Diet-induced Ketoacidosis in a Non-diabetic: A Case Report

Introduction: Anion gap metabolic acidosis is a common disorder seen in the emergency department. The differential can include toxicological, renal, endocrine, infectious, and cardiogenic disorders. Ketosis, however, is one of the rarer causes of metabolic acidosis seen by the emergency physician in developed nations.Case Report: A 53-year-old female presented after starting a low-carbohydrate ketogenic diet for weight loss. She reported xerostomia, nausea with abdominal pain and a 17-pound weight loss over the previous 22 days. Labs revealed an anion-gap metabolic acidosis with ketosis. She was treated with 5% dextrose in normal saline and a sliding scale insulin coverage. Her anion gap corrected during her hospital course and was discharged on hospital day three.Discussion: The ketogenic diet typically consists of a high-fat, adequate protein and low carbohydrate diet that has previously been thought to be relatively safe for weight loss. However, when carbohydrates are completely removed from the diet an overproduction of ketones bodies results in ketoacidosis. Treatment should be aimed at halting the ketogenic process and patient education.Conclusion: Although rarely included in the differential for metabolic acidosis, diet-induced ketosis should be included by the emergency physician when faced with a patient who recently changed their eating patterns

Exploring business transformation : the challenges of developing a benefits realization capability.

The successful management of change continues to be a major issue for organizations. This article draws on rich qualitative data to provide evidence of issues faced by organizations as they try to realize benefits from investments in IT-enabled change, and as they try to develop and enhance their benefits realization capability. Several of these issues are not effectively covered by previous research, for example managing the overall portfolio of change initiatives and how to develop the capacity of the organization for benefits realization. The research also provides empirical evidence that supports the theoretical propositions from dynamic capability theory that routines (practices) are often similar across different organizations, and that organizations go through a number of stages in developing competences. A further contribution of the research is to develop an enhanced model of an organizational competence, which has important implications for the action required to develop competences

Direct numerical simulation of buoyantly driven turbulence

Numerical simulations of homogeneous turbulence subject to buoyant forcing were performed. The presence of a mean temperature gradient combined with a gravitational field results in a forcing term in the momentum equations. The development of the turbulence was studied and compared to the decay of similar fields in the absence of gravity. In the buoyantly driven field, the vorticity is preferentially aligned with the intermediate eigenvector of the strain-rate tensor and the local temperature gradient is more likely to be aligned with the most compressive eigenvector. These relationships are qualitatively similar to those observed in previous shear flow results studied by Ashurst (1987). A tensor diffusivity model for passive scalar transport developed from shear flow results in Rogers, Moin, and Reynolds (1986) also predicts this buoyant scalar transport, indicating that the relationship between the scalar flux and the Reynolds stress is similar in both flows

“EATING OUR OWN DOG FOOD” TO TRANSFORM RESEARCH INTO PRACTICE

In this paper I have followed the practice I learnt while a consultant at Microsoft: that is “eating your own dog food”. At Microsoft it means running the business on your own software including the latest beta software. I have used Benefits Management as a framework to explore the huge challenges involved in transforming research into practice and to clarify some of the changes required. I have explored how learning from practice can influence the process of research so that research can become more relevant. In particular, I have considered how ‘agile’ principles and practices can be adapted to research projects. This appears to be a valuable line of inquiry with good opportunities for transforming research into practice for individual researchers as well as the wider academic community

Worsbrough : change and continuity in the society, economy and buildings of a South Yorkshire township, 1600 - 1851.

Changes and continuities in the South Yorkshire township of Worsbrough are examined in detail, bringing together documentary, environmental and archaeological evidence in an analysis of the development of the township from a rural, mainly agricultural, community to one dominated by heavy industry in the mid-nineteenth century. This progression is viewed through the involvement of, and effects on, the whole range of Worsbrough society, placing the changes in a regional and national context. A review of the natural resources within the township boundaries considers both their potential for exploitation in establishing a successful settlement and the problems of communication which affected economic development. A brief review of the early history of Worsbrough establishes the manorial structure and the role of the church, important influences in the development of the township. Surveys of surviving early buildings in Worsbrough, many with related Probate Inventories, illustrate the changing fortunes of different levels ofsociety, providing a context for a review of the demographic changes throughout the period. The structure of the society is examined with statistical analysis of the composition and variability of the population. Aspects of social behaviour and control are investigated, including provision for the poor and sick, related to the activities of the church and manor officers. The economic structure of the, township is examined, emphasising the interaction of industry and agriculture, with particular reference to the stress generated in the community as Worsbrough developed into an industrialised urban township in the early nineteenth century

Observing bullying at school: The mental health implications of witness status

This study explores the impact of bullying on the mental health of students who witness it. A representative sample of 2,002 students aged 12 to 16 years attending 14 schools in the United Kingdom were surveyed using a questionnaire that included measures of bullying at school, substance abuse, and mental health risk. The results suggest that observing bullying at school predicted risks to mental health over and above that predicted for those students who were directly involved in bullying behavior as either a perpetrator or a victim. Observing others was also found to predict higher risk irrespective of whether students were or were not victims themselves. The results are discussed with reference to past research on bystander and witness behavior

Development of advanced fabrication techniques for regeneratively cooled thrust chambers by the gas-pressure-bonding process Final report, 29 Jun. 1967 - 30 Apr. 1970

Production of regeneratively cooled rocket thrust chambers by removable tooling and subsequent hot isostatic pressing in gas autoclav

A Pathway to Prophethood: Joseph Smith Junior as Rodsman, Village Seer, and Judeo-Christian Prophet

Joseph Smith Junior, founder of the Mormon faith, presented himself to America and the world as a prophet with the same powers as the widely known prophetic figures of the Bible. Like Moses and Elijah, he made God\u27s will known to humankind. Before assuming this role, Smith had used divining rods and then seer stones to find underground water, buried treasure, lost items, and stray livestock. This thesis charts Joseph Smith\u27s progression from rodsman to seer to prophet. For the most part, I present Joseph Smith\u27s divinatory development as he himself experienced it. Dowsing with a rod, seeing things in stones, and receiving heavenly revelations were as real to Smith as harvesting wheat. In order to understand his progression from rodsman to seer to prophet, one must first understand his worldview. The mental universe of early American water witches and village seers forms one of the historical and cultural contexts in which Joseph Smith developed his divinatory abilities

Liberal education in York since 1815, with special reference to provision for non-vocational adult education.

A study of the development of non-vocational education in York during the last century and a half reveals several interesting ventures in liberal adult education. In York as elsewhere, initially most of the experiments in adult education were, perforce, remedial and usually conducted by philanthropic organisations of individuals from a social class higher that that of the students who attended the school and institutes. Gradually all the early institutions deviated from their original aims – and in doing often became successful. The York Mechanics’ Institute became a Literary and Scientific Society; the Adult Schools became Temperance Organisations or what amounted to Recreational Clubs; the York Settlement, created to provide a basic education for working men, became a kind of middle class finishing school. Voluntary organisations remained the sole provider of adult education in York almost until the end of the 19th century. After 1902 the Local Education Authority was legally empowered to provide non-vocational adult education, but what it provided was sparse, drab and uninteresting and the position of the voluntary organisations went unchallenged. There was little alteration in the situation until after the Second World War when, in 1950, a start was made to improve local authority provision for adult education. In 1964, belatedly, York Education Authority created three new Evening Centres to provide a comprehensive system of attractively titled classes and courses. The immediate result was a dramatic increase in enrolments. The traditional providers of liberal adult education, the voluntary organisations, remain to complement the Education Authority’s provision but they are undergoing a process of reorientation as they seek a new role for themselves. The present provision for non-vocational adult education in York is probably as good as that in any city of comparable size and resources and there now exists a sound basis for future development