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Assessing the efficacy, safety and utility of hybrid closed-loop glucose control compared with standard insulin therapy combined with continuous glucose monitoring in young people (≥16 years) and adults with cystic fibrosis-related diabetes (CL4P-CF study): protocol for an open-label, multicentre, randomised, two-arm and single-period parallel trial
Get PDFIntroduction: Cystic fibrosis-related diabetes (CFRD) is one of the most clinically impactful comorbidities associated with cystic fibrosis (CF). Current recommended management with insulin therapy is challenging due to variable daily insulin requirements and adds to the significant burden of self-management. This study aims to determine if hybrid closed-loop insulin delivery can improve glucose outcomes compared with standard insulin therapy with continuous glucose monitoring (CGM) in young people (≥16 years) and adults with CFRD. Methods and analysis: This open-label, multicentre, randomised, two-arm, single-period parallel design study aims to randomise 114 young people (≥16 years) and adults with CFRD. Following a 2–3 weeks’ run-in period, during which time participants use a masked CGM, participants with time in target glucose range (3.9–10.0 mmol/L) 10.0 mmol/L), mean glucose and HbA1c. Other secondary efficacy outcomes include glucose and insulin metrics, change in forced expiratory volume in 1 s and body mass index. Safety, utility, participant experiences and participant-reported outcome measures will also be evaluated. The trial is funded by the National Institute for Health and Care Research. Ethics and dissemination: Ethics approval has been obtained from East of England–Cambridge South Research Ethics Committee. Results will be disseminated by peer-reviewed publications and conference presentations, and findings will be shared with people living with CF, healthcare providers and relevant stakeholders. Trial registration number: NCT05562492
A cross sectional feasibility study to evaluate the usability and efficacy of Swaasa AI platform for rapid respiratory health assessment
Get PDFAnalysing cough sounds is vital in pulmonary medicine. Recently, AI tools are being trained to analyse the acoustic signals of cough sounds so that more cases can be quickly tested, thereby reducing the patient load on primary healthcare systems. In this paper, we evaluate ”Swaasa”, our AI-based platform for rapid respiratory screening, highlighting its efficacy and ease of use. We applied our trained classifier to catch underlying pathologies from cough sound data collected from diverse sources. We then used a pattern classifier to identify specific respiratory conditions based on cough sound patterns. We tested the robustness of our methods by comparing our results with that of a pulmonary physician in 355 cases and show that Swaasa correctly predicted associated risk in 87.32% of those cases. Our platform has a sensitivity of 97.27% with a Positive Predictive Value (PPV) of 88.54%, giving us the potential to revolutionise disease screening, especially for large populations and in isolated rural areas. Our rapid and easy-to-use Software as a Service (SaaS) solution efficiently diagnoses and conserves resources, improves patient outcomes, and establishes a comprehensive and accessible healthcare framework
The need for an empirical research program regarding human–AI relational norms
Get PDFAs artificial intelligence (AI) systems begin to take on social roles traditionally filled by humans, it will be crucial to understand how this affects people’s cooperative expectations. In the case of human–human dyads, different relationships are governed by different norms: For example, how two strangers—versus two friends or colleagues—should interact when faced with a similar coordination problem often differs. How will the rise of ‘social’ artificial intelligence (and ultimately, superintelligent AI) complicate people’s expectations about the cooperative norms that should govern different types of relationships, whether human–human or human–AI? Do people expect AI to adhere to the same cooperative dynamics as humans when in a given social role? Conversely, will they begin to expect humans in certain types of relationships to act more like AI? Here, we consider how people’s cooperative expectations may pull apart between human–human and human–AI relationships, detailing an empirical proposal for mapping these distinctions across relationship types. We see the data resulting from our proposal as relevant for understanding people’s relationship–specific cooperative expectations in an age of social AI, which may also forecast potential resistance towards AI systems occupying certain social roles. Finally, these data can form the basis for ethical evaluations: What relationship–specific cooperative norms we should adopt for human–AI interactions, or reinforce through responsible AI design, depends partly on empirical facts about what norms people find intuitive for such interactions (along with the costs and benefits of maintaining these). Toward the end of the paper, we discuss how these relational norms may change over time and consider the implications of this for the proposed research program
Empowering voices: the influence of Old Norse mythology on women’s writing from 1950-2012
Get PDFIn the following thesis, I shall address a very particular lacuna in Old Norse reception studies; that of women’s voices. In recent years, the main focus has been on Norse symbolism in politics, cinema, comics and gaming, or, in literary reception, how male writers like Tolkien, Lewis and Auden have engaged with Norse mythology. I now wish to explore the use of Old Norse mythology specifically in women’s creative, original writing in the UK, and thus demonstrate the true flexibility of the pantheon as a signifier. As a summative study of women in this category would be too large, and would also risk binarization of writers, I shall instead explore how and why certain female writers have engaged with the particular sensations of power associated with Old Norse mythology, and what such engagement communicates about their own contexts. My chosen period of focus is between 1950 and 2012, between the colonialist viking craze of the early twentieth century, and the neo-medievalist surge of ‘viking’ pop culture. As well as demonstrating the ongoing (albeit subtler) reliance on powerful Old Norse content in this period, I shall explore the ways in which usage of the mythology by women authors changed with the rapidly changing social climate. Each of my chosen writers - Sylvia Plath, A.S. Byatt and Kathleen Jamie - comes from a very different context within the twentieth century, but all, tellingly, have one thing in common: they have written about Old Norse mythology in a way which makes them feel powerful, whether through expressing intense emotions, breaking the boundaries of established thinking, or using their voice to address wider issues and empower others. While commenting on their writing, I shall also comment on the importance of such individuals to the ongoing arc of reception studies as a whole
Bayesian inference of phylogenetic distances: revisiting the eigenvalue approach
Get PDFUsing genetic data to infer evolutionary distances between molecular sequence pairs based on a Markov substitution model is a common procedure in phylogenetics, in particular for selecting a good starting tree to improve upon. Many evolutionary patterns can be accurately modelled using substitution models that are available in closed form, including the popular general time reversible model (GTR) for DNA data. For more complex biological phenomena, such as variations in lineage-specific evolutionary rates over time (heterotachy), other approaches such as the GTR with rate variation (GTR +Γ ) are required, but do not admit analytical solutions and do not automatically allow for likelihood calculations crucial for Bayesian analysis. In this paper, we derive a hybrid approach between these two methods, incorporating Γ(α,α) -distributed rate variation and heterotachy into a hierarchical Bayesian GTR-style framework. Our approach is differentiable and amenable to both stochastic gradient descent for optimisation and Hamiltonian Markov chain Monte Carlo for Bayesian inference. We show the utility of our approach by studying hypotheses regarding the origins of the eukaryotic cell within the context of a universal tree of life and find evidence for a two-domain theory
The magnitude and cross reactivity of SARS-CoV-2 specific antibody responses in Sri Lankan children and association with the nutritional status
Get PDFBackground: In order to determine if undernutrition affects the presence, breadth and magnitude of antibodies to SARS-CoV-2 and variants, we studied SARS-CoV-2 specific antibody responses in a large island wide serosurvey in children in Sri Lanka. Methods: Using the WHO UNITY protocol, we recruited 5207 children, aged 10 to 20 years, and assessed anthropometric measures, seropositive rates, ACE2 blocking antibodies and antibodies to omicron variants, in vaccinated and unvaccinated children. Results: 3111/3119 (99.7%) vaccinated and 2008/2088 (96.2%) of unvaccinated children were seropositive for SARS-CoV-2, although the detection of ACE2 blocking antibodies were significantly higher in vaccinated children (2984/3111, 95.9%) compared to unvaccinated (1346/2008, 67.0%). 1057 (22.1%) had a BMI < 3rd centile for age, and therefore were classified as underweight. Unvaccinated children, with < 3rd BMI centile had significantly lower ACE2 blocking antibodies than other groups. There were no differences in the antibody titres to XBB.1.5 or BA.2.75 based on the BMI category. Conclusions: The high seropositivity rates, with high antibody titres to SARS-CoV-2 variants in unvaccinated children indicates possible multiple infections with SARS-CoV-2. The implications of lower antibody levels in underweight children should be further investigated
Scalar play: the poetics of bodily entanglement in the work of Marie-Claire Bancquart
No full textThis article investigates how the late French poet Marie-Claire Bancquart plays with different scales of perception in her work, shifting between microscopic and macroscopic visions, between evocations of geological time, human time, and nanoseconds. It examines how her poetry uses shifts in scale to expose the liveliness of material substances and the processes of becoming that they pursue in and through the human body. Analysing how Bancquart uses scalar play to jolt her reader into a new awareness of the body, I explore how she encourages us to perceive our bodily existence, not from the outside but the inside, as we emerge from the entanglements that occur between diverse material and immaterial processes.
Drawing parallels between Bancquart’s poetry and the works of Donna Haraway, Jane Bennett, and Astrida Neimanis, this study argues that Bancquart’s scalar play anticipates certain key features of their nonanthropocentric thought. It proposes that her poetry is prescient in the way that it trains us to become aware of the partiality of the human perspective and encourages us to attend to and to speculate about the material life of the human body, especially the activities that are blocked or filtered out by our own humanscaled perception
Observing simultaneous low temperature heat release and deflagration in a spark ignition engine using formaldehyde planar laser induced fluorescence
Get PDFLow temperature heat release (LTHR) and its underlying chemistry is of particular interest for its potential to mitigate knock in spark ignition (SI) engines and enable advanced combustion strategies that rely on end gas autoignition. It has been proposed that, in SI engines, LTHR can occur volumetrically in the end gas, after ignition, whilst deflagration occurs elsewhere in the cylinder, however, current pressure-based heat release metering techniques are unable to distinguish such LTHR from high temperature heat release (HTHR) due to the overlapping pressure rise characteristics. Planar laser-induced fluorescence (PLIF) of formaldehyde, a known product of LTHR which is consumed during HTHR, offers an opportunity to detect end gas LTHR simultaneously with deflagration but is challenging to implement, as end gas is often located closer to cylinder walls and away from typical optically accessible locations. An optically accessible SI engine was used to show formaldehyde PLIF signal intensity under motored conditions is well correlated to cumulative LTHR intensity, using a recent method to isolate LTHR in SI engine conditions. An alternative ignition method using four side-mounted spark plugs was implemented to generate end gas close to the cylinder axis. This enabled measurement of LTHR within the end gas during the deflagration process of a SI engine, demonstrating the utility of formaldehyde PLIF to optically measure LTHR under conditions where pressure-based diagnostics cannot isolate the contribution of LTHR
Planning and optimizing a digital self‐management support intervention: Acne Care Online
Get PDFObjectives: To showcase the planning and optimization processes involved in developing a digital behaviour change intervention through the example of a self‐management support tool for young people with acne (‘Acne Care Online’). Design: Following Medical Research Council guidance, a theory, evidence, and person‐based approach was employed, drawing on existing evidence, stakeholder expertise, health psychology theory, and qualitative methods to underpin intervention content, structure and functionality. Methods: Systematic reviews of literature concerning acne help‐seeking and treatment adherence, theoretical understandings of health‐related behaviour, guidance from public contributors, and interviews with young people with acne (n = 24), their parents/carers (n = 8) and healthcare professionals (n = 18), informed the intervention's guiding principles and logic model. Draft intervention content was then developed by a multidisciplinary study team including public contributors and health professionals, and optimized through 53 think‐aloud interviews with intended users. Results: The development process created Acne Care Online ready for trial evaluation. It also provided insights into self‐management challenges amongst this group – including their reluctance to consult, and misconceptions about treatments that hinder effective management (e.g., using products with no active ingredients, concerns about side effects, and unrealistic expectations). Acne Care Online appeared engaging, informative and relevant, with early feedback from health professionals suggesting it could be integrated into current healthcare practice. Conclusions: This study provides insights into theory and person‐informed development processes for behaviour change interventions. Here, the acceptability and perceived value of Acne Care Online was evidenced. The work also provides important insights for clinicians managing young people seeking support for acne