Assessment of urinary albumin-creatinine ratio in the diabetic patient : a retrospective study

BACKGROUND: Microalbuminuria is one of the earliest markers of diabetic kidney disease. Hence, the National Institute for Health and Care Excellence (NICE, NG18) recommends screening diabetic adults, children and young people on an annual basis with urinary albumin-to-creatinine ratio (ACR) for the early detection of diabetic kidney disease. Timely detection of a positive urinary ACR leads to earlier intervention, better glycaemic control and surveillance.METHOD: Patients over the age of 18 attending the Diabetes Clinic at Mater Dei Hospital over a 1-week period in June 2021 were identified. Data regarding order requests and test results of urinary ACR was collected from iSOFT Clinical Manager System and iLab Laboratory Information System in liaison with the Clinical Chemistry Lab.RESULTS: A total of 168 patients were identified for the purpose of this study. The majority (45.2%) had a new case appointment and were excluded. Results show that despite urinary ACR being requested by the reviewing physician (90.2%), only 49.4% of these test samples were submitted to the laboratory services. The median average urinary ACR was found to be 13.9mg/g.CONCLUSION: There is appropriate knowledge amongst doctors caring for diabetic patients regarding the importance of checking urinary ACR yearly. Suboptimal sample submission rate highlights the lack of awareness amongst patients about its underlying use of detecting kidney disease. Hence, improved patient education and logistical planning are required to ensure detection and timely intervention.peer-reviewe

A meteo-hydrological modelling system for the reconstruction of river runoff: the case of the Ofanto river catchment

A meteo-hydrological modelling system has been designed for the reconstruction of long time series of rainfall and river runoff events. The modelling chain consists of the mesoscale meteorological model of the Weather Research and Forecasting (WRF), the land surface model NOAH-MP and the hydrology-hydraulics model WRF-Hydro. Two 3-month periods are reconstructed for winter 2011 and autumn 2013, containing heavy rainfall and river flooding events. Several sensitivity tests were performed along with an assessment of which tunable parameters, numerical choices and forcing data most impacted on the modelling performance. The calibration of the experiments highlighted that the infiltration and aquifer coefficients should be considered as seasonally dependent. The WRF precipitation was validated by a comparison with rain gauges in the Ofanto basin. The WRF model was demonstrated to be sensitive to the initialization time and a spin-up of about 1.5 days was needed before the start of the major rainfall events in order to improve the accuracy of the reconstruction. However, this was not sufficient and an optimal interpolation method was developed to correct the precipitation simulation. It is based on an objective analysis (OA) and a least square (LS) melding scheme, collectively named OA+LS. We demonstrated that the OA+LS method is a powerful tool to reduce the precipitation uncertainties and produce a lower error precipitation reconstruction that itself generates a better river discharge time series. The validation of the river streamflow showed promising statistical indices. The final set-up of our meteo-hydrological modelling system was able to realistically reconstruct the local rainfall and the Ofanto hydrograph

A meteo-hydrological modelling system for the reconstruction of river runoff: the case of the Ofanto river catchment

Abstract. A meteo-hydrological modelling system has been designed for the reconstruction of long time series of rainfall and river runoff events. The modelling chain consists of the mesoscale meteorological model of the Weather Research and Forecasting (WRF), the land surface model NOAH-MP and the hydrology–hydraulics model WRF-Hydro. Two 3-month periods are reconstructed for winter 2011 and autumn 2013, containing heavy rainfall and river flooding events. Several sensitivity tests were performed along with an assessment of which tunable parameters, numerical choices and forcing data most impacted on the modelling performance.The calibration of the experiments highlighted that the infiltration and aquifer coefficients should be considered as seasonally dependent.The WRF precipitation was validated by a comparison with rain gauges in the Ofanto basin. The WRF model was demonstrated to be sensitive to the initialization time and a spin-up of about 1.5 days was needed before the start of the major rainfall events in order to improve the accuracy of the reconstruction. However, this was not sufficient and an optimal interpolation method was developed to correct the precipitation simulation. It is based on an objective analysis (OA) and a least square (LS) melding scheme, collectively named OA+LS. We demonstrated that the OA+LS method is a powerful tool to reduce the precipitation uncertainties and produce a lower error precipitation reconstruction that itself generates a better river discharge time series. The validation of the river streamflow showed promising statistical indices.The final set-up of our meteo-hydrological modelling system was able to realistically reconstruct the local rainfall and the Ofanto hydrograph

Segmental lower limb mobility, muscle activity and plantar pressure analysis in individuals living with diabetic peripheral neuropathy : a systematic review and meta-analysis

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, affecting up to 50% of individuals and their quality of life. DPN is characterised by the progressive loss of proprioception, somatosensory sensitivity and intrinsic distal muscle function. Musculoskeletal complications may cause bony deformities, such as clawing of digits and prominence of metatarsophalangeal joints and increase plantar pressures resulting in skin breakdown and ulceration. Since the repetitive action of mechanical stress during gait in the presence of DPN may lead to ulcer development, better understanding of the mechanism and biomechanical components of ulcer development is of vital importance. Literature shows that DFU are found on high plantar pressure areas, however, in the absence of neuropathy, high pressure areas alone do not lead to ulceration. This systematic review and meta-analysis aims to provide a comprehensive understanding of lower limb joint and muscle function and plantar pressures during gait in the presence of DPN. This, may provide evidence for the design of more efficient and specific treatment options of healing in order to prevent risk of amputation and reulceration. Reducing the mechanical loading on the ulcerated foot during gait may influence the healing of DFU and provide preventative mechanisms of ulceration.peer-reviewe

The Joint IOC (of UNESCO) and WMO collaborative effort for met-ocean services

The Joint Committee for Oceanography and Marine Meteorology (JCOMM), a joint technical commission of IOC of UNESCO and WMO, has devised a coordination mechanism for the fit-for-purpose delivery of an end-to-end system, from ocean observations to met-ocean operational services. This paper offers a complete overview of the activities carried out by JCOMM and the status of the achievements up to 2017. The JCOMM stakeholders are the WMO Members and the IOC Member States, their research and operational Institutions, which mandated JCOMM to devise an international strategy to advance toward the achievement of the United Nations Sustainable Development Goals. The three activity areas, namely the Observation Program Area-OPA, the Data Management Program Area-DMPA and the Services and Forecasting Services Program Area-SFSPA have established several expert teams to contribute to the international coordination. OPA is organized in observing networks connected with different observing technologies, DMPA organizes the overall near-real time and delayed mode data assembly and delivery methodology and architecture and the SFSPA coordinates the met-ocean services stemming out of observations and data management. The future developments should strengthen the coordination in the three program areas considering the inclusion of new and emergent observing technologies, the interoperability of met-ocean data assembly centers and the establishment of efficient research to operations protocols, as well as better fit-for-purpose customized services for the public and private sectors

Copernicus Ocean State Report, issue 6

The 6th issue of the Copernicus OSR incorporates a large range of topics for the blue, white and green ocean for all European regional seas, and the global ocean over 1993–2020 with a special focus on 2020

The Joint IOC (of UNESCO) and WMO collaborative effort for Met-Ocean services

The WMO-IOC Joint Technical Commission for Oceanography and Marine Meteorology (JCOMM) has devised a coordination mechanism for the fit-for-purpose delivery of an end-to-end system, from ocean observations to met-ocean operational services. This paper offers a complete overview of the activities carried out by JCOMM and the status of the achievements up to 2018. The JCOMM stakeholders consist of the research and operational institutions of WMO members and the IOC member states, which mandated JCOMM to devise an international strategy to move toward the achievement of the United Nations Sustainable Development Goals. The three areas of activity are the Observation Program Area (OPA), the Data Management Program Area (DMPA) and the Services and Forecasting Services Program Area (SFSPA), and several expert teams have been established to contribute to the international coordination efforts. OPA is organized into observing networks connected by different observing technologies, DMPA organizes the overall near-real time and delayed mode data assembly, and the delivery methodology and architecture, and the SFSPA coordinates the met-ocean services resulting from the observations and data management. Future developments should enhance coordination in these three program areas by considering the inclusion of new and emergent observing technologies, the interoperability of met-ocean data assembly centers and the establishment of efficient research to operations protocols, in addition to better fit-for-purpose customized services in both the public and private sectors

Screaming more, Listening less? An investigation of participation and deliberation dynamics in the Italian Five Stars Movement

This paper investigates the tension between participation and deliberation in the Italian “Five Stars” Movement. This grassroots movement has based its activity almost entirely on the internet, becoming a political organization able to receive more than 25% in the last national elections. While its success seems to be a good outcome for democratic participation, the effects on deliberation seems to be more complex. This study analyzes the comments on the communication platform of the Movement, its leader Beppe Grillo’s blog. The comments reveal a low level of criticism towards the leader’s opinions, a high uncivil tone, a tendency to avoid policy discussion, a low level of justifications for claims expressed and, lastly, very few diverse points of views presented. Overall, the implications for political deliberation are not very positive: while the Five Stars movement, through the internet, has promoted civic engagement and participation, his members do not seem to be engaged in a civil and rational discussion, at least on the Movement’s most important communication platform