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Search Results: 1 - 10 of 365605 matches for " Joy S. Michael "
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Tuberculosis in Otorhinolaryngology: Clinical Presentation and Diagnostic Challenges
Rajiv C. Michael,Joy S. Michael
International Journal of Otolaryngology , 2011, DOI: 10.1155/2011/686894
Abstract: Tuberculosis affects all tissues of the body, although some more commonly than the others. Pulmonary tuberculosis is the most common type of tuberculosis accounting for approximately 80% of the tuberculosis cases. Tuberculosis of the otorhinolaryngeal region is one of the rarer forms of extrapulmonary tuberculosis but still poses a significant clinical and diagnostic challenge. Over three years, only five out of 121 patients suspected to have tuberculosis of the otorhinolaryngeal region (cervical adenitis excluded) had Mycobacterium tuberculosis culture-proven disease. Additional 7 had histology-proven tuberculosis. Only one patient had concomitant sputum-positive pulmonary tuberculosis. We look at the various clinical and laboratory aspects of tuberculosis of the otorhinolaryngeal region that would help to diagnose this uncommon but important form of extrapulmonary tuberculosis.
Tuberculosis in Otorhinolaryngology: Clinical Presentation and Diagnostic Challenges
Rajiv C. Michael,Joy S. Michael
International Journal of Otolaryngology , 2011, DOI: 10.1155/2011/686894
Abstract: Tuberculosis affects all tissues of the body, although some more commonly than the others. Pulmonary tuberculosis is the most common type of tuberculosis accounting for approximately 80% of the tuberculosis cases. Tuberculosis of the otorhinolaryngeal region is one of the rarer forms of extrapulmonary tuberculosis but still poses a significant clinical and diagnostic challenge. Over three years, only five out of 121 patients suspected to have tuberculosis of the otorhinolaryngeal region (cervical adenitis excluded) had Mycobacterium tuberculosis culture-proven disease. Additional 7 had histology-proven tuberculosis. Only one patient had concomitant sputum-positive pulmonary tuberculosis. We look at the various clinical and laboratory aspects of tuberculosis of the otorhinolaryngeal region that would help to diagnose this uncommon but important form of extrapulmonary tuberculosis. 1. Introduction Though Mycobacterium tuberculosis infection can occur in all tissues of the body, pulmonary tuberculosis infection is overwhelmingly the most common type of infection representing approximately 80% of all cases of tuberculosis (TB) [1]. Among the extrapulmonary tuberculoses, the most common manifestation is lymphadenitis [2]. Tuberculosis of otorhinolaryngeal region is an uncommon, but not a rare, clinical problem. The commonest otorhinolaryngeal manifestation of TB is laryngeal tuberculosis excluding cervical lymphadenitis [3]. Previous reports state that around 25–30% of patients with otorhinolaryngeal TB have concomitant pulmonary TB [4]. However, since 1990, there have been reports of cases without pulmonary tuberculosis infection. Tuberculosis of the mastoid air cells and the middle ear is the next commonest manifestation in this group. Symptoms and signs of tuberculosis of this region can mimic malignancy, and; hence, an early diagnosis is essential. Most physicians do not consider TB in the differential diagnosis of various otorhinolaryngeal symptoms, resulting in misdiagnosis and improper treatment. In addition, AIDS and other immunosuppressive diseases or treatments have increased the incidence and spectrum of tuberculosis [2]. The diagnosis of TB is mainly based on a positive mycobacterial smear and culture or the histopathological presence of a chronic/caseating granuloma. Since there are a reasonable number of differential diagnoses to a clinical presentation of tuberculosis of the otorhinolaryngeal region, we report our clinical and laboratory experience with the clinical presentation, diagnosis, and treatment of tuberculosis of the
A Pilot Study of Short-Duration Sputum Pretreatment Procedures for Optimizing Smear Microscopy for Tuberculosis
Peter Daley, Joy Sarojini Michael, Kalaiselvan S, Asha Latha, Dilip Mathai, K. R. John, Madhukar Pai
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0005626
Abstract: Background Direct sputum smear microscopy for tuberculosis (TB) lacks sensitivity for the detection of acid fast bacilli. Sputum pretreatment procedures may enhance sensitivity. We did a pilot study to compare the diagnostic accuracy and incremental yield of two short-duration (<1 hour) sputum pretreatment procedures to optimize direct smears among patients with suspected TB at a referral hospital in India. Methodology/Findings Blinded laboratory comparison of bleach and universal sediment processing (USP) pretreated centrifuged auramine smears to direct Ziehl-Neelsen (ZN) and direct auramine smears and to solid (Loweinstein-Jensen (LJ)) and liquid (BACTEC 460) culture. 178 pulmonary and extrapulmonary TB suspects were prospectively recruited during a one year period. Thirty six (20.2%) were positive by either solid or liquid culture. Direct ZN smear detected 22 of 36 cases and direct auramine smears detected 26 of 36 cases. Bleach and USP centrifugation detected 24 cases each, providing no incremental yield beyond direct smears. When compared to combined culture, pretreated smears were not more sensitive than direct smears (66.6% vs 61.1 (ZN) or 72.2 (auramine)), and were not more specific (92.3% vs 93.0 (ZN) or 97.2 (auramine). Conclusions/Significance Short duration sputum pretreatment with bleach and USP centrifugation did not increase yield as compared to direct sputum smears. Further work is needed to confirm this in a larger study and also determine if longer duration pre-treatment might be effective in optimizing smear microscopy for TB.
A whey-protein supplement increases fat loss and spares lean muscle in obese subjects: a randomized human clinical study
Joy L Frestedt, John L Zenk, Michael A Kuskowski, Loren S Ward, Eric D Bastian
Nutrition & Metabolism , 2008, DOI: 10.1186/1743-7075-5-8
Abstract: This was a randomized, double-blind, parallel-arm, 12-week study. Caloric intake was reduced 500 calories per day. Subjects consumed Prolibra or an isocaloric ready-to-mix beverage 20 minutes before breakfast and 20 minutes before dinner. Body fat and lean muscle tissue were measured by dual-energy x-ray absorptiometry (DEXA). Body weight and anthropometric measurements were recorded every 4 weeks. Blood samples were taken at the beginning and end of the study. Statistical analyses were performed on all subjects that completed (completer analysis) and all subjects that lost at least 2.25 kg of body weight (responder analysis). Within group significance was determined at P < 0.05 using a two-tailed paired t-test and between group significance was determined using one way analysis of covariance with baseline data as a covariate.Both groups lost a significant amount of weight and the Prolibra group tended to lose more weight than the control group; however the amount of weight loss was not significantly different between groups after 12 weeks. Prolibra subjects lost significantly more body fat compared to control subjects for both the completer (2.81 vs. 1.62 kg P = 0.03) and responder (3.63 vs. 2.11 kg, P = 0.01) groups. Prolibra subjects lost significantly less lean muscle mass in the responder group (1.07 vs. 2.41 kg, P = 0.02). The ratio of fat to lean loss (kg fat lost/kg lean lost) was much larger for Prolibra subjects for both completer (3.75 vs. 1.05) and responder (3.39 vs. 0.88) groups.Subjects in both the control and treatment group lost a significant amount of weight with a 500 calorie reduced diet. Subjects taking Prolibra lost significantly more body fat and showed a greater preservation of lean muscle compared to subjects consuming the control beverage. Because subjects taking Prolibra lost 6.1% of their body fat mass, and because a 5% reduction of body fat mass has been shown to reduce the risk of obesity related disease, the results have practical sign
Standing Shock Instability in Advection-Dominated Accretion Flows
Truong Le,Kent S. Wood,Michael T. Wolff,Peter A. Becker,Joy Putney
Physics , 2015,
Abstract: Depending on the values of the energy and angular momentum per unit mass in the gas supplied at large radii, inviscid advection-dominated accretion flows can display velocity profiles with either pre-shock deceleration or pre-shock acceleration. Nakayama has shown that these two types of flow configurations are expected to have different stability properties. By employing the Chevalier & Imamura linearization method and the Nakayama instability boundary conditions, we discover that there are regions of parameters space where disk/shocks with outflows can be stable or unstable. In region of instability, we find that pre-shock deceleration is always unstable to the zeroth mode with zero frequency of oscillation, but is always stable to the fundamental and overtones. Furthermore, we also find that pre-shock acceleration is always unstable to the zeroth mode, and that the fundamental and overtones become increasingly less stable as the shock location moves away from the horizon when the disk half-height expands above $\sim 12$ gravitational radii at the shock radius. In region of stability, we demonstrate the zeroth mode to be stable for the velocity profiles that exhibit pre-shock acceleration and deceleration. Moreover, for models that are linearly unstable, our model suggests the possible existence of QPOs with ratios 2:3 and 3:5. These ratios are believed to occur in stellar and supermassive black hole candidates, for example in GRS 1915+105 and Sgr A*, respectively. We expect similar QPO ratios also exist in region of stable shocks.
The Pathogenic Mechanism of the Mycobacterium ulcerans Virulence Factor, Mycolactone, Depends on Blockade of Protein Translocation into the ER
Belinda S. Hall,Kirsti Hill,Michael McKenna,Joy Ogbechi,Stephen High,Anne E. Willis,Rachel E. Simmonds
PLOS Pathogens , 2014, DOI: doi/10.1371/journal.ppat.1004061
Abstract: Infection with Mycobacterium ulcerans is characterised by tissue necrosis and immunosuppression due to mycolactone, the necessary and sufficient virulence factor for Buruli ulcer disease pathology. Many of its effects are known to involve down-regulation of specific proteins implicated in important cellular processes, such as immune responses and cell adhesion. We have previously shown mycolactone completely blocks the production of LPS-dependent proinflammatory mediators post-transcriptionally. Using polysome profiling we now demonstrate conclusively that mycolactone does not prevent translation of TNF, IL-6 and Cox-2 mRNAs in macrophages. Instead, it inhibits the production of these, along with nearly all other (induced and constitutive) proteins that transit through the ER. This is due to a blockade of protein translocation and subsequent degradation of aberrantly located protein. Several lines of evidence support this transformative explanation of mycolactone function. First, cellular TNF and Cox-2 can be once more detected if the action of the 26S proteasome is inhibited concurrently. Second, restored protein is found in the cytosol, indicating an inability to translocate. Third, in vitro translation assays show mycolactone prevents the translocation of TNF and other proteins into the ER. This is specific as the insertion of tail-anchored proteins into the ER is unaffected showing that the ER remains structurally intact. Fourth, metabolic labelling reveals a near-complete loss of glycosylated and secreted proteins from treated cells, whereas cytosolic proteins are unaffected. Notably, the profound lack of glycosylated and secreted protein production is apparent in a range of different disease-relevant cell types. These studies provide a new mechanism underlying mycolactone's observed pathological activities both in vitro and in vivo. Mycolactone-dependent inhibition of protein translocation into the ER not only explains the deficit of innate cytokines, but also the loss of membrane receptors, adhesion molecules and T-cell cytokines that drive the aetiology of Buruli ulcer.
Area and Speed Efficient Implementation of Symmetric FIR Digital Filter through Reduced Parallel LUT Decomposed DA Approach  [PDF]
S. C. Prasanna, S. P. Joy Vasantha Rani
Circuits and Systems (CS) , 2016, DOI: 10.4236/cs.2016.78121
Abstract: This brief proposes an area and speed efficient implementation of symmetric finite impulse response (FIR) digital filter using reduced parallel look-up table (LUT) distributed arithmetic (DA) based approach. The complexity lying in the realization of FIR filter is dominated by the multiplier structure. This complexity grows further with filter order, which results in increased area, power, and reduced speed of operation. The speed of operation is improved over multiply-accumulate approach using multiplier less conventional DA based design and decomposed DA based design. Both the structure requires B clock cycles to get the filter output for the input width of B, which limits the speed of DA structure. This limitation is addressed using parallel LUTs, called high speed DA FIR, at the expense of additional hardware cost. With large number of taps, the number of LUTs and its size also becomes large. In the proposed method, by exploiting coefficient symmetry property, the number of LUTs in the decomposed DA form is reduced by a factor of about 2. This proposed approach is applied in high speed DA based FIR design, to obtain area and speed efficient structure. The proposed design offers around 40% less area and 53.98% less slice-delay product (SDP) than the high throughput DA based structure when it’s implemented over Xilinx Virtex-5 FPGA device-XC5VSX95T-1FF1136 for 16-tap symmetric FIR filter. The proposed design on the same FPGA device, supports up to 607 MHz input sampling frequency, and offers 60.5% more speed and 67.71% less SDP than the systolic DA based design.
The triple combination of tenofovir, emtricitabine and efavirenz shows synergistic anti-HIV-1 activity in vitro: a mechanism of action study
Joy Y Feng, John K Ly, Florence Myrick, Derrick Goodman, Kirsten L White, Evguenia S Svarovskaia, Katyna Borroto-Esoda, Michael D Miller
Retrovirology , 2009, DOI: 10.1186/1742-4690-6-44
Abstract: In this study, we demonstrated the combinations of TFV+FTC, TFV+EFV, FTC+EFV, and TFV+FTC+EFV synergistically inhibit HIV replication in cell culture and synergistically inhibit HIV-1 reverse transcriptase (RT) catalyzed DNA synthesis in biochemical assays. Several different methods were applied to define synergy including median-effect analysis, MacSynergy?II and quantitative isobologram analysis. We demonstrated that the enhanced formation of dead-end complexes (DEC) by HIV-1 RT and TFV-terminated DNA in the presence of FTC-triphosphate (TP) could contribute to the synergy observed for the combination of TFV+FTC, possibly through reduced terminal NRTI excision. Furthermore, we showed that EFV facilitated efficient formation of stable, DEC-like complexes by TFV- or FTC-monophosphate (MP)-terminated DNA and this can contribute to the synergistic inhibition of HIV-1 RT by TFV-diphosphate (DP)+EFV and FTC-TP+EFV combinations.This study demonstrated a clear correlation between the synergistic antiviral activities of TFV+FTC, TFV+EFV, FTC+EFV, and TFV+FTC+EFV combinations and synergistic HIV-1 RT inhibition at the enzymatic level. We propose the molecular mechanisms for the TFV+FTC+EFV synergy to be a combination of increased levels of the active metabolites TFV-DP and FTC-TP and enhanced DEC formation by a chain-terminated DNA and HIV-1 RT in the presence of the second and the third drug in the combination. This study furthers the understanding of the longstanding observations of synergistic anti-HIV-1 effects of many NRTI+NNRTI and certain NRTI+NRTI combinations in cell culture, and provides biochemical evidence that combinations of anti-HIV agents can increase the intracellular drug efficacy, without increasing the extracellular drug concentrations.Combination of anti-HIV agents has long been an indispensable tool in fighting the AIDS epidemic. Combination of drugs from different classes has proven to be beneficial in terms of sustained efficacy and long-term safety,
Error Estimations, Error Computations, and Convergence Rates in FEM for BVPs  [PDF]
Karan S. Surana, A. D. Joy, J. N. Reddy
Applied Mathematics (AM) , 2016, DOI: 10.4236/am.2016.712120
Abstract: This paper presents derivation of a priori error estimates and convergence rates of finite element processes for boundary value problems (BVPs) described by self adjoint, non-self adjoint, and nonlinear differential operators. A posteriori error estimates are discussed in context with local approximations in higher order scalar product spaces. A posteriori error computational framework (without the knowledge of theoretical solution) is presented for all BVPs regardless of the method of approximation employed in constructing the integral form. This enables computations of local errors as well as the global errors in the computed finite element solutions. The two most significant and essential aspects of the research presented in this paper that enable all of the features described above are: 1) ensuring variational consistency of the integral form(s) resulting from the methods of approximation for self adjoint, non-self adjoint, and nonlinear differential operators and 2) choosing local approximations for the elements of a discretization in a subspace of a higher order scalar product space that is minimally conforming, hence ensuring desired global differentiability of the approximations over the discretizations. It is shown that when the theoretical solution of a BVP is analytic, the a priori error estimate (in the asymptotic range, discussed in a later section of the paper) is independent of the method of approximation or the nature of the differential operator provided the resulting integral form is variationally consistent. Thus, the finite element processes utilizing integral forms based on different methods of approximation but resulting in VC integral forms result in the same a priori error estimate and convergence rate. It is shown that a variationally consistent (VC) integral form has best approximation property in some norm, conversely an integral form with best approximation property in some norm is variationally consistent. That is best approximation property of the integral form and the VC of the integral form is equivalent, one cannot exist without the other, hence can be used interchangeably. Dimensional model problems consisting of diffusion equation, convection-diffusion equation, and Burgers equation described by self adjoint, non-self adjoint, and nonlinear differential operators are considered to present extensive numerical studies using Galerkin method with weak form (GM/WF) and least squares process (LSP) to determine computed convergence rates of various error norms and present comparisons with the theoretical convergence rates.
Enhancement in Channel Equalization Using Particle Swarm Optimization Techniques  [PDF]
D. C. Diana, S. P. Joy Vasantha Rani
Circuits and Systems (CS) , 2016, DOI: 10.4236/cs.2016.712336
Abstract: This work proposes an improved inertia weight update method and position update method in Particle Swarm Optimization (PSO) to enhance the convergence and mean square error of channel equalizer. The search abilities of PSO are managed by the key parameter Inertia Weight (IW). A higher value leads to global search whereas a smaller value shifts the search to local which makes convergence faster. Different approaches are reported in literature to improve PSO by modifying inertia weight. This work investigates the performance of the existing PSO variants related to time varying inertia weight methods and proposes new strategies to improve the convergence and mean square error of channel equalizer. Also the position update method in PSO is modified to achieve better convergence in channel equalization. The simulation presents the enhanced performance of the proposed techniques in transversal and decision feedback models. The simulation results also analyze the superiority in linear and nonlinear channel conditions.
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