A meta-analysis of rate ratios for nocturnal confirmed hypoglycaemia with insulin degludec vs. insulin glargine using different definitions for hypoglycaemia

Aims: A prospective meta-analysis of phase 3 trials showed lower rates of nocturnal hypoglycaemia with insulin degludec vs. insulin glargine. We investigated the consistency of the results across different definitions of hypoglycaemia. Methods: This post-hoc, patient-level meta-analysis included six randomized, controlled, 26- or 52-week phase 3a trials in insulin-naïve participants with Type 2 diabetes mellitus (Type 2 diabetesinsulin naïve), participants with Type 2 diabetes mellitus using basal−bolus therapy (Type 2 diabetesBB) and those with Type 1 diabetes mellitus. We used three definitions of hypoglycaemia and different timescales for the nocturnal period. Rates were analysed for the entire core trial period, the ‘maintenance period’ only, and the extension trial set population. Analyses utilized a negative binomial regression model. Results: In Type 2 diabetesinsulin naïve participants, risk of nocturnal hypoglycaemia was significantly lower with insulin degludec vs. insulin glargine for all hypoglycaemia definitions and trial periods. Risk was also lower for the timescale 21.59–05.59, but not 00.01–07.59. For Type 2 diabetesBB, nocturnal hypoglycaemia rates were lower with insulin degludec vs. insulin glargine across all definitions, timescales and trial periods, with one exception. For individuals with Type 1 diabetes mellitus, nocturnal hypoglycaemia risk was significantly lower with insulin degludec during the maintenance period for the original definition (plasma glucose < 3.1 mmol/l, timescale 00.01–05.59) and in the extension trial set population for all hypoglycaemia definitions except for the nocturnal timescale 00.01–07.59. Conclusions: Compared with insulin glargine, insulin degludec is associated with lower rates of nocturnal hypoglycaemia in people with Type 2 diabetes mellitus, and similar or lower rates in Type 1 diabetes mellitus, across different definitions

En stad i två länder : regional identitet och kulturarv på gränsen HaparandaTornio under COVID-19-pandemin

The collaborative cross-border region HaparandaTornio has been recognised as the most peaceful border in the world due to its shared history, which can be examined through the common tangible and intangible cultural heritage. The tangible cultural heritage can be investigated through four phases of HaparandaTornio's institutionalisation; (1) the motion of single projects, (2) joint local policy agreements, (3) creating a joint body and (4) continued responsibility of being defined as a Twin City. The intangible cultural heritage can be recognised through the border being a uniting seam, rather than an isolating barrier, where different languages, mentality and traditions have merged. In March 2020 the COVID-19 pandemic forced national decision-makers to close the border between HaparandaTornio. The border closing has not only restricted local habitants of moving freely in their region but also intensified the "we and them"-mentality amongst the habitants from the respective cities. This shows that collaborative regional decision-making is crucial of maintaining the common cultural heritage of HaparandaTornio, but also to cultivate the everyday life of the habitants living in the cross-border region. Yet, HaparandaTornio remains just as a concept, being identified as one city in two countries. This identification can not be legally defined which creates contradictions in the regional will and national law. If the border were to close again, communication between regional authorities and national decision-makers are necessary, to constitute reasonable measures that serves cross-border regions. The results of this thesis have been gathered through a site-visit, interviews and a survey

A study of back kinematics in riding horses with low-grade hind limb asymmetries

Ryggsmärta är en vanlig orsak till prestationsnedsättning hos ridhästar och att diagnostisera orsaken till dessa problem kan vara utmanade. När man studerat ryggkinematik hos hästar har man uppmätt skillnader i rörelsen mellan friska hästar och hästar med ryggproblem. Det kan alltså finnas ett diagnostiskt värde i att kunna utvärdera ryggkinematik i det kliniska arbetet. Dock saknas kunskap om den biologiska variationen samt hur sambandet mellan asymmetriska gångarter och förändrad ryggrörelse ser ut. I detta försök studerades ryggkinematik i trav hos ridhästar av varmblodstyp. Hästarna skulle anses friska av sina ägare och inte bedömas som halta vid något av mättillfällena. De mättes i trav på rakt spår vid flera tillfällen med två olika trådlösa sensorsystem. Erhållna data jämfördes mellan gånger då korsets vertikala rörelse haft mindre än 3 mm skillnad (symmetrisk) mellan stegcykelns första och andra maximala- respektive minimala amplitud (max- resp minD) samt när de uppvisat en skillnad på mer än 3mm (asymmetrisk). Rotationer, symmetriindex samt min- och maxD studerades för huvudet, manken, ryggens lägsta punkt (omkring T13), L1, tuber sacrale, kaudala sacrum samt höger och vänster tuber coxae. Resultaten visar att hästar med låggradiga bakbensasymmetrier uppvisar mätbara skillnader i sin ryggkinematik jämfört med när samma hästar rör sig symmetriskt i trav. Signifikanta skillnader uppmättes avseende max- och minD, framförallt i lumbosakralregionen. I de mer kranialt belägna mätpunkterna sågs förändringar framförallt avseende flexion-extension. Det asymmetriska benets tuber coxae fick en större maxD och en minskad symmetri i sin rörelse då hästarna uppvisade låggradiga bakbensasymmetrier, medan det motstående bakbenet fick en mindre maxD vid den asymmetriska mätningen. Även vid den symmetriska mätningen uppmättes en skillnad i den vertikala amplituden mellan de båda sidornas tuber coxae. Resultaten visar att man kan uppmäta skillnader i ryggkinematik hos hästar med låggradiga bakbensasymmetrier. Det går dock inte att säga något om det kausala sambandet. Genom att mäta fler hästar, kartlägga vilka kinematikförändringar som är kopplade till olika sjukdomar och skador skulle analys av ryggkinematik i framtiden kunna vara ett värdefullt hjälpmedel för att följa upp lokalanestesier och behandlingar av ryggpatienter

Effect of feed access and eating time on the well-being of horses

Ättiden kan påverka hästars välmående. Syftet med litteraturarbetet var att studera hur man kan tillgodose hästens behov av att äta en stor del av dygnet, samt anpassa utfodringen inte bara till näringsbehovet utan även behovet av att utföra ätbeteende. Hästar i det vilda ägnar större delen av sin tid åt att äta och samma beteende ses hos tamhästar om de ges möjligheten. I det vilda äter hästar i perioder om 2-4 timmar åt gången, och uppehållen varar inte längre än 3-5 timmar. Begränsad utfodring kan innebära en stress för hästen om den inte kan tillfredsställa sitt beteendebehov av att äta. Det finns ett samband mellan begränsad fodertillgång och onormala beteenden. Onormala beteenden uttrycks ofta i samband med utfodring. Faktorer som smak, doft, utseende och struktur på fodret påverkar längden på en måltid. Eventuellt är det antalet tuggningar som reglerar mättnaden. Gastriska och metabola stimuli påverkar hur länge hästen är mätt, och därmed hur ofta den vill äta. Hästen kan äta en större männgd torrsubstans av ett pelleterat foder än av samma foder i form av löst hö och den totala ättiden är kortare för hästar som ges en pelleterad diet. Ättiden påverkas även av fodrets torrsubstans, ättiden per kg/torrsubstans och den totala konsumtionen torrsubstans av fodret ökar båda två då torrsubstansen minskar. Även mognadsgraden på plantan vid skörd påverkar ättiden, ett sent skördat foder har högre fiberinnehåll än ett tidigt skördat och ättiden per mängd torrsubstans är längre för en sen skörd än för en tidig. Fiberinnehållet kan vara relaterat till antalet tuggningar. Energiinnehållet är lägre i en sen skörd vilket gör att man kan utfodra med en större mängd av detta utan att öka hästens energiintag.The eating time can affect the well-being of horses. The purpose of this literature study was to study how to accommodate the horse needs to eat a large part of the day, and adjust feeding not only the nutritional needs but also the need to perform eating behaviour. Horses in the wild spend most of their time eating and the same behaviour is seen in domestic horses if given the opportunity. In the wild horses eat for periods of 2-4 hours at a time, and pauses lasting no longer than 3-5 hours. Restricted access to feed might be stressful for the horse if it cannot satisfy its behavioural needs of eating. There is a relationship between limited food supply and abnormal behaviour. Abnormal behaviour is often expressed in relation to feeding. Factors such as taste, smell, appearance and texture of the feed affect the length of a meal. Optionally, the number of chews might regulate saturation. Gastric and metabolic stimuli affect how long the horse is satisfied, and thus how often it wants to eat. The horse can eat more of pelleted feed than of loose hay and the total eating time is shorter for horses given a pelleted diet. The dry matter content affects both eating time and consumption, both of which increases when the dry matter decreases. Although the level of maturity of the plant at harvest affects eating time, a late harvested fodder has a higher fiber content than early harvested fodder, and the eating time per amount of dry matter is longer for a late harvest than for an early harvest. Fiber content can be related to the number of chews. The energy content is lower in a late harvest, which means that you can feed with a larger amount of this without increasing the horse's energy intake. Because a limited access to feed is associated with stress in the horse, it’s a good idea to take eating time in consideration when calculating a ration. Horses have different nutritional needs, and although free feed access might be the best to satisfy their behavioural needs, it is not always possible. Eating time can be extended by giving the horses free access to feed, impeding the intake of feed by using a hay net or grid, feeding with several different types of fodder, allowing visual contact with other horses, providing a feed with a low nutrient, high fiber (late harvest, straw) and low dry matter content

Modelling and optimising of crude oil desalting process

The history of crude oil desalting/dehydration plant (DDP) has been marked in progressive phases-the simple gravity settling phase, the chemical treatment phase, the electrical enhancement phase and the dilution water phase. In recent times, the proper cachet would be the control-optimisation phase marked by terms such as "DDP process control", "desalter optimisation control" or "DDP automating technology". Another less perceptible aspect, but nonetheless important, has been both a punch listing of traditional plant boundaries and a grouping of factors that play the essential roles in a desalting/dehydration plant (DDP). Nowadays, modelling and optimising of a DDP performance has become more apparent in petroleum and chemical engineering, which has been traditionally concerned with production and refinery processing industries. Today's desalting/dehydration technology finds itself as an important factor in such diverse areas as petroleum engineering, environmental concerns, and advanced technology materials. The movement into these areas has created a need not only for sources useful for professionals but also for gathering relevant information essential in improving product quality and its impact on health, safety and environmental (HSE) aspects. All of the foregoing, clearly establishes the need for a comprehensive knowledge of DDP and emulsion theories, process modelling and optimisation techniques. The main objective of this work is to model and qualitatively optimise a desalting/dehydration plant. In due course, the contents of this thesis will cover in depth both the basic areas of emulsion treatment fundamentals, modelling desalting/dehydration processes and optimising the performance of desalting plants. In addition, emphasis is also placed on more advanced topics such as optimisation technology and process modifications. At the results and recommendation stage, the theme of this work-optimising desalting/dehydration plant will practically be furnished in an applicable scheme. Finally, a significant compendium of figures and experimental data are presented. This thesis, therefore, essentially presents the research and important principles of desalting/dehydration systems. It also gives the oil industry a wide breadth of important information presented in a concise and focused manner. In search of data quality and product on-line-improvement, this combination will be a powerful tool for operators and professionals in a decision support environment.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Procedural theory - mental activity progressions, sketching and drawing procedure during the design process

Landscaping is the act of taking a piece of land and analysing, evaluating, and beautifying it, while focusing on maintaining and increasing sustainability, functionality, and usability for people in a cost-effective way. The course Urban Landscape Design (LK0400) is a bachelor’s level course focusing on design of urban green spaces, offered at the Swedish University of Agricultural Sciences, and run by the Department of Landscape Architecture, Planning and Management (LTV faculty). The course is run as a stand-alone course for national and international students and as a programme course in the Landscape Engineer Programme at Uppsala and Alnarp, and in the Garden Design, Landscape Engineer Programme at Alnarp

International prevalence of adolescent non-suicidal self-injury and deliberate self-harm

<p>Abstract</p> <p>Background</p> <p>The behaviours of non-suicidal self-injury (NSSI) and deliberate self-harm (DSH) are prevalent among adolescents, and an increase of rates in recent years has been postulated. There is a lack of studies to support this postulation, and comparing prevalence across studies and nations is complicated due to substantial differences in the methodology and nomenclature of existing research.</p> <p>Methods</p> <p>We conducted a systematic review of current (2005 - 2011) empirical studies reporting on the prevalence of NSSI and DSH in adolescent samples across the globe.</p> <p>Results</p> <p>Fifty-two studies fulfilling the inclusion criteria were obtained for analysis. No statistically significant differences were found between NSSI (18.0% SD = 7.3) and DSH (16.1% SD = 11.6) studies. Assessment using single item questions led to lower prevalence rates than assessment with specific behaviour checklists. Mean prevalence rates have not increased in the past five years, suggesting stabilization.</p> <p>Conclusion</p> <p>NSSI and DSH have a comparable prevalence in studies with adolescents from different countries. The field would benefit from adopting a common approach to assessment to aide cross-cultural study and comparisons.</p