Use of Personal Continuous Glucose Monitoring (CGM) with Support in People with Type 1 and 2 Diabetes Treated with Insulin in the Outpatient Clinic: A Single-Center Retrospective Cohort Study

Objective: The aim of this study was to assess how short-term personal CGM with professional support would affect treatment decisions and glucose control in people with type 1 (T1D) and 2 (T2D) diabetes treated with insulin in clinical practice. Materials and methods: This was a single-center retrospective cohort study of insulin-treated patients withdiabetes who attended the diabetes clinic between March 2021 and March 2022 in Ruttonjee Hospital. It included 90 people with diabetes who were offered a physician-initiated 10 to 14-day CGM (rtCGM or isCGM) in addition to usual care (CGM group), and 90 people with diabetes with usual care alone (control group) after propensity score matching. Upon completion of CGM, the downloaded report was read by physicians for treatment advice (CGM group). Results: The overall mean HbA1c decreased in the CGM group compared with the control group (adjusted group difference, –0.40%; 95% CI, –0.68 to –0.12%; p = 0.005). In T2D, mean HbA1c decreased in the CGM group compared with the control (adjusted group difference, –0.46%; 95% CI, –0.78% to –0.15%; p = 0.005). The mean HbA1c decrease was non-significant in T1D between CGM and control groups. CGM intervention resulted in 69% in the CGM group had an additional pharmacological adjustment, 60% had dietary advice, and 13.3% had corrected matching of insulin doses to carbohydrates. Conclusions: This study demonstrated that a 10 to 14-day CGM with professional support is beneficial in improving glucose control for people with diabetes treated with insulin in the outpatient clinic

Понятие и основные признаки административных налоговых правонарушений

Hadoop distributed file system (HDFS) wasoriginally designed for large files. HDFS stores eachsmall file as one separate block although the size ofseveral small files is lesser than the size of block size.Therefore, a large number of blocks are created withmassive small files. When the large number of smallfiles is accessed, NameNode often becomes thebottleneck. The problem of storing and accessinglarge number of small files is named as small fileproblem. In order to solve this issue in HDFS, anapproach of merging small files on HDFS isproposed. In this paper, small files are merged into alarger file based on the agglomerative hierarchicalclustering mechanism to reduce NameNode memoryconsumption. This approach will provide small filesfor cloud storage

Use of antiarrhythmic drugs in elderly patients

Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, and bradycardia requiring pacemaker placement, all increase exponentially after the age of 60. It is important to distinguish between the normal, physiological consequences of aging on cardiac electrophysiology and the abnormal, pathological alterations. The age-related cardiac changes include ventricular hypertrophy, senile amyloidosis, cardiac valvular degenerative changes and annular calcification, fibrous infiltration of the conduction system, and loss of natural pacemaker cells and these changes could have a profound effect on the development of arrhythmias. The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intracellular $Ca^{2+}$ overload which promote the development of cardiac arrhythmias. As ion channels are the substrates of antiarrhythmic drugs, it follows that the pharmacokinetics and pharmacodynamics of these drugs will also change with age. Aging alters the absorption, distribution, metabolism, and elimination of antiarrhythmic drugs, so liver and kidney function must be monitored to avoid potential adverse drug effects, and antiarrhythmic dosing may need to be adjusted for age. Elderly patients are also more susceptible to the side effects of many antiarrhythmics, including bradycardia, orthostatic hypotension, urinary retention, and falls. Moreover, the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polypharmacy, and the astute physician must pay careful attention to potential drug-drug interactions. Finally, it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient's physiology, disease processes, and medication regimen

Evaluation of physicochemical characteristics and genetic diversity of widely consumed rice varieties in Kyaukse area, Myanmar

Consumer preferences are greatly influenced by eating and cooking qualities of rice grains, along with the economic value of a specific rice variety. This study was to evaluate ten rice varieties including the check variety IR64 on their physicochemical, cooking and eating qualities as well as to identify their genetic diversity using SSR markers. Most rice varieties are medium-grain types based on length-breadth ratio, whereas the famous Myanmar rice variety, Paw San Bay Kyar, (PSBK) is bold. PSBK showed the best cooking and eating quality traits with intermediate amylose content (AC), intermediate gelatinization temperature (GT), soft gel consistency (GC), and the highest elongation ratio among the studied rice varieties. Seventeen SSR markers linked with cooking and eating traits were used to assess the extent of polymorphism and genetic variation among ten rice varieties. There were 49 alleles in total, with an average of 2.88 alleles per locus. RM592 had the maximum number of alleles. The average PIC value ranged from 0.22 (RM540) to 0.77 (RM592). Cluster analysis with UPGMA method based on Jaccard’s similarity coefficient divided ten rice varieties into two main groups and four sub-clusters. In multiple regression analysis, RM190 and Wx primers were discovered to be significantly associated with AC, GC and GT of cooking and eating quality traits. This study could contribute to the choice of rice varieties with superior cooking and eating qualities for rice breeding programs by implementing physicochemical characteristics and molecular analysis

Education Curriculum on Extracorporeal Membrane Oxygenation: The Evolving Role of Simulation Training

Continuing education is essential for the success and safety of an extracorporeal membrane oxygenation (ECMO) programme. However, it is challenging due to the intrinsic characteristic of ECMO—a complex, high-risk, low-volume clinical activity which require teamwork, inter-professional communication, critical decision and rapid response especially in emergency. Thus, simulation is a rapidly evolving teaching methodology in ECMO education to address those training needs that cannot be entirely addressed by traditional teaching modalities. The development of a simulation programme requires commitment on resources for equipment, environment setup and training of personnel. Knowledge on ECMO management, education science and debriefing technique forms the cornerstone of successful ECMO simulation facilitators and hence the simulation programme. Currently, researches have already shown that ECMO simulation can improve individual and team performance despite that its impact on patient outcome is still unknown. In the future, the role of simulation will increase importantly in multicentre research, certifying specialists and credentialing if standardization of training curriculum can be achieved

Knockdown of Dinoflagellate Cellulose Synthase CesA1 Resulted in Malformed Intracellular Cellulosic Thecal Plates and Severely Impeded Cyst-to-Swarmer Transition

Cellulose synthesis (CS) is conducted by membrane-bound cellulose synthase complexes (CSCs), containing cellulose synthases (CesA), that are either arranged in hexagonal structures in higher plants or in linear arrays in most microbial organisms, including dinoflagellates. Dinoflagellates are a major phytoplankton group having linear-type CSCs and internal cellulosic thecal plates (CTPs) in large cortical vesicles. Immunological study suggested CesA1p were cortically localized to the periphery of CTPs. During cyst-to-swarmer transition (TC–S), synchronized peaks of CesA1 transcription, CesA1p expression, CS and CTP formation occurred in respective order, over 12–16 h, strategically allowing the study of CS regulation and CTP biogenesis. CesA1-knockdown resulted in 40% reduction in CesA1p level and time required for swarmer cells reappearance. CTPs were severely malformed with reduced cellulose content. As CTPs are deposited in internal organelle, the present study demonstrated dinoflagellate CesA1 ortholog was adapted for non-surface deposition; this is different to paradigm of other CesAps which require plasmamembrane for cellulose fiber deposition. This pioneer gene-knockdown study demonstrated the requirement of a gene for dinoflagellate cell wall remodeling and proper TC–S, which are prominent in dinoflagellate life-cycles

Review on the characteristic and feasibility of leachate for biogas production by anaerobic digestion

The sound handling of municipal solid waste (MSW) is of high priority to minimise environmental degradation and pollution. MSW can be treated via various technologies including landfilling, incineration, composting, anaerobic digestion (AD) and more. Landfill without landfill gas capturing serves as an enclosed bioreactor to store and stabilise waste. Other technologies such as incineration, composting and AD allow substantial volume reduction and generate value-added products. The treatment for MSW is commonly focusing on the solid part. Organic waste contains high moisture content of 70 - 90 %. The pressing of the water content before entering treatment unit, the release of water during and after the treatment, can generate high strength wastewater, known as leachate. Leachate is rich in organic matter, organic pollutants, pathogens, heavy metals and more, which can lead to severe secondary environmental pollution if not properly treated. Leachate from different treatment units showed certain unique characteristics, such as high Na, high Ca, different species and availability of heavy metals. This review summarised some of the important characteristics of different leachates and the suitability of AD as a mean of treatment. The efficiency of AD to treat leachate was presented in terms of the removal efficiency of chemical oxygen demand (COD) and biogas production. The COD removal efficiency was between 60 - 98 %, following the treatment of different leachates under different reactors and operational parameters. Among the different stream of leachates, the leachate from landfill is most commonly studied as a co-digestion substrate for AD, as compared to leachate from the composting facility

Spatial distribution, work patterns, and perception towards malaria interventions among temporary mobile/migrant workers in artemisinin resistance containment zone

BACKGROUND: Mobile populations are at a high risk of malaria infection and suspected to carry and spread resistant parasites. The Myanmar National Malaria Control Programme focuses on preventive interventions and vector control measures for the temporary mobile/migrant workers in Myanmar Artemisinin Resistance Containment Zones. METHODS: A prospective cross-sectional study was conducted in 2012 in Kawthaung and Bokepyin townships of Tanintharyi Region, Myanmar, covering 192 mobile/migrant aggregates. The objectives were to identify the spatial distribution of the mobile/migrant populations, and to assess knowledge, attitudes, perceptions, and practices concerning malaria prevention and control, and their preferred methods of interventions. The structure of the192 migrant aggregates was investigated using a migrant mapping tool. Individual and household information was collected by structured interviews of 408 respondents from 39 aggregates, supplemented by 12 in-depth interviews of health care providers, authorities, volunteers, and employers. Data were analyzed by triangulating quantitative and qualitative data. RESULTS: The primary reasons for the limitation in access to formal health services for suspected malaria within 24 hours were identified to be scattered distribution of migrant aggregates, variable working hours and the lack of transportation. Only 19.6% of respondents reported working at night from dusk to dawn. Among study populations, 73% reported a perceived risk of contracting malaria and 60% reported to know how to confirm a suspected case of malaria. Moreover, only 15% was able to cite correct antimalarial drugs, and less than 10% believed that non-compliance with antimalarial treatment may be related to the risk of drug resistance. About 50% of study population reported to seeking health care from the public sector, and to sleep under ITNs/LLINs the night before the survey. There was a gap in willingness to buy ITNs/LLINs and affordability (88.5% vs. 60.2%) which may affect their sustained and consistent use. Only 32.4% across all aggregates realized the importance of community participation in effective malaria prevention and control. CONCLUSIONS: Community-based innovative approaches through strong collaboration and coordination of multi-stakeholders are desirable for relaying information on ITNs/LLINs, rapid diagnostic test, and artemisinin combination therapy and drug resistance successfully across the social and economic diversity of mobile/migrant aggregates in Myanmar