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

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

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 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

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

Deviation From \Lambda CDM With Cosmic Strings Networks

In this work, we consider a network of cosmic strings to explain possible deviation from \Lambda CDM behaviour. We use different observational data to constrain the model and show that a small but non zero contribution from the string network is allowed by the observational data which can result in a reasonable departure from \Lambda CDM evolution. But by calculating the Bayesian Evidence, we show that the present data still strongly favour the concordance \Lambda CDM model irrespective of the choice of the prior.Comment: 15 Pages, Latex Style, 4 eps figures, Revised Version, Accepted for publication in European Physical Journal

The acceleration of the universe and the physics behind it

Using a general classification of dark enegy models in four classes, we discuss the complementarity of cosmological observations to tackle down the physics beyond the acceleration of our universe. We discuss the tests distinguishing the four classes and then focus on the dynamics of the perturbations in the Newtonian regime. We also exhibit explicitely models that have identical predictions for a subset of observations.Comment: 18 pages, 18 figure

Black Holes in Higher-Dimensional Gravity

These lectures review some of the recent progress in uncovering the phase structure of black hole solutions in higher-dimensional vacuum Einstein gravity. The two classes on which we focus are Kaluza-Klein black holes, i.e. static solutions with an event horizon in asymptotically flat spaces with compact directions, and stationary solutions with an event horizon in asymptotically flat space. Highlights include the recently constructed multi-black hole configurations on the cylinder and thin rotating black rings in dimensions higher than five. The phase diagram that is emerging for each of the two classes will be discussed, including an intriguing connection that relates the phase structure of Kaluza-Klein black holes with that of asymptotically flat rotating black holes.Comment: latex, 49 pages, 5 figures. Lectures to appear in the proceedings of the Fourth Aegean Summer School, Mytiline, Lesvos, Greece, September 17-22, 200

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

Functional mechanisms underlying pleiotropic risk alleles at the 19p13.1 breast-ovarian cancer susceptibility locus

A locus at 19p13 is associated with breast cancer (BC) and ovarian cancer (OC) risk. Here we analyse 438 SNPs in this region in 46,451 BC and 15,438 OC cases, 15,252 BRCA1 mutation carriers and 73,444 controls and identify 13 candidate causal SNPs associated with serous OC (P=9.2 × 10-20), ER-negative BC (P=1.1 × 10-13), BRCA1-associated BC (P=7.7 × 10-16) and triple negative BC (P-diff=2 × 10-5). Genotype-gene expression associations are identified for candidate target genes ANKLE1 (P=2 × 10-3) and ABHD8 (P<2 × 10-3). Chromosome conformation capture identifies interactions between four candidate SNPs and ABHD8, and luciferase assays indicate six risk alleles increased transactivation of the ADHD8 promoter. Targeted deletion of a region containing risk SNP rs56069439 in a putative enhancer induces ANKLE1 downregulation; and mRNA stability assays indicate functional effects for an ANKLE1 3′-UTR SNP. Altogether, these data suggest that multiple SNPs at 19p13 regulate ABHD8 and perhaps ANKLE1 expression, and indicate common mechanisms underlying breast and ovarian cancer risk