Continuous glucose monitoring sensors: Past, present and future algorithmic challenges

Continuous glucose monitoring (CGM) sensors are portable devices that allow measuring and visualizing the glucose concentration in real time almost continuously for several days and are provided with hypo/hyperglycemic alerts and glucose trend information. CGM sensors have revolutionized Type 1 diabetes (T1D) management, improving glucose control when used adjunctively to self-monitoring blood glucose systems. Furthermore, CGM devices have stimulated the development of applications that were impossible to create without a continuous-time glucose signal, e.g., real-time predictive alerts of hypo/hyperglycemic episodes based on the prediction of future glucose concentration, automatic basal insulin attenuation methods for hypoglycemia prevention, and the artificial pancreas. However, CGM sensors’ lack of accuracy and reliability limited their usability in the clinical practice, calling upon the academic community for the development of suitable signal processing methods to improve CGM performance. The aim of this paper is to review the past and present algorithmic challenges of CGM sensors, to show how they have been tackled by our research group, and to identify the possible future ones

Train-the-trainers in hand hygiene : a standardized approach to guide education in infection prevention and control

Background Harmonization in hand hygiene training for infection prevention and control (IPC) professionals is lacking. We describe a standardized approach to training, using a “Train-the-Trainers” (TTT) concept for IPC professionals and assess its impact on hand hygiene knowledge in six countries.Methods We developed a three-day simulation-based TTT course based on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. To evaluate its impact, we have performed a pre-and post-course knowledge questionnaire. The Wilcoxon signed-rank test was used to compare the results before and after training.Results Between June 2016 and January 2018 we conducted seven TTT courses in six countries: Iran, Malaysia, Mexico, South Africa, Spain and Thailand. A total of 305 IPC professionals completed the programme. Participants included nurses (n = 196; 64.2%), physicians (n = 53; 17.3%) and other health professionals (n = 56; 18.3%). In total, participants from more than 20 countries were trained. A significant (p < 0.05) improvement in knowledge between the pre- and post-TTT training phases was observed in all countries. Puebla (Mexico) had the highest improvement (22.3%; p < 0.001), followed by Malaysia (21.2%; p < 0.001), Jalisco (Mexico; 20.2%; p < 0.001), Thailand (18.8%; p < 0.001), South Africa (18.3%; p < 0.001), Iran (17.5%; p < 0.001) and Spain (9.7%; p = 0.047). Spain had the highest overall test scores, while Thailand had the lowest pre- and post-scores. Positive aspects reported included: unique learning environment, sharing experiences, hands-on practices on a secure environment and networking among IPC professionals. Sustainability was assessed through follow-up evaluations conducted in three original TTT course sites in Mexico (Jalisco and Puebla) and in Spain: improvement was sustained in the last follow-up phase when assessed 5 months, 1 year and 2 years after the first TTT course, respectively.Conclusions The TTT in hand hygiene model proved to be effective in enhancing participant’s knowledge, sharing experiences and networking. IPC professionals can use this reference training method worldwide to further disseminate knowledge to other health care workers.peer-reviewe

Innovation as an Emerging System Property: An Agent Based Simulation Model

The paper elaborates the notion of innovation as an emerging property of complex system dynamics and presents an agent-based simulation model (ABM) of an economy where systemic knowledge interactions among heterogeneous agents are crucial for the recombinant generation of new technological knowledge and the introduction of innovations. In this approach the organization of the system plays a crucial role in assessing the chances of individual firms to actually introduce innovations because it qualifies the access to external knowledge, an indispensable input, together with internal learning and research activities, into the recombinant generation of new knowledge. The introduction of innovations is analyzed as the result of systemic knowledge interactions among myopic agents that are credited with an extended procedural rationality that includes forms of creative reaction. The creative reaction of agents may lead to the introduction of productivity enhancing innovations. This takes place only when the structural, organizational and institutional characteristics of the system are such that agents, reacting to out-of-equilibrium conditions, can actually take advantage of external knowledge available within the innovation system into which they are embedded to generate new technological knowledge. The ABM enables one to explore effects of alternative organizational features of the systems, namely different configurations of the intellectual property right regimes and different architectural configurations of the regional structure into which knowledge interactions take place, on the rates of introduction of technological innovations. The results of the ABM suggest that the dissemination of knowledge favors the emergence of creative reactions and hence faster rates of introduction of technological innovations.Complex System Dynamics, Innovation, Emergent Property, Technological Knowledge, Intellectual Property Rights, Knowledge Dissemination

A THEORY OF PACKER SELF PRODUCTION IN THE SWINE INDUSTRY

An analytical model is developed to explain the increasing tendency of pork packers to produce their own hogs. Upstream integration is motivated by recent events including increasing hog buyer consolidation and a need for traceability, but is held in check since it lowers upstream managerial incentives to make non-contractible investments.Livestock Production/Industries,

Precipitation in a warming world: Assessing projected hydro-climate changes in California and other Mediterranean climate regions.

In most Mediterranean climate (MedClim) regions around the world, global climate models (GCMs) consistently project drier futures. In California, however, projections of changes in annual precipitation are inconsistent. Analysis of daily precipitation in 30 GCMs reveals patterns in projected hydrometeorology over each of the five MedClm regions globally and helps disentangle their causes. MedClim regions, except California, are expected to dry via decreased frequency of winter precipitation. Frequencies of extreme precipitation, however, are projected to increase over the two MedClim regions of the Northern Hemisphere where projected warming is strongest. The increase in heavy and extreme precipitation is particularly robust over California, where it is only partially offset by projected decreases in low-medium intensity precipitation. Over the Mediterranean Basin, however, losses from decreasing frequency of low-medium-intensity precipitation are projected to dominate gains from intensifying projected extreme precipitation. MedClim regions are projected to become more sub-tropical, i.e. made dryer via pole-ward expanding subtropical subsidence. California's more nuanced hydrological future reflects a precarious balance between the expanding subtropical high from the south and the south-eastward extending Aleutian low from the north-west. These dynamical mechanisms and thermodynamic moistening of the warming atmosphere result in increased horizontal water vapor transport, bolstering extreme precipitation events