5,058 research outputs found
Practical Approaches to Continuous Glucose Monitoring in Primary Care: A UK-Based Consensus Opinion
No full textINTRODUCTION: Type 2 diabetes (T2D) imposes significant personal challenges and societal costs. Continuous glucose monitoring (CGM) is recognised as a state-of-the-art tool, but remains underutilised. Adoption of CGM in primary care should be informed by a broader understanding of the technology's capabilities and limitations. METHODS: An expert panel was convened to review current literature and clinical experience to provide practical approaches to CGM for primary care practitioners and discuss the technology's value in the routine management of T2D. The goals were to review and reach consensus on the current state of CGM in non-specialist practice settings and on strategies for successfully initiating and maintaining people on CGM. RESULTS: Initiation and maintenance of CGM therapy can be successfully conducted in primary care settings. CGM therapy should include proper patient selection, proper setting of expectations, and evidence-based adjustments to therapy. Most patients are likely to see quick, meaningful, and lasting improvements in their diabetes, along with a better understanding of their condition and greater motivation for successful management. Retrospective report interpretation is feasible and intuitive. Barriers to adoption and sustained use include cost, technological limitations, behavioural or psychological factors, and therapeutic inertia. Addressing these barriers is critical to enable better access to CGM. Continuous glucose monitoring can be leveraged by primary care teams to inform treatment decisions and also by patients to inform diabetes self-management. CONCLUSION: CGM should be considered for all people with T2D. The recommendations provided here should simplify adoption and maintenance use of CGM in primary care and maximise the glycaemic and psychosocial benefits of the technology.Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Journal content freely available via Open Access. Some content may be unavailable due to publisher embargo. Click on the 'Additional link' above to access the full-text
Dual Temperature and Strain Measurement with the Combined Fluorescence Lifetime and Bragg Wavelength Shift Approach in Doped Optical Fiber
No full textWe have constructed fiber-optic sensors to measure temperature and strain by combining the properties of fiber Bragg gratings with the fluorescent lifetimes of various doped fibers. Sensors have been made with the fiber Bragg grating written directly into the doped fiber to ensure the collocation of the strain and temperature measurement points. Results are compared with those obtained previously from a Bragg grating written into standard photosensitive fiber spliced to doped fiber. Standard deviation errors of 7 με and 0.8 °C have been obtained for strain and temperature ranges of up to 1860 με and 120 °C, respectively
Epidemiological model based periodic intervention policies for COVID-19 mitigation in the United Kingdom
No full textThis is the final version. Available on open access from Nature Research via the DOI in this recordAs the UK, together with numerous countries in the world, moves towards a new phase of the COVID-19 pandemic, there is a need to be able to predict trends in sufficient time to limit the pressure faced by the National Health Service (NHS) and maintain low hospitalisation levels. In this study, we explore the use of an epidemiological compartmental model to devise a periodic adaptive suppression/intervention policy to alleviate the pressure on the NHS. The proposed model facilitates the understanding of the progression of the specific stages of COVID-19 in communities in the UK including: the susceptible population, the infected population, the hospitalised population, the recovered population, the deceased population, and the vaccinated population. We identify the parameters of the model by relying on past data within the period from 1 October 2020 to 1 June 2021. We use the total number of hospitalised patients and the fraction of those infected who are being admitted to hospital to develop adaptive policies: these modulate the recommended level of social restriction measures and realisable vaccination target adjustments. The analysis over the period 1 October 2020 to 1 June 2021 demonstrates our periodic adaptive policies have the potential to reduce the hospitalisation by 58% on average per month. In a further prospective analysis over the period August 2021 to May 2022, we analyse several future scenarios, characterised by the relaxation of restrictions, the vaccination ineffectiveness and the gradual decay of the vaccination-induced immunity within the population. In addition, we simulate the surge of plausible variants characterised by an higher transmission rate. In such scenarios, we show that our periodic intervention is effective and able to maintain the hospitalisation rate to a manageable level.Engineering and Physical Sciences Research Council (EPSRC
Spatial distribution of brittle strain in layered sequences
No full textA new method of spatial analysis of brittle deformation is proposed that can be applied to both opening mode fractures (joints and veins) and faults. The method has been developed to provide a measure of heterogeneity based on both the position and displacement of individual fractures sampled along a linear traverse. It is based on a non-parametric comparison of the cumulative frequency and strain with that for a uniform distribution. In addition the method provides a statistic that may be used to test a cumulative data-set for significant departures from a uniform distribution.Two areas of lower Jurassic strata in England provide exceptional outcrops of several kilometre lengths displaying groups of tensile fractures (veins) and normal faults with displacements ranging over 5 to 6 orders of magnitude. The strata consist of shales interbedded with carbonates (decimetres to metres thick), having shale/carbonate ratios of 5/1 and 13/1. Data collected along 25 scan-lines of different length and resolution were analysed. The results show that strain is highly localized at the vein-scale in the more carbonate-rich sequence whilst it is uniformly distributed in the mudstone-dominated sequence. Fault-strain is fairly homogenously distributed in both study areas. These differences may be due to mechanically different behaviours of the sedimentary successions during early deformation history
Distribution of faults and extensional strain in fractured carbonates of the North Malta Graben
No full textFaults in carbonate rocks occur over a wide range of scales, some of which lie below the resolution of seismic reflection surveys. For this reason, our knowledge of the spatial and size distributions of subseismic faults is very limited. In this study, we address this issue by directly measuring the positions and displacements of extensional faults along a total of 56 km (35 mi) of outcrop and map-derived cross sections from the pelagic carbonates of the Maltese Islands. The data cover close to four orders of displacement magnitude and provide insight into the organization of the fault system associated with the North Malta Graben system. Virtually all the brittle extension in the Maltese Islands is accommodated by faults, with displacements ranging from centimeters to greater than 100 m (328 ft). This extension is not homogeneously distributed across the islands but is localized in a few kilometer-wide higher strain zones, which are separated by virtually undeformed lower strain regions. At the centimeter scale, both regions have an average fault density of about 10–1 m–1 (spacing 10 m [33 ft]). In the lower strain areas, few of these faults attain displacements of greater than 10 m (33 ft) and would be below the resolution of most commercial seismic surveys. In the higher strain regions, however, faults with displacements of greater than10 m (33 ft) occur at spacings of about 1 km (0.6 mi). This difference is reflected in the scaling exponents of D = 0.84 (higher strain) and D = 1.26 (lower strain), with larger faults dominating the deformation when D is greater than 1. Higher strain zones are more prominent in the North Malta Graben and produce an overall extension of approximately 3.3%, whereas they occur only locally in the surrounding horst regions where the extension is about 1.8%. These results indicate that high-quality seismic reflection surveys across the Malta platform might miss between 40 and 45% of the total extension and that estimates of subseismic faulting need to consider differences in the scaling of the higher and lower strain zones.<br/
The distribution of faults and fractures and their importance in accommodating extensional strain at Kimmeridge Bay, Dorset, UK
No full textThe spatial distribution of extensional strain in interbedded mudstones and carbonates from around Kimmeridge Bay in southern England is examined using a variety of line samples. Normal faults and tensile fractures (veins) from the same deformation event show displacements ranging over 6 orders of magnitude. The relative contribution of these structures to the overall extension varies, with large faults (>10 m heave) accommodating about 65%, smaller faults (1–10 m heave) about 25% and veins less than 10% of the overall extension. The heterogeneity of fracture density and strain can be quantified from cumulative plots by applying a non-parametric method based on Kuiper's test. Both the degree and statistical significance of strain heterogeneity can be determined and are shown to be scale-dependent. Thin veins accommodate a fairly constant background strain across the region, whilst thick veins and small faults take up localized higher strains in damage zones around larger faults. Fault-strain is relatively homogenously distributed across the region. The faults and veins do not share the same scaling relationship. Thus, this study shows that it is not possible to simply extrapolate fracture frequencies and strain from fault scale to vein scale, and that the heterogeneity of extensional strain is scale dependent
Perceived exertion is as effective as the perceptual strain index in predicting physiological strain when wearing personal protective clothing
No full textObjective\ud
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The perceptual strain index (PeSI) has been shown to overcome the limitations associated with the assessment of the physiological strain index (PSI), primarily the need to obtain a core body temperature measurement. The PeSI uses the subjective scales of thermal sensation and perceived exertion (RPE) to provide surrogate measures of core temperature and heart rate, respectively. Unfortunately, thermal sensation has shown large variability in providing an estimation of core body temperature. Therefore, the primary aim of this study was to determine if thermal comfort improved the ability of the PeSI to predict the PSI during exertional-heat stress.\ud
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Methods\ud
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Eighteen healthy males (age: 23.5 years; body mass: 79.4 kg; maximal aerobic capacity: 57.2 ml·kg− 1·min− 1) wore four different chemical/biological protective garments while walking on treadmill at a low (< 325 W) or moderate (326–499 W) metabolic workload in environmental conditions equivalent to wet bulb globe temperatures 21, 30 or 37 °C. Trials were terminated when heart rate exceeded 90% of maximum, when core body temperature reached 39 °C, at 120 min or due to volitional fatigue. Core body temperature, heart rate, thermal sensation, thermal comfort and RPE were recorded at 15 min intervals and at termination. Multiple statistical methods were used to determine the most accurate perceptual predictor.\ud
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Results\ud
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Significant moderate relationships were observed between the PeSI (r = 0.74; p < 0.001), the modified PeSI (r = 0.73; p < 0.001) and unexpectedly RPE (r = 0.71; p < 0.001) with the PSI, respectively. The PeSI (mean bias: − 0.8 ± 1.5 based on a 0–10 scale; area under the curve: 0.887), modified PeSI (mean bias: − 0.5 ± 1.4 based on 0–10 scale; area under the curve: 0.886) and RPE (mean bias: − 0.7 ± 1.4 based on a 0–10 scale; area under the curve: 0.883) displayed similar predictive performance when participants experienced high-to-very high levels of physiological strain.\ud
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Conclusions\ud
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Modifying the PeSI did not improve the subjective prediction of physiological strain. However, RPE provided an equally accurate prediction of physiological strain, particularly when high-to-very high levels of strain were observed. Therefore, given its predictive performance and user-friendliness, the evidence suggests that RPE in isolation is a practical and cost-effective tool able to estimate physiological strain during exertional-heat stress under these work conditions
Genome sequence of the Chlamydophila abortus variant strain LLG
No full textChlamydophila abortus is a common cause of ruminant abortion. Here we report the genome sequence of strain LLG, which differs genotypically and phenotypically from the wild-type strain S26/3. Genome sequencing revealed differences between LLG and S26/3 to occur in pseudogene content, in transmembrane head/inc family proteins, and in biotin biosynthesis genes
The strain-dependence of the critical current density in the high-field superconductor Nb(_3)Sn
No full textMeasurements of the critical current density (J_c) of Nb(_3)Sn superconducting wires were performed as a function of magnetic field (B ≤ 23 T), temperature (4.2 K ≤ T ≤ 12 K), and axial strain (-1.6% ≤ ɛ ≤ 0.7%). Data are presented for wires measured on helical strain springs of different materials and geometries, together with results from finite element analysis (FEA) of these systems. It is demonstrated that the differential thermal contraction of the spring only affects the behaviour of the wire via a change in the parameter ɛ(_M) (the applied strain at the peak), and that the data for different spring geometries show good agreement when the strain is calculated at the midpoint of the wire using FEA. Strain cycling measurement show that the critical current density and n-value behave reversibly for applied strains up to 0.3% (-500 cycles), increase irreversibly for strains up to 0.6% (-1000 cycles in total), and decrease irreversibly at higher strains (˃0.75%). Comparisons of electric field-temperature characteristics (as measured for the ITER model coils) with the standard electric field-current density characteristics show agreement to within an experimental uncertainty of-20 mK. Comprehensive J(_c)(B, T, ɛ(_1)) data are presented for two ITER Nb(_3)Sn wires, which are characterised by high effective upper critical fields [B(_c2)(0)]. A new universal relation between normalised [B(_c2)(0)]and strain is reported, which shows a stronger strain-dependence than previous data for binary Nb(_3)Sn. A power-law relation between B(_c2)(0, ɛ,) and T(_c)( ɛ,) (the effective critical temperature) is observed with an exponent of -2.2, compared to the value > 3 for binary Nb(_3)Sn. This is in agreement with microscopic theory, which predicts a power law with an exponent that is lower for dirtier materials, and also shows that the uniaxial strain effects are predominantly due to changes in the phonon properties. A new general scaling law is proposed that parameterises complete J(_c)(B,T, ɛ) datasets with a typical accuracy of -4%, and also provides reasonable predictions from partial datasets
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