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This paper deals with the recognition of handwritten Malayalam character using wavelet energy feature (WEF) and extreme learning machine (ELM). The wavelet energy (WE) is a new and robust parameter, and is derived using wavelet transform. It can reduce the influences of different types of noise at different levels. WEF can reflect the WE distribution of characters in several directions at different scales. To a non oscillating pattern, the amplitudes of wavelet coefficients increase when the scale of wavelet decomposition increase. WE of different decomposition levels have different powers to discriminate the character images. These features constitute patterns of handwritten characters for classification. The traditional learning algorithms of the different classifiers are far slower than required. So we have used an extremely fast leaning algorithm called ELM for single hidden layer feed forward networks (SLFN), which randomly chooses the input weights and analytically determines the output weights of SLFN. This algorithm learns much faster than traditional popular learning algorithms for feed forward neural networks. This feature vector, classifier combination gave good recognition accuracy at level 6 of the wavelet decomposition.

IntroductionThere is unequivocal evidence that the emergency department (ED) is a challenging environment to deliver holistic care to older adults living with frailty; prolonged exposure predisposes older adults to a range of adverse outcomes. The Geriatric Emergency Medicine (GEM) Unit opened in University Hospital Limerick (UHL) in 2023 with the overall aim of improving the experience and outcomes of older adults aged ≥75 years that attend the ED. The GEM Unit is operational 24/7 and is staffed by an interdisciplinary team comprising Emergency Medicine, Nursing, and Health and Social Care Professions (HSCP). This service evaluation aims to profile 6-month disposition and process outcomes.MethodologyOur initiative was underpinned by a quality improvement methodology comprising tests of change. Descriptive statistics were used to profile the baseline and demographic characteristics and to summarize data related to process outcomes.ResultsA total of 845 older adults were assessed by the HSCP team in Q1 and Q2 2024; 58.2% (N=492) were discharged home following their index attendance with 41.8% (N=353) requiring admission. The overall GEM Unit conversion rate of 41.8% is 11.7% lower than the composite UHL 75+ conversion rate of 53.5% (HSE Planning and Performance Unit). Based on empirical evidence, this equates to cost savings of €606,672 year to date (YTD) and predicted annual savings of €1,213,344 based on a 5-day HSCP service (https://doi.org/10.1371/journal.pone.0298162). The 30-day unscheduled ED revisit continues to trend down year-on-year from 18.8% in 2019 to 13% YTD 2024.ConclusionThe interdisciplinary team espouse an integrated approach to care at the primary-secondary care interface and focus on a left-shift in reform and activity. This is achieved by exploring alternatives to hospital admission with older adults and active engagement with colleagues across the HSE Mid-West health region to ensure older adults are supported to return home.

Curcumin, the active component present in Curcuma longa of the family Zingiberaceae, has a number of pharmacological effects, including potential anti-inflammatory activity. One of the major limitations of curcumin/turmeric extract is its poor absorption through the gastrointestinal tract. Several approaches have been adopted to increase the bioavailability of curcumin, including loading curcumin into liposomes or nanoparticles, complexation with phospholipids, addition of essential oils and synthesizing structural analogues of curcumin. In the present study, the toxicity and safety of one such bioavailable turmeric formulation, curcuminoid-essential oil complex (CEC), the toxicity profile of which has not been reported, were examined using in vivo and in vitro models, as per the guidelines of the Organisation for Economic Co-operation and Development. Investigations of acute toxicity study were performed in rats and mice, and the results revealed no signs and symptoms or toxicity or mortality in any of the animals at the maximum recommended dose level of 5,000 mg/kg body weight. The repeated administration of CEC for 90 days in Wistar rats at a dose of 1,000 mg/kg body weight did not induce any observable toxic effects, compared with corresponding control animals. Mutagenicity/genotoxicity investigations were also performed using a bacterial reverse mutation assay (Ames test), a mammalian bone marrow chromosome aberration test and a mammalian erythrocyte micronucleus test in mice. CEC was found to be non-mutagenic in all three mutagenic investigations. Consequently, the present study indicated that CEC elicited no toxic effects in animals or in vitro. Therefore, following investigations of acute toxicity, repeated dose toxicity and mutagenicity, CEC was deemed a safe, non-toxic pharmacological formulation.

Endocrine disorders manifest as a disturbance in the milieu of multiple organ systems. The cardiovascular system may be directly affected or alter its function to maintain the state of homeostasis. In this article, we aim to review the pathophysiology, diagnosis, clinical features and management of cardiac manifestations of various endocrine disorders.

The present study deals with the evaluation and assessment of the safety/toxic potential of Boswellia serrata, a well known Ayurvedic herb used to treat disorders of digestive system, respiratory ailments and bone related diseases. A repeated dose oral (90 days) toxicity study of Boswellia serrata was carried out. For this, 10 rats of each sex were treated with the Boswellia serrata at three different doses i.e. 100, 500 and 1000 mg/kg B. wt. /day. As a control, 10 rats of each sex were treated with corn oil only which was the vehicle. Two groups consisting of five male and five female rats were kept as control recovery and high dose recovery group which were treated with the vehicle (corn oil) and the Boswellia serrata at the dose of 1000 mg/kg B. wt. Animals of control recovery and high dose recovery groups were further observed for 28 days without any treatment. From this study, it was found that the rats treated with high dose of the Boswellia serrata gained their body weight with much less rate than that of the control group. However, during the recovery period, the loss in body weight gain as observed during the study period exhibits a reversible effect on the metabolic activity and recovered. The results also indicate that Boswellia serrata is relatively safe in rat up to the dose of 500 mg/kg B.wt. as no adverse impact on health factors was observed. Thus, the No observed adverse effect level is 500 mg/kg B. wt.

This study aims at cloning, sequencing, and phylogenetic analysis of a partial CDS of gene in pET-32a - DH5α system, with the objective of identifying the conserved nature of the gene in the genus . A partial CDS (nucleotide 1873 to nucleotide 3363) of the gene was amplified from genomic DNA of serovar Canicola by polymerase chain reaction (PCR). The PCR-amplified DNA was cloned into pET-32a vector and transformed into competent DH5α bacterial cells. The partial gene insert was sequenced and the nucleotide sequences obtained were aligned with the published gene sequences of other serovars, using nucleotide BLAST, NCBI. Phylogenetic analysis of the gene sequence was done by maximum likelihood method using Mega 6.06 software. The PCR could amplify the 1491 nucleotide sequence spanning from nucleotide 1873 to nucleotide 3363 of the gene and the partial gene could be successfully cloned in DH5α cells. The nucleotide sequence when analyzed for homology with the reported gene sequences of other serovars was found to have 100% homology to the 1910 bp to 3320 bp sequence of gene of strain Kito serogroup Canicola. The predicted protein consisted of 470 aminoacids. Phylogenetic analysis revealed that the gene was conserved in species. The partial gene could be successfully cloned and sequenced from DH5α cells. The sequence showed 100% homology to the published gene sequences. The phylogenetic analysis revealed the conserved nature of the gene. Further studies on the expression and immunogenicity of the partial LigA protein need to be carried out to determine its competence as a subunit vaccine candidate.

To report the International Nosocomial Infection Control Consortium surveillance data from 40 hospitals (20 cities) in India 2004-2013. Surveillance using US National Healthcare Safety Network's criteria and definitions, and International Nosocomial Infection Control Consortium methodology. We collected data from 236,700 ICU patients for 970,713 bed-days Pooled device-associated healthcare-associated infection rates for adult and pediatric ICUs were 5.1 central line-associated bloodstream infections (CLABSIs)/1,000 central line-days, 9.4 cases of ventilator-associated pneumonia (VAPs)/1,000 mechanical ventilator-days, and 2.1 catheter-associated urinary tract infections/1,000 urinary catheter-days In neonatal ICUs (NICUs) pooled rates were 36.2 CLABSIs/1,000 central line-days and 1.9 VAPs/1,000 mechanical ventilator-days Extra length of stay in adult and pediatric ICUs was 9.5 for CLABSI, 9.1 for VAP, and 10.0 for catheter-associated urinary tract infections. Extra length of stay in NICUs was 14.7 for CLABSI and 38.7 for VAP Crude extra mortality was 16.3% for CLABSI, 22.7% for VAP, and 6.6% for catheter-associated urinary tract infections in adult and pediatric ICUs, and 1.2% for CLABSI and 8.3% for VAP in NICUs Pooled device use ratios were 0.21 for mechanical ventilator, 0.39 for central line, and 0.53 for urinary catheter in adult and pediatric ICUs; and 0.07 for mechanical ventilator and 0.06 for central line in NICUs. Despite a lower device use ratio in our ICUs, our device-associated healthcare-associated infection rates are higher than National Healthcare Safety Network, but lower than International Nosocomial Infection Control Consortium Report.

PurposeLimited published data exist on the clinical epidemiology of atrial fibrillation (AF) in South Asia including India. Most of the published data are from the Western countries and the Far East. The Kerala AF registry was initiated to collect systematic, prospective data on clinical characteristics, risk factors, treatment pattern and outcomes of consecutive AF patients who consulted cardiologists across the state of Kerala, India.ParticipantsAll newly diagnosed and previously reported patients aged ≥18 years with documented evidence of AF on ECG were included. Patients with transient AF due to infection, acute myocardial infarction, alcohol intoxication, metabolic abnormalities and AF seen in postoperative cases and critically ill patients with life expectancy less than 30 days were excluded.Findings to dateA total of 3421 patients were recruited from 53 hospitals across Kerala from April 2016 to April 2017. There were 51% (n=1744) women. The median age of the cohort was 65 (IQR 56–74) years. Hypertension, diabetes mellitus and dyslipidaemia were present in 53.8%, 34.5% and 42.2% patients, respectively. Chronic kidney disease was observed in 46.6%, coronary artery disease in 34.8% and heart failure (HF) in 26.5% of patients. Mean CHA2DS2-VASc score of the cohort was 2.9, and HAS-BLED score was 1.7. Detailed information of antithrombotic and antiarrhythmic drugs was collected at baseline and on follow-up. During 1-year follow-up, 443 deaths (12.9%) occurred of which 332 (9.7%) were cardiac death and 63 (1.8%) were due to stroke. There were 578 (16.8%) hospitalisations mainly due to acute coronary syndrome, arrythmias and HF.Future plansCurrently, this is the largest prospective study on AF patients from India, and the cohort will be followed for 5 years to observe the treatment patterns and clinical outcomes. The investigators encourage collaborations with national and international AF researchers.Trial registration numberCTRI/2017/10/010097.

Background Much data informing sex differences in atrial fibrillation (AF) comes from Western cohorts. In this analysis, we describe sex differences in Kerala, India, using the Kerala‐AF registry—the largest AF registry from the Indian subcontinent. Methods Patients aged ≥18 years were recruited from 53 hospitals across Kerala. Patients were compared for demographics, treatments, and 12‐month outcomes, including major adverse cardiovascular events (MACE) and bleeding. Results Male patients were more likely to have a smoking and/or alcohol history and had more ischaemic heart disease (46.2% vs. 25.5%; p < 0.001). Female patients had more valvular AF (35.1% vs. 18.0%; p < 0.001), and more use of calcium‐channel blockers (23.3% vs. 16.5%; p < 0.001) or digoxin (39.6% vs. 28.5%; p < 0.001). Almost one in four patients were not anticoagulated despite raised CHA2DS2‐VASc scores. 12‐month MACE outcomes did not differ by sex (male: 30.2% vs. female: 29.4%; p = 0.685), though bleeding events were more common in male patients (2.4% vs. 1.3%; p = −0.038), driven by minor bleeding (1.2% vs. 0.5%). Conclusion In this large AF cohort from India, male patients had a higher prevalence of ischaemic heart disease, smoking, and alcohol use, while female patients had a higher prevalence of valvular heart disease. MACE did not differ by sex, though bleeding was more common in males. Almost a quarter of patients were not anticoagulated despite raised thromboembolic risk. This study describes the demographic, clinical, therapeutic, and 12‐month outcome differences between male and female patients in the Kerala‐AF registry. AF—Atrial Fibrillation. *Missing anticoagulation is defined as the absence of anticoagulation therapy despite an elevated CHA2DS2‐VASc score.

Background There is ongoing debate around rate versus rhythm control strategies for managing atrial fibrillation (AF), however, much of the data comes from Western cohorts. Kerala‐AF represents the largest prospective AF cohort study from the Indian subcontinent. Objectives To compare 12‐month outcomes between rate and rhythm control strategies. Methods Patients aged ≥18 years with non‐transient AF were recruited from 53 hospitals across Kerala. Patients were stratified by rate or rhythm control. The primary outcome was a composite of all‐cause mortality, arterial thromboembolism, acute coronary syndrome or hospitalization due to heart failure or arrhythmia at 12 months. Secondary outcomes included bleeding events and individual components of the primary. Predictors of the composite outcome were analysed by logistic regression. Results A total of 2901 patients (mean age 64.6 years, 51% female) were included (2464 rate control, 437 rhythm control). Rates of the primary composite outcome did not differ between groups (29.7% vs 30.0%; p = .955), nor did any component of the primary. Bleeding outcomes were also similar (1.6% vs 1.9%; p = .848). Independent predictors of the primary composite outcome were older age (aOR 1.01; p = .013), BMI <18 (aOR 1.51; p = .025), permanent AF (aOR 0.78; p = .010), HFpEF (aOR 1.40; p = .023), HFrEF (aOR 1.39; p = .004), chronic kidney disease (aOR 1.36; p < .001), and prior thromboembolism (aOR 1.31; p = .014). Conclusion In the Kerala‐AF registry, 12‐month outcomes did not differ between rate and rhythm control cohorts. No significant difference was found between rate and rhythm control approaches to atrial fibrillation management in the 1‐year follow‐up of the Kerala‐AF cohort. Independent predictors of adverse outcomes included age, underweight BMI, heart failure, and chronic renal failure.