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Aims: To investigate characteristics of people hospitalized with coronavirus-disease-2019 (COVID-19) and diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state (HHS), and to identify risk factors for mortality and intensive care admission. Materials and methods: Retrospective cohort study with anonymized data from the Association of British Clinical Diabetologists nationwide audit of hospital admissions with COVID-19 and diabetes, from start of pandemic to November 2021. The primary outcome was inpatient mortality. DKA and HHS were adjudicated against national criteria. Age-adjusted odds ratios were calculated using logistic regression. Results: In total, 85 confirmed DKA cases, and 20 HHS, occurred among 4073 people (211 type 1 diabetes, 3748 type 2 diabetes, 114 unknown type) hospitalized with COVID-19. Mean (SD) age was 60 (18.2) years in DKA and 74 (11.8) years in HHS (p

This thesis demonstrates the research conducted to investigate the aerodynamic interaction between an inverted wing of varying spans in ground effect and a rotating wheel in a straight-line, a cornering and a fixed yaw condition. Experimental methods such as Particle Image Velocimetry (PIV) and force-balance measurements were performed to validate the data obtained from Detached Eddy Simulations (DES) that formed the basis of the numerical simulations. During the validation, whilst the flow predictions by the DES k-ω SST and the DES Spalart-Allmaras (S-A) models correlated well with the experimental data for the wing geometry, only the flow prediction from the DES k-ω SST model correlated well for the wheel geometry, and significantly outperformed the DES S-A model. After the analysis of the wing and wheel geometries in an isolated configuration, placing the two com- ponents together in the straight-line condition revealed a highly complex interaction that was strongly dependent on the wingspan. In all cases, the wing experienced a downforce and drag reduction relative to the isolated configuration, with the wing that fully overlapped the wheel experiencing the largest loss of 35% and 43%, respectively, due to the high pressure on the front face of the wheel impinging onto its surfaces. The modifications to the wheel’s wake topology were ascribed to the introduction of the wing’s endplate vortices and the wing-induced upwash and crossflows, particularly the interaction of these flow features with the wheel’s upper vortices. The cornering condition led to little change to the wing’s downforce, whilst the drag increased by approximately 10% relative to the straight-line condition. The wake, however, was noticeably modified immediately behind the wheel, with two factors being responsible for this: the freestream crossflow over the wheel that influenced the strength and positioning of the upper wheel vortices, and the changes to the strengths and paths of the endplate vortices. Together with the trajectory of the freestream flow, the wake’s downstream evolution was notably different from a topological and a positional perspective. The fixed yaw condition was derived from the cornering condition to investigate the validity of ap- proximating the effects of cornering in a wind tunnel environment. It was found that the wing generated very similar downforce and drag levels to the cornering condition, although topological and positional differences in the wheel wake occurred. These were due to the difference in the crossflow over the wheels that led to the different strengths and positioning of the upper wheel vortices, together with the differences in the strengths of the endplate vortices and the trajectory of the freestream flow.

Oral profiles of head and neck cancer patients vary substantially, for this reason dental protocols should be tailored accordingly.

A review of the body of knowledge has provided an insightful overview of the significant strides taken in the field of multiple sclerosis. For instance, the literature has made clear the considerable impact this autoimmune disease can have on an individual and how treatment can modulate the processes that underline this condition. However, this review equally highlighted an absence of literature exploring the experiences of both relapsing-remitting multiple sclerosis and disease-modifying treatment. It is in this context that this thesis is based. That is, this thesis sets out to address this gap in theoretical and clinical practice by employing a methodology and method that would discern individual accounts on the experience of being diagnosed with relapsing-remitting multiple sclerosis and the experience of taking disease-modifying treatment. Guided by a qualitative research design, semi-structured interviews were undertaken with six participants and analysed using Max van Manen’s hermeneutic phenomenological method. For participants diagnosed with relapsing-remitting multiple sclerosis, the analysis organised the discerned themes around four lifeworld existential elements: Bodily Interruption, Fatigue, and Psychological Distress (corporeality), Guilt and Power Imbalance (relationality), Secrecy (spatiality), and Death (temporality). Subsequent themes were discerned in relation to the experience of taking disease-modifying treatment: Body Object, Decision Dilemma, Pain, Reformulated Life, and Complementary and Alternative Medicine (corporeality) and Future Orientated (temporality). These themes, serving as navigators, discerned the manner in which a diagnosis permeated everyday living so that an individual’s experience of themselves, of others, and of the world became scientized. Equally, how this encounter with medical terminology influenced treatment decision making and views pertaining to the future. The discussion addressed the complexity associated to a diagnosis of relapsing-remitting multiple sclerosis (before, during and after) and provided an understanding as to why individuals supplement disease-modifying treatment with complementary and alternative medicine. With this in mind, specific recommendations were suggested: (i) clinicians should give more attention to relapsing-remitting multiple sclerosis as a relational and lived phenomenon, (ii) clinical practice should include discussions surrounding complementary and alternative medicine, and (iii) future research should be developed to the point that the principles of evidence-based disease-modifying treatment practice can be applied to complementary and alternative medicine treatment.

AimsWe compared feasibility, quality and outcomes of visual field (VF) testing in children with neuro-ophthalmic disease between the discontinued 'gold-standard' Goldmann and Octopus perimeters.MethodsChildren with neuro-ophthalmic disease, attending Great Ormond Street Hospital, London, were assessed using standardised protocols by one examiner in a single sitting, using Goldmann and Octopus kinetic perimetry. Outputs were classified to compare severity of loss and defect type. Test quality was assessed using both qualitative and quantitative methods.ResultsThirty children (40% female) aged 5-15 years participated. Goldmann perimetry was completed in full by 90.0% vs 72.4% for Octopus. Inability to plot the blind spot was the most common reason for not completing testing. Over 75% completed a test in ≤20 min. Duration was similar between perimeters (paired t-test, mean difference: 0.48min (-1.2, 2.2), p=0.559). The lowest quality tests were for Octopus perimetry in children

Purpose To investigate feasibility, reliability and repeatability of perimetry in children. Methods A prospective, observational study recruiting 154 children aged 5–15 years, without an ophthalmic condition that affects the visual field (controls), identified consecutively between May 2012 and November 2013 from hospital eye clinics. Perimetry was undertaken in a single sitting, with standardised protocols, in a randomised order using the Humphrey static (SITA 24–2 FAST), Goldmann and Octopus kinetic perimeters. Data collected included test duration, subjective experience and test quality (incorporating examiner ratings on comprehension of instructions, fatigue, response to visual and auditory stimuli, concentration and co-operation) to assess feasibility and reliability. Testing was repeated within 6 months to assess repeatability. Results Overall feasibility was very high (Goldmann=96.1%, Octopus=89% and Humphrey=100% completed the tests). Examiner rated reliability was ‘good’ in 125 (81.2%) children for Goldmann, 100 (64.9%) for Octopus and 98 (63.6%) for Humphrey perimetry. Goldmann perimetry was the most reliable method in children under 9 years of age. Reliability improved with increasing age (multinomial logistic regression (Goldmann, Octopus and Humphrey), p

The emergence of clinical care pathways within dentistry has placed renewed emphasis on the caries risk assessment of patients to help predict further disease and guide future prevention and intervention strategies. With dietary intake of non-milk extrinsic sugars (NMES) a key aetiological factor in the development of caries, the predictive level of risk posed by some dietary habits is questioned. Therefore the aim of this study was to investigate the influence of dietary habits on the prevalence of dental caries with adolescent schoolchildren. Dietary risk factors concerning the frequency and timing of NMES consumption including snacking between meals and bedtime consumption were investigated to determine if any factors could be utilized to predict caries risk.128 subjects, 12-13 years of age, were randomly selected from an observational epidemiological survey for which the caries status and level of material deprivation was available. Caries experience was recorded with the variable DMFT, where the caries threshold was defined as code 4 (dentine involvement) with the International Caries Detection and Assessment System (ICDAS). Subjects underwent a 24 hour dietary recall interview with a dietician focussing on NMES intake; an estimation of which was based on McCance and Widdowson’s food composition tables. Logistic regression and odds ratio estimation was used to determine if any dietary habits predicted caries experience. The level of statistical significance was set at p=0.05.54 (42%) subjects were found to have caries (ICDAS>4). Chi-square analysis for subject groups with/without caries revealed no significant differences in caries experience between high and low deprivation, consumption of NMES between meals and percentage of total NMES consumed. The consumption of NMES before bedtime revealed a statistically significant difference between the caries/no caries groups (p

Increased glucose levels are associated with increased risk of vascular disease. The risk is elevated 2-4 fold in type 2 diabetes and there is a positive relationship between glucose (or HbA1c) levels and vascular disease in the general population. We tested the hypothesis that there is a glycaemia-mediated impairment of reverse cholesterol transport (RCT) by studying an early key step, notably the expression and activity of the ATP binding cassette transporter-A1 (ABCA1). This protein exports cellular cholesterol to apolipoprotein A1 (ApoA-I), thereby forming nascent HDL. In this thesis, it is shown that ABCA1 gene expression in leukocytes in men is reduced in Type 2 diabetes and correlates negatively with circulating HbA1c levels and fasting glucose. This confirms our earlier findings in healthy men. An independent relationship between glycaemia and leukocyte ABCG1 gene expression was not seen. ABCA1 protein concentrations in blood leukocytes were reduced in patients with diabetes. ApoA-I-mediated cholesterol efflux in cultured fibroblasts taken from subjects was studied as a measure of ABCA1 function. This negatively associated with fasting glucose at the time of sampling as well as adiposity. Cellular cholesterol removal was reduced in subjects with diabetes compared with controls. There was a positive relationship between both ABCA1 function and leukocyte protein concentration with circulating HDL cholesterol. These relationships were independent of expression of liver X receptor-α (LXRα) and peroxisome proliferator-activated receptor-γ (PPARγ). These data imply a persistent glycaemia-mediated suppression of an early step in RCT which may contribute to the excess vascular disease observed in such patients. It further proposes impaired cholesterol efflux may contribute to the low circulating HDL cholesterol which is commonly seen in patients with impaired glucose regulation.

PurposeWe sought to define normative visual field (VF) values for children using common clinical test protocols for kinetic and static perimetry.DesignProspective, observational study.SubjectsWe recruited 154 children aged 5 to 15 years without any ophthalmic condition that would affect the VF (controls) from pediatric clinics at Moorfields Eye Hospital.MethodsChildren performed perimetric assessments in a randomized order using Goldmann and Octopus kinetic perimetry, and Humphrey static perimetry (Swedish Interactive Thresholding Algorithm [SITA] 24-2 FAST), in a single sitting, using standardized clinical protocols, with assessment by a single examiner. Unreliable results (assessed qualitatively) were excluded from the normative data analysis. Linear, piecewise, and quantile mixed-effects regression models were used. We developed a method to display age-specific normative isopters graphically on a VF plot to aid interpretation.Main Outcome MeasuresSummary measures and graphical plots describing normative VF data for 3 common perimetric tests.ResultsVisual field area increased with age on testing with Goldmann isopters III4e, I4e, and I2e (linear regression; P < 0.001) and for Octopus isopters III4e and I4e (linear regression; P < 0.005). Visual field development occurs predominately in the inferotemporal field. Humphrey mean deviation (MD) showed an increase of 0.3 decibels (dB; 95% CI, 0.21–0.40) MD per year up to 12 years of age, when adult MD values were reached and thereafter maintained.ConclusionsVisual field size and sensitivity increase with age in patterns that are specific to the perimetric approach used. These developmental changes should be accounted for when interpreting perimetric test results in children, particularly when monitoring change over time.