The Impact of poor glycaemic control on the prevalence of erectile dysfunction in men with type 2 Diabetes Mellitus: A Systematic Review.

To determine the impact of poor glycaemic control on the prevalence of erectile dysfunction among men with type 2 Diabetics aged 27 to 85 years.The databases Embase classic+Embase, Global health, Ovid Medline and PsychINFO, were searched for relevant studies in June 2014 using the keywords: (Diabetes Mellitus OR diabetes mellitus type2 OR DM2 OR T2DM OR insulin resistance) AND (erectile dysfunction OR sexual dysfunction OR impotence) AND glycaemic control.All study settings were considered (primary care, secondary care and tertiary care setting).Type 2 Diabetic Patients with erectile dysfunction.Included studies must include one of the following outcomes: (1) HBA1c for assess the level of glycaemic control; (2) Erectile dysfunction (any stage: IIEF-5 = 21 or less).Five cross-sectional studies involving 3299 patients were included. The findings pointed to a positive association between erectile dysfunction and glycaemic control. Three studies showed a significant positive association, while one study showed only a weak correlation and one study showed borderline significance. Patients age, diabetes mellitus duration, peripheral neuropathy and body mass index had positive association with erectile dysfunction. However, smoking and hypertension were not associated with erectile dysfunction in most included studies. Physical activity had a protective effect against erectile dysfunction.We may conclude that the risk of erectile dysfunction is higher in type 2 diabetic men with poor glycaemic control than those with good control

Ethnic group differences in overweight and obese children and young people in England: cross sectional survey

Aims: To determine the percentage of children and young adults who are obese or overweight within different ethnic and socioeconomic groups.Methods: Secondary analysis of data on 5689 children and young adults aged 2 - 20 years from the 1999 Health Survey for England.Results: Twenty three per cent of children (n = 1311) were overweight, of whom 6% ( n = 358) were obese. More girls than boys were overweight ( 24% v 22%). Afro-Caribbean girls were more likely to be overweight ( odds ratio 1.73, 95% CI 1.29 to 2.33), and Afro-Caribbean and Pakistani girls were more likely to be obese than girls in the general population ( odds ratios 2.74 ( 95% CI 1.74 to 4.31) and 1.71 ( 95% CI 1.06 to 2.76), respectively). Indian and Pakistani boys were more likely to be overweight ( odds ratios 1.55 ( 95% CI 1.12 to 2.17) and 1.36 ( 95% CI 1.01 to 1.83), respectively). There were no significant differences in the prevalence of obese and overweight children from different social classes.Conclusion: The percentage of children and young adults who are obese and overweight differs by ethnic group and sex, but not by social class. British Afro-Caribbean and Pakistani girls have an increased risk of being obese and Indian and Pakistani boys have an increased risk of being overweight than the general population. These individuals may be at greater combined cumulative risk of morbidity and mortality from cardiovascular disease and so may be a priority for initiatives to target groups of children at particular risk of obesity

Quality of care in University Hospitals in Saudi Arabia: systematic review

Objectives: To identify the key issues, problems, barriers and challenges particularly in relation to the quality of care in university hospitals in the Kingdom of Saudi Arabia (KSA), and to provide recommendations for improvement. Methods: A systematic search was carried out using five electronic databases, for articles published between January 2004 and January 2015. We included studies conducted in university hospitals in KSA that focused on the quality of healthcare. Three independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted their relevant characteristics. All studies were assessed using the Institute of Medicine indicators of quality of care. Results: Of the 1430 references identified in the initial search, eight studies were identified that met the inclusion criteria. The included studies clearly highlight a need to improve the quality of healthcare delivery, specifically in areas of patient safety, clinical effectiveness and patient-centredness, at university hospitals in KSA. Problems with quality of care could be due to failures of leadership, a requirement for better management and a need to establish a culture of safety alongside leadership reform in university hospitals. Lack of instructions given to patients and language communication were key factors impeding optimum delivery of patient-centred care. Decisionmakers in KSA university hospitals should consider programmes and assessment tools to reveal problems and issues related to language as a barrier to quality of care. Conclusions: This review exemplifies the need for further improvement in the quality of healthcare in university hospitals in KSA. Many of the problems identified in this review could be addressed by establishing an independent body in KSA, which could monitor healthcare services and push for improvements in efficiency and quality of care

Prediction of the Scale Removal Rate in Heat Exchanger Piping

The possibility of predicting the mass transfer controlled CaCO3 scale removal rate has been investigated.Experiments were carried out using chelating agents as a cleaning solution at different time and Reynoldss number. The results of CaCO3 scale removal or (mass transfer rate) (as it is the controlling process) are compared with proposed model of prandtls and Taylor particularly based on the concept of analogy among momentum and mass transfer.Correlation for the variation of Sherwood number ( or mass transfer rate ) with Reynoldss number have been obtained

Development of Finite Element Techniques to Simulate Concrete-Filled Fiber-Reinforced Polymer Tube Structures

This dissertation presents the development of finite-element (FE) techniques to simulate the behavior of concrete-filled fiber reinforced polymer (FRP) tubes (CFFTs) in support of more effective structural design and analysis methods for buried composite arch bridges (BCABs) that use CFFT arches as main structural members. The research includes three specific topics to make contributions in different aspects of the investigation of these complex structures. The first topic is the nonlinear three-dimensional FE modeling of steel-free CFFT splices. For model validation, comparisons were made between the model predictions and control beam and spliced beams with and without internal collars tested by others. The modeling was complex due to the need to capture the nonlinear constitutive response of the confined concrete, simulate concrete-FRP interaction, and explicitly incorporate the splice components. Therefore, the numerical analysis utilized the Abaqus/CAE software package with a modified damage concrete plasticity model to idealize the concretefill. The second topic of this research is the development of a computationally efficient structural FE analysis technique for the second-order inelastic behavior of these CFFT arches that includes initial arch curvature. A curved, planar, corotational, flexibility-based (FB), layered frame element is employed to handle geometric and material nonlinearities. An FRP-confined concrete stress-strain model that explicitly considers the effect of dilation of the concrete core and confinement provide by the FRP tube is implemented. Verification of the FB formulation was carried out for elastic-plastic analysis of a beam and elastic post-buckling analysis of a circular arch. The measured flexural responses of different isolated CFFT arches available in the literature were used to verify the proposed model. The model was shown to accurately predict the load-carrying capacity and ductility of the tested CFFT arches. The model captured arch collapse mechanisms arising from FRP rupture and concrete crushing at the apex of the arches. The third topic is an extension of the planar FB model to three-dimensions and incorporation of a soil-spring model to simulate soil-structure interaction using a recently developed horizontal earth pressure model. The model rigorously incorporates the interaction between axial load and bending effects in the arches and permits the examination of out-of-plane stability and arch deformations due to bridge skew. Parametric studies were conducted to assess the effect of abutment skew angle on the behavior of CFFT arch bridge components, an important practical design consideration

Training interventions for improving telephone consultation skills in clinicians

The objectives are as follows: To assess the effectiveness of training interventions on clinician telephone skills

Phagosome-lysosome fusion is a calcium-independent event in macrophages.

Phagosome-lysosome membrane fusion is a highly regulated event that is essential for intracellular killing of microorganisms. Functionally, it represents a form of polarized regulated secretion, which is classically dependent on increases in intracellular ionized calcium ([Ca2+]i). Indeed, increases in [Ca2+]i are essential for phagosome-granule (lysosome) fusion in neutrophils and for lysosomal fusion events that mediate host cell invasion by Trypanosoma cruzi trypomastigotes. Since several intracellular pathogens survive in macrophage phagosomes that do not fuse with lysosomes, we examined the regulation of phagosome-lysosome fusion in macrophages. Macrophages (M phi) were treated with 12.5 microM bis-(2-amino-S-methylphenoxy) ethane-N,N,N',N',-tetraacetic acid tetraacetoxymethyl ester (MAPT/AM), a cell-permeant calcium chelator which reduced resting cytoplasmic [Ca2+]; from 80 nM to < or = 20 nM and completely blocked increases in [Ca2+]i in response to multiple stimuli, even in the presence of extracellular calcium. Subsequently, M phi phagocytosed serum-opsonized zymosan, staphylococci, or Mycobacterium bovis. Microbes were enumerated by 4',6-diamidino-2-phenylindole, dihydrochloride (DAPI) staining, and phagosome-lysosome fusion was scored using both lysosome-associated membrane protein (LAMP-1) as a membrane marker and rhodamine dextran as a content marker for lysosomes. Confirmation of phagosome-lysosome fusion by electron microscopy validated the fluorescence microscopy findings. We found that phagosome-lysosome fusion in M phi occurs noramlly at very low [Ca2+]i (< or = 20 nM). Kinetic analysis showed that in M phi none of the steps leading from particle binding to eventual phagosome-lysosome fusion are regulated by [Ca2+]i in a rate-limiting way. Furthermore, confocal microscopy revealed no difference in the intensity of LAMP-1 immunofluorescence in phagolysosome membranes in calcium-buffered vs. control macrophages. We conclude that neither membrane recognition nor fusion events in the phagosomal pathway in macrophages are dependent on or regulated by calcium

Eligibility for bariatric surgery among adults in England: analysis of a national cross-sectional survey.

This study aimed to determine the number eligible for bariatric surgery and their sociodemographic characteristics.We used Health Survey for England 2006 data, representative of the non-institutionalized English population.The number of people eligible for bariatric surgery in England based on national guidance is unknown. The UK National Institute for Health and Clinical Excellence criteria for eligibility are those with body mass index (BMI) 35-40 kg/m(2) with at least one comorbidity potentially improved by losing weight or a BMI > 40 kg/m(2).Of 13,742 adult respondents (≥18 years), we excluded participants with invalid BMI (n = 2103), comorbidities (n = 2187) or sociodemographic variables (n = 27) data, for a final study sample of 9425 participants.The comorbidities examined were hypertension, type 2 diabetes, stroke, coronary heart disease and osteoarthritis. Sociodemographic variables assessed included age, sex, employment status, highest educational qualification, social class and smoking status.5.4% (95% CI 5.0-5.9) of the non-institutionalized adult population in England could meet criteria for having bariatric surgery after accounting for survey weights. Those eligible were more likely than the general population to be women (60.1% vs. 39.9%, p<0.01), retired (22.4% vs. 12.8% p<0.01), and have no formal educational qualifications (35.7% vs. 21.3%, p<0.01).The number of adults potentially eligible for bariatric surgery in England (2,147,683 people based on these results and 2006 population estimates) far exceeds previous estimates of eligibility. In view of the sociodemographic characteristics of this group, careful resource allocation is required to ensure equitable access on the basis of need