Modern DRAMs have multiple banks to serve multiple memory requests in parallel. However, when two requests go to the same bank, they have to be served serially, exacerbating the high latency of off-chip memory. Adding more banks to the system to mitigate this problem incurs high system cost. Our goal in this work is to achieve the benefits of increasing the number of banks with a low cost approach. To this end, we propose three new mechanisms that overlap the latencies of different requests that go to the same bank. The key observation exploited by our mechanisms is that a modern DRAM bank is implemented as a collection of subarrays that operate largely independently while sharing few global peripheral structures.Our proposed mechanisms (SALP-1, SALP-2, and MASA) mitigate the negative impact of bank serialization by overlapping different components of the bank access latencies of multiple requests that go to different subarrays within the same bank. SALP-1 requires no changes to the existing DRAM structure and only needs reinterpretation of some DRAM timing parameters. SALP-2 and MASA require only modest changes (< 0.15% area overhead) to the DRAM peripheral structures, which are much less design constrained than the DRAM core. Evaluations show that all our schemes significantly improve performance for both single-core systems and multi-core systems. Our schemes also interact positively with applicationaware memory request scheduling in multi-core systems.

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BackgroundSleep disturbances are common in individuals with diabetes. Patients with diabetes have higher rates of insomnia, excessive daytime sleepiness and increased incidence of restless leg syndrome. The purpose of our study was to investigate the prevalence and determine the predictors of sleep dysfunction in patients with type 2 diabetes in a southeast Asian Indian population.MethodsWe enrolled 120 patients with type 2 diabetes who attended an endocrinology clinic in a tertiary-care hospital. After we collected their demographic data, we recorded their anthropometric measurements. Fasting, postprandial blood glucose values and glycosylated hemoglobin (HbA1c) values were then obtained. Quality of sleep was evaluated in all the patients through the Pittsburgh Sleep Quality Index (PSQI), which is a questionnaire that assesses sleep quality and disturbances over a monthlong period. A Global Sleep Quality score ≥5 discriminates between good and poor sleepers.ResultsThe mean global PSQI score was 7.08 (standard deviation, 3.89), which suggested poor sleep quality in this population. Sixty-nine percent of patients had a global PSQI score ≥5, indicating that they were "poor sleepers." The global PSQI score positively correlated with the duration of diabetes and was also independent of other variables such as age, gender, body mass index, HbA1c, or medications.ConclusionWe found a high prevalence of sleep dysfunction in patients with type 2 diabetes. We also found a significant correlation between duration of diabetes and quality of sleep, independent of other variables. It is important for physicians to address the quality and duration of sleep in patients with type 2 diabetes.

Introduction:Hypoglycemia being the rate limiting complication in the attainment of strict glycemic control in diabetes management, in this study, we intended to study the knowledge of its symptoms, target blood levels during treatment and ways of prevention among type 2 diabetes patients attending Outpatient Department (OPD) of a medical college hospital.Materials and Methods:Every fifth patient attending the OPD during the 4 months between March and June 2013 was interviewed using a questionnaire.Results:The study included 366 type 2 diabetic patients, of which 76.5% were females. The target fasting and postprandial blood glucose levels while on treatment was known to 135 (36.9%) and 126 (34.4%) patients, respectively. The common symptoms of hypoglycemia known to the study subjects were dizziness (81.4%), weakness (73.8%), and drowsiness (72.1%). Overall, 242 (66.1%) diabetic patients had good knowledge on hypoglycemia (knowledge of at least three symptoms of hypoglycemia together with at least one precipitating factor and at least one remedial measure). Higher age, illiteracy, low socioeconomic status were associated with poor knowledge whereas treatment with insulin along with oral hypoglycemic agents was associated with good knowledge on hypoglycemia. Sex and duration of disease were not associated with knowledge on hypoglycemia.Conclusion:Although the knowledge on symptoms of hypoglycemia, precipitating factors, remedial measures are high in this study, the target blood levels, complications were known to just a third of them. There is a knowledge gap on important aspects of hypoglycemia among type 2 diabetic patients.

Background:In recent times, high-resolution ultrasound thyroid imaging has paved the way for significant transformation in clinical approach to thyroid nodule. There are several risk stratification systems in thyroid imaging, developed with an aim, not only to reduce the inter-observer variability but also to establish effective communication system. Thyroid image reporting and data system (TIRADS) classification system, which is similar to breast imaging reporting and data system for breast lesion, is the most useful of all. To our knowledge, there is just a handful published research articles available based on Indian population in this regard. In this article, we study the thyroid nodules using high-resolution ultrasound in Indian population and we try to correlate the TIRADS and Bethesda system for reporting thyroid cytopathology.Materials and Methods:This prospective study includes 184 patients studied over a period of 2 years (April 2015–April 2017). Patients having thyroid nodule in B-mode ultrasound and are scheduled to get a fine-needle aspiration cytology (FNAC) done. Bethesda classification of these nodules is tabulated in follow-up period simultaneously. By comparing these data, efficacy of TIRADS in differentiating benign from malignant nodules are assessed finally using accuracy, positive predictive value (PPV), cross-tabulation, and Chi-square tests.Results:Out of the 117 TIRADS 2 nodules, none turned out to be Bethesda IV or higher, which means none of these nodules turned out to be malignant. The risk of malignancy for TIRADS 2, TIRADS 3, TIRADS 4, and TIRADS 5 was 0, 2.2, 38.5, and 77.8%, respectively. The risk of malignancy percentage in our study is similar to those values obtained in other prominent studies.Conclusion:The probability of a particular nodule being malignant can be effectively inferred from the ultrasound-based TIRADS system with a certain level of confidence. Considering our results and other literature reviews, it be can be safely assumed that FNAC can be at least deferred in patients having TIRADS 2 nodules, which contribute to majority of newly detected cases. In our experience, there is a remarkable correlation exists between TIRADS ultrasound classification and Bethesda cytology, especially for benign nodules.

The role of vitamin D in the pathogenesis and prevention of diabetes has sparked widespread interest. Vitamin D receptors are present in both pancreatic beta-cells and immune cells. Beside its classical role as the major regulator for calcium absorption, vitamin D mediates the activity of beta-cell calcium-dependent endopeptidases promotes conversion of proinsulin to insulin and increases insulin output. In peripheral insulin target tissues, vitamin D enhances insulin action via regulation of the calcium pool. Vitamin D also acts as a potent immunosuppressor. It tends to down-regulate the transcription of various proinflammatory cytokine genes like Interleukin-2, Interlukin-12, and Tumor Necrosis Factor-α. It promotes the induction of regulatory T-lymphocytes, the production of antiinflammatory cytokines and protects beta-cell from destruction. Vitamin D deficiency predisposes to type 1 diabetes in animal models and in humans. It is probable that a similar relationship exists for type 2 diabetes. Vitamin D deficiency impairs insulin secretion and induces glucose intolerance. Several vitamin D related genes are associated with different pathogenetic traits of the disease. Vitamin D supplementation has shown to reduce the risk of developing type 1 diabetes. Vitamin D has also been shown to reduce the risk of diabetes associated complications. Prospective clinical studies on vitamin D are required to firmly establish the role of vitamin D in the prevention and management of diabetes.

Introduction:Hypoglycemia tops the list of hurdles in preventing tight glycemic control in diabetic patients. It is even considered as a cardiovascular risk factor. However, it continues to be a neglected complication with very limited epidemiological data in our country.Aim:To study the self-reported prevalence of hypoglycemia among type 2 diabetic patients and the practices adopted by them during and after the episodes to manage and avert future occurrences.Materials and Methods:It is a questionnaire-based cross-sectional study done using systematic random sampling selecting every 5th patient attending the diabetic Out-Patient (OP) in a tertiary medical college hospital.Results:There were 366 participants with median age of 60 years. Around 96% reported any one symptom of hypoglycemia, but 78% had eaten following the episode and got relieved of the symptoms. Weakness (76.2%) and dizziness (74%) were the most common symptoms reported by the patients. A quarter of them reported having severe attacks requiring somebody's assistance. Most patients resorted to timely meals (85%) to avert future attacks. Patients who took insulin along with oral hypoglycemic agents (OHAs) were at a higher risk (OR = 2.3) for hypoglycemia compared to patients taking only OHAs (P < 0.01).Conclusion:The reported prevalence of hypoglycemia among type 2 diabetes patients is quite high. This finding reiterates the importance of enquiring and educating every diabetic patient about hypoglycemic episodes during every health visit.

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