Daily adherence to antihypertensive medications is necessary to control hypertension. Under the State hypertension control program, hypertensive patients are enrolled in public health settings, ...provided with 30‐day medication prescriptions, and advised to return to the health facility monthly. However, at least 50‐60% of patients do not visit the health facility for their scheduled follow‐up appointments. The authors aimed to document the major reasons for missed appointments and to characterize patient and health system barriers. By telephone, the authors interviewed 300 randomly selected patients who missed appointments for more than three consecutive months. Out of the 300, 206 were interviewed using a pre‐structured questionnaire to explore patients’ experiences along with medical record reviews from the patient database. Not feeling sick or not experiencing any symptoms (24.8%) was the major reason why patients did not return to the clinic, followed by far distance from the facility (22.3%). Among other reasons for missing follow‐up appointments, lack of instructions/guidance from the facility (15.3%), acute illness among patients (8.3%), and long waiting time at the facilities (7%) were also documented. Most of these patients (55.4%) continued treatment from other sources, and a majority (54%) preferred private clinics. These results suggest the need for a more patient‐centered care model, including education about hypertension as an asymptomatic but life‐threatening condition and addressing the barrier of travel distance between a patient's home and the health facility. Further, introducing a reminder system using telephone calls, text messages, or home visits by health workers may increase the follow‐up rate among patients.
This review paper aimed to document the major reasons for missed appointments among hypertensive patient attending public health facilities in India. The authors found not experiencing any symptoms, distance between health facility and patient's home, lack of proper guidance from the health facility, acute conditions among patients, and long waiting time at health facilities were documented as the major reasons for missed appointments. Thus, a patient‐centric, decentralized service, along with proper patient guidance and a good patient information system, may minimize these issues and improve patients’ follow‐up visit in the long run, thus resulting in a better blood pressure control.
One of the 'best buys' for preventing Non-Communicable Diseases (NCDs) is to reduce tobacco use. The synergy scenario of NCDs with tobacco use necessitates converging interventions under two vertical ...programs to address co-morbidities and other collateral benefits. The current study was undertaken with an objective to ascertain the feasibility of integrating a tobacco cessation package into NCD clinics, especially from the perspective of healthcare providers, along with potential drivers and barriers impacting its implementation.
A disease-specific, patient-centric, and culturally-sensitive tobacco cessation intervention package was developed (published elsewhere) for the Health Care Providers (HCPs) and patients attending the NCD clinics of Punjab, India. The HCPs received training on how to deliver the package. Between January to April 2020, we conducted a total of 45 in-depth interviews medical officers (n = 12), counselors (n = 13), program officers (n = 10), and nurses (n = 10) within the trained cohort across various districts of Punjab until no new information emerged. The interview data wereanalyzed deductively based on six focus areas concerning feasibility studies (acceptability, demand, adaptation, practicality, implementation, and integration) using the 7- step Framework method of qualitative analysis and put under preset themes.
The respondent's Mean ± SD age was 39.2± 9.2 years, and years of service in the current position were 5.5 ± 3.7 years. The study participants emphasized the role of HCPs in cessation support (theme: appropriateness and suitability), use of motivational interviewing, 5A's & 5R's protocol learned during the training & tailoring the cessation advice (theme: actual use of intervention activities); preferred face-to-face counseling using regional images, metaphors, language, case vignettes in package (theme: the extent of delivery to intended participants). Besides, they also highlighted various roadblocks and facilitators during implementation at four levels, viz. HCP, facility, patient, and community (theme: barriers and favorable factors); suggested various adaptations to keep the HCPs motivated along with the development of integrated standard operating procedures (SOPs), digitalization of the intervention package, involvement of grassroots level workers (theme: modifications required); the establishment of an inter-programmatic referral system, and a strong politico-administrative commitment (theme: integrational perspectives).
The findings suggest that implementing a tobacco cessation intervention package through the existing NCD clinics is feasible, and it forges synergies to obtain mutual benefits. Therefore, an integrated approach at the primary & secondary levels needs to be adopted to strengthen the existing healthcare systems.
With the increasing advent in digital age, it is required to set up an inter-satellite optical wireless communication (IsOWC) that can support ultra-high bit rate. Here the proposed IsOWC system is ...implemented using dense wavelength division multiplexing and sub carrier multiplexing. The proposed model is designed to work at three different wavelengths i.e. 850, 1064 and 1550 nm. The performance of the proposed models is measured in terms of Q-Factor and Bit error rate at a different transmitted optical power level and transmission bit rate. It is observed that by incorporating multiplexing techniques, higher transmission bit rates can be achieved. It is observed that maximum bit rate achieved by proposed IsOWC system employing multiplexing technique is multiple of the number of channels used in multiplexing i.e. four times the individual PSK modulated optical system. Finally, it is concluded that IsOWC system employing multiplexing techniques provides enhanced performance than single PSK modulated optical wave with existing optical infrastructure.
This paper presents the design of a desired linear phase digital Finite Impulse Response (FIR) High Pass (HP) filter based on Adaptive Systematic Cuckoo Search Algorithm (ACSA). The deviation, or ...error from the desired response, is assessed along with the stop-band and pass-band attenuation of the filter. The Cuckoo Search algorithm (CS) is used to avoid local minima because the error surface is typically non-differentiable, nonlinear, and multimodal. The ACSA is applied to the minimax criterion (L∞-norm) based error fitness function, which offers a better equiripple response for passband and stopband, high stopband attenuation, and rapid convergence for the developed optimal HP FIR filter algorithm. The simulation findings demonstrate that when compared to the Parks McClellan (PM), Particle Swarm Optimization (PSO), CRazy Particle Swarm Optimization (CRPSO), and Cuckoo Search algorithms, the proposed HP FIR filter employing ACSA leads to better solutions.
Design and Optimization of Novel Shaped FinFET Kaur, Navneet; Rattan, Munish; Gill, Sandeep Singh
Arabian journal for science and engineering (2011),
04/2019, Volume:
44, Issue:
4
Journal Article
Peer reviewed
A novel high-performance and miniaturized fin-shaped field effect transistor has been proposed which has been named as rectzoidal (rectz) because of its origin from the existing rectangular (rect) ...and trapezoidal (trap) structures. The rationale behind proposing this structure is to sustain the integration of millions of transistors on integrated circuits (ICs), further utilizing these scaled transistors in advanced processors of leading semiconductor industries. The work presented here is divided into two phases: first phase presents the proposed transistor design at 20 nm gate length and its comparative simulation analysis with the previous rect and trap transistor structures in terms of short channel effects and other analog and RF parameters like transconductance, output conductance, intrinsic gain, gate capacitance, unity gain frequency etc. using Cogenda three-dimensional Technology Computer-Aided Design (TCAD) tool. In the subsequent phase, i.e., optimization phase, artificial neural network was trained with design parameters of proposed structure and fitness function was formulated using weighted sum approach. Evolutionary and swarm-based optimization algorithms have been applied to obtain optimum design parameters of proposed transistor structure corresponding to minimum fitness function value. Results obtained through these optimizers are in good consistence with TCAD simulation results.
This study uses the Lightning Attachment Procedure Optimization (LAPO) method to show how to design a digital finite impulse response (FIR) 20th order band stop filter (BSF). LAPO is a physical-based ...metaheuristic optimization algorithm. One of the main goals of filter design is the simultaneous reduction of pass band ripples and stop band ripples. The aim is to identify such ideal filter coefficients that reduce the magnitude and phase errors. Comparing the LAPO method to the Cuckoo Search Algorithm (CSA) and Particle Swarm Optimization (PSO), the comprehensive simulation results and Wilcoxon rank-sum test at 99% level of confidence demonstrate how effectively the LAPO algorithm works in determining the optimal coefficients of the digital FIR BSF. For this design, the LAPO method achieves its global best solution in 11.94 seconds which is 25.84%, 25.19% and 0.83% better as compared to time taken by PSO, CSA and Integrated Optimization Technique (IOT), respectively since LAPO technique has no parameter adjustment.
Abstract
Introduction
Integrated care is likely to improve outcomes in strained healthcare systems while limiting costs. NCD clinics were introduced under the “National Programme for Prevention and ...Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke” (NPCDCS) in India; however, there is limited literature on the costs of delivering tobacco cessation interventions within NPCDCS. One of the study’s objectives was to estimate the cost of delivering a culturally specific patient-centric behavioral intervention package in two district-level NCD clinics in Punjab, India.
Methods
Costing was undertaken using the health systems perspective. A top-down or financial costing approach and a bottom-up or activity-based approach were employed at each step of development and implementation. The opportunity cost was used to include the cost of human resources, infrastructure, and capital resources used. All infrastructure and capital costs were annualized using a 3% annual discount rate. Four additional scenarios were built up concerning three major components to reduce costs further when rolled out on a large scale.
Results
The cost of intervention package development, human resource training, and unit cost of implementation were estimated to be INR 6,47,827 (USD 8,874); INR 134,002 (USD 1810); and INR 272 (USD 3.67), respectively. Based on our sensitivity analysis results, the service delivery cost varied from INR 184 (USD 2.48) to INR 326 (USD 4.40) per patient.
Conclusion
The development costs of the intervention package accounted for the majority proportion of the total cost. Of the total unit cost of implementation, the telephonic follow-up, human resources, and capital resources were the major contributory components.
Implications
The current study aims to fill gaps by estimating the unit-level health systems cost of a culturally sensitive, disease-specific, and patient-centric tobacco cessation intervention package delivered at the outpatient settings of NCD clinics at the secondary level hospital, which represents a major link in the health care system of India. Findings from this study could be used to provide supportive evidence to policymakers and program managers for rolling out such interventions in established NCD clinics through the NPCDCS program of the Indian Government.
Fin-typed field effect transistor (FinFET) has considered a suitable device for low power and high-performance applications. The incorporation of gate dielectric lanthanum doped zirconium oxide ...(LaZrO
) in the 14 nm silicon on insulator (SOI) FinFET not only enhanced effective carrier mobility but also diminished the short channel effects (SCEs). The FinFET embodiment with LaZrO
has dwindled subthreshold swing (SS), reduced drain-induced barrier lowering (DIBL), and raised on-current to off-current ratio as a contrast to SiO
-based FinFET. A remarkable enhancement of 1.18×, 11×, and 1.3× for transconductance (
), early voltage (
), and an intrinsic gain (
), respectively, have been investigated. Further, LaZrO
-based n-FinFET and p-FinFET devices have devised with equal dimensions. The improved noise margin of 0.375 V using a single-fin FinFET-based inverter circuit has proven the acceptance of this device in a circuit application.
A physical layer enhanced secure future generation passive optical network (PON) based on chaotic signal scrambling and the secure hash algorithm (SHA) is proposed and demonstrated. In this paper, ...the architecture of a wavelength-division multiplexed orthogonal frequency division multiplexing (OFDM) PON system based on a centralized light source using direct detection is analyzed. A logistic chaos map is employed here for the scrambling of OFDM symbols in the frequency and time domains. Before transmitting the signal over optical fiber, a message- digest of scrambled and descrambled OFDM signals is computed and compared at the optical line terminal and optical network unit, respectively, to verify the actual data recovered. For the downstream channel, a 10 Gbps 32 quadrature amplitude modulation OFDM signal is successfully transmitted over a distance of 50 km single-mode fiber within the limits of the peak-to-average-power value. The results show that the proposed scheme can protect the system from bad actors and eavesdroppers, while chaos encryption with SHA-2 provides a robust and promising secure strategy for future-generation PON systems.
Now a days MEMS based for biomedical applications with high performance parameters like sensitivity and linearity are required for low pressure range.The low-pressure range (1–5 kPa) is a significant ...range that comprises intra-body pressures like intracranial pressure (ICP) and intraocular pressure (IOP).A lot of work on piezoresistive pressure sensor with different shapes diaphragms like squared, circular and rectangular has been carried out.In MEMS Piezoresistive Pressure sensors the most important pressure-sensitive component is the squared diaphragm. The performance of the Micro-sensor is directly determined, under uniform applied pressure with its deformation. In pressure sensor design, the accurate relationship between pressure and deformation plays a very consequence role. In this paper, squared diaphragm of silicon material is modeled and simulate using the analytical equations for a thin plate, along with the theory of small-deflection to providing quick insight regarding important parameter like stress and Deformation for the operating pressure range of 0 kPa–5 kPa. The mechanical behavior of micro-machined silicon diaphragm in terms of stress and deflection generation has been simulated.
The piezoresistivity principle is used to assess the sensor's sensitivity. The mechanical change in the thin diaphragm in the form of deflection and stress is calculated and presented. In this Modeling both the analytical and simulated(FEA) results for the performance parameters such as stress, Deflection and the output voltage is computed and compared, it is found that the error between analytical and simulation results is no more than 5.6–6.5%.
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