Ruptured Infected Aneurysm of the Aorta Secondary to Appendicitis

AbstractWe report a case of an infected aneurysm that developed in a previously normal aorta as a result of bacteraemic spread from appendicitis. Blood cultures and culture of the aneurysm wall grew Bacteroides fragilis. He was treated with appendicectomy, oversewing of the aorta, and a rifampicin-bonded axillobifemoral bypass graft

How tightly controlled do fluctuations in blood glucose levels need to be to reduce the risk of developing complications in people with Type 1 diabetes?

In 2011, the James Lind Alliance published a ‘top 10’ list of priorities for Type 1 diabetes research based on a structured consultation process. Whether reducing fluctuations in blood glucose can prevent long‐term microvascular and macrovascular complications was one of these. In this narrative review, 8 years on, we have assessed the updated evidence for the assertion that increased glucose variability plays an independent and clinically important role in the complications of Type 1 diabetes, over and above mean blood glucose and the effects of hypoglycaemia: the ‘glucose variability hypothesis’. Although studies in cultured cells and ex vivo vessels have been suggestive, most studies in Type 1 diabetes have been small and/or cross‐sectional, and based on ‘finger‐prick’ glucose measurements that capture glucose variability only in waking hours and are affected by missing data. A recent analysis of the Diabetes Control and Complications Trial that formally imputed missing data found no independent effect of short‐term glucose variability on long‐term complications. Few other high‐quality longitudinal studies have directly addressed the glucose variability hypothesis in Type 1 diabetes. We conclude that there is little substantial evidence to date to support this hypothesis in Type 1 diabetes, although increasing use of continuous glucose monitoring provides an opportunity to test it more definitively. In the meantime, we recommend that control of glycaemia in Type 1 diabetes should continue to focus on the sustained achievement of target HbA1c and avoidance of hypoglycaemia

How tightly controlled do fluctuations in blood glucose levels need to be to reduce the risk of developing complications in people with Type 1 diabetes?

In 2011, the James Lind Alliance published a ‘top 10’ list of priorities for Type 1 diabetes research based on a structured consultation process. Whether reducing fluctuations in blood glucose can prevent long‐term microvascular and macrovascular complications was one of these. In this narrative review, 8 years on, we have assessed the updated evidence for the assertion that increased glucose variability plays an independent and clinically important role in the complications of Type 1 diabetes, over and above mean blood glucose and the effects of hypoglycaemia: the ‘glucose variability hypothesis’. Although studies in cultured cells and ex vivo vessels have been suggestive, most studies in Type 1 diabetes have been small and/or cross‐sectional, and based on ‘finger‐prick’ glucose measurements that capture glucose variability only in waking hours and are affected by missing data. A recent analysis of the Diabetes Control and Complications Trial that formally imputed missing data found no independent effect of short‐term glucose variability on long‐term complications. Few other high‐quality longitudinal studies have directly addressed the glucose variability hypothesis in Type 1 diabetes. We conclude that there is little substantial evidence to date to support this hypothesis in Type 1 diabetes, although increasing use of continuous glucose monitoring provides an opportunity to test it more definitively. In the meantime, we recommend that control of glycaemia in Type 1 diabetes should continue to focus on the sustained achievement of target HbA1c and avoidance of hypoglycaemia

Effectiveness and cost-effectiveness of daily all-over-body application of emollient during the first year of life for preventing atopic eczema in high-risk children (The BEEP trial): protocol for a randomised controlled trial.

BACKGROUND: Atopic eczema (AE) is a common skin problem that impairs quality of life and is associated with the development of other atopic diseases including asthma, food allergy and allergic rhinitis. AE treatment is a significant cost burden for health care providers. The purpose of the trial is to investigate whether daily application of emollients for the first year of life can prevent AE developing in high-risk infants (first-degree relative with asthma, AE or allergic rhinitis). METHODS: This is a protocol for a pragmatic, two-arm, randomised controlled, multicentre trial. Up to 1400 term infants at high risk of developing AE will be recruited through the community, primary and secondary care in England. Participating families will be randomised in a 1:1 ratio to receive general infant skin-care advice, or general skin-care advice plus emollients with advice to apply daily to the infant for the first year of life. Families will not be blinded to treatment allocation. The primary outcome will be a blinded assessment of AE at 24 months of age using the UK Working Party Diagnostic Criteria for Atopic Eczema. Secondary outcomes are other definitions of AE, time to AE onset, severity of AE (EASI and POEM), presence of other allergic diseases including food allergy, asthma and hay fever, allergic sensitisation, quality of life, cost-effectiveness and safety of the emollients. Subgroup analyses are planned for the primary outcome according to filaggrin genotype and the number of first-degree relatives with AE and other atopic diseases. Families will be followed up by online and postal questionnaire at 3, 6, 12 and 18 months with a face-to-face visit at 24 months. Long-term follow-up until 60 months will be via annual questionnaires. DISCUSSION: This trial will demonstrate whether skin-barrier enhancement through daily emollient for the first year of life can prevent AE from developing in high-risk infants. If effective, this simple and cheap intervention has the potential to result in significant cost savings for health care providers throughout the world by preventing AE and possibly other associated allergic diseases. TRIAL REGISTRATION: ISRCTN registry; ID: ISRCTN21528841 . Registered on 25 July 2014

Nature of Sonoluminescence: Noble Gas Radiation Excited by Hot Electrons in "Cold" Water

We show that strong electric fields occurring in water near the surface of collapsing gas bubbles because of the flexoelectric effect can provoke dynamic electric breakdown in a micron-size region near the bubble and consider the scenario of the SBSL. The scenario is: (i) at the last stage of incomplete collapse of the bubble the gradient of pressure in water near the bubble surface has such a value and sign that the electric field arising from the flexoelectric effect exceeds the threshold field of the dynamic electrical breakdown of water and is directed to the bubble center; (ii) mobile electrons are generated because of thermal ionization of water molecules near the bubble surface; (iii) these electrons are accelerated in ''cold'' water by the strong electric fields; (iv) these hot electrons transfer noble gas atoms dissolved in water to high-energy excited states and optical transitions between these states produce SBSL UV flashes in the trasparency window of water; (v) the breakdown can be repeated several times and the power and duration of the UV flash are determined by the multiplicity of the breakdowns. The SBSL spectrum is found to resemble a black-body spectrum where temperature is given by the effective temperature of the hot electrons. The pulse energy and some other characteristics of the SBSL are found to be in agreement with the experimental data when realistic estimations are made.Comment: 11 pages (RevTex), 1 figure (.ps

A systematic cross-search for radio/infrared counterparts of XMM-Newton sources

We present a catalog of cross-correlated radio, infrared and X-ray sources using a very restrictive selection criteria with an IDL-based code developed by us. The significance of the observed coincidences was evaluated through Monte Carlo simulations of synthetic sources following a well-tested protocol. We found 3320 coincident radio/X-ray sources with a high statistical significance characterized by the sum of error-weighted coordinate differences. For 997 of them, 2MASS counterparts were found. The percentage of chance coincidences is less than 1%. X-ray hardness ratios of well-known populations of objects were used to provide a crude representation of their X-ray spectrum and to make a preliminary diagnosis of the possible nature of unidentified X-ray sources. The results support the fact that the X-ray sky is largely dominated by Active Galactic Nuclei at high galactic latitudes (|b| >= 10^\circ). At low galactic latitudes (|b| <= 10^\circ) most of unidentified X-ray sources (~94%) lie at |b| <= 2^\circ. This result suggests that most of the unidentified sources found toward the Milky Way plane are galactic objects. Well-known and unidentified sources were classified in different tables with their corresponding radio/infrared and X-ray properties. These tables are intended as a useful tool for researchers interested in particular identifications.Comment: Accepted for publication in Ap&SS. 47 pages, 10 figures. On-line material: figures and table

The symptom to assessment pathway for suspected chronic limb-threatening ischaemia (CLTI) affects quality of care: a process mapping exercise

Background: Delays in the pathway from first symptom to treatment of chronic limb-threatening ischaemia (CLTI) are associated with worse mortality and limb loss outcomes. This study examined the processes used by vascular services to provide urgent care to patients with suspected CLTI referred from the community. Methods: Vascular surgery units from various regions in England were invited to participate in a process mapping exercise. Clinical and non-clinical staff at participating units were interviewed, and process maps were created that captured key staff and structures used to create processes for referral receipt, triage and assessment at the units. Results: Twelve vascular units participated, and process maps were created after interviews with 45 participants. The units offered multiple points of access for urgent referrals from general practitioners and other community clinicians. Triage processes were varied, with units using different mixes of staff (including medical staff, podiatrists and s) and this led to processes of varying speed. The organisation of clinics to provide slots for ‘urgent’ patients was also varied, with some adopting hot clinics, while others used dedicated slots in routine clinics. Service organisation could be further complicated by separate processes for patients with and without diabetes, and because of the organisation of services regionally into vascular networks that had arterial and non-arterial centres. Conclusions: For referred patients with symptoms of CLTI, the points of access, triage and assessment processes used by vascular units are diverse. This reflects the local context and ingenuity of vascular units but can lead to complex processes. It is likely that benefits might be gained from simplification

The role of the supply chain in the elimination and reduction of construction rework and defects: an action research approach

Since 2007, Ireland has suffered a circa 80% reduction in construction output. This has resulted in bankruptcy, unemployment and bad debt. Contractors have attached greater emphasis to production efficiency and cost reduction as a means of survival. An Action Research (AR) strategy was used in this research to improve processes adopted by a SME contractor for the control of defects in its supply chain. It is conservatively estimated that rework, typically accounts for, circa 5% of total project costs. Rework is wasteful and presents an obvious target for improvement. The research reported here concerns the (first) diagnosing stage of the AR cycle only, involving: observation of fieldwork, analysis of contract documents, and semi-structured interviews with supply chain members. The results indicate potential for supply chain participants to identify root causes of defects and propose solutions, having regard to best practice to avoid re-occurrence. A lack of collaborative forums to contribute to production improvement was identified. Additionally the processes, used to collect, manage and disseminate data were unstructured and uncoordinated, indicating scope for developing more efficient methods. The research indicates good understanding of the potential benefits for supply chain collaboration but suggests that the tools and knowledge to collaborate are currently lacking in the SME sector

Absolute Proper Motions to B~22.5: IV. Faint, Low Velocity White Dwarfs and the White Dwarf Population Density Law

The reduced proper motion diagram (RPMD) for a complete sample of faint stars with high accuracy proper motions in the North Galactic Pole field SA57 is investigated. Eight stars with very large reduced proper motions are identified as faint white dwarf candidates. We discriminate these white dwarf candidates from the several times more numerous QSOs based on proper motion and variability. We discuss the implausibility that these stars could be any kind of survey contaminant. If {\it bona fide} white dwarfs, the eight candidates found here represent a portion of the white dwarf population hitherto uninvestigated by previous surveys by virtue of the faint magnitudes and low proper motions. The newly discovered stars suggest a disk white dwarf scaleheight larger than the values of 250-350 pc typically assumed in assessments of the local white dwarf density. Both a <V/V_{max}> and a more complex maximum likelihood analysis of the spatial distribution of our likely thin disk white dwarfs yield scaleheights of 400-600 pc while at the same time give a reasonable match to the local white dwarf volume density found in other surveys. Our results could have interesting implications for white dwarfs as potential MACHO objects. We can place some direct constraints (albeit weak ones) on the contribution of halo white dwarfs to the dark matter of the Galaxy. Moreover, the elevated scale height that we measure for the thin disk could alter the interpretation of microlensing results to the extent of making white dwarfs untenable as the dominant MACHO contributor. (Abridged)Comment: 38 pages, 5 figures, to appear in April Ap