Type 2 diabetes (T2D) has a reported greater prevalence and poorer treatment outcomes in people living with HIV (PLWH) than comparable HIV-uninfected cohorts. We conducted a cross-sectional study to ...delineate the factors driving T2D in PLWH in an ethnically diverse cohort, and additionally observed how these have changed over time.
We studied a diverse HIV cohort in London to determine the prevalence and risk factors for T2D, and compared them to a cohort studied 10 years previously.
Patients were classified as normoglycaemic (fasting glucose <6.0 mmol/l) or dysglycaemic (≥6.0 mmol/l). The relative contribution to dysglycaemia of modifiable and fixed factors, including demographics, anthropometrics, comorbidities, immune status, and HIV therapy, were analysed using univariate and logistic regression analyses.
T2D prevalence was 15.1% in 2015 with a relative risk of 2.4 compared to the general population. The prevalence compared to 6.8% ten years earlier. The 2015 versus the 2005 cohort was significantly older (median age 49 (42-57) years versus 41 (IQR 35-47), p<0.001), had a higher BMI (27.4 (23.3-29.9) versus 24.9 (22.4-28.0) kg/m2 respectively, p = 0.019) and hypertensive (37.9% versus 19.6 respectively, p<0.001). The strongest predictors of dysglycaemia in the 2015 cohort were hepatic steatosis and hypertension, odds ratios (OR) and 95% confidence intervals (CI) 6.74 (3.48-13.03) and 2.92 (1.66-5.16) respectively, and also HIV-related factors of weight gain following antiretroviral initiation and longer known duration of HIV infection (OR 1.07 (1.04-1.11) and 1.06 (1.02-1.10) respectively).
The alarmingly high prevalence of T2D in HIV requires improved screening, targeted to older patients and those with a longer duration of exposure to antiretrovirals. Effective diabetes prevention and management strategies are needed urgently to reduce this risk; such interventions should target both conventional risk factors, such as abdominal obesity, and HIV-specific risk factors such as weight gain following initiation of antiretrovirals.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
La forme et le style des romans de Claude Simon, surtout entre Le Vent(1957) et La Route des Flandres(1960), doivent beaucoup aux romans de Faulkner traduits au début des années cinquante, L’Intrus, ...Les Palmiers sauvageset Absalon, Absalon!Les traductions de Faulkner, profondément revues depuis la fin du siècle dernier, doivent quelque chose à l’exemple de Simon : sa phrase a élargi les limites de ce qui pouvait s’écrire en bon français. L’influence de Simon et de Faulkner se fait encore sentir, séparément ou conjointement, sur des romans du collectif Inculte : J’ai appris à ne pas rire du démond’Arno Bertina, Zone de Mathias Énard, Naissance d’un pontde Maylis de Kerangal.
Fluid off-takes and complex delivery ducts are common in many engineering systems but designing them can be a challenging task. At the conceptual design phase many system parameters are open to ...consideration and preliminary design studies are necessary to instruct the conceptualisation process in an iterative development of design ideas. This paper presents a simple methodology to parametrically design, explore and optimise such systems at low cost. The method is then applied to an aerodynamic system including an off-take followed by a complex delivery duct. A selection of nine input variables is explored via a fractional factorial design approach that consists of three individual seven-level cubic factorial designs. Numerical predictions are characterised based on multiple aerodynamic objectives. A scaled representation of these objectives allows for a scalarisation technique to be employed in the form of a global criterion which indicates a set of trade-off geometries. This leads to the selection of a set of nominal designs and the determination of their robustness which will eventually instruct the next conceptual design iteration. The results are presented and discussed based on criterion space, design variable space and contours of several flow quantities on a selection of optimal geometries.
IntroductionCardiovascular diseases (CVDs) are the single greatest contributor to global mortality. The successful introduction and scale-up of antiretroviral therapy (ART) delivered a reduction in ...HIV mortality. Consequently, an association was found between the scale-up of ART and an increased prevalence of comorbidities among people living with HIV (PLWH) such as hypertension and dyslipidaemia. A higher quality diet can delay the onset of comorbidities related to HIV infection. Diet quality and its methods of assessment are not fully established among PLWH. This review will identify the diet quality and food insecurity indices that have been used among PLWH and how these constructs are associated with risk of developing CVD.Methods and analysisThe frameworks recommended by Arksey and O’Malley and the Joanna Briggs Institute’s manual for conducting scoping reviews will be adopted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines will be used for reporting. A search strategy was developed using keywords related to the topic. A preliminary MEDLINE (via PubMed) search was conducted on 11 November 2020 to develop a comprehensive search strategy. The final search will be conducted on PubMed, EbscoHost, Scopus, Web of Science and Cochrane Library databases. Titles and abstracts of retrieved records will be screened independently by two reviewers. Data will be extracted from records that meet the inclusion criteria using a predesigned charting tool. Discrepancies in decisions made by reviewers will be resolved by consensus or the decision of a third reviewer. Extracted data will be presented in tables or charts. A descriptive summary of the charts or tables will follow.Ethics and disseminationEthical approval is not required for a scoping review. Findings will inform other studies currently underway and will be presented at conferences and published in peer-reviewed journals.Registration numberhttps://osf.io/7k3ja.
This paper describes benchmark testing of a diffusive and an inertial formulation of the de St. Venant equations implemented within the LISFLOOD-FP hydraulic model using high resolution terrestrial ...LiDAR data. The models are applied to a hypothetical flooding scenario in a section of Alcester, UK which experienced significant surface water flooding in the June and July floods of 2007 in the UK. The sensitivity of water elevation and velocity simulations to model formulation and grid resolution are analyzed. The differences in depth and velocity estimates between the diffusive and inertial approximations are within 10% of the simulated value but inertial effects persist at the wetting front in steep catchments. Both models portray a similar scale dependency between 50
cm and 5
m resolution which reiterates previous findings that errors in coarse scale topographic data sets are significantly larger than differences between numerical approximations. In particular, these results confirm the need to distinctly represent the camber and curbs of roads in the numerical grid when simulating surface water flooding events. Furthermore, although water depth estimates at grid scales coarser than 1
m appear robust, velocity estimates at these scales seem to be inconsistent compared to the 50
cm benchmark. The inertial formulation is shown to reduce computational cost by up to three orders of magnitude at high resolutions thus making simulations at this scale viable in practice compared to diffusive models. For the first time, this paper highlights the utility of high resolution terrestrial LiDAR data to inform small-scale flood risk management studies.
► Urban DEMs with spatial resolutions of 10cm and 1m are constructed using terrestrial LIDAR data. ► Inundation is simulated using a rapid flood spreading algorithm and a simplified 2D shallow water ...model. ► Hydraulic connectivity over the DEM is shown to be sensitive to small scale features captured by terrestrial LIDAR. ► The simplified shallow water model is more robust to changes in DEM resolution. ► The flood spreading algorithm provides a significant advantage in computational efficiency.
The advent of airborne LIDAR sparked a renewed research drive in two-dimensional hydraulic modelling at the turn of the millennium due to its ability to rapidly generate accurate DEMs over wide areas. Terrestrial LIDAR applies the same principle but uses a mobile ground-based platform, allowing rapid collection of terrain data in urban areas at decimetric scale. Here we apply two computationally efficient hydraulic models to DEMs of a small urban test site in Alcester, UK, derived from terrestrial and airborne LIDAR data at 10cm and 1m scales. The first model, LISFLOOD-FP, is a 2D raster-based model employing a simplified formulation of the de St. Venant equations, whilst the second model, ISIS-FAST, employs a proprietary rapid flood spreading algorithm. The response of the models to changes in DEM resolution and data source are analysed and compared across two event scales. For the first time we show that a flood wave propagating across an urban domain responds to small scale topographic features, such as street kerbs and road surface camber, which are not represented in airborne data but which are resolved by the terrestrial laser scanner. Importantly these features are preserved even if the 10cm terrestrial data are degraded to the 1m scale of the airborne DEM. The results indicate that inclusion of these features improves the representation of hydraulic connectivity over the DEM, and hence flood risk estimation. LISFLOOD-FP is shown to be more robust to changes in DEM resolution than ISIS-FAST due to the momentum conservation inherent to the simplified shallow water formulation, but the reduced computational requirements of ISIS-FAST at 10cm scale allow it to be used for ensemble simulations. The extra detail inherent in terrestrial laser scanning data is advantageous where accurate representation of surface features is required, with potential benefit to high asset-value flood risk analysis and future studies into coupled surface/sewer and pluvial urban inundation models.
To determine comparative fracture risk in HIV patients compared with uninfected controls.
A randomised cross-sectional study assessing bone mineral density (BMD), fracture history and risk factors in ...the 2 groups.
Hospital Outpatients.
222 HIV infected patients and an equal number of age-matched controls.
Fracture risk factors were assessed and biochemical, endocrine and bone markers measured. BMD was assessed at hip and spine. 10-year fracture probability (FRAX) and remaining lifetime fracture probability (RFLP) were calculated.
BMD, and history of fractures.
Reported fractures occurred more frequently in HIV than controls, (45 vs. 16; 20.3 vs. 7%; OR=3.27; p=0.0001), and unsurprisingly in this age range, non-fragility fractures in men substantially contributed to this increase. Osteoporosis was more prevalent in patients with HIV (17.6% vs. 3.6%, p<0.0001). BMD was most reduced, and predicted fracture rates most increased, at the spine. Low BMD was associated with antiretroviral therapy (ART), low body mass index and PTH. 10-year FRAX risk was <5% for all groups. RLFP was greater in patients with HIV (OR=1.22; p=0.003) and increased with ART (2.4 vs. 1.50; OR= 1.50; p=0.03).
The increased fracture rate in HIV patients in our relatively youthful population is partly driven by fractures, including non-fragility fractures, in men. Nonetheless, these findings may herald a rise in osteoporotic fractures in HIV patients. An appropriate screening and management response is required to assess these risks and identify associated lifestyle factors that are also associated with other conditions such as cardiovascular disease and diabetes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
New treatments and increased experience are changing the management of hospitalized coronavirus disease 2019 patients but the impact on ICU management is unclear.
To examine characteristics, ...ventilatory management, and outcomes of critically ill patients in two distinct waves of the pandemic.
Observational cohort study in an ICU in a single-center university-affiliated U.K. hospital. Two-hundred ten adults with coronavirus disease 2019 admitted to ICU between March 17, 2020, to May 31, 2020, and September 1, 2020, to December 10, 2020, with hourly data and 100% follow-up to ICU discharge.
Data were extracted from the electronic medical record for patient characteristics and clinical data. Patients were classified into distinct waves of the pandemic and assessed for differences between the two waves.
The duration of noninvasive ventilation/nasal high flow increased in wave 2 versus wave 1, both in self-ventilating patients (107 vs 72 hr;
= 0.02), and in those ultimately requiring invasive mechanical ventilation (34 vs 10 hr;
= 0.02). The proportion of survivors treated without invasive mechanical ventilation increased in wave 2 (59% vs 39%;
= 0.01). In both waves, longer duration of noninvasive ventilation/nasal high flow prior to intubation was associated with higher ICU mortality (survivors 10 hr 4-21 hr vs nonsurvivors 50 hr 23-124 hr;
< 0.01). Proned invasive mechanical ventilation was common (54.7%) and prolonged. In wave 2, invasive mechanical ventilation patients were generally more hypoxic with proning initiated at lower Pao
/Fio
ratios (81 vs 116 mm Hg;
= 0.02) and yielding smaller improvements in Fio
requirements. Continued proning episodes despite poor responses were commonplace and typically futile. Length of stay for patients requiring tracheostomy increased markedly in wave 2 (51.3 vs 33.7 d;
= 0.03). Overall survival remained similar in wave 2 (68.0% vs 60.9%;
= 0.31).
Our data suggest that management of critically ill coronavirus disease 2019 patients is changing with more survivors avoiding invasive mechanical ventilation. Duration of noninvasive ventilation/nasal high flow use is increasing, which may be associated with worsening outcomes for individuals who require invasive mechanical ventilation. Among invasively ventilated patients, changes in the use of and response to prone positioning and increased length of stay following tracheostomy may imply that the care of these patients is becoming more challenging.
Each year in the United Kingdom, nearly one-third of women giving birth will receive a central neuraxial block (CNB). The majority of postpartum neurological complications are secondary to intrinsic ...obstetric palsies. Despite this, neurological injury can occur following obstetric regional anesthesia. Any postpartum neurological deficit identified by the patient, anesthetist, midwife, or obstetrician should be investigated thoroughly. Prompt recognition and appropriate management of neurological complications is of the utmost importance in reducing the risk of permanent impairment. Anesthetists must recognize and coordinate the appropriate initial management for the complications associated with CNB in order to prevent permanent neurological damage.
Les deux auteurs se proposent d’étudier les romans de Jean-Yves Laurichesse dans le but de faire apparaître leur évolution mais aussi la récurrence de formes et de thèmes qui contribuent à dessiner ...la cohérence globale d’une œuvre.
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