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OBJECTIVE To evaluate the performance of a real-time continuous glucose monitor (CGM) in individuals with diabetes on peritoneal dialysis (PD). RESEARCH DESIGN AND METHODS Thirty participants with type 2 diabetes on continuous ambulatory PD wore a Guardian Sensor 3 on the upper arm paired with Guardian Connect for 14 days. We compared CGM readings against Yellow Springs Instrument (YSI) venous glucose during an 8-h in-clinic session with glucose challenge. RESULTS The mean absolute relative difference (MARD) was 10.4% (95% CI 9.6, 11.7) from 941 CGM-YSI matched pairs; 81.3% of readings were within %15/15 of YSI values in the full glycemic range. Consensus error grid analysis showed 99.9% of sensor values in zones A and B. There were no correlations between pH, uremia, hydration status, and MARD. CONCLUSIONS We showed satisfactory performance of a real-time CGM sensor in PD patients with diabetes, supporting future use to facilitate treatment decisions.

Glycated hemoglobin A1c (HbA1c) has reduced reliability in advanced chronic kidney disease (CKD) owing to factors influencing red cell turnover. Recent guidelines support the use of continuous glucose monitoring (CGM) in glycemic assessment in these patients. We evaluated relationships between HbA1c and CGM metrics of average glycemia and glucose variability (GV) in moderate-to-advanced CKD.There were a total of 90 patients with diabetes in CKD stages G3b (Correlations between glucose management indicator (GMI) and HbA1c attenuated with advancing CKD (G3b [CGM-derived indices might serve as an adjunct to HbA1c monitoring to guide glycemic management, especially in those with eGFR 30 ml/min per 1.73 m

Objective: To evaluate the performance of a real-time continuous glucose monitor (CGM) in individuals with diabetes on peritoneal dialysis (PD). Research Design and methods: Thirty type 2 diabetes participants on continuous ambulatory peritoneal dialysis (CAPD) wore a Guardian Sensor™ 3 on the upper arm paired with Guardian Connect™ for 14 days. We compared CGM readings against Yellow Springs Instrument (YSI) venous glucose during an 8-hour in-clinic session with glucose challenge. Results: The mean absolute relative difference (MARD) was 10.4% (95% confidence interval: 9.6, 11.7) from 941 CGM-YSI matched pairs; 81.3% of readings were within 15/15% of YSI values in the full glycemic range. Consensus error grid analysis showed 99.9% of sensor values in zones A and B. There were no correlations between pH, uremia, hydration status and MARD. Conclusion: We showed satisfactory performance of a real-time CGM sensor in PD patients with diabetes, supporting future use to facilitate treatment decisions.

Introduction To compare glycemic variability (GV) and time in range (TIR) in Chinese patients with type 2 diabetes (T2D) initiated on once-daily bedtime insulin glargine 300U/ml (Gla-300) versus neutral protamine Hagedorn (NPH) insulin using continuous glucose monitoring (CGM). Methods This was a 24-week, open-label exploratory study with 1:1 randomization comparing patient-adjusted titration of Gla-300 (n = 23) versus NPH (n = 23) at bedtime in insulin-naïve T2D patients on maximum oral glucose-lowering drugs. The starting dose was 0.2 U/kg/day and with self-titration of one unit per week to achieve a target fasting glucose of 4.4–6 mmol/l, without hypoglycemia. Participants had masked CGM at baseline, weeks 11 and 24. The primary outcome was between-treatment differences in CGM glucose standard deviation (SD) at week 24. Results HbA1c at week 24 were similar, with 21% of Gla-300 versus 4% of NPH-treated patients achieving HbA1c

Patients with moderate-to-advanced diabetic kidney disease (DKD) are at high risk of hypoglycemia. There are few studies evaluating personal continuous glucose monitoring (CGM) use in this group. We investigated whether flash glucose monitoring (FGM) was effective in reducing hypoglycemia compared with standard self-monitoring of blood glucose (SMBG) in individuals with chronic kidney disease (CKD) stages 3b-5 (non-dialysis). This was a single-centre, parallel-group randomised clinical trial of 94 adults with diabetes and CKD [G3b (n=36), G4 (n=44) and G5 (n=14)] and a history of hypoglycemia. Patients were randomly assigned 1:1 to FGM or SMBG for 16 weeks. Both groups received structured education on hypoglycemia and monthly reviews by healthcare professionals. Blinded CGM was performed at baseline and end of study in both groups. Patients were aged (mean±SD) 65.4±9.0 years with estimated glomerular filtration rate (eGFR) 26.1±9.6 ml/min/1.73m2, HbA1c 7.4±0.8% and median duration of diabetes for 20 years. 93 patients had type 2 diabetes and 99% were on insulin. After 16 weeks, percentage time Disclosure J. Ling: None. J. K. Ng: None. R. C. Ma: Other Relationship; Self; AstraZeneca, Medtronic, Research Support; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Tricida, Inc. A. P. Kong: Advisory Panel; Self; Lilly Diabetes, Speaker’s Bureau; Self; Abbott, AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Lilly Diabetes, Sanofi, Stock/Shareholder; Self; Aptorum. A. Luk: None. C. Szeto: None. J. C. Chan: Consultant; Self; Bayer AG, Boehringer Ingelheim International GmbH, MSD Corporation, Sanofi, Other Relationship; Self; Asia Diabetes Foundation, GemVCare, Research Support; Self; Applied Therapeutics, AstraZeneca, Hua Medicine, Lilly Diabetes, Merck KGaA. E. Chow: Research Support; Self; Medtronic, Speaker’s Bureau; Self; Novartis Pharmaceuticals Corporation, Sanofi-Aventis. Funding Hong Kong College of Physicians; University Grants Committee Research Matching Grant Scheme

As part of the communication activities in Work Package 9, Greenovate! Europe has produced three animated videos. The subject of the videos is the three valorisation lines being demonstrated in SCALIBUR, for the conversion of biowaste into added value products. The objective of the 3 videos is to introduce stakeholders to the valorisation processes, providing a short, visually appealing, ‘trailer’ to raise interest in the processes under development. The videos have been designed to address multiple stakeholders, including municipalities, the R&D community and also citizens. The videos have been published on the SCALIBUR youtube channel, and the files have been made available to project partners for use at conferences and exhibitions. Whenever possible the videos should be published next to a link to the relevant page on the SCALIBUR project website, where interested parties can access additional information and contact the responsible SCALIBUR partner.

Background: Increased glycemic variability (GV) is thought to represent abnormalities of glucose homeostasis in the progression from prediabetes to diabetes. We evaluated the association between GV, beta-cell function and glucagon-like peptide 1 (GLP-1) response among individuals with prediabetes. Methods: 61 individuals with prediabetes (age Mean±SD 56±9 years, 31 male) each wore a blinded continuous glucose monitor (Medtronic iPro2) for 72 hours. Standard deviation (SD) and coefficient of variation (CV) were calculated from CGM glucose. Participants underwent a 2-hour mixed-meal tolerance test with measurement of insulin, C-peptide, GLP-1 for modelling of beta-cell function. Results: Early and late GLP-1/glucose ratio were positively correlated with CGM sensor glucose SD (r = 0.29, p=0.02 and r= 0.28 p = 0.048 respectively). Beta-cell glucose sensitivity (βCGS) was negatively correlated with SD (r = -0.28, p = 0.03). In multivariate analyses, only βCGS and GLP-1 response were significant predictors of SD, while early phase insulin and insulin secretion rate predicted average sensor glucose but not indices of GV. Conclusions: Higher GLP-1 response and reduced βCGS are associated with greater glucose fluctuations in the prediabetic range. Disclosure E. Chow: Research Support; Self; Powder Pharmaceuticals Inc., Sanofi-Aventis. A. Luk: None. J. Ling: None. A.P. Kong: Advisory Panel; Self; Lilly Diabetes. Research Support; Self; AstraZeneca, Lilly Diabetes. Speaker's Bureau; Self; Abbott. Other Relationship; Self; AstraZeneca, Novartis Pharmaceuticals Corporation, Sanofi. R.C. Ma: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Research Support; Self; AstraZeneca, Bayer AG, Pfizer Inc. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; AstraZeneca. E. Ferrannini: None. J.C. Chan: Board Member; Self; Asia Diabetes Foundation. Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Medtronic, Merck Sharp & Dohme Corp., Sanofi-Aventis. Research Support; Self; Amgen Inc., AstraZeneca, Lee Powder, Lilly Diabetes, Pfizer Inc., Sanofi-Aventis. Speaker's Bureau; Self; Ascensia Diabetes Care. Stock/Shareholder; Self; GemVCare.

Heat Recovery Ventilators (HRV) are gradually becoming more popular in urban cities and buildings as it is able to effectively maintain the indoor air quality while also using minimal amounts of energy. The key component in the HRV is the Paper Heat Exchanger, which allows the heat exchange of indoor and outdoor air through a crossflow, while also filtering out stale air and dust particles. This article investigates the effect of manipulating the supply and exhaust air velocity on the enthalpy and temperature exchange efficiency of a paper heat exchanger. Data is obtained from experimental results, where the experiments are conducted in a test lab using heat recovery ventilators (HRV) installed with paper heat exchangers. Two paper heat exchangers from different suppliers were tested inside a HRV installed in an air conditioned room. The HRV fan speed was varied at a fixed interval of 0.5 m/s, and the air velocity was measured by using a wind speed meter. At the same time, a USB data logger was used to collect relative humidity and temperature of the air at the supply inlet, indoor air inlet, and return air outlet to determine temperature exchange efficiency and the enthalpy of air. The results of the testing shows that the HRV was able to achieve a temperature exchange efficiency of 47 to 63% and enthalpy exchange efficiency of 63 to 94% for PHEX-A, and a temperature exchange efficiency of 28 to 48% and enthalpy exchange efficiency of 57 to 85% for PHEX-B. The data shows that PHEX-A has higher efficiency than PHEX-B.

Heat Recovery Ventilator (VHR) is widely used nowadays as it is capable to maintain high Indoor Air Quality (IAQ) while minimizing the energy loss of indoor air through air-to-air heat exchanger principle. The main component that enables VHR to perform air-to-air heat exchange is known as Paper Heat Exchanger (PP-HEX). Hence, the objective of this research is to study and analyse the performance of a PP-HEX under different return and outdoor air temperatures as well as their effect on both enthalpy and temperature exchange efficiency. Moreover, some numerical models of VHR have been developed to optimize some complex cases and the numerical models are meant to reduce the physical experiments to analyze or improve complex cases in the future. To the best of the authors knowledge, there is no experimental data available from any sources to validate the numerical models. To address this issue, two different supplies of PP-HEX are tested with an actual VHR, and both PP-HEXs will be referred to as PP-HEX-A and PP-HEX-B due to confidentiality. Furthermore, the testing is conducted in a temperature-controlled testing laboratory and the testing conditions are set according to the ISO standard. The preliminary testing results show that the temperature exchange efficiency and enthalpy exchange efficiency of the PP-HEXs have the same trends while the outdoor air temperature is fixed and varying the temperature of indoor air. In contrary, the temperature exchange efficiency and enthalpy exchange efficiency of the PP-HEXs have the same trends while the indoor air temperature is fixed and varying the temperature of outdoor air as well. With the default voltage supplies (240V) to VHR and the setup conditions (according to the ISO Standard) of return air to be 27°C and outdoor air to be 35°C, the testing results show that PP-HEX-A has a temperature exchange efficiency and enthalpy exchange efficiency with a range of (37.97 – 40.28) % and (30.77 – 57.81) % respectively. While PP-HEX-B has a temperature exchange efficiency and enthalpy exchange efficiency with a range of (35.29 – 42.5) % and (39.6 – 55.93) % respectively.

OBJECTIVES To determine whether geriatric hip fractures can be managed effectively within a level 1 trauma center. DESIGN A prospective observational cohort study with a historical control group. SETTING Level 1 trauma center. PATIENTS A total of 199 patients admitted under our hip fracture service were prospectively identified from 2011-2012. These were compared with 191 hip fracture patients who were admitted before the service. INTERVENTION The hip fracture service includes coadmission under an orthopaedic and a geriatric team. A daily, consultant-led operating list was made available for hip fracture surgery. A "neck of femur" nurse was employed to coordinate patient care. MAIN OUTCOME MEASUREMENTS Time to surgery, length of stay, discharge destination, and mortality. A cost-benefit analysis and a comparison with a lower acuity hospital were also performed. RESULTS Since the hip fracture service, more patients underwent surgery within 48 hours (67% vs. 52%; P = 0.004), the length of stay significantly decreased from 26 to 22 days (P = 0.004), significantly more patients were admitted to the rehabilitation unit (58.7% vs. 3.5%; P < 0.001) and ultimately discharged to their own residence (51.6% vs. 40.5%; P = 0.034). Inpatient mortality rates did not change significantly (7.5% vs. 6.8%; P = 0.780). The estimated cost saving in 2011 was $981,040. CONCLUSIONS Only minor changes are required to significantly improve the management of geriatric hip fracture patients. These patients can be managed effectively within a level 1 trauma center when an organized service prioritizing these patients is used. LEVEL OF EVIDENCE Therapeutic level III. See Instructions for authors for a complete description of levels of evidence.

First edition of the Bio4Products project newsletter.&nbsp

OBJECTIVES: The aims of this research were to characterise the injury patterns associated with nail guns, highlight their potential complications and review treatment options. METHODS: A retrospective case series was conducted of all patients with a nail gun injury to the upper or lower limb who presented to the Princess Alexandra Hospital from 1 January 2007 to 30 July 2012. RESULTS: Young men in the work environment were at most risk of sustaining a nail gun injury to their non-dominant hand. Out of 87 cases identified, 29% were intra-articular, 16% had evidence of neurovascular injury, 24% involved bone and 37% had evidence of tendon injury. Fifty-eight per cent underwent operative management, 32% were treated solely in the ED and 10% were transferred to a private facility. At the time of operation, 14% of cases had tendon, joint or neurovascular involvement and 20% had retained foreign material. The median length of operation was 17 min and no anaesthetic complications were identified. Four (13%) patients had ongoing pain, paraesthesia or stiffness at the time of follow up. CONCLUSIONS: The present study characterises the injury patterns caused by nail guns. Treatment of these injuries should be based on clinical findings; however, the majority of cases should undergo surgical treatment. The required operation is a short and safe treatment modality that might allow a thorough assessment of the injury, removal of embedded material, repair of structural damage and a sterile washout to be performed. Language: en

Guidelines for the surgical treatment of cutaneous primary malignant melanoma are well established; however, the approach to the treatment of the regional lymph nodes remains more controversial. In many centres, sentinel lymph node biopsy has been adopted as routine in the treatment of malignant melanoma for prognostic purposes, as it is not of proven therapeutic benefit. The Multicentre Selective Lymphadenectomy Trial II aims to determine the comparative benefits of subsequent completion lymphadenectomy versus observation in those found to have a positive sentinel node biopsy. Until results are available, the risks of the procedure must be weighed against the value of prognostic information gained from performing a sentinel node biopsy. In this retrospective analysis of sentinel lymph node biopsies at our institution, we show that in general, short-term morbidity associated with this procedure is low, but that morbidity is higher in a subgroup of people with higher weight or body mass index, and in those whose biopsy is located in the groin.

The aims of this research were to characterise the injury patterns associated with nail guns, highlight their potential complications and review treatment options.A retrospective case series was conducted of all patients with a nail gun injury to the upper or lower limb who presented to the Princess Alexandra Hospital from 1 January 2007 to 30 July 2012.Young men in the work environment were at most risk of sustaining a nail gun injury to their non-dominant hand. Out of 87 cases identified, 29% were intra-articular, 16% had evidence of neurovascular injury, 24% involved bone and 37% had evidence of tendon injury. Fifty-eight per cent underwent operative management, 32% were treated solely in the ED and 10% were transferred to a private facility. At the time of operation, 14% of cases had tendon, joint or neurovascular involvement and 20% had retained foreign material. The median length of operation was 17 min and no anaesthetic complications were identified. Four (13%) patients had ongoing pain, paraesthesia or stiffness at the time of follow up.The present study characterises the injury patterns caused by nail guns. Treatment of these injuries should be based on clinical findings; however, the majority of cases should undergo surgical treatment. The required operation is a short and safe treatment modality that might allow a thorough assessment of the injury, removal of embedded material, repair of structural damage and a sterile washout to be performed.

Typically, the effectiveness of agricultural and forestry BMPs is evaluated based on in-stream measurements of nutrients and sediment. However, as can be seen from the wide range of reduction efficiencies attributed to any BMP from published research, a large number of climatic, fate, and transport variables often obscure cause and effect relationships and the exact mechanisms responsible for load reduction. In-stream pollutant reductions from BMP implementation are also typically not immediate, but gradually accrue over time as vegetative BMPs mature, or while BMPs reduce nutrient build-up in the soil or bacteria attached to channel sediments. Because of these uncontrolled variables and time lags between BMP implementation and pollutant reduction, BMP performance efficiencies are difficult to evaluate.

Purpose Carotid artery stenting is a relatively new intervention for the treatment of carotid artery stenosis, and the long-term outcomes and complications are therefore yet to be determined. In one surgeon's practice, it was found that a stent fracture was the etiological factor for recurrent stenosis. A retrospective study was therefore performed with the hypothesis that carotid stent fractures are common. The aims were to determine prevalence of fractures in this surgeon's series, risk factors, and most importantly, clinical relevance. Methods Patients from one surgeon's private practice who had carotid stenosis deemed suitable for intervention (>80% asymptomatic, >70% symptomatic, 50% to 70% if an ulcerated lesion) and had suitable aortic and carotid morphology for carotid stenting between March 2004 and December 2006 were included. To enhance the quality of the measurement, two vascular surgeons and one radiologist examined the films independently to determine if there was a fracture present. Given that this was a retrospective study, there was no preconceived sample size determined. Results Fracture prevalence was found to be 29.2% or 14 out of 48 stents. Restenosis occurred in 21% of those stents with a detected fracture, after an average follow-up of 15 months. Several anetiological factors are proposed, with a finding in this series, of a strong and significant association between the presence of calcified vessels and the presence of fractures (odds ratio 7.7; standard error 5.6; 95% confidence interval 1.9-32.0, P =.003). Conclusions Although this is a small study, it demonstrates that carotid stent fractures do exist, and importantly, not all of them are benign. Therefore, the authors recommend regular surveillance with plain radiography in addition to duplex ultrasonography to enable early detection of fracturing. Following detection, institution of increased surveillance frequency and/or any appropriate intervention can be implemented, to aid in the prevention of complications resulting from restenosis should it become apparent.

Most aneurysms can be effectively managed using endovascular coiling or microsurgical clipping, but in an acute subarachnoid haemorrhage where there are multiple aneurysms identified, a sequential multimodal approach may prove more beneficial. This report involves a 31-year-old man who presented with sudden onset of severe headache and photophobia. A computed tomography brain scan revealed a diffuse grade II subarachnoid haemorrhagic pattern, and four-vessel angiography revealed two aneurysms: a right middle cerebral artery bifurcation aneurysm measuring 12 × 8 mm and a 4-mm basilar artery aneurysm associated with a fenestration at the confluence of the vertebral arteries. It was not possible to determine which aneurysm or aneurysms were responsible for the haemorrhage using the customary criteria. The patient underwent sequential endovascular coiling of the vertebrobasilar aneurysm without delay, followed immediately by microsurgical clipping of the right middle cerebral artery aneurysm, under a single anaesthetic. The postoperative course was uneventful. This method is a treatment option for acute subarachnoid haemorrhage where there are multiple aneurysms. It is a logical progression of management that could be employed at any experienced neurovascular centre; the employment of a sequential multimodal approach from the integration of these techniques is beneficial to the patient because it decreases morbidity and mortality.

The aim of this study was to determine diabetes care processes and intermediate clinical outcomes in a remote primary care service in 2009 compared with 2004. A retrospective review of diabetes care from January 2009 to January 2010 was conducted using a chronic disease register (Project Ferret). Completeness of ascertainment was verified by a manual audit of charts. The results from this audit were compared with a similar study conducted in this community in 2004. The main outcome measure was diabetic management: in terms of (a) regular monitoring of diabetic care processes, and (b) compliance with national optimal management guidelines and comparison with diabetic outcomes data from a 2004 audit and the National data from 2009. People with diabetes on the register increased from 60 in 2004 to 77 in 2009. They were younger and heavier with a shorter duration of diagnosed diabetes. Recording of diabetic care processes in 2009 decreased between 5 and 32% compared with 2004 data. Intermediate clinical measures (e.g. glycosylated haemoglobin, blood pressure, triglycerides, albumin creatinine ratio) indicate stable or poorer diabetic control across all measures except total cholesterol. When compared with non-Indigenous diabetics, diabetes is diagnosed earlier and rates of smoking, hypertension, dyslipidaemia and diabetic nephropathy are higher in this population. Insulin use appears to be lower in the study population than reported in the national sample. Improved diabetic care processes and outcomes reported from 1999 to 2003 have not been sustained, and intermediate clinical measures have become more adverse over a 5 year period in this high risk remote community. Chronic care systems, including quality improvement, require renewed investment. Refereed/Peer-reviewed

These factsheets give the essential information about the key 6 results from the Bio4Products project: Pilot plant for extracting bio-based chemicals and materials from pyrolysis oil Pyrolytic lignin and sugar feedstocks for bio-based products and materials Bio-based foam resins for building insulation Bio-based moulding compounds for household and automotive products Sustainable chemicals from renewable raw materials Faunawood - wood modified with wood, a circular alternative to creosote &nbsp