Benefits Of A Surveillance And Response System (SRS) Dashboard - The Philadelphia Water Department Experience

The Philadelphia Water Department (PWD) developed a comprehensive Surveillance and Response System (SRS) (formerly Contamination Warning System) for its drinking water system under a Water Security initiative grant from the U.S. Environmental Protection Agency. A full-scale SRS is comprised of four monitoring/surveillance components – online water quality monitoring (OWQM), enhanced security monitoring, consumer complaint surveillance, and public health surveillance, and two response components – consequence management and sampling and analysis. The integration of multiple information streams is a core element of an SRS. Taken separately, each surveillance component provides its own set of event triggers that have value for event detection. For example, OWQM data is extracted from the ClearSCADA Historian which synchronizes with OWQM station data repositories every two minutes, and is filtered through a Kisters WISKI database and the BlueBox Event Detection System where anomalous data creates alerts. However, contamination events typically involve more than one component and by comparing multiple data streams events can be more accurately validated and investigated. In this project information from four surveillance components were integrated into a centralized platform and displayed on the SRS Dashboard. Thus the Dashboard was used a) to determine whether a water contamination event has occurred and b) to activate appropriate response components, i.e. consequence management and sampling analysis. The SRS Dashboard serves as a centralized SRS event data management, incident investigation, and issue resolution platform for PWD. The SRS Dashboard provides automatic event detection, opportunity for preliminary cross-component data analysis and map display for quick response and coordination among a large group of users, including PWD, Philadelphia Department of Public Health, and other agencies. This paper provides an overview of the SRS Dashboard and presents some case studies where the dashboard was used to resolve water quality issues in the water distribution system

PENERAPAN METODE RESITASI DALAM MENINGKATKAN EFEKTIVITAS BELAJAR SISWA PADA MATA PELAJARAN QURDIS DI MTs. NEGERI 7 JEMBER

Metode rsitasi merupakan salah satu metode yang sangat urgen danmembantu terhadap siswa dalam mendalami memahami materi al qur’anhadits, dimana siswa dituntut mampu menyelesaikan tugasnya dengan jalanpemberian tugas. Penerapan metode resitasi dapat membantu guru dalammenstranfer pengetahuan qurdis kepada peserta didik dengan baik, dan siswasangat diuntungkan karena dapat membantu bagi peningkatan kemampuankognitif siswa dan life skill anak dalam kehidupannya. Motivasi juga sangatperlu ditanamkan dalam jiwa siswa, sebab dengan motivasi, akan dapatmerubah jati diri dan kepribadiannya. Setelah memperoleh berbagai ilmu danpengalaman maka selanjutnya diamalkan secara istiqomah/kontinue agar segalayang diperolehnya tidak mudah hilang dan memberikan makna yang positifbagi kehidupanny

PREVALENCE OF METABOLIC SYNDROME IN YOUNG V/S OLD APPARENTLY HEALTHY ASIAN INDIAN GUJARATI POPULATION

Introduction: The metabolic syndrome (MetS) is an epidemiological construct of different permutations of risk factors. We aimed to compare and study the overall prevalence of MetS in healthy, asymptomatic young v/s old Gujarati population. Methods: This population based- cross sectional study involved a total of 3329 healthy adults of 18-70 years of age. Clinical data such as body mass index (BMI), waist circumference (WC), blood pressure (BP) were measured along with the biochemical estimations of lipids and fasting blood glucose (FBS). The overall population was categorized in young (<40 years) and old (≥40 years) individuals. Results: The overall prevalence of MetS was 34.3% where the incidence was found to be more than double in old(45.4%) as compared to young population (20.8%, p<0.0001). The level of FBS (99.82 ± 38.49 vs 87.65 ± 19.82), HDL-C (38.94 ± 7.35 vs 37 ± 6.42) and LDL-C (129.45 ± 33.88 vs 117.39 ± 30.38) were significantly (p<0.05) higher in older population as compared to younger population. In both the age groups the prevalence of MetS was higher in males as compared to females and was majorly contributed by increased FBS level. However in old (95.6% vs 84.2) and young (84% vs 96%) females, the abnormalities of WC were significantly higher than their male counterparts. Conclusion: In summary we conclude that MetS is prevalent in Gujarati population and is subjected to age and gender. This results reinforces the need of early life style intervention and awareness programs in this ethnic group

Effect of Antiretroviral Therapy on Circulating Lipid Levels in Human Immunodeficiency Virus Infected Patients: A Cross-sectional Study

Introduction: The antiretroviral drugs have improved the quality and extent of life of Human Immunodeficiency Virus (HIV) infected patients, yet like any other long-term medication, these are known to cause several adverse effects. One such adverse effect is on the lipid metabolism in individuals on Antiretroviral Therapy (ART). Aim: To analyse the effect of ART on the circulating lipid levels in HIV patients. The secondary aim was to compare the lipid changes in patients treated with ZLN (Zidovudine+Lamivudine +Nevirapine) drug regimen against those, with TLE (Tenofovir+ Lamivudine+Efavirenz). Materials and Methods: This cross-sectional study was conducted from December 2019 to March 2021 at the District Hospital, Chamarajanagar Karnataka, India. A total of 200 HIV positive patients between 18-55 years of age with no associated co-morbidities and who have been on ART were recruited into this study. Of the total 91 patients were on TLE (Tenofovir+ Lamivudine+ Efavirenz) and 109 were on ZLN (Zidovudine+ Lamivudine+Nevirapine) regimen. Blood samples were collected from all the patients and lipid profile analysis was done. results: Statistically significant increase was observed in all lipid parameters in the ZLN group compared to TLE group. Serum Total Cholesterol (TC) {ZLN 190.92±43.57 vs 164.23±40.7 in TLE group (p-value <0.0001)} serum Low Density Lipoprotein Cholesterol (LDL-C) {ZLN 120.44±35.46 vs 100.81±26.84 in TLE group (p-value <0.0001)}, Triglyceride (TG) {ZLN 245.68±132.42 vs 171.56±77.30 in TLE group (p-value <0.0001)} and High Density Lipoprotein Cholesterol (HDL-C) {ZLN 60.71±17.51 vs 53.31±13.8 in TLE group (p-value=0.0012)}. Also the non HDL-C levels {ZLN 130.2±39.51 vs 110.91±36.87 in TLE group (p-value <0.0005)} were higher in patients receiving ZLN drug regimen than those who were on TLE. Of the 200 HIV patients, 53 were taking ART for less than five years (mean 2.51±1.12 years), 109 were receiving ART between 5-10 years (mean 7.78±1.50 years), 38 patients were on ART treatment for more than 10 years (mean 11.73±0.76 years). A positive significant association between lipid derangement and disease/ ART duration was observed. conclusion: Lipid abnormalities were more in HIV patients on ZLN drug regimen, than those on TLE regimen. The longer course of disease/ART is associated with imminent lipoprotein derangement. Periodic monitoring of lipid levels are recommended in these patients

Predictive role of fragmented QRS in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Objective: Fragmented QRS (fQRS), as defined by additional spikes in the QRS complex of a 12-lead electrocardiogram (ECG), is a marker of scarred myocardium. In patients with coronary artery disease (CAD), fQRS is a predictor of heart failure (HF) and other major adverse cardiac events (MACE). The study was aimed to evaluate the role of fQRS in prediction of HF in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: In a prospective, non-randomized, small observational study, we enrolled 188 consecutive patients with STEMI undergoing primary PCI. Patients were grouped according to the presence or absence of fQRS and their in-hospital, 1 and 6-month MACE outcomes were assessed. Results: Of the 188 patients, fQRS were noted in 92 (48.94%) patients. Patients with fQRS were more likely to have Killip class II/III/IV. Patients with fQRS had a significantly higher corrected QT interval, lower left ventricular ejection fraction (LVEF), and higher N-terminal pro brain natriuretic peptide (NT-pro BNP) at 24 hours and 48 hours compared to patients without fQRS. The in-hospital (P=0.001), 30-day (P=0.03) and 6-month (p=0.01) MACE were higher in patients with fQRS. On logistic multiple analysis, fQRS in anterior leads (OR=3.70, CI=1.68-10.02, p=0.001), fQRS in more than 2 leads (OR=5.20, CI=1.51-12.83, p=0.01), NT-proBNP (OR=1.05, CI=1.03-1.08, p=0.02) and Killip class II/III/IV were found to be significant predictors for HF hospitalization. Conclusion: Our findings suggest that fQRS can be a predictor for HF in patients with STEMI and provide a simple and readily available technique for predicting prognosis. Larger studies are required to validate these findings

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