Glargine co-administration with intravenous insulin in pediatric diabetic ketoacidosis is safe and facilitates transition to a subcutaneous regimen

Background: Diabetes ketoacidosis (DKA) is a common presentation and complication of type 1 diabetes (T1D). While intravenous insulin is typically used to treat acute metabolic abnormalities, the transition from intravenous to subcutaneous treatment can present a challenge. We hypothesize that co-administration of glargine, a subcutaneous long-acting insulin analog, during insulin infusion may facilitate a flexible and safe transition from intravenous to subcutaneous therapy. Objective: To determine if the practice of administering subcutaneous glargine during intravenous insulin is associated with an increased risk of hypoglycemia, hypokalemia, or other complications in children with DKA. Methods: Retrospective chart review of patients aged 2 to 21 years, presenting to our center with DKA between April 2012 and June 2014. Patients were divided into two groups: those co-administered subcutaneous glargine with intravenous insulin for over 4 hours (G+); and patients with less than 2 hours of overlap (G−). Results: We reviewed 149 DKA admissions (55 G+, 94 G−) from 129 unique patients. There was a similar incidence of hypoglycemia between groups (25% G+ vs 20% G−, P = 0.46). Hypokalemia (<3.5 mmol/L) occurred more frequently in the G+ group (OR = 3.4, 95% CI 1.7-7.0, P = 0.001). Cerebral edema occurred in 2/55 (3.6%) of the G− group and none of the G+ subjects. Conclusion: Co-administration of glargine early in the course of DKA treatment is well tolerated and convenient for discharge planning; however, this approach is associated with an increased risk of hypokalemia. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Lt

On occurrence of spectral edges for periodic operators inside the Brillouin zone

The article discusses the following frequently arising question on the spectral structure of periodic operators of mathematical physics (e.g., Schroedinger, Maxwell, waveguide operators, etc.). Is it true that one can obtain the correct spectrum by using the values of the quasimomentum running over the boundary of the (reduced) Brillouin zone only, rather than the whole zone? Or, do the edges of the spectrum occur necessarily at the set of ``corner'' high symmetry points? This is known to be true in 1D, while no apparent reasons exist for this to be happening in higher dimensions. In many practical cases, though, this appears to be correct, which sometimes leads to the claims that this is always true. There seems to be no definite answer in the literature, and one encounters different opinions about this problem in the community. In this paper, starting with simple discrete graph operators, we construct a variety of convincing multiply-periodic examples showing that the spectral edges might occur deeply inside the Brillouin zone. On the other hand, it is also shown that in a ``generic'' case, the situation of spectral edges appearing at high symmetry points is stable under small perturbations. This explains to some degree why in many (maybe even most) practical cases the statement still holds.Comment: 25 pages, 10 EPS figures. Typos corrected and a reference added in the new versio

Getting evidence into clinical practice: protocol for evaluation of the implementation of a home-based cardiac rehabilitation programme for patients with heart failure

INTRODUCTION: Cardiac rehabilitation (CR) improves health-related quality of life and reduces hospital admissions. However, patients with heart failure (HF) often fail to attend centre-based CR programmes. Novel ways of delivering healthcare, such as home-based CR programmes, may improve uptake of CR. Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) is a new, effective and cost-effective home-based CR programme for people with HF. The aim of this prospective mixed-method implementation evaluation study is to assess the implementation of the REACH-HF CR programme in the UK National Health Service (NHS). The specific objectives are to (1) explore NHS staff perceptions of the barriers and facilitators to the implementation of REACH-HF, (2) assess the quality of delivery of the programme in real-life clinical settings, (3) consider the nature of any adaptation(s) made and how they might impact on intervention effectiveness and (4) compare real-world patient outcomes to those seen in a prior clinical trial. METHODS AND ANALYSIS: REACH-HF will be rolled out in four NHS CR centres across the UK. Three healthcare professionals from each site will be trained to deliver the 12-week programme. In-depth qualitative interviews and focus groups will be conducted with approximately 24 NHS professionals involved in delivering or commissioning the programme. Consultations for 48 patients (12 per site) will be audio recorded and scored using an intervention fidelity checklist. Outcomes routinely recorded in the National Audit of Cardiac Rehabilitation will be analysed and compared with outcomes from a recent randomised controlled trial: the Minnesota Living with HF Questionnaire and exercise capacity (Incremental Shuttle Walk Test). Qualitative research findings will be mapped onto the Normalisation Process Theory framework and presented in the form of a narrative synthesis. Results of the study will inform national roll-out of REACH-HF. ETHICS AND DISSEMINATION: The study (IRAS 261723) has received ethics approval from the South Central (Hampshire B) Research Ethics Committee (19/SC/0304). Written informed consent will be obtained from all health professionals and patients participating in the study. The research team will ensure that the study is conducted in accordance with the Declaration of Helsinki, the Data Protection Act 2018, General Data Protection Regulations and in accordance with the Research Governance Framework for Health and Social Care (2005). Findings will be published in scientific peer-reviewed journals and presented at local, national and international meetings to publicise and explain the research methods and findings to key audiences to facilitate the further uptake of the REACH-HF intervention. TRIAL REGISTRATION: ISRCTN86234930

Decaying Dark Matter in the Supersymmetric Standard Model with Freeze-in and Seesaw mechanims

Inspired by the decaying dark matter (DM) which can explain cosmic ray anomalies naturally, we consider the supersymmetric Standard Model with three right-handed neutrinos (RHNs) and R-parity, and introduce a TeV-scale DM sector with two fields \phi_{1,2} and a $Z_3$ discrete symmetry. The DM sector only interacts with the RHNs via a very heavy field exchange and then we can explain the cosmic ray anomalies. With the second right-handed neutrino N_2 dominant seesaw mechanism at the low scale around 10^4 GeV, we show that \phi_{1,2} can obtain the vacuum expectation values around the TeV scale, and then the lightest state from \phi_{1,2} is the decay DM with lifetime around \sim 10^{26}s. In particular, the DM very long lifetime is related to the tiny neutrino masses, and the dominant DM decay channels to \mu and \tau are related to the approximate \mu-\tau symmetry. Furthermore, the correct DM relic density can be obtained via the freeze-in mechanism, the small-scale problem for power spectrum can be solved due to the decays of the R-parity odd meta-stable states in the DM sector, and the baryon asymmetry can be generated via the soft leptogensis.Comment: 24 pages,3 figure

A systematic review of provider-and system-level factors influencing the delivery of cardiac rehabilitation for heart failure

BACKGROUND: There is a longstanding research-to-practice gap in the delivery of cardiac rehabilitation for patients with heart failure. Despite adequate evidence confirming that comprehensive cardiac rehabilitation can improve quality of life and decrease morbidity and mortality in heart failure patients, only a fraction of eligible patients receives it. Many studies and reviews have identified patient-level barriers that might contribute to this disparity, yet little is known about provider- and system-level influences. METHODS: A systematic review using narrative synthesis. The aims of the systematic review were to a) determine provider- and system-level barriers and enablers that affect the delivery of cardiac rehabilitation for heart failure and b) juxtapose identified barriers with possible solutions reported in the literature. A comprehensive search strategy was applied to the MEDLINE, Embase, PsycINFO, CINAHL Plus, EThoS and ProQuest databases. Articles were included if they were empirical, peer-reviewed, conducted in any setting, using any study design and describing factors influencing the delivery of cardiac rehabilitation for heart failure patients. Data were synthesised using inductive thematic analysis and a triangulation protocol to identify convergence/contradiction between different data sources. RESULTS: Seven eligible studies were identified. Thematic analysis identified nine overarching categories of barriers and enablers which were classified into 24 and 26 themes respectively. The most prevalent categories were 'the organisation of healthcare system', 'the organisation of cardiac rehabilitation programmes', 'healthcare professional' factors and 'guidelines'. The most frequent themes included 'lack of resources: time, staff, facilities and equipment' and 'professional's knowledge, awareness and attitude'. CONCLUSIONS: Our systematic review identified a wide range of provider- and system-level barriers impacting the delivery of cardiac rehabilitation for heart failure, along with a range of potential solutions. This information may be useful for healthcare professionals to deliver, plan or commission cardiac rehabilitation services, as well as future research

The retreat from widening participation? : the National Scholarship Programme and new access agreements in English higher education

This article critically analyses the impact of reforms to the student financial support system in English higher education. Comparative analysis of financial support mechanisms and patterns of outreach engagement with groups underrepresented in higher education show a marked deterioration in the levels of cash support available and an increasingly focus on the brightest poor students (in the form of merit aid) at the expense of the generality of poorer students since the new support programme came into place. This can be seen as part of a wider policy shift away from generic widening participation to the targeting of specific cohorts to raise the attainment level of intakes or to meet recruitment shortfalls. The findings are located in a context of a (near) trebling of tuition fees, stagnation in overall student numbers and the promotion of market mechanisms, all of which can be seen as a challenge to the notion of social justice through the higher education system