IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India.

BACKGROUND: India accounts for 13.3% of global disability-adjusted life years (DALYs) lost due to stroke with a relatively younger age of onset compared to the Western population. In India's public healthcare system, many stroke patients seek care at tertiary-level government-funded medical colleges where an optimal level of stroke care is expected. However, there are no studies from India that have assessed the quality of stroke care, including infrastructure, imaging facilities, or the availability of stroke care units in medical colleges. AIM: This study aimed to understand the existing protocols and management of acute stroke care across 22 medical colleges in India, as part of the baseline assessment of the ongoing IMPETUS stroke study. METHODS: A semi-structured quantitative pre-tested questionnaire, developed based on review of literature and expert discussion, was mailed to 22 participating sites of the IMPETUS stroke study. The questionnaire assessed comprehensively all components of stroke care, including human resources, emergency system, in-hospital care, and secondary prevention. A descriptive analysis of their status was undertaken. RESULTS: In the emergency services, limited stroke helpline numbers, 3/22 (14%); prenotification system, 5/22 (23%); and stroke-trained physicians were available, 6/22 (27%). One-third of hospitals did not have on-call neurologists. Although non-contrast computed tomography (NCCT) was always available, 39% of hospitals were not doing computed tomography (CT) angiography and 13/22 (59%) were not doing magnetic resonance imaging (MRI) after routine working hours. Intravenous thrombolysis was being done in 20/22 (91%) hospitals, but 36% of hospitals did not provide it free of cost. Endovascular therapy was available only in 6/22 (27%) hospitals. The study highlighted the scarcity of multidisciplinary stroke teams, 8/22 (36%), and stroke units, 7/22 (32%). Lifesaving surgeries like hematoma evacuation, 11/22 (50%), and decompressive craniectomy, 9/22 (41%), were performed in limited numbers. The availability of occupational therapists, speech therapists, and cognitive rehabilitation was minimal. CONCLUSION: This study highlighted the current status of acute stroke management in publicly funded tertiary care hospitals. Lack of prenotification, limited number of stroke-trained physicians and neurosurgeons, relatively lesser provision of free thrombolytic agents, limited stroke units, and lack of rehabilitation services are areas needing urgent attention by policymakers and creation of sustainable education models for uniform stroke care by medical professionals across the country.

Scientific advisory on nocturnal hypoglycemia in insulin-treated patients with diabetes: Recommendations from Indian experts.

INTRODUCTION: Insulin is one of the commonly prescribed glucose lowering agents in diabetes. Hypoglycemia is the most common complication, and severe hypoglycemia is the most serious complication of insulin therapy. Almost half of all severe hypoglycemia episodes (HEs) occur at night. However, patients are often unaware of their nocturnal hypoglycaemia (NH) risk. Additionally, both healthcare professionals and patients find it difficult to manage NH. The purpose of this expert group meeting is to improve NH awareness and provide guidance for the physicians to recognize and manage NH. METHOD: The panel of experts in an e-board deliberated extensively upon the available literature and guidelines on hypoglycemia and NH discussed the consensus on definition, detection, reporting, monitoring, treatment, and optimization of therapy in NH. RESULT: & Conclusion: Though there are many guidelines on the management of HEs in patients with diabetes, very few touch the topic of NH. This scientific advisory on management of NH in insulin treated patients with diabetes is formulated to address this gap in understanding regarding management of NH. The experts provide recommendations for the nocturnal window, defining NH based on blood glucose values, recognition, prevention and management of NH.

Evaluating the Impact of Nitrogen Application on Growth and Productivity of Maize Under Control Conditions.

Climatic conditions significantly affect the maize productivity. Among abiotic factors, nitrogen (N) fertilizer and temperature are the two important factors which dominantly affect the maize (Zea mays L.) production during the early crop growth stages. Two experiments were conducted to determine the impact of N fertilizer and temperature on the maize growth and yield. In the first experiment, the maize hybrids were screened for their sensitivity to temperature variations. The screening was based on the growth performance of the hybrids under three temperatures (T 1 = ambient open-air temperature, T 2 = 1°C higher than the ambient temperature, and T 3 = 1°C lower than the ambient temperature) range. The results showed that an increase in temperature was resulted less 50% emergence and mean emergence (4.1 and 6.3 days, respectively), while emergence energy and full emergence were higher (25.4 and 75.2%, respectively) under the higher temperature exposure. The results showed that Syngenta 7720 and Muqabla S 25W87 were temperature tolerant and sensitive maize hybrids, respectively. The second experiment was carried out to study the response of the two selected maize hybrids (Syngenta 7720 and Muqabla S 25W87) to four N fertilizer applications. The results revealed that the maximum N use efficiency (19.5 kg kg-1) was achieved in maize hybrids with low N application (75 kg N ha-1 equivalent to 1.13 g N plant-1). However, the maximum maize grain yield (86.4 g plant-1), dry weight (203 g plant-1), and grain protein content (15.0%) were observed in maize hybrids that were grown with the application of 300 kg N ha-1 (equivalent to 4.52 g N plant-1). Therefore, it is recommended that the application of 300 kg N ha-1 to temperature tolerant maize hybrid may be considered best agricultural management practices for obtaining optimum maize grain yield under present changing climate.

Unravelling the utility of modern sulfonylureas from cardiovascular outcome trials and landmark trials: expert opinion from an international panel.

AIM: The primary objective of this review is to develop practice-based expert group opinions on the cardiovascular (CV) safety and utility of modern sulfonylureas (SUs) in cardiovascular outcome trials (CVOTs). BACKGROUND: The United States Food and Drug Administration issued new guidance to the pharmaceutical industry in 2008 regarding the development of new antihyperglycemic drugs. The guidance expanded the scope for the approval of novel antihyperglycemic drugs by mandating CVOTs for safety. A few long-term CVOTs on dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors have been completed, while others are ongoing. SUs, which constitute one of the key antihyperglycemic agents used for the management of type 2 diabetes mellitus (T2DM), have been used as comparator agents in several CVOTs. However, the need for CVOTs on modern SUs remains debatable. In this context, a multinational group of endocrinologists convened for a meeting and discussed the need for CVOTs of modern SUs to evaluate their utility in the management of patients with T2DM. At the meeting, CVOTs of modern SUs conducted to date and the hypotheses derived from the results of these trials were discussed. REVIEW RESULTS: The expert group analyzed the key trials emphasizing the CV safety of modern SUs and also reviewed the results of various CVOTs in which modern SUs were used as comparators. Based on literature evidence and individual clinical insights, the expert group opined that modern SUs are cardiosafe and that since they have been used as comparators in other CVOTs, CVOTs of SUs are not required. CONCLUSION: Modern SUs can be considered a cardiosafe option for the management of patients with diabetes mellitus and CV disease; thus CVOTs among individuals with T2DM are not required.

Behavior-driven arc expression is reduced in all ventral hippocampal subfields compared to CA1, CA3, and dentate gyrus in rat dorsal hippocampus.

Anatomical connectivity and lesion studies reveal distinct functional heterogeneity along the dorsal-ventral axis of the hippocampus. The immediate early gene Arc is known to be involved in neural plasticity and memory and can be used as a marker for cell activity that occurs, for example, when hippocampal place cells fire. We report here, that Arc is expressed in a greater proportion of cells in dorsal CA1, CA3, and dentate gyrus (DG), following spatial behavioral experiences compared to ventral hippocampal subregions (dorsal CA1 = 33%; ventral CA1 = 13%; dorsal CA3 = 23%; ventral CA3 = 8%; and dorsal DG = 2.5%; ventral DG = 1.2%). The technique used here to obtain estimates of numbers of behavior-driven cells across the dorsal-ventral axis, however, corresponds quite well with samples from available single unit recording studies. Several explanations for the two- to-threefold reduction in spatial behavior-driven cell activity in the ventral hippocampus can be offered. These include anatomical connectivity differences, differential gain of the self-motion signals that appear to alter the scale of place fields and the proportion of active cells, and possibly variations in the neuronal responses to non-spatial information within the hippocampus along its dorso-ventral axis.

Developing indicators for evaluation of age-friendly communities in Canada: process and results. / Élaboration d'indicateurs pour l'évaluation des collectivités-amies des aînés au Canada : démarche et résultats.

INTRODUCTION: In 2006, the World Health Organization launched the Global Age-Friendly Cities Project to support active aging. Canada has a large number of age-friendly initiatives; however, little is known about the effectiveness and outcomes of age-friendly community (AFC) initiatives. In addition, stakeholders report that they lack the capacity and tools to develop and conduct evaluations of their AFC initiatives. In order to address these gaps, the Public Health Agency of Canada developed indicators to support the evaluation of AFC initiatives relevant to a wide range of Canadian communities. These indicators meet the varied needs of communities, but are not designed to evaluate collective impact or enable crosscommunity comparisons. METHODS: An evidence-based, iterative consultation approach was used to develop indicators for AFCs. This involved a literature review and an environmental scan. Two rounds of key expert and stakeholder consultations were conducted to rate potential indicators according to their importance, actionability and feasibility. A final list of indicators and potential measures were developed based on results from these consultations, as well as key policy considerations. RESULTS: Thirty-nine indicators emerged across eight AFC domains plus four indicators related to long-term health and social outcomes. All meet the intended purpose of evaluating AFC initiatives at the community level. A user-friendly guide is available to support and share this work. CONCLUSION: The AFC indicators can help communities evaluate age-friendly initiatives, which is the final step in completing a cycle of the Pan-Canadian AFC milestones. Communities are encouraged to use the evaluation results to improve their AFC initiatives, thereby benefiting a broad range of Canadians.

INTRODUCTION: En 2006, l'Organisation mondiale de la Santé (OMS) a lancé le projet mondial « Villes-amies des aînés ¼ afin de favoriser un vieillissement actif. Si un grand nombre d'initiatives « amies des aînés ¼ ont été mises en oeuvre au Canada, on dispose de peu d'information sur l'efficacité et les résultats des initiatives des collectivités-amies des aînés (CAA). En outre, les intervenants affirment qu'ils n'ont pas la capacité et les outils nécessaires pour élaborer et réaliser des évaluations relatives à leurs initiatives de CAA. Afin de pallier ces lacunes, l'Agence de la santé publique du Canada a mis au point des indicateurs pour l'évaluation des initiatives de CAA dans de nombreuses collectivités canadiennes. Ces indicateurs, destinés à répondre aux différents besoins des collectivités, ne sont pas conçus pour faire l'évaluation de répercussions collectives ou pour rendre possible une comparaison entre collectivités. MÉTHODOLOGIE: Une démarche de consultation itérative fondée sur des données probantes a été employée pour l'élaboration d'indicateurs relatifs aux CAA. Elle a nécessité une revue de la littérature et une analyse du contexte. Deux rondes de consultation auprès d'experts et d'intervenants clés ont été menées, ce qui a permis de classer les indicateurs potentiels en fonction de leur importance, de leur capacité à être mis en pratique et de leur faisabilité. Une liste définitive d'indicateurs et de mesures potentielles a ensuite été mise au point, en fonction des résultats de ces consultations et de considérations clés relatives aux politiques. RÉSULTATS: Trente-neuf indicateurs répartis en huit domaines relevant des CAA et quatre indicateurs relevant des résultats liés à la santé et aux conditions sociales à long terme ont été sélectionnés. Tous sont conformes à l'objectif énoncé, à savoir l'évaluation des initiatives de CAA à l'échelon local. Un guide convivial est disponible pour soutenir et diffuser ce travail. CONCLUSION: Les indicateurs de CAA sont susceptibles d'aider les collectivités à procéder à l'évaluation de leurs initiatives amies des aînés, ce qui constitue la dernière étape du cycle des jalons pancanadiens des CAA. Les collectivités sont en effet encouragées à améliorer leurs initiatives amies des aînés à partir de l'évaluation de leurs résultats, afin d'en faire profiter un large éventail de Canadiens.

Nonuniform allocation of hippocampal neurons to place fields across all hippocampal subfields.

The mechanisms governing how the hippocampus selects neurons to exhibit place fields are not well understood. A default assumption in some previous studies was the uniform random draw with replacement (URDWR) model, which, theoretically, maximizes spatial "pattern separation", and predicts a Poisson distribution of the numbers of place fields expressed by a given cell per unit area. The actual distribution of mean firing rates exhibited by a population of hippocampal neurons, however, is approximately exponential or log-normal in a given environment and these rates are somewhat correlated across multiple places, at least under some conditions. The advantage of neural activity-dependent immediate-early gene (IEG) analysis, as a proxy for electrophysiological recording, is the ability to obtain much larger samples of cells, even those whose activity is so sparse that they are overlooked in recording studies. Thus, a more accurate representation of the activation statistics can potentially be achieved. Some previous IEG studies that examined behavior-driven IEG expression in CA1 appear to support URDWR. There was, however, in some of the same studies, an under-recruitment of dentate gyrus granule cells, indicating a highly skewed excitability distribution, which is inconsistent with URDWR. Although it was suggested that this skewness might be related to increased excitability of recently generated granule cells, we show here that CA1, CA3, and subiculum also exhibit cumulative under-recruitment of neurons. Thus, a highly skewed excitability distribution is a general principle common to all major hippocampal subfields. Finally, a more detailed analysis of the frequency distributions of IEG intranuclear transcription foci suggests that a large fraction of hippocampal neurons is virtually silent, even during sleep. Whether the skewing of the excitability distribution is cell-intrinsic or a network phenomenon, and the degree to which this excitability is fixed or possibly time-varying are open questions for future studies. © 2016 Wiley Periodicals, Inc.

Technical aspects of endobronchial ultrasound-guided transbronchial needle aspiration: CHEST guideline and expert panel report

BACKGROUND: Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians. METHODS: Rigorous methodology has been applied to provide a trustworthy evidence-based guideline and expert panel report. A group of approved panelists developed key clinical questions by using the PICO (population, intervention, comparator, and outcome) format that addressed specific topics on the technical aspects of EBUS-TBNA. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature, which was supplemented by manual searches. References were screened for inclusion, and well-recognized document evaluation tools were used to assess the quality of included studies, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion. RESULTS: Our systematic review and critical analysis of the literature on 15 PICO questions related to the technical aspects of EBUS-TBNA resulted in 12 tatements: 7 evidence-based graded recommendations and 5 ungraded consensus-based statements. Three questions did not have sufficient evidence to generate a statement. CONCLUSIONS: Evidence on the technical aspects of EBUS-TBNA varies in strength but is satisfactory in certain areas to guide clinicians on the best conditions to perform EBUS-guided tissue sampling. Additional research is needed to enhance our knowledge regarding the optimal performance of this effective procedure.(AU)

A founder mutation p.H701P identified as a major cause of SPG7 in Norway.

BACKGROUND AND PURPOSE: SPG7 is one of the most common forms of autosomal recessive hereditary spastic paraplegia. The phenotype has been shown to be heterogeneous, varying from a complex spastic ataxia to pure spastic paraplegia or pure ataxia. The aim of this study was to clinically and genetically characterize patients with SPG7 in Norway. METHODS: Six Norwegian families with a clinical diagnosis of hereditary spastic paraplegia were diagnosed with SPG7 through Sanger sequencing and whole-exome sequencing. Haplotypes were established to identify a possible founder mutation. All patients were thoroughly examined and the clinical and molecular findings are described. RESULTS: The core phenotype was spastic paraparesis with ataxia, bladder disturbances and progressive external ophthalmoplegia. The variant p.H701P was identified in homozygous state in one family and in compound heterozygous state in three families. Haplotype analysis of seven surrounding single nucleotide polymorphisms supports that this variant resides on a founder haplotype. Four of the families were compound heterozygous for the previously well-described p.A510V variant. CONCLUSION: SPG7 is a common subgroup of hereditary spinocerebellar disorders in Norway. The broad phenotype in the Norwegian SPG7 population illustrates the challenges with the traditional dichotomous classification of hereditary spinocerebellar disorders into hereditary spastic paraplegia or hereditary ataxia. A Norwegian founder mutation p.H701P was identified in four out of six families, making it a major cause of SPG7 in Norway.

Two cases of acute severe flaccid myelitis associated with enterovirus D68 infection in children, Norway, autumn 2014.

Enterovirus D68 (EV-D68), phylogenetic clade B was identified in nasopharyngeal specimens of two cases of severe acute flaccid myelitis. The cases were six and five years-old and occurred in September and November 2014. EV-D68 is increasingly associated with acute flaccid myelitis in children, most cases being reported in the United States. Awareness of this possible neurological complication of enterovirus D68 infection is needed.

The effect of vildagliptin relative to sulphonylureas in Muslim patients with type 2 diabetes fasting during Ramadan: the VIRTUE study.

AIMS: To assess, in a real-world setting, the effect of vildagliptin compared with sulphonylurea (SU) treatment on hypoglycaemia in Muslim patients with type 2 diabetes mellitus (T2DM) fasting during Ramadan. METHODS: This multinational, non-interventional study, conducted in Asia and the Middle East, included Muslim adult patients with T2DM who received treatment with vildagliptin or SU as add-on to metformin or monotherapy. During a ~16-week observation period, data were collected up to 6 weeks before and 6 weeks after Ramadan fasting. The primary study objective was to compare the proportion of patients with ≥ 1 hypoglycaemic event (HE) during fasting. RESULTS: Of > 1300 patients enrolled in the study, 684 were treated with vildagliptin and 631 with SUs. Significantly fewer patients experienced ≥ 1 HE with vildagliptin compared with those receiving SUs (5.4% vs. 19.8%, respectively; p < 0.001); no vildagliptin-treated patients reported a grade 2 HE, vs. 4 SU-treated patients (p = 0.053). Mean HbA1c changes from baseline were vildagliptin: -0.24%, SUs: +0.02% (p < 0.001). Mean body weight reductions from baseline were vildagliptin: -0.76 kg, SUs: -0.13 kg (p < 0.001). A higher proportion of SU-treated patients experienced adverse events (AEs) compared with vildagliptin (22.8% vs. 10.2%). This difference was driven by hypoglycaemia as the most common AE. CONCLUSIONS: In this real-world study of fasting Muslim patients with T2DM, vildagliptin was associated with significantly fewer hypoglycaemic episodes compared with SU therapy. This outcome is particularly meaningful when viewed in the context of good glycaemic and weight control observed in vildagliptin-treated patients. Vildagliptin was well tolerated in this patient population.

Coexistence of allergic bronchopulmonary aspergillosis and allergic aspergillus sinusitis in a patient without clinical asthma.

All patients with prolonged cough with a history of atopy, even if not clinically asthmatic, should be evaluated for allergic bronchopulmonary aspergillosis (ABPA); also, we suspect that we may miss the early diagnosis of ABPA if bronchial asthma is considered as a major criteria for the diagnosis of ABPA.

Age-related changes in Arc transcription and DNA methylation within the hippocampus.

The transcription of genes that support memory processes are likely to be impacted by the normal aging process. Because Arc is necessary for memory consolidation and enduring synaptic plasticity, we examined Arc transcription within the aged hippocampus. Here, we report that Arc transcription is reduced within the aged hippocampus compared to the adult hippocampus during both "off line" periods of rest, and following spatial behavior. This reduction is observed within ensembles of CA1 "place cells", which make less mRNA per cell, and in the dentate gyrus (DG) where fewer granule cells are activated by behavior. In addition, we present data suggesting that aberrant changes in methylation of the Arc gene may be responsible for age-related decreases in Arc transcription within CA1 and the DG. Given that Arc is necessary for normal memory function, these subregion-specific epigenetic and transcriptional changes may result in less efficient memory storage and retrieval during aging.

Hippocampal granule cells opt for early retirement.

Increased excitability and plasticity of adult-generated hippocampal granule cells during a critical period suggests that they may "orthogonalize" memories according to time. One version of this "temporal tag" hypothesis suggests that young granule cells are particularly responsive during a specific time period after their genesis, allowing them to play a significant role in sculpting CA3 representations, after which they become much less responsive to any input. An alternative possibility is that the granule cells active during their window of increased plasticity, and excitability become selectively tuned to events that occurred during that time and participate in later reinstatement of those experiences, to the exclusion of other cells. To discriminate between these possibilities, rats were exposed to different environments at different times over many weeks, and cell activation was subsequently assessed during a single session in which all environments were revisited. Dispersing the initial experiences in time did not lead to the increase in total recruitment at reinstatement time predicted by the selective tuning hypothesis. The data indicate that, during a given time frame, only a very small number of granule cells participate in many experiences, with most not participating significantly in any. Based on these and previous data, the small excitable population of granule cells probably correspond to the most recently generated cells. It appears that, rather than contributing to the recollection of long past events, most granule cells, possibly 90-95%, are effectively "retired." If granule cells indeed sculpt CA3 representations (which remains to be shown), then a possible consequence of having a new set of granule cells participate when old memories are reinstated is that new representations of these experiences might be generated in CA3. Whatever the case, the present data may be interpreted to undermine the standard "orthogonalizer" theory of the role of the dentate gyrus in memory.

Non-alcoholic fatty liver disease (NAFLD)--the hepatic component of metabolic syndrome.

AIMS: To study the prevalence of NAFLD in those patients attending the routine health checkup and to establish a relationship between NAFLD and metabolic syndrome. PATIENTS AND METHODS: All patients attending the health check-up had their blood pressure, height and weight, waist circumference measurements, blood sugars, lipid levels and ultrasound abdomen done. The prevalence of NAFLD among these subjects was determined and the presence of risk factors for metabolic disease in each individual was analysed. A relationship between NAFLD and metabolic syndrome was then established. RESULTS: Of the 1003 people 225 (22.6%) had NAFLD with higher prevalence among males 164/565 (29%) than among females 61/438 (13.9%). In the NAFLD group normal body mass index (BMI) was present in only 49/225 (20%) of the subjects while 119/225 (52.8%) were overweight and 56/225 (24.8%) were obese. Though liver enzymes were normal the mean AST among cases was 37.41 +/- 14.50 and 33.93 +/- 14.15 among controls and the mean ALT was 38.74 +/- 17.96 among cases and 31.62 +/- 13.49 among controls. Prevalence of metabolic syndrome was 106/225 (47%) among cases and 179/778 (23%) among controls. CONCLUSION: A diagnosis of fatty liver on ultrasound in an asymptomatic person should alert us of metabolic syndrome and its progression to cardiovascular disease. NAFLD may be considered as the hepatic component of metabolic syndrome.

A new statistical PCA-ICA algorithm for location of R-peaks in ECG.

The success of ICA to separate the independent components from the mixture depends on the properties of the electrocardiogram (ECG) recordings. This paper discusses some of the conditions of independent component analysis (ICA) that could affect the reliability of the separation and evaluation of issues related to the properties of the signals and number of sources. Principal component analysis (PCA) scatter plots are plotted to indicate the diagnostic features in the presence and absence of base-line wander in interpreting the ECG signals. In this analysis, a newly developed statistical algorithm by authors, based on the use of combined PCA-ICA for two correlated channels of 12-channel ECG data is proposed. ICA technique has been successfully implemented in identifying and removal of noise and artifacts from ECG signals. Cleaned ECG signals are obtained using statistical measures like kurtosis and variance of variance after ICA processing. This analysis also paper deals with the detection of QRS complexes in electrocardiograms using combined PCA-ICA algorithm. The efficacy of the combined PCA-ICA algorithm lies in the fact that the location of the R-peaks is bounded from above and below by the location of the cross-over points, hence none of the peaks are ignored or missed.

Artifacts and noise removal in electrocardiograms using independent component analysis.

Independent component analysis (ICA) is a novel technique capable of separating independent components from electrocardiogram (ECG) complex signals. The purpose of this analysis is to evaluate the effectiveness of ICA in removing artifacts and noise from ECG recordings. ICA is applied to remove artifacts and noise in ECG segments of either an individual ECG CSE data base file or all files. The reconstructed ECGs are compared with the original ECG signal. For the four special cases discussed, the R-Peak magnitudes of the CSE data base ECG waveforms before and after applying ICA are also found. In the results, it is shown that in most of the cases, the percentage error in reconstruction is very small. The results show that there is a significant improvement in signal quality, i.e. SNR. All the ECG recording cases dealt showed an improved ECG appearance after the use of ICA. This establishes the efficacy of ICA in elimination of noise and artifacts in electrocardiograms.