Home > Determining the Level of Agreement for Atherosclerotic Cardiovascular Disease Risk Stratification Between Coronary Artery Calcium Score and Traditional Cardiovascular Risk Models.
Determining the Level of Agreement for Atherosclerotic Cardiovascular Disease Risk Stratification Between Coronary Artery Calcium Score and Traditional Cardiovascular Risk Models.
Introduction: Estimating the risk of future cardiovascular (CV) events is an essential step in the management and prevention of cardiovascular diseases. Many cardiovascular risk tools are available such as the Framingham Risk Score (FRS), the American Heart Association/ American College of Cardiology (AHA/ACC) and the International Society of Hypertension and World Health Organization (ISH/WHO) risk charts. Regrettably, none of these tools has yet to be validated based on data from our Kenyan population. This study, therefore, sought to compare the accuracy of FRS and ACC/AHA in a Kenyan population. The risk estimates derived from the CV tools were correlated with coronary artery calcium score (CACS), a well-established reliable predictor of future risk of cardiovascular events.
Objective: Determining the level of agreement between coronary calcium score and traditional cardiovascular risk models for coronary artery disease risk stratification in a multiethnic population at a tertiary healthcare institution in Kenya.
Design: A cross-sectional study
Methods: Data were collected retrospectively from the medical records of 200 patients referred to the Radiology department for a CT coronary artery calcium score.190 patients met the inclusion criteria. Comparisons for risk stratification were made according to FRS, ACC/AHA, WHO/ISH and CACS and the agreement (Kappa) and correlation (Spearman rho) between them were calculated. Statistical significance was set at p
Results: There was poor agreement (Kappa >0.191) between CACS and the clinical CVD riskmodels in the Kenyan population studied. In relation to this, 83.6%, 81.8 % and 66.2% of the intermediate risk group according to FRS, ACC/AHA and WHO/ISH, respectively, were down-classified by CACS. Moreover, 81.6%, 84.6% and 66.7% of those who would qualify for aggressive management as per FRS, ACC/AHA, and WHO/ISH risk-based algorithms, respectively, would not qualify for the same management as per the CACS.
Conclusion: The poor agreement between CACS and these clinical CVD risk scores suggests that the clinical CVD risk tools currently used in our Kenyan population might be incorrectly stratifying CV risk in patients. This highlights the need to externally validate these CVD risk models in our population to better risk predictions and set appropriate population-wide thresholds that are essential to aid better clinical decision making.
ہمارے لئے یہ کتنا غم ناک سانحہ ہے کہ آج ہمارا قلم اس کا ماتم کرے جس کا قلم کل تک قوم و ملت کا ماتم گسار تھا، ۱۲؍ ربیع الثانی ۱۳۴۳ھ کا واقعہ ہے کہ مولوی ابوالحسنات ندوی نے اس عالم آب و گل کو خیرباد کہا، وہ ہماری کوششوں اور ندوہ اور دارالمصنفین کی تعلیم و تربیت کی سب سے بڑی کمائی تھے، ان کی موت نے ہماری علمی مجلس کو وہ صدمہ پہنچایا ہے جس کی تلافی شاید آخر وقت تک نہ ہوسکے، اب جب دن آئے تھے کہ وہ ملک و قوم کی دماغی و ذہنی رہبری کرسکیں تو یک بیک دستِ قضانے ہم سے وہ ہمارا بڑا سرمایہ چھین لیا، جس سے ہم بڑی توقع رکھتے تھے۔ مولوی ابوالحسنات ایک نہایت ہی ذہین، طباع اور بلند حوصلہ نوجوان تھے، (پٹنہ کے ضلع میں اشرف پوران کا وطن تھا، ابتدائی تعلیم اپنے وطن ہی میں حاصل کی، مجھ سے ان کی ملاقات ۱۹۱۲ء میں الہلالؔ کلکتہ میں ہوئی، میں نے ان کو جوہر قابل پاکر خود پڑھانا شروع کیا، جب کلکتہ چھوڑا تو انہیں لکھنؤ ندوہ میں بھجوا دیا۔ جہاں انہوں نے چند سال تعلیم پائی) ندوہ کی تعلیم کے بعد ۱۹۱۸ء میں وہ دارالمصنفین آئے اور آخر دم تک ان کا رشتہ اس علمی مجلس سے بندھا رہا۔ یہاں رہ کہ انہوں نے جو علمی مضامین لکھے ہیں وہ تاریخی حیثیت سے ہمیشہ یادگار اور قابل مطالعہ رہیں گے، تحریک خلافت کے سلسلہ میں ان کے مضامین نے خاص اہمیت حاصل کرلی تھی اور وہ ’’ترک و خلافت‘‘ کے نام سے کتابی صورت میں شائع ہوگئے تھے، اس کے علاوہ ہندوستان کے اسلامی مدارس پر ایک پُراز معلومات مبسوط مضمون لکھا تھا، جسے وکیل امرتسر شائع کرنے والا ہے، اس کے ساتھ ہی اورنگ زیب...
Psychosocial nurturing of children is linked with Parenting and personality development theories and child development theories too report evidences of influences of parenting on children nurturing. The purpose of this paper is to explore existing parenting styles in current literature and how these parenting styles influence upon and form the personality of the children in their early years. The paper aims to examine parenting with reference to authoritarian parenting, authoritative parenting, permissive parenting and uninvolved parenting. It discussed the expectations and responsiveness of the parents which determine their behavior and style. Through parenting, psychosocial nurturing of the children is determined and it was explained in existing literature and analyzed in Islamic teachings. The study followed a critical interpretivist method which examined the literature and conducted content analysis. The study examines the parenting concept and parenting style in Islamic teachings. Islam lays special emphasis on communication and attitude of the parents towards their children particularly in early childhood. Parenting style in Islamic teaching displays a loving and guiding mode. It is less demanding and more responsive in early years. Parenting in Islamic teaching encourages developing tolerance, harmony and peace. It shows flexibility to accept children’s dispositions and tries to discipline their inner faculties. Islamic teachings expect from parents to be responsive with love and passion. It gives children freedom to talk, walk, think and act in a carefree environment where they can become socially and emotionally strong. Parenting in Islam accepts children’s interests and attitudes with positive responses and respects their rights with warmth and love. It particularly develops moral awareness so that children can distinguish between right and wrong and also understand that they need to abide by rules and regulations. Lastly literature also reports that parenting in Islam does not allow any sort of harassment, coercion, frightening and unjust environment for the little angels.
Fossil fuels are a major contributor to the today’s world energy demand as well as greenhouse gases causing global warming. The idea to reduce the dependence on fossil fuels for a green future needs a stepwise transition from fossil fuels to renewable sources. Among the various renewable sources hydrogen is probably the most promising alternative due to its availability, high heating value per unit weight, and zero emissions. The only challenge associated with hydrogen is its safe and feasible storage. The methylcyclohexane-toluene-hydrogen (MTH) system is the one that is considered safe and economical option for hydrogen production, storage and transportation, and utilization. The dehydrogenation reaction of the MTH system is highly endothermic and requires considerable amount of heat energy at a fast rate to have high equilibrium conversions. The successful utilization of hydrogen economy based on the MTH system therefore requires a highly active, selective, and stable dehydrogenation catalyst with its associated reaction kinetics. An intensified dehydrogenation reactor design that supplies high rates of heat transfer to the catalyst bed is also desired. A comprehensive review of the literature regarding kinetics of the methylcyclohexane (MCH) dehydrogenation over Pt containing catalysts has revealed that there is no consensus among the researchers on describing the reaction mechanism, rate-determining step, and inhibition offered by a product. Different researchers have suggested different reaction chemistry and developed different kinetic rate equation. There is hardly a study on the design and simulation of an intensified dehydrogenation reactor that is capable of being used on commercial scale applications. In the present study, an attempt is made to address the discrepancies in the kinetics of the MCH dehydrogenation that exist in the literature. The experimental data of 5 different Pt containing catalysts over a wide range of operating conditions is used to conduct a detailed kinetic study of the dehydrogenation reaction. Various kinetic models are developed based on the power law, Langmuir-Hinshelwood-Hougen-Watson (LHHW), and Horiuti-Polanyi reaction mechanism. The developed kinetic model equations are analyzed both kinetically and statistically and the best fitted kinetic model for each of the catalysts is worked out. The kinetic model based on single-site LHHW kinetics where loss of first hydrogen is the rate limiting step is found appropriate in representing the data of all the catalysts. This leads to report a unified kinetic model for the methylcyclohexane dehydrogenation reaction over any Pt containing catalyst. In addition to that, a new reaction mechanism called associative adsorption of methylcyclohexane is proposed and a kinetic model equation developed based on this mechanism is found successful in representing the relevant experimental data. A 2.0 MW power plant, working on the methylcyclohexane dehydrogenation reaction to yield hydrogen gas as fuel for the power production, is proposed and simulated in Aspen Hysys. The operating conditions such as stream flowrates, temperatures, pressures, and thermal efficiency are worked out. It is found that 17.4148 kmol/h methylcyclohexane are required to produce 2.0 MW net power output. Also, it is found that there is enough energy in the exhaust gases of the turbine that can carry out the dehydrogenation reaction. Using the best-fit kinetic model and the simulation data obtained for 2.0 MW power plant, a novel reactor-heat exchanger design is mathematically modeled and simulated. The proposed reactor configuration is found highly appropriate in carrying out the dehydrogenation reaction.