles and extracted data for our study. A total of > 2000 participants were included and excluded several other trace elements as well as various vitamins, but in inclusion criteria mainly concentrated on those who have shown propitious immune-modulatory effects against viral respiratory infections. Conclusions: We have encapsulated the potential health benefits of some minerals, vitamins, as well as certain designer foods, nutraceuticals, and probiotics in viral infections. Based on this nutritional interventional strategy available from our present data, it could be promising to abstain and reduce the COVID-19 infection replication and boost our immunity to fight against the virus.Keywords: COVID-19, immunity, vitamins, nutritional intervention strategy
Procedia PDF Downloads 1347 A Co-Relational Descriptive Study to Assess the Impact of Cancer Event on Self, Family, Coping Level of Cancer Clients and Quality of Life among Them
Authors: Padma Sree Potru
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Abstract: A co-relational descriptive study was conducted to assess the impact of cancer event on self, on family, coping strategies of cancer clients and quality of life among them in G.G.H., Guntur, Andhra Pradesh, India. Aim: The aim of the study was to investigate the impact of cancer events on self, on family, coping of clients and quality of life among cancer patients. Methods: 50 cancer patients were selected through random sampling technique. The data were obtained by using impact of events scale, impact on family scale, coping health inventory and WHOQOL-BREF scale. Results: The results revealed that majority (32%) of them were in the age group of 36-45 years, 72% were females, 44% were having the income of Rs. 5001-10000/- per month, 40% were working for daily wage, and 15% were newly diagnosed of cancer. Among 50 cancer patients, 65% had extreme impact of events, 61% shows extreme impact on family, 46% possess minimal coping strategies and 68% had poor quality of life. This study focuses on that there is a strong positive correlation between quality of life and coping behavior r=0.603 and also between impact of event and impact on family r=0.610, but a negative correlation existed between quality of life and impact of events r= -0.201. ANOVA test reveals that there is a significant difference between subscales of impact on family and coping behavior with f values = 3.893, 3.957 respectively. Chi-square highlights that there is a significant association between impact of events with age, occupation and impact on family with duration of illness. Conclusion: Even though cancer is a dreadful disease still there are many emerging treatment modalities and innovative procedures which are focusing on improving the standards of life among cancer clients. But all this can happen only when the clients accepts the reality, increase their willpower and confidence, desire to live, focusing on coping mechanisms and good ongoing support from the family members.Keywords: impact of event, impact on family, coping, quality of event
Procedia PDF Downloads 4506 Partial Purification and Characterization of a Low Molecular Weight and Industrially Important Chitinase and a Chitin Deacetylase Enzyme from Streptomyces Chilikensis RC1830, a Novel Strain Isolated from Chilika Lake, India
Authors: Lopamudra Ray, Malla Padma, Dibya Bhol, Samir Ranjan Mishra, A. N. Panda, Gurdeep Rastogi, T. K. Adhya, Ajit Kumar Pattnaik, Mrutyunjay Suar, Vishakha Raina
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Chilika Lake is the largest coastal estuarine brackish water lagoon in Asia situated on the east coast of India and is a designated Ramsar site. In the current study, several chitinolytic microorganisms were isolated and screened by appearance of clearance zone on 0.5% colloidal chitin agar plate. A strain designated as RC 1830 displayed maximum colloidal chitin degradation by release of 112 μmol/ml/min of N-acetyl D-glucosamine (GlcNAc) in 48h. The strain was taxonomically identified by polyphasic approach based on a range of phenotypic and genotypic properties and was found to be a novel species named Streptomyces chilikensis RC1830. The organism was halophilic (12% NaCl w/v), alkalophilic (pH10) and was capable of hydrolyzing chitin, starch, cellulose, gelatin, casein, tributyrin and tween 80. The partial purification of chitinase enzymes from RC1830 was performed by DEAE Sephacel anion exchange chromatography which revealed the presence of a very low molecular weight chitinase(10.5kD) which may be a probable chitobiosidase enzyme. The study reports the presence of a low MW chitinase (10.5kD) and a chitin decaetylase from a novel Streptomyces strain RC1830 isolated from Chilika Lake. Previously chitinases less than 20.5kD have not been reported from any other Streptomyces species. The enzymes was characterized with respect to optimum pH, temperature, and substrate specificity and temperature stability.Keywords: chitinases, chitobiosidase, Chilika Lake, India
Procedia PDF Downloads 4995 Application of Hydrologic Engineering Centers and River Analysis System Model for Hydrodynamic Analysis of Arial Khan River
Authors: Najeeb Hassan, Mahmudur Rahman
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Arial Khan River is one of the main south-eastward outlets of the River Padma. This river maintains a meander channel through its course and is erosional in nature. The specific objective of the research is to study and evaluate the hydrological characteristics in the form of assessing changes of cross-sections, discharge, water level and velocity profile in different stations and to create a hydrodynamic model of the Arial Khan River. Necessary data have been collected from Bangladesh Water Development Board (BWDB) and Center for Environment and Geographic Information Services (CEGIS). Satellite images have been observed from Google earth. In this study, hydrodynamic model of Arial Khan River has been developed using well known steady open channel flow code Hydrologic Engineering Centers and River Analysis System (HEC-RAS) using field surveyed geometric data. Cross-section properties at 22 locations of River Arial Khan for the years 2011, 2013 and 2015 were also analysed. 1-D HEC-RAS model has been developed using the cross sectional data of 2015 and appropriate boundary condition is being used to run the model. This Arial Khan River model is calibrated using the pick discharge of 2015. The applicable value of Mannings roughness coefficient (n) is adjusted through the process of calibration. The value of water level which ties with the observed data to an acceptable accuracy is taken as calibrated model. The 1-D HEC-RAS model then validated by using the pick discharges from 2009-2018. Variation in observed water level in the model and collected water level data is being compared to validate the model. It is observed that due to seasonal variation, discharge of the river changes rapidly and Mannings roughness coefficient (n) also changes due to the vegetation growth along the river banks. This river model may act as a tool to measure flood area in future. By considering the past pick flow discharge, it is strongly recommended to improve the carrying capacity of Arial Khan River to protect the surrounding areas from flash flood.Keywords: BWDB, CEGIS, HEC-RAS
Procedia PDF Downloads 1834 Groundwater Arsenic Contamination in Brahmaputra River Basin: A Water Quality Assessment in Jorhat (Assam), India
Authors: Kruti Jaruriya
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Distribution of arsenic (As) and its compound and related toxicology are serious concerns. This is particularly so since millions worldwide are suffering from toxicity due to drinking of As-contaminated groundwater. The Bengal delta plain, formed by the Ganga– Padma–Meghna–Brahmaputra river basin, covering several districts of West Bengal, India and Bangladesh is considered as the worst As affected alluvial basin. However, some equally affected, if not more, areas are emerging in upper Brahmaputra plains. The present study was carried out to examine As contamination trends in the worst affected part of Assam, India. Arsenic (As) mobilization to the groundwater of Brahmaputra floodplains was investigated in Titabor, Jorhat District, located in the North Eastern part of India. The groundwater and the aquifer geochemistry were characterized. The groundwater is characterized by high dissolved Fe, Mn, and HCO-3 and low concentrations of NO-3 and SO2-4 indicating anoxic conditions prevailing in the groundwater. Fifty groundwater samples collected from shallow and deep tubewells of Titabor, Jorhat district (Assam) were examined. Along with total As, examination of concentration levels of other key parameters, viz., pH, EC, Fe, Mn , Mg2+, Ca2+, Na+, K+, PO43- , HCO-3 , NO3- ,Cl - and SO42- was also carried out. In respect to the permissible guideline of World Health Organization (WHO: As 0.01 ppm, Fe 1.0 ppm, and Mn 0.3 ppm for potable water), the range of As concentration in the groundwater varied from 0.014 to 0.604 mg/L with mean concentration 0.184 mg/L. The present study showed that out of the 50 groundwater samples,100%, 54%, and 42% were found contaminated with higher metal contents (for total As, Fe, and Mn, respectively). The results of hydrogeochemical study revealed that the reductive dissolution of MnOOH and FeOOH represents an important mechanism of arsenic release in the study area along with major cations playing an important role in leaching of As into the groundwater. Arsenic released by oxidation of pyrite, as water levels are drawn down and air enters the aquifer, contributes negligibly to the problem of As pollution. Identification of the mechanism of As release to groundwater helps to provide a framework to guide the placement of new water wells so that they will have acceptable concentrations of As.Keywords: arsenic, assam, brahmaputra floodplain, groundwater, hydrogeochemistry
Procedia PDF Downloads 3103 Enhancement of Morphogenetic Potential to Obtain Elite Varities of Sauropus androgynous (L.) Merr. through Somatic Embryogenesis
Authors: S. Padma, D. H. Tejavathi
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Somatic embryogenesis is a remarkable illustration of the dictum of plant totipotency where developmental reconstruction of somatic cells takes place towards the embryogenic pathway. It recapitulates the morphological and developmental process that occurs in zygotic embryogenesis. S. androgynous commonly called as multivitamin plant. The leaves are consumed as green leafy vegetable by the Southeast Asian communities due to their rich nutritional profile. Despite being a good nutritional vegetable with proteins, vitamins, minerals, amino acids, it is warned for excessive intake due to the presence of alkoloid called papaverine. Papaverine at higher concentrations is toxic and leads to a syndrome called Bronchiolitis Obliterans. In the present study, morphogenetic potential of shoot tip, leaf and nodal explants of Sauropus androgynous was investigated to develop and enhance the reliable plant regeneration protocol via somatic embryogenesis. Somatic embryos were derived directly from the embryogenic callus derived from shoot tip, node and leaf cultures on Phillips and Collins (L2) medium supplemented with NAA at various concentrations ranging from 5.3 µM/l to 26.85 µM/l within two months of inoculation. Thus obtained embryos were sub cultured to modified L2 media supplemented with increased vitamin level for the further growth. Somatic embryos with well-developed cotyledons were transferred to normal and modified L2 basal medium for conversion. The plantlets thus obtained were subjected to brief acclimatization before transferring them to land. About 95% of survival rate was recorded. The augmentation process of culturing various explants through somatic embryogenesis using synthetic medium with various plant growth regulators under controlled conditions have aggrandized the commercial production of Sauropus making it easily available over the conventional propagation methods. In addition, regeneration process through somatic embryogenesis has ameliorated the development of desired character in Sauropus with low papaverine content thereby providing a valuable resource to the food and pharmaceutical industry. Based on this research, plant tissue culture techniques have shown promise for economical and convenient application in Sauropus androgynous breeding.Keywords: L2 medium, multivitamin plant, NAA, papaverine
Procedia PDF Downloads 2072 Long Term Survival after a First Transient Ischemic Attack in England: A Case-Control Study
Authors: Padma Chutoo, Elena Kulinskaya, Ilyas Bakbergenuly, Nicholas Steel, Dmitri Pchejetski
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Transient ischaemic attacks (TIAs) are warning signs for future strokes. TIA patients are at increased risk of stroke and cardio-vascular events after a first episode. A majority of studies on TIA focused on the occurrence of these ancillary events after a TIA. Long-term mortality after TIA received only limited attention. We undertook this study to determine the long-term hazards of all-cause mortality following a first episode of a TIA using anonymised electronic health records (EHRs). We used a retrospective case-control study using electronic primary health care records from The Health Improvement Network (THIN) database. Patients born prior to or in year 1960, resident in England, with a first diagnosis of TIA between January 1986 and January 2017 were matched to three controls on age, sex and general medical practice. The primary outcome was all-cause mortality. The hazards of all-cause mortality were estimated using a time-varying Weibull-Cox survival model which included both scale and shape effects and a random frailty effect of GP practice. 20,633 cases and 58,634 controls were included. Cases aged 39 to 60 years at the first TIA event had the highest hazard ratio (HR) of mortality compared to matched controls (HR = 3.04, 95% CI (2.91 - 3.18)). The HRs for cases aged 61-70 years, 71-76 years and 77+ years were 1.98 (1.55 - 2.30), 1.79 (1.20 - 2.07) and 1.52 (1.15 - 1.97) compared to matched controls. Aspirin provided long-term survival benefits to cases. Cases aged 39-60 years on aspirin had HR of 0.93 (0.84 - 1.00), 0.90 (0.82 - 0.98) and 0.88 (0.80 - 0.96) at 5 years, 10 years and 15 years, respectively, compared to cases in the same age group who were not on antiplatelets. Similar beneficial effects of aspirin were observed in other age groups. There were no significant survival benefits with other antiplatelet options. No survival benefits of antiplatelet drugs were observed in controls. Our study highlights the excess long-term risk of death of TIA patients and cautions that TIA should not be treated as a benign condition. The study further recommends aspirin as the better option for secondary prevention for TIA patients compared to clopidogrel recommended by NICE guidelines. Management of risk factors and treatment strategies should be important challenges to reduce the burden of disease.Keywords: dual antiplatelet therapy (DAPT), General Practice, Multiple Imputation, The Health Improvement Network(THIN), hazard ratio (HR), Weibull-Cox model
Procedia PDF Downloads 1491 Survival Analysis after a First Ischaemic Stroke Event: A Case-Control Study in the Adult Population of England.
Authors: Padma Chutoo, Elena Kulinskaya, Ilyas Bakbergenuly, Nicholas Steel, Dmitri Pchejetski
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Stroke is associated with a significant risk of morbidity and mortality. There is scarcity of research on the long-term survival after first-ever ischaemic stroke (IS) events in England with regards to effects of different medical therapies and comorbidities. The objective of this study was to model the all-cause mortality after an IS diagnosis in the adult population of England. Using a retrospective case-control design, we extracted the electronic medical records of patients born prior to or in year 1960 in England with a first-ever ischaemic stroke diagnosis from January 1986 to January 2017 within the Health and Improvement Network (THIN) database. Participants with a history of ischaemic stroke were matched to 3 controls by sex and age at diagnosis and general practice. The primary outcome was the all-cause mortality. The hazards of the all-cause mortality were estimated using a Weibull-Cox survival model which included both scale and shape effects and a shared random effect of general practice. The model included sex, birth cohort, socio-economic status, comorbidities and medical therapies. 20,250 patients with a history of IS (cases) and 55,519 controls were followed up to 30 years. From 2008 to 2015, the one-year all-cause mortality for the IS patients declined with an absolute change of -0.5%. Preventive treatments to cases increased considerably over time. These included prescriptions of statins and antihypertensives. However, prescriptions for antiplatelet drugs decreased in the routine general practice since 2010. The survival model revealed a survival benefit of antiplatelet treatment to stroke survivors with hazard ratio (HR) of 0.92 (0.90 – 0.94). IS diagnosis had significant interactions with gender and age at entry and hypertension diagnosis. IS diagnosis was associated with high risk of all-cause mortality with HR= 3.39 (3.05-3.72) for cases compared to controls. Hypertension was associated with poor survival with HR = 4.79 (4.49 - 5.09) for hypertensive cases relative to non-hypertensive controls, though the detrimental effect of hypertension has not reached significance for hypertensive controls, HR = 1.19(0.82-1.56). This study of English primary care data showed that between 2008 and 2015, the rates of prescriptions of stroke preventive treatments increased, and a short-term all-cause mortality after IS stroke declined. However, stroke resulted in poor long-term survival. Hypertension, a modifiable risk factor, was found to be associated with poor survival outcomes in IS patients. Antiplatelet drugs were found to be protective to survival. Better efforts are required to reduce the burden of stroke through health service development and primary prevention.Keywords: general practice, hazard ratio, health improvement network (THIN), ischaemic stroke, multiple imputation, Weibull-Cox model.
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