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The prevalence of diabetes in Birmingham is 11% but it is 22% in hospital inpatients. Queen Elizabeth Hospital in Birmingham (QEHB) serves a multi-ethnic population with 6% Afro-Caribbean, 19% South Asian and 70% White European. A clinical audit of 18,965 emergency admissions to QEHB showed that 5% were undiagnosed but had admission glucose in the ‘diabetes’ range and 16% were in the ‘at risk’ range. The proportion of Afro-Caribbeans (7%) and South Asians (8%) in the ‘diabetes’ range was higher than White Europeans (5%). Given the magnitude of the problem, this paper explores the issues concerning the use of reflex HbA1c testing in the UK for diagnosis of diabetes in hospital admissions. HbA1c testing is suitable for most patients but conditions affecting red blood cell turnover invalidate the results in a small number of people. However, there are pertinent questions relating to the introduction of such testing in the NHS on a routine basis. Literature searches on a topical question ‘Is hyperglycaemia identified during emergency admission/attendance acted upon?’, were performed from 2016 to 2021 and 2016 to 2022. They identified 21 different, relevant, research papers - 5 from Australia, 9 from Europe including 4 from the UK, 5 from America and 1 each from Canada and Africa. These papers revealed an absence of established procedures for the management and follow-up of routinely detected hyperglycaemia using HbA1c when no previous diabetes diagnosis was recorded. Further work is required to determine the role of reflex HbA1c testing for diagnosis of diabetes in admissions with hyperglycaemia, and the cost-effectiveness and role of point-of-care HbA1c testing.

The present experimental analysis has been carried out to compare the changes in the tribological and mechanical properties of brass samples with and without heat treatment. Four Cu-Zn alloy samples are heated in various temperature ranges between 350°C to 800°C. Changes in hardness of all samples are recorded to observe the effect of temperature and time duration. Wear tests are performed in both dry and lubricated conditions. Wear loss and coefficient of friction of samples were measured at loads 20 N, 30 N, 40 N, and 50 N and at rotating disc speeds of 120 rpm, 140 rpm, 160 rpm, and 180 rpm at fixed track diameter for 8 minutes. Better tribological performance was found in the lubricating condition within the entire range of tests carried out. Minimum wear rate was observed for the samples heat treated at 650°C. The wear behavior is also investigated for both kind of samples. Deep grooving and micro ploughing phenomena are observed for non-heat-treated specimens. In the heat-treated state, the plasticity formation is more prominent.

Aims: Infection is a major trigger for both Lupus flare and Macrophage activation syndrome. Scrub typhus infection associated with lupus flare or MAS has been very rarely reported. We report a case of scrub typhus-induced MAS along with a flare of disease activity in a neuropsychiatric lupus patient presenting after discontinuation of medications. Presentation of Case: 13-year-old girl, a known case of neuropsychiatric lupus with lupus nephritis, on immunosuppressant for the last 1 year had stopped all medications for 3 months. She had presented with a fever and altered sensorium. Based on clinical and laboratory investigations, a diagnosis of scrub typhus-induced macrophage activation syndrome with a flare of lupus disease activity was made and the patient was treated with injection doxycycline and glucocorticoids. There was rapid clinical improvement with treatment. Discussion: The case emphasizes the importance of identifying the exact trigger behind the deterioration of a patient with lupus and its therapeutic implications. An infection alone requires antibiotics only, flare without infection requires up titrating immunosuppressants but the presence of life-threatening complications like MAS along with infection requires prompt treatment of both facets simultaneously. Conclusion: Scrub typhus infection should be ruled out apart from other common infections in any patient with lupus flare or MAS.

Cervical artery dissection is a major cause of ischaemic stroke in young adults. The diagnosis can be challenging as some patients may present with seemingly benign symptoms such as a headache, neck pain or dizziness. However, the neurological sequelae of a transient ischaemic attack, vision loss or ischaemic stroke are potentially devastating. All hospital clinicians must be able to recognise this diagnosis and organise timely and appropriate investigations as antithrombotic treatment reduces the risk of stroke recurrence. This article reviews the literature to provide practical information for clinicians to recognise key risk factors and features of history and examination which should raise suspicion of cervical artery dissection. Diagnosis can now be made using the non-invasive, commonly available modalities of computed tomography angiography or magnetic resonance angiography. Timely treatment with antithrombotic agents is recommended to reduce the rate of an ischaemic stroke.

Periodontal disease is a public health problem and is associated with systemic diseases. Periodontitis is a highly prevalent disease in developed and developing country across all age group & gender. Majority of population in the developing countries suffer from different stages and grades of periodontitis which causes alveolar bone loss, tooth mobility and tooth loss.A cross-sectional study was conductedon 2220 dentate person including both male & female aged from 20 to 65 reported in the Department of Periodontics in 3 months It was observed estimated prevalence of periodontitis increased with age which is much higher among subjects with poor oral hygiene practice and females are suffering more than male. The current study collected significant data for prevalence Inadequate and/or improper maintenance of Oral hygiene confirmed as the most important predictor for periodontitis. Severity was found to be increased with increasing age also more in female than male.The effect of age and gender on the progression of periodontitis seemed to be less important when good oral hygiene is practiced.

This paper addresses the finite-time stabilization of nonlinear polytopic systems. Sufficient conditions are proposed for the existence of a continuous time-invariant finite-time stabilizing state feedback controller through a robust control Lyapunov function. It is shown that the obtained sufficient condition is also necessary if there exists a state feedback controller such that the closed-loop system has a robust Lyapunov function for all possible uncertainties. Finally, to verify the efficacy of the proposed control design, a numerical example is presented.

A coupled electron–nuclear dynamical study is performed to investigate the sub-cycle dissociation and ionization of the H2 molecule in a strong 750 nm 4.5 fs elliptically polarized laser pulse.

Localized inflammatory or reactive overgrowths are quite more common clinical findings on human gingiva. Most of the lesions are benign and innocuous though some have potency to transfer in to a malignant lesion. These types of lesions are difficult to identify clinically as their appearance are quite similar so only Histopathological evaluation can detect their identity. In this case report we displayed a case of Peripheral Ossifying Fibroma in maxillary anterior tooth region in 32 year old female patient along with clinical, Histopathological evaluation along with present and future treatment details. Peripheral ossifying fibroma (POF) is usually a fibromatic, non neoplastic enlargement of the gingiva which shows areas of calcification or ossification. Synonyms for POF include Peripheral cementifying fibroma, Peripheral fibroma with calcification, Calcifying or ossifying fibrous epulis and Calcifying fibroblastic granuloma. Keywords: Gingival overgrowth, Ossifying fibroma, Peripheral ossifying fibroma, Peripheral cementifying fibroma

This paper proposes a distributed artificially delayed output feedback‐based leader–follower and leaderless consensus control for the uncertain general linear multiagent systems (MASs) with an arbitrary relative degree. Based on the measured relative output and their delayed information with respect to neighbours, two distributed controllers are designed, which relaxes the requirement of all relative states information of agents. Through the Lyapunov–Krasovskii functional, linear matrix inequalities (LMIs) are formulated, and these LMIs are feasible for arbitrary small delays selected by the user. Delay‐dependent sufficient conditions are provided to guarantee the asymptotic convergence of nominal error systems and ultimately uniform boundedness in the case of a perturbed error system, using the input to state stability (ISS) theory. Finally, the efficacy of the proposed method is illustrated through numerical examples.

The presence of pulpal pathosis and inflammatory periodontal disease concomitantly can complicate diagnosis and treatment planning of any tooth. It requires a combined treatment approach involving endodontic, periodontic and prosthodontic intervention. Often, the periodontal and prosthodontic aspects are neglected by the clinicians after successful endodontic treatment resulting in failure. The present case report describes a multidisciplinary approach for the treatment of a tooth that presented with an endo-perio lesion; using non-surgical root canal treatment and periodontal regenerative surgery (non-incised papillae surgical approach, {NIPSA} long with GTR membrane and an alloplastic bone graft) which were then followed by the placement of a conservative tooth coverage restoration (endocrown). A significant gain in clinical attachment level was seen 6 months postoperatively. Radiographically also a significant amount of bone fill was observed. Keywords: Endo-perio lesion, NIPSA, Endocrown

Modern power sector requires grid observability under all scenarios for its ideal functioning. This enforces the operator to incorporate state estimation solutions based on a priori measurements to deduce the corresponding operating states of the grid. The key principle for such aforementioned algorithms lies on an occurrence of an over determined class of system having an ample redundancy in the measurements. Operators employ state forecasting solutions to counter the loss of real-time measurements. This work encompasses a critical comparison between several machine learning models along with ARIMA and time delayed neural network architecture for proper forecasting of operating states under normal as well as contingency scenarios. To showcase the efficacy of the proposed approach, this work incorporates a comprehensive comparison between them based on RMSE, MSE and MAE index. Copula-based synthetic data generation based on Gaussian multivariate distribution of the a priori measurements and operating states along with optimal hyper-parameter tuning of the models have shown the effectiveness of such algorithms in predicting future state estimates. The proposed machine learning models can be also seen to showcase an effective forecasting strategy under varying noise scenarios. This work also showcases the implementation of the models for real-time state forecasting strategy having computational times in the order of micro seconds. All the simulations have been carried out on the standard IEEE 14 bus test bench to support the former proposals.