A critical review of whether goals for treatment in type 2 diabetes mellitus as set out by the 2012 Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) guidelines are being achieved in patients attending the diabetic clinic at Helen Joseph Hospital

A dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in fulfilment for the requirements of the degree of Master of Medicine. Johannesburg, 2018.Background The risk of complications from T2DM is high. Complications reduce quality of life and place a large burden on our health system and economy. Achieving targets in our diabetic patients significantly reduces the morbidity and mortality of the disease. This study aims to assess whether patients at the Helen Joseph Academic Hospital Diabetic Clinic are meeting the 2012 SEMDSA targets for diabetes with the current hospital treatment protocols. Methods A Retrospective Clinical Audit was carried out at the Helen Joseph Hospital Diabetic Clinic. The files of 321 patients with T2DM for a duration of longer than five years and who were on insulin were reviewed. The following information was assessed: Glycated haemoglobin (HbA1c), Blood pressure, abdominal circumference and lipograms. Results The study population of 321 patients compromised majority black (44.6%) and coloured (34%) patients. The mean age amongst these patients was 59.4 years. This sample was predominantly female (62.3%). A large proportion of patients had concomitant Hypertension (89.1%) and dyslipidaemia (82.2%); with 91.2% fulfilling criteria for the diagnosis of metabolic syndrome. The majority of patients 56.3% did not exercise. A small amount partook in recreational activities that increase cardiovascular risk (smoking 12.5% and alcohol use 10.6%). Target HbA1c used for the purpose of this study was 7% or lower. The mean HbA1c in this study population was 9.5% (range 3.9 – 16.9%). Only 15.3% achieved the 7% target. The number of patients who achieved the target Blood Pressure of <140/90 was 72 (25%) (95% CI 20.2-30.5). LDL target was achieved in 22.6% and abdominal circumference 11%. Conclusions Despite adequate protocols and access to tertiary medical care, only a very small percentage of patients at the diabetic clinic are achieving proposed targets. Other audits have revealed a range of reasons for poor control in their patients. More comprehensive analysis is required to assess the reasons in this clinic if we are to address the problem with the urgency it requires. Ultimately, the goal is to offer the best treatment and quality of life to our ever increasing diabetic population.LG201

Crossover between Rayleigh-Taylor Instability and turbulent cascading atomization mechanism in the bag-breakup regime

The question whether liquid atomization (or pulverization) resorts to instability dynamics (through refinements of Rayleigh-Plateau, Rayleigh-Taylor or Kelvin-Helmholtz mechanism) or to turbulent cascades similar to Richardson and Kolmogorov first ideas seems to be still open. In this paper, we report experimental evidences that both mechanisms are needed to explain the spray drop PDF obtained from an industrial nozzle. Instability of Rayleigh-Taylor kind governs the size of the largest droplets while the smallest ones obey a PDF given by a turbulent cascading mechanism resulting in a log-L\'evy stable law of stability parameter close to 1.68. This value, very close to the inverse of the Flory exponent, can be related to a recent model for intermittency modeling stemming from self-avoiding random vortex stretching.Comment: new alpha version (precedent was a draft

Does accelerating universe indicates Brans-Dicke theory

The evolution of universe in Brans-Dicke (BD) theory is discussed in this paper. Considering a parameterized scenario for BD scalar field $\phi=\phi_{0}a^{\alpha}$ which plays the role of gravitational "constant" $G$, we apply the Markov Chain Monte Carlo method to investigate a global constraints on BD theory with a self-interacting potential according to the current observational data: Union2 dataset of type supernovae Ia (SNIa), high-redshift Gamma-Ray Bursts (GRBs) data, observational Hubble data (OHD), the cluster X-ray gas mass fraction, the baryon acoustic oscillation (BAO), and the cosmic microwave background (CMB) data. It is shown that an expanded universe from deceleration to acceleration is given in this theory, and the constraint results of dimensionless matter density $\Omega_{0m}$ and parameter $\alpha$ are, $\Omega_{0m}=0.286^{+0.037+0.050}_{-0.039-0.047}$ and $\alpha=0.0046^{+0.0149+0.0171}_{-0.0171-0.0206}$ which is consistent with the result of current experiment exploration, $\mid\alpha\mid \leq 0.132124$. In addition, we use the geometrical diagnostic method, jerk parameter $j$, to distinguish the BD theory and cosmological constant model in Einstein's theory of general relativity.Comment: 16 pages, 3 figure

The Seventh Data Release of the Sloan Digital Sky Survey

This paper describes the Seventh Data Release of the Sloan Digital Sky Survey (SDSS), marking the completion of the original goals of the SDSS and the end of the phase known as SDSS-II. It includes 11663 deg^2 of imaging data, with most of the roughly 2000 deg^2 increment over the previous data release lying in regions of low Galactic latitude. The catalog contains five-band photometry for 357 million distinct objects. The survey also includes repeat photometry over 250 deg^2 along the Celestial Equator in the Southern Galactic Cap. A coaddition of these data goes roughly two magnitudes fainter than the main survey. The spectroscopy is now complete over a contiguous area of 7500 deg^2 in the Northern Galactic Cap, closing the gap that was present in previous data releases. There are over 1.6 million spectra in total, including 930,000 galaxies, 120,000 quasars, and 460,000 stars. The data release includes improved stellar photometry at low Galactic latitude. The astrometry has all been recalibrated with the second version of the USNO CCD Astrograph Catalog (UCAC-2), reducing the rms statistical errors at the bright end to 45 milli-arcseconds per coordinate. A systematic error in bright galaxy photometr is less severe than previously reported for the majority of galaxies. Finally, we describe a series of improvements to the spectroscopic reductions, including better flat-fielding and improved wavelength calibration at the blue end, better processing of objects with extremely strong narrow emission lines, and an improved determination of stellar metallicities. (Abridged)Comment: 20 pages, 10 embedded figures. Accepted to ApJS after minor correction

What helps or hinders the transformation from a major tertiary center to a major trauma center? Identifying barriers and enablers using the Theoretical Domains Framework

BACKGROUND: Major Trauma Centers (MTCs), as part of a trauma system, improve survival and functional outcomes from injury. Developing such centers from current teaching hospitals is likely to generate diverse beliefs amongst staff. These may act as barriers or enablers. Prior identification of these may make the service development process more efficient. The importance of applying theory to systematically identify barriers and enablers to changing clinical practice in emergency medicine has been emphasized. This study systematically explored theory-based barriers and enablers towards implementing the transformation of a tertiary hospital into a MTC. Our goal was to demonstrate the use of a replicable method to identify targets that could be addressed to achieve a successful transformation from an organization evolved to provide a particular type of clinical care into a clinical system with different demands, requirements and expectations. METHODS: The Theoretical Domains Framework (TDF) is a tool designed to elicit and analyze beliefs affecting behavior. Semi-structured interviews based around the TDF were conducted in a major tertiary hospital in Scotland due to become a MTC with a purposive sample of major stakeholders including clinicians and nurses from specialties involved in trauma care, clinical managers and administration. Belief statements were identified through qualitative analysis, and assessed for importance according to prevalence, discordance and evidence base. RESULTS AND DISCUSSION: 1728 utterances were recorded and coded into 91 belief statements. 58 were classified as important barriers/enablers. There were major concerns about resource demands, with optimism conditional on these being met. Distracting priorities abound within the Emergency Department. Better communication is needed. Staff motivation is high and they should be engaged in skills development and developing performance improvement processes. CONCLUSIONS: This study presents a systematic and replicable method of identifying theory-based barriers and enablers towards complex service development. It identifies multiple barriers/enablers that may serve as a basis for developing an implementation intervention to enhance the development of MTCs. This method can be used to address similar challenges in developing specialist centers or implementing clinical practice change in emergency care across both developing and developed countries

Dynamics of Envelope Evolution in Clade C SHIV-Infected Pig-Tailed Macaques during Disease Progression Analyzed by Ultra-Deep Pyrosequencing

Understanding the evolution of the human immunodeficiency virus type 1 (HIV-1) envelope during disease progression can provide tremendous insights for vaccine development, and simian-human immunodeficiency virus (SHIV) infection of non-human primate provides an ideal platform for such studies. A newly developed clade C SHIV, SHIV-1157ipd3N4, which was able to infect rhesus macaques, closely resembled primary HIV-1 in transmission and pathogenesis, was used to infect several pig-tailed macaques. One of the infected animals subsequently progressed to AIDS, whereas one remained a non-progressor. The viral envelope evolution in the infected animals during disease progression was analyzed by a bioinformatics approach using ultra-deep pyrosequencing. Our results showed substantial envelope variations emerging in the progressor animal after the onset of AIDS. These envelope variations impacted the length of the variable loops and charges of different envelope regions. Additionally, multiple mutations were located at the CD4 and CCR5 binding sites, potentially affecting receptor binding affinity, viral fitness and they might be selected at late stages of disease. More importantly, these envelope mutations are not random since they had repeatedly been observed in a rhesus macaque and a human infant infected by either SHIV or HIV-1, respectively, carrying the parental envelope of the infectious molecular clone SHIV-1157ipd3N4. Moreover, similar mutations were also observed from other studies on different clades of envelopes regardless of the host species. These recurring mutations in different envelopes suggest that there may be a common evolutionary pattern and selection pathway for the HIV-1 envelope during disease progression

The Second Data Release of the Sloan Digital Sky Survey

The Sloan Digital Sky Survey (SDSS) has validated and made publicly available its Second Data Release. This data release consists of 3324 deg2 of five-band (ugriz) imaging data with photometry for over 88 million unique objects, 367,360 spectra of galaxies, quasars, stars, and calibrating blank sky patches selected over 2627 deg2 of this area, and tables of measured parameters from these data. The imaging data reach a depth of r ≈ 22.2 (95% completeness limit for point sources) and are photometrically and astrometrically calibrated to 2% rms and 100 mas rms per coordinate, respectively. The imaging data have all been processed through a new version of the SDSS imaging pipeline, in which the most important improvement since the last data release is fixing an error in the model fits to each object. The result is that model magnitudes are now a good proxy for point-spread function magnitudes for point sources, and Petrosian magnitudes for extended sources. The spectroscopy extends from 3800 to 9200 Å at a resolution of 2000. The spectroscopic software now repairs a systematic error in the radial velocities of certain types of stars and has substantially improved spectrophotometry. All data included in the SDSS Early Data Release and First Data Release are reprocessed with the improved pipelines and included in the Second Data Release. Further characteristics of the data are described, as are the data products themselves and the tools for accessing them

The First Data Release of the Sloan Digital Sky Survey

The Sloan Digital Sky Survey has validated and made publicly available its First Data Release. This consists of 2099 square degrees of five-band (u, g, r, i, z) imaging data, 186,240 spectra of galaxies, quasars, stars and calibrating blank sky patches selected over 1360 square degrees of this area, and tables of measured parameters from these data. The imaging data go to a depth of r ~ 22.6 and are photometrically and astrometrically calibrated to 2% rms and 100 milli-arcsec rms per coordinate, respectively. The spectra cover the range 3800--9200 A, with a resolution of 1800--2100. Further characteristics of the data are described, as are the data products themselves.Comment: Submitted to The Astronomical Journal. 16 pages. For associated documentation, see http://www.sdss.org/dr

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

The Effects of DACAmentation: The Impact of Deferred Action for Childhood Arrivals on Unauthorized Immigrants

As the largest immigration policy in 25 years, Deferred Action for Childhood Arrivals (DACA) made deportation relief and work authorization available to 1.7 million unauthorized immigrants. This paper looks at how DACA affects DACA-eligible immigrants' labor market outcomes. I use a difference-in-differences design for unauthorized immigrants near the criteria cutoffs for DACA eligibility. I find DACA increases the likelihood of working by increasing labor force participation and decreasing the unemployment rate for DACA-eligible immigrants. I also find DACA increases the income of unauthorized immigrants in the bottom of the income distribution. I find little evidence that DACA affects the likelihood of attending school. Using these estimates, DACA moved 50,000 to 75,000 unauthorized immigrants into employment. If the effects of Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) are similar to DACA, then DAPA could potentially move over 250,000 unauthorized immigrants into employment