Improving the quality of assessment and management of hypoglycaemia in hospitalised patients with diabetes mellitus by introducing 'hypo boxes' to general medical wards with a specialist interest in diabetes

Diabetes is becoming more prevalent in the UK and this is represented in the in-patient cohort, such that 1 in 6 hospital patients have diabetes (1). The UK National Diabetes In-Patient Audit in 2012 estimated that 30% of patients experience one episode of hypoglycaemia during admission. Hypoglycaemia is associated with increased morbidity and mortality, and longer length of hospital stay. It is therefore important that hypoglycaemia is managed promptly and effectively to reduce associated morbidity. The Joint British Diabetes Society recommends that all wards should have access to ‘Hypo Boxes’ (2). We assessed all episodes of hypoglycaemia (<4.0 mmol/l) in the diabetes wards in over a 4 week period. ‘Hypo Boxes’ were installed to the wards and the appropriateness of treatment and time to correction of hypoglycaemia was re-assessed. Assessment of hypoglycaemia pre-intervention revealed 45 episodes of hypoglycaemia in 14 patients, and 42% (n=19) of episodes were deemed to have been treated appropriately. Only 17.8% of episodes were corrected within 30 minutes, and 33.3% were corrected within 60 minutes. A third of patients (35%) did not have a further blood glucose checked. Following intervention, there was a marked improvement in management. The proportion of appropriately managed episodes increased to 82% (n=35) and management of episodes of severe hypoglycaemia (<3.0 mmol/l) increased to 94%. The time to correction increased with 40% of episodes corrected to >4.0 mmol/l within 30 minutes, and a further 54% between 30-60 minutes. In conclusion, the introduction of ‘Hypo Boxes’ improved the assessment and management of hypoglycaemia

Managing biowaste and promoting sustainability - profiling community composting

The voluntary and community waste sector makes an important contribution to waste objectives (Williams et al, 2006). The community composting sector would appear to be leading the development of innovative biowaste collection and processing systems in areas unsuitable for traditional kerbside. Such schemes can contribute to developing local areas by improving local soils and green spaces as well as diverting waste from landfill. However, this is often only part of the story. Well managed community activity has huge potential for providing work and volunteering opportunities, as well as bringing people together and improving skills, knowledge and self-confidence. Considered collectively these factors may contribute to local sustainability more effectively than reliance on meeting particular targets. Although there is some anecdotal and financial evidence for the growth in, and diversity of, community composting, there is very little comprehensive data that draws together the activity of the sector as a whole. The paper addresses this gap by presenting findings from a national survey profiling community based composting. Results show that a range of activities fall under the umbrella of community composting and these include: collecting / receiving and processing material, running education campaigns, promoting home composting and facilitating others to develop / promote community composting. The survey recorded over 100 groups actively engaged in at least one of these activities with many involved in more than one. Overall 80% of groups are involved in collecting and composting material and 20% are involved in composting related activity other than collecting and composting, such as educational and promotional activities. The sector has a large potential for providing work and volunteering opportunities and results indicate over 1,300 volunteers, trainees and staff involved in community composting. In addition, most groups (68%) carry out composting alongside other waste and recycling activities or, more commonly, alongside non-waste activities such as community gardens, city farms, local food production, day and residential services and work integration schemes. These activities may bring about positive environmental impacts and social benefits over and above quantities of material diverted from landfill, and these benefits often cut across different policy agendas. Knowing and understanding these impacts and benefits is important in understanding the role of the community composting sector. In addition to results from profiling the sector, this paper will also present findings from participatory research with groups to develop ways to better understand and demonstrate the impacts of their work

Enhancing sustainable biowaste management in the UK: the role of the commercial and community composting sectors

This paper considers the different roles of the commercial and community composting sectors in contributing to sustainable biowaste management in the UK. Legislation and policy have driven the rapid development of a diverse composting sector. The next section sets out this policy context. This is followed with an analysis of the growth in, and characteristics of, the commercial composting sector and then the community composting sector. It is contended that both sectors have different strengths in contributing to sustainable biowaste management. For commercial composting this is based around large-scale composting and quality products, for the community sector this is based around services in difficult collection environments, local sustainability, promoting social cohesion and building stronger communities. The extent to which the benefits from the commercial and composting sectors will be realised in the future will depend on whether the sectors can develop synergistically and the extent to which this is encouraged by national and local policies

Unlocking the potential of community composting: Full project report

Community based composting schemes can make valuable contributions to the development of local infrastructure and amenities by improving soils and green spaces in addition to diverting waste from landfill. Furthermore, well managed community activities have potential for providing work and volunteering opportunities, as well as bringing people together and improving skills, knowledge and self-confidence. Considered collectively these factors may contribute to local sustainability more effectively than focusing on meeting particular waste related targets. Although there is some anecdotal and financial evidence for the growth in, and diversity of, community composting, there is very little comprehensive data that draws together the activity of the sector as a whole. This research set out to understand and assess the current and potential role of the community composting sector in achieving Defra’s waste related targets and Government’s other wider environmental and social objectives. Thus this research is timely both in terms of establishing what has been achieved in the community composting sector to-date and in terms of possibilities for future achievements

Hermitian and skew hermitian forms over local rings

We study the classification problem of possibly degenerate hermitian and skew hermitian bilinear forms over local rings where 2 is a unit

Unbound Star-forming Molecular Clouds

We explore whether observed molecular clouds could include a substantial population of unbound clouds. Using simulations which include only turbulence and gravity, we are able to match observed relations and naturally reproduce the observed scatter in the cloud size-linewidth coefficient, at fixed surface density. We identify the source of this scatter as a spread in the intrinsic virial parameter. Thus these observational trends do not require that clouds exist in a state of dynamical equilibrium. We demonstrate that cloud virial parameters can be accurately determined observationally with an appropriate size estimator. All our simulated clouds eventually form collapsing cores, regardless of whether the cloud is bound overall. This supports the idea that molecular clouds do not have to be bound to form stars or to have observed properties like those of nearby low-mass clouds.Comment: 9 pages, 6 figures, Accepted for publication by MNRA

Evolving Molecular Cloud Structure and the Column Density Probability Distribution Function

The structure of molecular clouds can be characterized with the probability distribution function (PDF) of the mass surface density. In particular, the properties of the distribution can reveal the nature of the turbulence and star formation present inside the molecular cloud. In this paper, we explore how these structural characteristics evolve with time and also how they relate to various cloud properties as measured from a sample of synthetic column density maps of molecular clouds. We find that, as a cloud evolves, the peak of its column density PDF will shift to surface densities below the observational threshold for detection, resulting in an underlying lognormal distribution which has been effectively lost at late times. Our results explain why certain observations of actively star-forming, dynamically older clouds, such as the Orion molecular cloud, do not appear to have any evidence of a lognormal distribution in their column density PDFs. We also study the evolution of the slope and deviation point of the power-law tails for our sample of simulated clouds and show that both properties trend towards constant values, thus linking the column density structure of the molecular cloud to the surface density threshold for star formation.Comment: 10 pages, 9 figures, Accepted for publication by MNRA