343 results on '"Sunil Mathew"'
Search Results
302. WEAK SELF-SIMILAR SETS IN SEPARABLE COMPLETE METRIC SPACES
- Author
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Sunil Mathew and R. K. Aswathy
- Subjects
Discrete mathematics ,Weak convergence ,Self-similarity ,Applied Mathematics ,010102 general mathematics ,Invariant (physics) ,01 natural sciences ,Complete metric space ,Separable space ,010101 applied mathematics ,Metric space ,Hausdorff distance ,Modeling and Simulation ,Geometry and Topology ,0101 mathematics ,Scaling ,Mathematics - Abstract
Self-similarity is a common tendency in nature and physics. It is wide spread in geo-physical phenomena like diffusion and iteration. Physically, an object is self-similar if it is invariant under a set of scaling transformation. This paper gives a brief outline of the analytical and set theoretical properties of different types of weak self-similar sets. It is proved that weak sub self-similar sets are closed under finite union. Weak sub self-similar property of the topological boundary of a weak self-similar set is also discussed. The denseness of non-weak super self-similar sets in the set of all non-empty compact subsets of a separable complete metric space is established. It is proved that the power of weak self-similar sets are weak super self-similar in the product metric and weak self-similarity is preserved under isometry. A characterization of weak super self-similar sets using weak sub contractions is also presented. Exact weak sub and super self-similar sets are introduced in this paper and some necessary and sufficient conditions in terms of weak condensation IFS are presented. A condition for a set to be both exact weak super and sub self-similar is obtained and the denseness of exact weak super self similar sets in the set of all weak self-similar sets is discussed.
- Published
- 2017
303. On transit functions in weighted graphs
- Author
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Sunil Mathew and M. V. Dhanyamol
- Subjects
010101 applied mathematics ,Discrete mathematics ,Geodesic ,010201 computation theory & mathematics ,Mathematical analysis ,Discrete Mathematics and Combinatorics ,Interval (graph theory) ,0102 computer and information sciences ,Transit (astronomy) ,0101 mathematics ,01 natural sciences ,Convexity ,Mathematics - Abstract
Certain types of transit functions are studied in this paper. Strong intervals and strong gates are introduced. Since there are different metrics available in weighted graphs, different intervals can be studied. Strong intervals and strong convexity arising out of strong geodesics are considered and as a consequence the concept of gate is introduced. Several results related to these definitions are obtained.
- Published
- 2017
304. Calvarial tuberculosis presenting as multiple osteolytic soft tissue lesions
- Author
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Robert Patrick Selvam, Sunil Mathew, and Reddy Ravikanth
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0301 basic medicine ,medicine.medical_specialty ,Tuberculosis ,030106 microbiology ,lcsh:Medicine ,03 medical and health sciences ,0302 clinical medicine ,Button sequestrum ,medicine ,030212 general & internal medicine ,Multiple myeloma ,Primary tuberculosis ,lcsh:RT1-120 ,lcsh:Nursing ,business.industry ,lcsh:R ,Rare entity ,Soft tissue ,General Medicine ,calvarial tuberculosis ,osteolytic lesions ,medicine.disease ,multiple myeloma ,Skull ,medicine.anatomical_structure ,Radiology ,business - Abstract
Primary tuberculosis (TB) of the skull is a very rare entity scantily described in literature with 0.2%–1.3% of cases. The different radiological forms of calvarial TB described are - circumscribed lesions of the sclerotic and lytic type and diffuse TB of the cranium. Treatment for skull TB includes antituberculous therapy along with appropriate surgical intervention. Here, we present a case of calvarial TB presenting as multiple osteolytic soft tissue lesions.
- Published
- 2017
305. Special sequences in weighted graphs
- Author
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Sunil Mathew and Jill K. Mathew
- Subjects
Combinatorics ,Discrete mathematics ,Computational Mathematics ,K-ary tree ,Computational Theory and Mathematics ,Partial k-tree ,Applied Mathematics ,Comparability graph ,Gomory–Hu tree ,Pseudorandom binary sequence ,Graph ,Mathematics ,Theoretical Computer Science - Abstract
In a weighted graph, the edges are mainly classified into α, β and δ. In this paper, some sequences in weighted graphs are introduced. These concepts are based on the above classification. Characterisations of partial blocks and partial trees are obtained. It is shown that sequence of a partial tree is the zero sequence, and sequence of a partial block is a binary sequence.
- Published
- 2017
306. Generation of Patient-Specific 3D Cardiac Chamber Models for Real-Time Guidance in Cardiac Ablation Procedures
- Author
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Joyeeta Mitra Mukherjee, Dave Krum, Amit Mukherjee, Sunil Mathew, and Jasbir Sra
- Subjects
Engineering ,Cardiac electrophysiology ,business.industry ,medicine.medical_treatment ,Location systems ,Patient specific ,Cardiac Ablation ,Ablation ,Visualization ,Catheter ,Cardiac chamber ,medicine ,business ,Biomedical engineering - Abstract
Cardiac ablation is currently the standard of care for the treatment of certain types of arrythmias [1]. During this procedure, a cardiac electrophysiologist destroys the substrate needed for initiation or sustainment of the arrhythmia using a cardiac mapping and ablation catheter which is placed in the heart transvenously. Electro-anatomical mapping (EAM) tools have enabled real-time guidance and visualization of the catheter and have additional features which facilitate the procedure, such as, real-time visualization of the chamber surface, ability to tag anatomic landmarks and ablation lesions, catheter display, and activation, voltage (or scar) mapping. Herein, we report on the problem of surface reconstruction (SR) from 3D points collected by a novel mapping tool called catheter 3D location system (C3DLS). We highlight the challenges of translating available SR algorithms into a clinical system prototype and discuss our validation strategy. Lastly, we compare our SR results on clinical data to an existing clinical system.
- Published
- 2014
307. Fractals in Partial Metric Spaces
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S. Minirani and Sunil Mathew
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Uniform continuity ,Metric space ,Pure mathematics ,Injective metric space ,Metric (mathematics) ,Dimension function ,Metric map ,Equivalence of metrics ,Topology ,Mathematics ,Convex metric space - Abstract
Partial metric space is a generalisation of metric space due to non zero self-distance. In this paper, we discuss the nature of fractals in a partial metric space.
- Published
- 2014
308. Connectivity analysis and construction of cyclically balanced graphs
- Author
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N. Jicy and Sunil Mathew
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Vertex (graph theory) ,Discrete mathematics ,Vertex connectivity ,Graph theory ,0102 computer and information sciences ,01 natural sciences ,Graph ,010101 applied mathematics ,Combinatorics ,Circulant graph ,Mathematics::K-Theory and Homology ,010201 computation theory & mathematics ,Discrete Mathematics and Combinatorics ,0101 mathematics ,Connectivity ,Mathematics - Abstract
The concepts of connectivity and cyclic connectivity play an important role in weighted graph theory. The concepts of cyclic cutvertex, cyclic bridge and cyclically balanced graphs are discussed in this paper. It is proved that a vertex in a weighted graph is a cyclic cutvertex if it is a common vertex of all strong cycles with maximum strength. Also a cyclic cutvertex cannot be an endvertex in a weighted graph. A characterization of cyclically balanced graphs is obtained. Concepts of cyclic vertex connectivity and cyclic arc connectivity are also introduced.
- Published
- 2016
309. Cycle connectivity in weighted graphs
- Author
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M. S. Sunitha and Sunil Mathew
- Subjects
Discrete mathematics ,General Mathematics ,Trapezoid graph ,partial cutnode ,strong cycle ,Graph ,Combinatorics ,Indifference graph ,Weighted graph ,partial bridge ,Chordal graph ,Partial k-tree ,cycle connectivity ,Mathematics ,MathematicsofComputing_DISCRETEMATHEMATICS - Abstract
Some new connectivity concepts in weighted graphs are introduced in this article. The concepts of strong arc, partial cutnode, bridge and block are introduced. Also three different types of cycles namely locamin cycle, multimin cycle and strongest strong cycle are introduced. Partial blocks in weighted graphs are characterized using strongest paths. Also a set of necessary conditions for a weighted graph to be a partial block involving strong cycles and a sufficient condition for a weighted graph to be a partial block involving strongest strong cycles are obtained. A new connectivity parameter called cycle connectivity and a new type of weighted graphs called θ - weighted graphs are introduced and partial blocks in θ - weighted graphs are fully characterized.
- Published
- 2011
310. Partial trees in weighted graphs-I
- Author
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Sunil Mathew
- Subjects
Discrete mathematics ,Combinatorics ,strength of connectedness ,Spanning tree ,Trémaux tree ,partial tree ,partial bridge ,General Mathematics ,Weight-balanced tree ,Graph theory ,Tree (graph theory) ,Mathematics - Abstract
This paper generalizes the tree concept in Graph Theory, which plays a crucial role in many areas of science and technology. This paper also characterizes partial trees using the concept of maximum spanning trees.
- Published
- 2011
311. Malignant melanoma metastatic to the stomach and duodenum
- Author
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Vijaykumar, Malladi, C, Palanivelu, Sunil, Mathew, P S, Rajan, Kalpesh, Jani, R, Senthilkumar, S, Senthilkumaran, and Alfie J, Kavalkat
- Subjects
Aged, 80 and over ,Male ,Skin Neoplasms ,Duodenal Neoplasms ,Stomach Neoplasms ,Humans ,Melanoma ,Aged - Published
- 2005
312. Covers in the Lattice of Fuzzy Topologies - I
- Author
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T. P. Johnson and Sunil Mathew
- Subjects
Physics ,ComputingMethodologies_PATTERNRECOGNITION ,Mathematics::General Mathematics ,General Mathematics ,Lattice (order) ,ComputingMethodologies_GENERAL ,Network topology ,Topology ,Fuzzy logic - Abstract
In this paper we combine the concept of simple extensions of a fuzzy topology with closure structure of fuzzy points to give certain necessary and sufficient conditions for a fuzzy topology to have a cover in the lattice of fuzzy topologies.
- Published
- 2004
313. WSDL
- Author
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Sunil Mathew, Sameer Tyagi, James McGovern, and Michael E. Stevens
- Published
- 2003
314. ebXML
- Author
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Sunil Mathew, Michael E. Stevens, James McGovern, and Sameer Tyagi
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ebXML ,business.industry ,Computer science ,computer.file_format ,Software engineering ,business ,computer - Published
- 2003
315. JAX-RPC
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James McGovern, Sunil Mathew, Sameer Tyagi, and Michael E. Stevens
- Published
- 2003
316. Future Standards
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James McGovern, Sunil Mathew, Michael E. Stevens, and Sameer Tyagi
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- 2003
317. Introduction to Advanced Topics
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Sunil Mathew, James McGovern, Michael E. Stevens, and Sameer Tyagi
- Published
- 2003
318. JAXB
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Michael E. Stevens, Sameer Tyagi, Sunil Mathew, and James McGovern
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- 2003
319. Component-Based Service Development
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Sameer Tyagi, Michael E. Stevens, James McGovern, and Sunil Mathew
- Subjects
Computer science ,Component (UML) ,Systems engineering ,Service development - Published
- 2003
320. Service-Oriented Architecture
- Author
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James McGovern, Michael E. Stevens, Sameer Tyagi, and Sunil Mathew
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Computer science ,computer.internet_protocol ,business.industry ,Service-oriented architecture ,Software engineering ,business ,computer - Published
- 2003
321. Web Services Overview
- Author
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Michael E. Stevens, James McGovern, Sunil Mathew, and Sameer Tyagi
- Subjects
World Wide Web ,Computer science ,Web service ,computer.software_genre ,computer - Published
- 2003
322. JAXR
- Author
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Sameer Tyagi, Sunil Mathew, James McGovern, and Michael E. Stevens
- Published
- 2003
323. SOAP
- Author
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Sunil Mathew, James McGovern, Michael E. Stevens, and Sameer Tyagi
- Subjects
World Wide Web ,SOAP ,computer.internet_protocol ,Computer science ,computer - Published
- 2003
324. Java Web Service Developer Pack
- Author
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Michael E. Stevens, James McGovern, Sunil Mathew, and Sameer Tyagi
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World Wide Web ,Java ,Computer science ,Web service ,computer.software_genre ,computer ,computer.programming_language - Published
- 2003
325. Transaction Management
- Author
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Michael E. Stevens, James McGovern, Sunil Mathew, and Sameer Tyagi
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Transaction management ,Process management ,Business - Published
- 2003
326. UDDI
- Author
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Sunil Mathew, James McGovern, Michael E. Stevens, and Sameer Tyagi
- Subjects
Universal Description Discovery and Integration - Published
- 2003
327. Introduction to The Foundation
- Author
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James McGovern, Michael E. Stevens, Sameer Tyagi, and Sunil Mathew
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Engineering ,business.industry ,Foundation (engineering) ,Engineering ethics ,business - Published
- 2003
328. Introduction to The JAX APIs
- Author
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Sunil Mathew, James McGovern, Michael E. Stevens, and Sameer Tyagi
- Published
- 2003
329. Security
- Author
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Michael E. Stevens, James McGovern, Sunil Mathew, and Sameer Tyagi
- Published
- 2003
330. Evaluation and management of sudden sensorineural hearing loss in Indian naval scenario - A prospective cohort study
- Author
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Sunil Mathews, Shivanand S Dalawayi, Varun Gangwar, and Arumugam Senthil Vadivu
- Subjects
hyperbaric oxygen therapy ,idiopathic ,noise induced ,steroid ,sudden sensorineural hearing loss ,Naval Science ,Medicine - Abstract
Introduction: Sudden sensorineural hearing loss (SSNHL) is a medical emergency and if treated early, may improve chances of recovery of lost hearing. Delay in diagnosis and/or initiation of treatment may cause a permanent hearing loss. A relative lack of standardized management protocol has resulted in wide variation among various institutes for investigations and treatment of SSNHL. Aims and Objectives: To provide an overview of causes, methods of evaluation, and management of SSNHL pertaining to the Indian Naval scenario, based on cases evaluated and managed at a zonal level hospital of Indian Navy, over a period of 1 year. Materials and Methods: A prospective cohort study was conducted at the department of otorhinolaryngology at a zonal hospital of Indian Navy from January 2018 to December 2018 and subsequent follow-up until June 2019, giving a minimum follow-up of 6 months for each case. Ten cases were included in the study, evaluated, and managed and the outcomes were analyzed. Among these, six were idiopathic SSNHL (ISSNHL) cases and four were noise-induced (after small-arm firing) SSNHL cases. Results and Conclusion: Hearing outcomes were better and statistically significant for ISSNHL cases compared to noise-induced SSNHL cases. There was a strong negative correlation between the delay in initiation of treatment with improvement in hearing after treatment. The pattern of audiogram is a good predictor for recovery/no recovery, wherein flat and ascending types showed complete recovery, whereas descending type and profound hearing loss type showed no/partial recovery.
- Published
- 2020
- Full Text
- View/download PDF
331. BOUNDS FOR DIMENSION OF THE ATTRACTOR OF A SCALED IFS
- Author
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S. Minirani and Sunil Mathew
- Subjects
Discrete mathematics ,Mathematics::Dynamical Systems ,General Mathematics ,Astrophysics::Instrumentation and Methods for Astrophysics ,Minkowski–Bouligand dimension ,Dimension function ,Effective dimension ,Computer Science::Digital Libraries ,Complete metric space ,Computer Science::Graphics ,Iterated function system ,Collage theorem ,Hausdorff dimension ,Attractor ,Mathematics - Abstract
A hyperbolic iterated function system (IFS) consists of a complete metric space X together with a finite set of contraction mappings on X. In this paper, the notion of scaled IFS is defined and its existence conditions are examined. The relation between the similarity dimension of the attractors of a given homogeneous IFS and a scaled IFS and its dependency on the scaling factor are studied. A lower and upper bounds for the Hausdorff dimension of the attractor of a scaled IFS is obtained.
- Published
- 2013
332. ON SET-INDEXERS OF PATHS, CYCLES AND CERTAIN RELATED GRAPHS
- Author
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Ullas Thomas and Sunil Mathew
- Subjects
Set (abstract data type) ,Combinatorics ,Path (graph theory) ,Discrete Mathematics and Combinatorics ,Order (group theory) ,Suns in alchemy ,Mathematics - Abstract
In this paper, we mainly obtain the set-indexing number of paths and certain cycles. For a given cycle, we show that there are only two possible values for the set-indexing number of it. We have also computed the set-indexing number of fans of order atleast five. Finally we study the set-indexers of certain wheels, suns and helms and derive the set-indexing numbers of the same.
- Published
- 2012
333. Orbits and Homogeneities of Invertible Fuzzy Topological Spaces
- Author
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Sunil Mathew and Anjaly Jose
- Subjects
Discrete mathematics ,Isolated point ,Pure mathematics ,Connected space ,Topological algebra ,Topological tensor product ,Topological ring ,Topological quantum number ,Topological vector space ,Mathematics ,Zero-dimensional space - Abstract
In this paper we study �the role of invertibility on �homogeneity of a fuzzy topological space and vice-versa. In general invertibility and homogeneity need not imply each other. However there are situations under which one implies the other. �If the invertible subspace is homogeneous, �then it is proved that the parent fuzzy topological space is also homogeneous. We also investigate the properties of orbits in invertible fuzzy topological spaces and characterize them.
- Published
- 2012
334. Java Web Services Architecture
- Author
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James McGovern, Sameer Tyagi, Michael Stevens, Sunil Mathew, James McGovern, Sameer Tyagi, Michael Stevens, and Sunil Mathew
- Subjects
- Computer architecture, Java (Computer program language), Web services
- Abstract
Written by industry thought leaders, Java Web Services Architecture is a no-nonsense guide to web services technologies including SOAP, WSDL, UDDI and the JAX APIs. This book is useful for systems architects and provides many of the practical considerations for implementing web services including authorization, encryption, transactions and the future of Web Services. Covers all the standards, the JAX APIs, transactions, security, and more.
- Published
- 2003
335. Numerical simulation of traveling bubble cavitation.
- Author
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Sunil Mathew, Theo G. Keith Jr, and Efstratios Nikolaidis
- Abstract
Purpose ? The purpose is to present a new approach for studying the phenomenon of traveling bubble cavitation. Design/methodology/approach ? A flow around a rigid, 2D hydrofoil (NACA-0012) with a smooth surface is analyzed computationally. The Rayleigh-Plesset equation is numerically integrated to simulate the growth and collapse of a cavitation bubble moving in a varying pressure field. The analysis is performed for both incompressible and compressible fluid cases. Considering the initial bubble radius as a uniformly distributed random variable, the probability density function of the maximum collapse pressure is determined. Findings ? The significance of the liquid compressibility during bubble collapse is illustrated. Furthermore, it is shown that the initial size of the bubble has a significant effect on the maximum pressure generated during the bubble collapse. The maximum local pressure developed during cavitation bubble collapse is of the order of 104?atm. Research limitations/implications ? A single bubble model that does not account for the effect of neighboring bubbles is used in this analysis. A spherical bubble is assumed. Originality/value ? A new approach has been developed to simulate traveling bubble cavitation by interfacing a CFD solver for simulating a flow with a program simulating the growth and collapse of the bubble. Probabilistic analysis of the local pressure due to bubble collapse has been performed. [ABSTRACT FROM AUTHOR]
- Published
- 2006
336. Adaptation of a standardized lifestyle intervention to maximize health outcomes in adolescent metabolic and bariatric surgery patients
- Author
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Maral Misserian, Alicia Wheelington, Rashon King, Jackson Francis, M. Sunil Mathew, Marlyn A. Allicock, Bethany R. Cartwright, Adejumoke Adewunmi, Aparajita Chandrasekhar, Dhatri Polavarapu, Faisal G. Qureshi, Sarah E. Barlow, and Sarah E. Messiah
- Subjects
Adolescent ,Metabolic and bariatric surgery ,Weight loss surgery ,Lifestyle intervention ,Weight loss ,Medicine - Abstract
Abstract Background Metabolic and bariatric surgery (MBS) is safe and efficacious in treating adolescents with severe obesity. Behavioral/lifestyle programs can support successful preparation for surgery and post-MBS weight loss, but no standardized lifestyle intervention exists for adolescents. Here we describe the process of developing and adapting the Diabetes Prevention Program Group Lifestyle Balance (DPP/GLB) curriculum to support adolescents pre- and post-MBS. Methods We collected both qualitative and quantitative data from a diverse group of adolescents (N = 19, mean age 15.2 years, range 13–17, 76% female, 42% non-Hispanic Black, 41% Hispanic, 17% other). Additionally, we included data from 13 parents, all of whom were mothers. These participants were recruited from an adolescent MBS program at Children’s Health System of Texas. In an online survey, we asked participants to rank their preferences and interests in DPP/GLB content topics. We complemented these results with in-depth interviews from a subset of 10 participants. This qualitative data triangulation informed the development of the TeenLYFT lifestyle intervention program, designed to support adolescents who were completing MBS and described here. This program was adapted from adolescent and parent DPP/GLB content preferences, incorporating the social cognitive model (SCM) and the socioecological model (SEM) constructs to better cater to the needs of adolescent MBS patients. Results Adolescents’ top 3 ranked areas of content were: (1) steps to adopt better eating habits and healthier foods; (2) healthy ways to cope with stress; and (3) steps to stay motivated and manage self-defeating thoughts. Nearly all adolescent participants preferred online delivery of content (versus in-person). Mothers chose similar topics with the addition of information on eating healthy outside the home. Key themes from the adolescent qualitative interviews included familial support, body image and self-confidence, and comorbidities as key motivating factors in moving forward with MBS. Conclusions The feedback provided by both adolescents and parents informed the development of TeenLYFT, an online support intervention for adolescent MBS candidates. The adapted program may reinforce healthy behaviors and by involving parents, help create a supportive environment, increasing the likelihood of sustained behavior change. Understanding adolescent/parent needs to support weight management may also help healthcare providers improve long-term health outcomes for this patient population.
- Published
- 2024
- Full Text
- View/download PDF
337. Tracheolaryngeal Adenoid Cystic Carcinoma : The tumour that almost took her breath away
- Author
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Rajat Bajaj, Manoj M. Gopal, and Sunil Mathews
- Subjects
na ,Medicine - Abstract
NA
- Published
- 2016
- Full Text
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338. Persistent symptoms and conditions among children and adolescents hospitalised with COVID-19 illness: a qualitative study
- Author
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M Sunil Mathew, Sarah E Messiah, Luyu Xie, Jackson Francis, Sitara Weerakoon, Sumbul Shaikh, Apurva Veeraswamy, Alejandra Lozano, Weiheng He, Dhatri Polavarapu, Nabila Ahmed, and Jeffrey Kahn
- Subjects
Medicine - Abstract
Objectives There is limited in-depth research exploring persistent symptoms and conditions among children and adolescents who contracted COVID-19 illness that required hospitalisation. The main objective of this study was to conduct qualitative interviews among families who had a child hospitalised with COVID-19 illness to elucidate their child’s physical, mental and social health outcomes months after initial acute infection.Design, setting and participants A qualitative study that composed of in-depth interviews among families with a child hospitalised with COVID-19 illness in one large urban US paediatric healthcare system. Parents (N=25) were recruited from an ongoing quantitative study to estimate the prevalence of long COVID in children hospitalised with COVID-19 illness. During in-depth interviews, parents were invited to describe their child’s post-COVID-19 symptoms and experiences. Interviews were audiotaped, transcribed and coded in NVivo.Results Seven themes were identified concerning the child’s prolonged COVID-19 experiences: (1) post-traumatic stress disorder, (2) social anxiety, (3) severe symptoms on reinfection, (4) worsened pre-existing conditions, (5) lack of insurance coverage for costly treatments, (6) access and utilisation of support systems and (7) overall resilience and recovery. Four parent-specific themes were identified: (1) fear of COVID-19 unknowns, (2) mixed messaging from health information sources, (3) schools being both a support system and a hindrance and (4) desire for and access to support systems.Conclusions A subset of children who were hospitalised with COVID-19 illness are experiencing a range of serious mental health impacts related to persistent COVID-19 symptoms. Clinical and public health support strategies should be developed to support these children and their families as they reintegrate in school, social and community activities.
- Published
- 2023
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339. Relationship between teacher fidelity to an early childhood obesity prevention program and the Child care center nutrition and physical activity environment
- Author
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Priyanka Rana, Folefac D. Atem, Cynthia Lebron, M. Sunil Mathew, Ruby A. Natale, and Sarah E. Messiah
- Subjects
Childhood obesity ,Childcare centers ,Caregivers ,Nutrition ,Physical activity ,Implementation fidelity ,Medicine - Abstract
Background: Child care centers (CCC) can be strategic settings to establish healthy lifestyle behaviors through obesity prevention programs. Fidelity to the implementation of such programs is a vital evaluation component, but is often not measured. This study assessed CCC teacher fidelity to the implementation of “Healthy Caregivers, Healthy Children (HC2)”, a CCC-based obesity prevention intervention. Methods: CCCs serving low-resource, ethnically diverse families with ≥ 50 children ages 2-to-5 years old that were randomized to the HC2 intervention and that had teacher fidelity data collected (n = 9 CCC) were included in this analysis. The Environment and Policy Assessment and Observation (EPAO) tool assessed the CCC nutrition and physical activity (PA) environment at the beginning/end of the school year. Fidelity assessments were conducted in CCCs randomized to HC2 in Spring 2016 (n = 33 teachers) and 2017 (n = 39 teachers) by a trained observer. The relationship between teacher fidelity and EPAO was assessed via mixed models. Results: For every-one unit rise in teacher fidelity, EPAO nutrition increased 0.055 points (p =.006). No significant relationship was shown between teacher fidelity and EPAO PA score (p =.14). Conclusion: Teacher fidelity to obesity prevention program implementation may support a healthy CCC obesity prevention and nutrition environment but might require continued support for all components.
- Published
- 2022
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340. Prevalence of polypharmacy and associated adverse outcomes and risk factors among children with asthma in the USA: a cross-sectional study
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George L Delclos, M Sunil Mathew, Caitlin C Murphy, Luyu Xie, Andrew Gelfand, Folefac Atem, and Sarah Messiah
- Subjects
Medicine - Abstract
Objective To estimate the prevalence of polypharmacy, identify risk factors and examine related adverse outcomes in the US children with asthma.Design, setting and participants This population-based, cross-sectional study included 1776 children with asthma from the 2011–2020 National Health and Nutrition Examination Surveys.Exposures Polypharmacy is defined as taking ≥2 medications concurrently for ≥1 day over the past 30 days.Main outcomes and measures (1) Weighted prevalence estimates of polypharmacy in children with asthma; (2) asthma attacks and emergency department (ED) visits.Results The estimated prevalence of polypharmacy in the US children with asthma was 33.49% (95% CI 31.81% to 35.17%). 15.53% (95% CI 14.31% to 16.75%), 12.63% (95% CI 11.37% to 13.88%) and 5.33% (95% CI) of participants were taking 2, 3–4, and 5 prescription medications, respectively. In addition to asthma medications, the most common sources of polypharmacy included antihistamines (20.17%, 95% CI 16.07% to 24.28%), glucocorticoids (16.67%, 95% 12.57% to 20.78%), and anti-infectives (14.28%, 95% CI 10.29 to 18.28). Risk factors for the increased number of medications included age 5–11 years old (vs 1–4 years: adjusted incidence rate ratio (aIRR) 1.38, 95% CI 1.10 to 1.72), fair-to-poor health (vs excellent or very good: aIRR 1.42, 95% CI 1.05 to 1.92), or ≥6 healthcare utilisation encounters over the last year (vs 0–5 encounters: aIRR 1.45, 95% CI 1.26 to 1.66). Polypharmacy increased the odds of an asthma attack (adjusted OR (aOR) 2.80, 95% CI 1.99 to 3.93) and ED visit (aOR 2.41, 95%1.59–3.63) after adjusting for demographics, insurance and health status.Conclusions Every one in three US children with asthma experienced polypharmacy. Although it may reflect the treatment guidelines that various asthma medications are needed for maintenance therapy, our results suggested that polypharmacy increased the odds of asthma attacks or ED visits. This may be due to the concurrent use with other non-asthma medications indicating that there is an opportunity to improve medication management in children with asthma.
- Published
- 2022
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341. Pediatric Telehealth Expansion in Response to COVID-19
- Author
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Stormee Williams, Kristina Hill, Luyu Xie, M. Sunil Mathew, Ashley Ofori, Tamara Perry, Danielle Wesley, and Sarah E. Messiah
- Subjects
telehealth ,pediatric ,expansion ,COVID-19 ,healthcare ,children ,Pediatrics ,RJ1-570 - Abstract
Introduction: Telehealth utilization has been steadily increasing for the past two decades and has been recognized for its ability to access rural and underserved populations. The advent of COVID-19 in March 2020 limited the feasibility of in-person healthcare visits which in turn increased telehealth demand and use. However, the long-term impacts of COVID-19 on the telehealth sector of the healthcare industry, and particularly on pediatric healthcare volume demand and subsequent expansion, are yet to be determined.Objective and Methods: To understand the impact of COVID-19 on telehealth utilization, volume demand, and expansion in one large pediatric healthcare system serving greater Dallas-Fort Worth, Texas, data on telehealth clinic visits by month, pre-COVID and post/current-COVID were compared. A quasi-experimental pretest-posttest design analysis compared telehealth visit counts from 54 ambulatory pediatric health specialties. Pre-post new patient counts were also analyzed via chi square.Results: Total telehealth visit counts significantly increased between March–October 2019 (2,033 visits) compared to March-October 2020 (54,276 visits). Mean monthly telehealth visits increased by 6,530 visits, or 2,569.75% over the same time period (p < 0.0001). In October 2020, total telehealth visits were still 1,194.78% above 2019 levels (345 visits in 2019 vs. 4467 visits in 2020).Discussion: Results here show a substantial volume increase in telehealth-delivered pediatric healthcare and resource utilization as a response to COVID-19. This provides a template for permanent adoption of pediatric telehealth delivery post pandemic. Further investigation is needed to determine impacts upon resource allocation, processes, and general models and standard of care to assist facilities and programs to better address the needs of the pediatric populations they serve in the post-COVID era.
- Published
- 2021
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342. Impact of change in neighborhood racial/ethnic segregation on cardiovascular health in minority youth attending a park-based afterschool program.
- Author
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D'Agostino, Emily M., Patel, Hersila H., Ahmed, Zafar, Hansen, Eric, Sunil Mathew, M., Nardi, Maria I., and Messiah, Sarah E.
- Subjects
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BLOOD pressure measurement , *EXERCISE physiology , *HEALTH promotion , *EVALUATION of medical care , *PROBABILITY theory , *BODY mass index , *HEALTH equity , *EVALUATION of human services programs , *HEALTH & social status - Abstract
Research on the mechanistic factors associating racial/ethnic residential segregation with health is needed to identify effective points of intervention to ultimately reduce health disparities in youth. We examined the association of changes in racial/ethnic segregation and cardiovascular health outcomes including body mass index percentile, sum of skinfold thicknesses, systolic and diastolic blood pressure percentile, and 400 m run time in non-Hispanic Black (NHB) and Hispanic youth (n = 2,250, mean age 9.1 years, 54% male; 51% Hispanic, 49% NHB; 49% high area poverty; 25% obese) attending Fit2Play™, a multisite park-based afterschool program in Miami, Florida, USA. A series of crude and adjusted two-level longitudinal generalized linear mixed models with random intercepts for park effects were fit to assess the association of change in segregation between home and program/park site and cardiovascular health outcomes for youth who participated for up to two school years in Fit2Play™. After adjusting for individual-level factors (sex, age, time, and park-area poverty) models showed significantly greater improvements in cardiovascular health if youth attended Fit2Play™ in an area less segregated than their home area (p < 0.05 for all outcomes) except 400 m run time and diastolic blood pressure percentile in Hispanics (p<.001 and p = 0.11, respectively). Area poverty was not found to confound or significantly modify this association. These findings have implications for youth programming focused on reducing health disparities and improving cardiovascular outcomes in NHB and Hispanic youth, particularly in light of a continually expanding obesity epidemic in these groups. Parks and Recreation Departments have potential to expand geographic mobility for minorities, therein supporting the national effort to reduce health inequalities. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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343. Relationship between teacher fidelity to an early childhood obesity prevention program and the Child care center nutrition and physical activity environment.
- Author
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Rana P, Atem FD, Lebron C, Sunil Mathew M, Natale RA, and Messiah SE
- Abstract
Background: Child care centers (CCC) can be strategic settings to establish healthy lifestyle behaviors through obesity prevention programs. Fidelity to the implementation of such programs is a vital evaluation component, but is often not measured. This study assessed CCC teacher fidelity to the implementation of "Healthy Caregivers, Healthy Children (HC2)", a CCC-based obesity prevention intervention., Methods: CCCs serving low-resource, ethnically diverse families with ≥ 50 children ages 2-to-5 years old that were randomized to the HC2 intervention and that had teacher fidelity data collected (n = 9 CCC) were included in this analysis. The Environment and Policy Assessment and Observation (EPAO) tool assessed the CCC nutrition and physical activity (PA) environment at the beginning/end of the school year. Fidelity assessments were conducted in CCCs randomized to HC2 in Spring 2016 (n = 33 teachers) and 2017 (n = 39 teachers) by a trained observer. The relationship between teacher fidelity and EPAO was assessed via mixed models., Results: For every-one unit rise in teacher fidelity, EPAO nutrition increased 0.055 points (p =.006). No significant relationship was shown between teacher fidelity and EPAO PA score (p =.14)., Conclusion: Teacher fidelity to obesity prevention program implementation may support a healthy CCC obesity prevention and nutrition environment but might require continued support for all components., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)
- Published
- 2022
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