Is all hypoglycaemia treated as equal? An observational study of how the type of diabetes and treatment prescribed prior to admission influences quality of treatment of inpatient hypoglycaemia

Aims: Inpatient hypoglycaemia is common and associated with adverse outcomes. There is often increased vigilance of hypoglycaemia in inpatients with type 1 diabetes (T1DM) compared to type 2 diabetes (T2DM). We aimed to investigate this apparent discrepancy, utilising the time to repeat (TTR) capillary blood glucose (CBG) measurement as a surrogate for engagement with guidelines stating that CBG should be rechecked following intervention within 15 min of an initial CBG of <4 mmol/L. Methods: This is an observational study of inpatient CBG data from 8 hospitals over a 7-year period. A national diabetes registry allowed identification of individual’s diagnosis and diabetes therapy. For each initial (index) CBG, the TTR for individuals with T2DM—on insulin or sulphonylurea—was compared with the TTR for individuals with T1DM, using a t test for significance performed on log(TTR). The median TTR was plotted for each group per index CBG. Results: In total, 1480,335 CBG measurements were obtained. A total of 26,664 were <4 mmol/L. The TTR in T2DM individuals on sulphonylurea was significantly greater than in T1DM individuals where index CBG was ≥2.3 mmol/L (except index CBG 2.6 mmol/L). For T2DM patients receiving insulin significance exists for index CBGs of ≥3.2 mmol/L. Conclusions: This analysis suggests that quality of care of hypoglycaemia varies according to diagnosis and medication. The group with the highest TTR (T2DM sulphonylurea treated) are possibly the clinical group in whom hypoglycaemia is most concerning. These data therefore suggest a need for education and raising awareness within the inpatient nursing staff

Evidence that stimulation of gluconeogenesis by fatty acid is mediated through thermodynamic mechanisms

AbstractWe have studied the stimulatory effects of palmitate on the rate of glucose synthesis from lactate in isolated hepatocytes. Control of the metabolic flow was achieved by modulating the activity of enolase using graded concentrations of fluoride. Unexpectedly, palmitate stimulated gluconeogenesis even when enolase was rate-limiting. This stimulation was also observed when the activities of phosphoenolpyruvate carboxykinase and aspartate aminotransferase were modulated using graded concentrations of quinolinate and aminooxyacetate, respectively. Linear force-flow relationships were found between the rate of gluconeogenesis and indicators of cellular energy status (i.e. mitochondrial membrane and redox potentials and cellular phosphorylation potential). These findings suggest that the fatty acid stimulation of glucose synthesis is in part mediated through thermodynamic mechanisms

Patterns and impact of hypoglycemia, hyperglycemia, and glucose variability on inpatients with insulin-treated cystic fibrosis-related diabetes

Introduction: Mortality in patients with cystic fibrosis-related diabetes (CFRD) is higher than that in patients with cystic fibrosis without diabetes. Hypoglycemia, hyperglycemia, and glucose variability confer excess mortality and morbidity in the general inpatient population with diabetes. Methods: We investigated patterns of hypoglycemia and the association of hypoglycemia, hyperglycemia, and glucose variability with mortality and readmission rate in inpatients with CFRD. All capillary blood glucose (CBG) readings (measured using the Abbott Precision web system) of patients with insulin-treated CFRD measured within our health board between January 2009 and January 2015 were. Frequency and timing of hypoglycemia (<4 mmol/L) and was recorded. The effect of dysglycemia on readmission and mortality was investigated with survival analysis. Results: Sixty-six patients were included. A total of 22,711 CBG results were included in the initial analysis. Hypoglycemia was common with 1433 episodes (6.3%). Hypoglycemia ascertainment was highest between 2400 and 0600 h. Hypoglycemia was associated with a significantly higher rate of readmission or death over the 3.5-year follow-up period (P = 0.03). There was no significant association between hyperglycemia or glucose variability and the rate of readmission and mortality. Conclusion: Among inpatients with CFRD hypoglycemia is common and is associated with an increased composite endpoint of readmission and death. As with previously reported trends in general inpatient population this group shows a peak incidence of hypoglycemic during the night

Small Black Holes on Cylinders

We find the metric of small black holes on cylinders, i.e. neutral and static black holes with a small mass in d-dimensional Minkowski-space times a circle. The metric is found using an ansatz for black holes on cylinders proposed in hep-th/0204047. We use the new metric to compute corrections to the thermodynamics which is seen to deviate from that of the (d+1)-dimensional Schwarzschild black hole. Moreover, we compute the leading correction to the relative binding energy which is found to be non-zero. We discuss the consequences of these results for the general understanding of black holes and we connect the results to the phase structure of black holes and strings on cylinders.Comment: 23 pages, 1 figure. v2: typos corrected, introduction expanded, v3: presentation of sections 2 and 3 reordered and improved, explanatory remarks added, refs adde

Practical guide to glucocorticoid induced hyperglycaemia and diabetes

Glucocorticoids, also known as steroids, are a class of anti-inflammatory drugs utilised widely in clinical practice for a variety of conditions. They are associated with a range of side effects including abnormalities of glucose metabolism. Multiple guidelines have been published to illustrate best management of glucocorticoid-induced hyperglycaemia and diabetes in a variety of settings. This article discusses current best clinical practice including diagnosis, investigations and ongoing management of glucocorticoid-induced dysglycaemia in both in- and outpatient settings

Conceptual design and performance evaluation of a hybrid concentrating photovoltaic system in preparation for energy

Concentrating sunlight and focussing it on smaller sized solar cells increases the device's power output per unit active area. However, this process tends to increase the solar cell temperature considerably and has the potential to compromise system reliability. Adding a heat exchanger system to regulate this temperature rise, can improve the electrical performance whilst simultaneously providing an additional source of low temperature heat. In this study the performance of a low concentrator photovoltaic system with thermal (LCPV/T) extraction was conceptualised and evaluated in depth. An experimental analysis was performed using a first-generation prototype consisting of 5 units of Cross Compound Parabolic Concentrators (CCPC) connected to a heat extraction unit. A bespoke rotating table was used as experimental apparatus to effectively evaluate the optical performance of the system, as a function of its angular positions to replicate the motion of actual sun. Key design performance parameters for the LCPV/T collector are presented and discussed. This work also provides a useful technique to effectively calculate system performance, as a function of the orientation-dependant electrical characterisation parameters data. Finally, a Computational Fluid Dynamics (CFD) model was also applied to investigate the efficacy of the heat exchanger and hence estimate the overall co-generation benefit of using such optimisation techniques on realistic CPV systems. It was highlighted through these simulations that the water flow rate had the potential to be a critical power-generation optimisation criterion for LCPV-T systems. The maximum power output at normal incidence with concentrators and no water flow was found to be 78.4 mW. The system was found to perform with an average electrical efficiency ranging between 10 and 16% when evaluated at five different geographic locations. Experimental analysis of the data obtained showed an increase in power of 141% (power ratio 2.41) compared to the analogous non-concentrating counterpart. For example, in the case of London which receives an annual solar radiation of 1300 kWh/m2 the system is expected to generate 210 kWh/m2. This may reduce further to include losses due to temperature, reflectance/glazing losses, and electrical losses in cabling and inverter by up to 36% leading to an annual power output of 134 kWh/m2 of module

A scaling law for monocrystalline PV/T modules with CCPC and comparison with triple junction PV cells

Scaling laws serve as a tool to convert the five parameters in a lumped one-diode electrical model of a photovoltaic (PV) cell/module/panel under indoor standard test conditions (STC) into the parameters under any outdoor conditions. By using the transformed parameters, a current-voltage curve can be established under any outdoor conditions to predict the PV cell/module/panel performance. A scaling law is developed for PV modules with and without crossed compound parabolic concentrator (CCPC) based on the experimental current-voltage curves of six flat monocrystalline PV modules collected from literature at variable irradiances and cell temperatures by using nonlinear least squares method. Experiments are performed to validate the model and method on a monocrystalline PV cell at various irradiances and cell temperatures. The proposed scaling law is compared with the existing one, and the former exhibits a much better accuracy when the cell temperature is higher than 40 °C. The scaling law of a triple junction flat PV cell is also compared with that of the monocrystalline cell and the CCPC effects on the scaling law are investigated with the monocrystalline PV cell. It is identified that the CCPCs impose a more significant influence on the scaling law for the monocrystalline PV cell in comparison with the triple junction PV cell. The proposed scaling law is applied to predict the electrical performance of PV/thermal modules with CCPC

Small localized black holes in a braneworld: Formulation and numerical method

No realistic black holes localized on a 3-brane in the Randall-Sundrum infinite braneworld have been found so far. The problem of finding a static black hole solution is reduced to a boundary value problem. We solve it by means of a numerical method, and show numerical examples of a localized black hole whose horizon radius is small compared to the bulk curvature scale. The sequence of small localized black holes exhibits a smooth transition from a five-dimensional Schwarzschild black hole, which is a solution in the limit of small horizon radius. The localized black hole tends to flatten as its horizon radius increases. However, it becomes difficult to find black hole solutions as its horizon radius increases.Comment: RevTeX, 13 pages, 6 figures, references corrected, typos corrected; to appear in Phys.Rev.

A coupled optical-thermal-electrical model to predict the performance of hybrid PV/T-CCPC roof-top systems

A crossed compound parabolic concentrator (CCPC) is applied into a photovoltaic/thermal (PV/T) hybrid solar collector, i.e. concentrating PV/T (CPV/T) collector, to develop new hybrid roof-top CPV/T systems. However, to optimise the system configuration and operational parameters as well as to predict their performances, a coupled optical, thermal and electrical model is essential. We establish this model by integrating a number of submodels sourced from literature as well as from our recent work on incidence-dependent optical efficiency, six-parameter electrical model and scaling law for outdoor conditions. With the model, electrical performance and cell temperature are predicted on specific days for the roof-top systems installed in Glasgow, Penryn and Jaen. Results obtained by the proposed model reasonably agree with monitored data and it is also clarified that the systems operate under off-optimal operating condition. Long-term electric performance of the CPV/T systems is estimated as well. In addition, effects of transient terms in heat transfer and diffuse solar irradiance on electric energy are identified and discussed

Results from MAGIC's first observation cycle on galactic sources

During its Cycle I, the MAGIC telescope targeted about 250 hours several galactic sources sought to be, or detected previously by other experiments in the same energy domain, gamma-ray emitters. This paper reviews some results of such MAGIC observations covering, among others, supernova remnants, the Galactic Center and microquasars. We will concentrate on the recent discovery at very high energy gamma-rays of the microquasar LS I +61 303.Comment: 6 pages, 8 figures. Prepared for "The Multi-messenger Approach to High-energy Gamma-ray Sources", Barcelona (Spain) 4-7 July 200