BackgroundIn ST-elevation myocardial infarction (STEMI), prehospital delay is a significant factor, decreasing likelihood of revascularization and increasing mortality. Prehospital delays are substantive in Indian patients with STEMI. Our study aimed to investigate factors associated with prehospital delay in patients with STEMI.MethodsA multicentric prospective analysis was conducted at five major cardiac care referral centers in Punjab including a tertiary care teaching hospital over a period of 1 year from January 2015 to December 2015. Patients presenting with STEMI were included in the study. A structured questionnaire was used to gather patient characteristics and factors responsible for prehospital delay.ResultsOf the 619 patients included in the study, 42% presented with more than 6 h of prehospital delay. On univariate analysis, delay was significantly higher among elderly (p = 0.01), illiterate patients (p = 0.02), and patients residing in rural areas (p = 0.04). Recognizing symptoms as cardiac in origin (p < 0.001), hospital as initial medical contact, and availability of prehospital electrocardiogram (ECG) (p = 0.001) were associated with shorter delays. On multivariate analysis, prehospital delay was significant in elderly patients, initial point of care as outpatient clinic, and patients without access to prehospital ECG.ConclusionOur study concludes that demographic and socioeconomic barriers exist that impede rapid care seeking and highlights the need for utilization of prehospital ECG to decrease prehospital delay. Possibilities include, educating the public on the importance of early emergency medical services contact or creating emergency stations in rural areas with ECG capabilities. Our study also invites further research, regarding role of telemedicine to triage patients derived from prehospital ECGs to decrease prehospital delay. Keywords: STEMI, Pre-hospital ECG, Pre-hospital delay, Factors, Telemedicine.

In today's world, effective management and quick retrieval of data is an important issue. It is very challenging task to provide maximum data availability and fault tolerant data access in the distributed systems as it scales over different geographical areas. To handle this issue data has to be replicated on large number of different sites. Data replication is a practical and effective method to enhance the performance and reliability in distributed systems by making multiple copies of same data. In this paper a study is conducted to examine already proposed data replication techniques in distributed systems and we found that replication techniques are designed based on various parameters such as availability, scalability, bandwidth consumption, access time and fault tolerance etc. A comparison has been done between different replication strategies based on different parameters. The paper also discusses future work in the area of replication in the distributed systems.

Different applications of Wireless Sensor Networks (WSNs) have different expectations from the working of Medium Access Control (MAC) protocols. Some value reliability more than delay incurred while some demand a fair trade-off for the factors like: Throughput, Bit Error Rate (BER) etc. This paper evaluates the performance of Wireless Personal Area Networks (WPANs) from 802.15.4 group for WSNs with modified algorithm which helps in reducing the Medium Access Delay and Delay in reaching of the packet from one end to another end. In this paper certain modifications to existing algorithm have been proposed for reducing the Medium Access Delay and to reduce the number of packets dropped. The result comparisons on the performance parameters like: network output load, generated acknowledged traffic, media access delay, battery consumed and delay in packet transmission from one end to another end that the back-off number & exponent values used for transmission play vital role for improving the performance of WSNs as they directly affect the number of packets dropped, successfully acknowledged and Medium Access Delay.

Different applications of Wireless Sensor Networks (WSNs) have different expectations from the working of Medium Access Control (MAC) protocols. Some value reliability more than delay incurred while some demand a fair trade-off for the factors like: Throughput, Bit Error Rate (BER) etc. This paper evaluates the performance of Wireless Personal Area Networks (WPANs) from 802.15.4 group for WSNs with modi ed algorithm which helps in reducing the Medium Access Delay and Delay in reaching of the packet from one end to another end. In this paper certain modi cations to existing algorithm have been proposed for reducing the Medium Access Delay and to reduce the number of packets dropped. The result comparisons on the performance parameters like: network output load, generated acknowledged tra c, media access delay, battery consumed and delay in packet transmission from one end to another end that the back-off number & exponent values used for transmission play vital role for improving the performance of WSNs as they directly affect the number of packets dropped, successfully acknowledged and Medium Access Delay.

Organizing pneumonia form of idiopathic interstitial pneumonia characterized by lung inflammation and scarring that obstructs the small airways and air sacs of the lungs (alveoli). Organising pneumonia is defined pathologically by the presence in the distal air spaces of buds of granulation tissue progressing from fibrin exudates to loose collagen containing fibroblasts. Since organising pneumonia is a non-specific inflammatory pulmonary process, it may result from a number of causes. Pathologists may report features of organising pneumonia in association with conditions such as infectious pneumonia, lung abscess, empyema, lung cancer, bronchiectasis, broncholithiasis, chronic pulmonary fibrosis, aspiration pneumonia (giant cells and foreign bodies usually are present), adult respiratory distress syndrome, pulmonary infarction, and middle lobe syndrome. This is an interesting, yet challenging case trying to formulate a diagnosis of a patient presented with worsening of dyspnea over more than a year. The patient has history of unsuccessful treatment of eosinophilic asthma with biological agents while also on treatment with prednisone for query organizing pneumonia.