Phase II study of tight glycaemic control in COPD patients with exacerbations admitted to the acute medical unit.

BACKGROUND: Hyperglycaemia is associated with poor outcomes from exacerbations of chronic obstructive pulmonary disease (COPD). Glycaemic control could improve outcomes by reducing infection, inflammation and myopathy. Most patients with COPD are managed on the acute medical unit (AMU) outside intensive care (ICU). OBJECTIVE: To determine the feasibility, safety and efficacy of tight glycaemic control in patients on an AMU. DESIGN: Prospective, non-randomised, phase II, single-arm study of tight glycaemic control in COPD patients with acute exacerbations and hyperglycaemia admitted to the AMU. Participants received intravenous, then subcutaneous, insulin to control blood glucose to 4.4-6.5 mmol/l. Tight glycaemic control was evaluated: feasibility, protocol adherence; acceptability, patient questionnaire; safety, frequency of hypoglycaemia (capillary blood glucose (CBG) <2.2 mmol/l and 2.2-3.3 mmol/l); efficacy, median CBG, fasting CBG, proportion of measurements/time in target range, glycaemic variability. RESULTS: were compared with 25 published ICU studies. Results 20 patients (10 females, age 71 ± 9 years; forced expiratory volume in 1 s: 41 ± 16% predicted) were recruited. Tight glycaemic control was feasible (78% CBG measurements and 89% of insulin-dose adjustments were adherent to protocol) and acceptable to patients. 0.2% CBG measurements were <2.2 mmol/l and 4.1% measurements 2.2-3.3 mmol/l. The study CBG and proportion of measurements/time in target range were similar to that of ICU studies, whereas the fasting CBG was lower, and the glycaemic variability was greater. CONCLUSIONS: Tight glycaemic control is feasible and has similar safety and efficacy on AMU to ICU. However, as more recent ICU studies have shown no benefit and possible harm from tight glycaemic control, alternative strategies for blood glucose control in COPD exacerbations should now be explored. Trial registration number ISRCTN: 42412334. http://Clinical.Trials.gov NCT00764556

Application of a stochastic weather generator to assess climate change impacts in a semi-arid climate: The Upper Indus Basin

Assessing local climate change impacts requires downscaling from Global Climate Model simulations. Here, a stochastic rainfall model (RainSim) combined with a rainfall conditioned weather generator (CRU WG) have been successfully applied in a semi-arid mountain climate, for part of the Upper Indus Basin (UIB), for point stations at a daily time-step to explore climate change impacts. Validation of the simulated time-series against observations (1961–1990) demonstrated the models’ skill in reproducing climatological means of core variables with monthly RMSE of <2.0 mm for precipitation and ⩽0.4 °C for mean temperature and daily temperature range. This level of performance is impressive given complexity of climate processes operating in this mountainous context at the boundary between monsoonal and mid-latitude (westerly) weather systems. Of equal importance the model captures well the observed interannual variability as quantified by the first and last decile of 30-year climatic periods. Differences between a control (1961–1990) and future (2071–2100) regional climate model (RCM) time-slice experiment were then used to provide change factors which could be applied within the rainfall and weather models to produce perturbed ‘future’ weather time-series. These project year-round increases in precipitation (maximum seasonal mean change:+27%, annual mean change: +18%) with increased intensity in the wettest months (February, March, April) and year-round increases in mean temperature (annual mean +4.8 °C). Climatic constraints on the productivity of natural resource-dependent systems were also assessed using relevant indices from the European Climate Assessment (ECA) and indicate potential future risk to water resources and local agriculture. However, the uniformity of projected temperature increases is in stark contrast to recent seasonally asymmetrical trends in observations, so an alternative scenario of extrapolated trends was also explored. We conclude that interannual variability in climate will continue to have the dominant impact on water resources management whichever trajectory is followed. This demonstrates the need for sophisticated downscaling methods which can evaluate changes in variability and sequencing of events to explore climate change impacts in this region

Delayed reception of live blowfly (Calliphora vicina and Chrysomya rufifacies) larval samples: implications for minimum postmortem interval estimates.

Forensic entomology evidence collected by police and mortuary staff may be delayed in getting to the entomologist. Live samples may continue developing and alter minimum postmortem interval (PMImin) estimates. This study investigated development of simulated evidential samples of Calliphora vicina Robineau-Desvoidy and Chrysomya rufifacies (Macquart) (Diptera: Calliphoridae) maggots. Maggots of each species were studied in three developmental classes: "small" (late second/early third instar), "mid" (mid third instar) and "large" (late third instar). Seven replicates of 11 maggots in each class were assigned without food to four treatments: (1) 24 h at 20 °C; (2) 24 h at 4 °C; (3) 48 h at 20 °C and (4) 48 h at 4 °C. There was a significant difference in absolute length change across treatments, reflecting size for C. vicina, and interaction between size, time and temperature for Ch. rufifacies. Calliphora vicina maggots showed minimal mortality, and most second instar larvae moulted by the experiment's end. Chrysomya rufifacies showed heavy mortality and minimal moulting from the second to third instar. Only "large" Ch. rufifacies maggots kept at room temperature for 48 h pupariated. Since these results confirm that development can continue in live unfed maggot samples after their collection, it is not advisable to delay their preservation

An Analysis of Informational Content in a Descriptive Narrative Task Completed by People with Aphasia

Speech and language are important tools used for communication. Communication techniques such as narrative story telling skills can be used to build relationships. People with aphasia may lack these effective communication skills. This study provides a close-up interpretation of people with aphasia telling the story of Cinderella. Two different approaches were used to analyze the elements of the participant’s stories. By using these approaches during speech therapy, Speech-Language Pathologists can help people with aphasia to build a more concise and thorough story

Communication, Machines & Human Augmentics

This essay reformulates the question of human augmentation as a problem of advanced human-machine communication, theorizing that such communication implies robust artificial intelligence and necessitates understanding the relational role new technologies play in human-machine communication. We focus on the questions, “When do electronic tools cease to be ‘simply’ tools, and become meaningfully part of ourselves,” and, “When might we think of these tools as augmenting our selves, rather than simply amplifying our capabilities?” These questions, already important to the medical and rehabilitative fields, loom larger with increasing commodification of pervasive augmentation technologies, and indicate the verge on which human-machine communication now finds itself. Through analyses of human and machine agency, mediated through a theory of close human-machine communication, we argue that the critical element in discussions of human-machine communication is an increase in sense of agency, extending the traditional human-computer interface dictum to provide an internal locus of control

Daily and Seasonal Variation in the Spectral Composition of Light Exposure in Humans

Light is considered the most potent synchronizer of the human circadian system and exerts many other non-image-forming effects, including those that affect brain function. These effects are mediated in part by intrinsically photosensitive retinal ganglion cells that express the photopigment melanopsin. The spectral sensitivity of melanopsin is greatest for blue light at approximately 480 nm. At present, there is little information on how the spectral composition of light to which people are exposed varies over the 24 h period and across seasons. Twenty-two subjects, aged 22±4 yrs (mean±SD) participated during the winter months (November–February), and 12 subjects aged 25±3 yrs participated during the summer months (April–August). Subjects wore Actiwatch-RGB monitors, as well as Actiwatch-L monitors, for seven consecutive days while living in England. These monitors measured activity and light exposure in the red, green, and blue spectral regions, in addition to broad-spectrum white light, with a 2 min resolution. Light exposure during the day was analyzed for the interval between 09:00 and 21:00 h. The time course of white-light exposure differed significantly between seasons (p = 0.0022), with light exposure increasing in the morning hours and declining in the afternoon hours, and with a more prominent decline in the winter. Overall light exposure was significantly higher in summer than winter (p = 0.0002). Seasonal differences in the relative contribution of blue-light exposure to overall light exposure were also observed (p = 0.0006), in particular during the evening hours. During the summer evenings (17:00–21:00 h), the relative contribution of blue light was significantly higher (p < 0.0001) (40.2±1.1%) than during winter evenings (26.6±0.9%). The present data show that in addition to overall light exposure, the spectral composition of light exposure varies over the day and with season

Additive Manufacturing and Injection Moulding of High-Performance IF-WS 2 /PEEK Nanocomposites: A Comparative Study

In this study, PEEK nanocomposites with 0, 0.5, 1, and 2wt% IF-WS2 were manufactured by injection moulding and Fused Deposition Modelling (FDM). To compare the impact of the two processing methods and the incorporated nanoparticles on the morphology, crystallization and final mechanical properties of the nanocomposites, SEM, DSC and tensile testing were performed. In general, a good distribution of nanoparticles was observed in PEEK, although larger agglomerates were visible at 2 wt% IF-WS2. The crystallization degree of PEEK increased with increasing loading of IF-WS2 nanoparticles up to 1wt% and then declined at 2 wt%, due to lower level of particle dispersion in this sample. The 3D printed samples showed slightly higher crystallinity at each IF-WS2 loading in relation to the injection moulded samples and extruded filaments, because of multiple reheating effect from subsequent layer deposition during FDM, causing recrystallization. In general, incorporation of IF-WS2 nanoparticles increased the mechanical properties of pure PEEK in both 3D printed and injection moulded samples. However, this increment was more noticeable in the 3D-printed nanocomposite samples, resulting in smaller gap between the mechanical properties of the 3D-printed samples and the injection moulded counterparts, in respect to pure PEEK, particularly at 1 wt% IF-WS2. This effect is ascribed to the increased inter-layer bonding of PEEK in the presence of IF-WS2 nanoparticles in FDM. In general, the lower mechanical properties of the 3D printed samples compared with the injection moulded ones are ascribed to poor interlayer bonding between the deposited layers and the presence of voids. However, addition of just 1 wt% of IF-WS2 nanoparticles into PEEK increased the tensile strength and Young’s modulus of the FDM PEEK materials to similar levels to those achieved for unfilled injection moulded PEEK. Therefore, incorporation of IF-WS2 nanoparticles into PEEK is a useful strategy to improve the mechanical performance of FDM PEEK

Melt-Blended Multifunctional PEEK/Expanded Graphite Composites

In this work, antistatic, high-performance composites of poly (ether ether ketone) (PEEK) and concentrations of 0.5–7 vol% expanded graphite (EG) were fabricated via twin-screw extrusion and injection moulding at mould temperatures of 200°C. The morphological, electrical, rheological, thermal, mechanical, and wear properties of the composites were investigated. Scanning electron microscope (SEM) images indicate that distribution and dispersion of EG platelets in the PEEK matrix are enhanced at higher EG loadings. The electrical conductivity of the composites with 5 vol% of EG exhibits a sharp rise in the electrical conductivity range of antistatic materials because of the formation of conductive paths. The formation of a three-dimensional EG network led to a rapid increase in the storage modulus of the melt of the 2 vol% of EG-loaded composite at a frequency of 0.1 rad/s and temperature of 370°C. The neat PEEK and composites containing 0.5–5 vol% EG indicated a cold-crystallisation peak in the first heating scan of a non-isothermal differential scan calorimetry (DSC) test and their crystallinity degrees changed slightly. However, after removing their thermal and stress histories, the EG platelets promoted nucleation and increased the PEEK crystallinity remarkably, indicating that annealing of the PEEK composites can improve their mechanical performance. The neat PEEK exhibits the standard tensile and flexural stress-strain behaviour of thermoplastics, and the composites exhibit elastic behaviour initially followed by a weak plastic deformation before fracture. The addition of 5 vol% of EG to PEEK increased the tensile and flexural modulus from 3.84 and 3.55 GPa to 4.15 and 4.40 GPa, decreased the strength from 96.73 and 156.41 MPa to 62 and 118.19 MPa, and the elongation at break from 27.09 and 12.9% to 4 and 4.6%, respectively. The wear resistance of the composite containing 3 vol% EG was enhanced by 37% compared with the neat PEEK