VLED and formula LED in the management of type 2 diabetes: defining the clinical need and research requirements

It has been known for many years that substantial weight loss, achieved by bariatric surgery or non-surgical means can mean normalise glucose tolerance. Recent RCT evidence indicates that >15 kg weight loss is necessary, to this and it may lead to near normalisation (doubling) of life expectancy. Less than 5% of patients achieve this through even the best, evidence-based medical weight management programme (Counterweight www.counterweight.org ). A weight loss of >15 kg is easily achievable by 8 weeks VLED/LELD in compliant patients, with little difference between 400-800 kcal/day, but weight maintenance after VLED has until recently been so poor that VLEDs are not, at present, recommended in clinical guidelines. However, mean weight loss close to >15 kg can be maintained 18-24 months using a variety of maintenance strategies. These include a structured reintroduction of foods linked to an education programme with behavioural strategies, intermittent VLED use and prescribable anti-obesity drugs (dexfenfluramine, orlistat, sibutramine). Most of these studies have been in non-diabetic subjects. A new “curative” paradigm in T2DM management, aiming to normalise glucose tolerance and health risks by achieving and maintaining >15 kg loss, as soon as possible after diagnosis, should be highly acceptable to patients, generating many additional QALYs. It is likely to be highly cost-effective by avoiding the current recommended, mainly palliative, model, using polypharmacy which provides an overall risk reduction of only 5-10%.. Clinical trials are on-going to establish the feasibility of delivering formula (LELD) and a maintenance programme to large numbers of patients within routine primary care. There is urgent need, to run similar studies in diabetic patients. New approaches to long-term (lifelong) maintenance of weight loss and a non-diabetic state may include anti-obesity drugs

An Estimate of Changes in the Sun's Total Irradiance Caused by UV Irradiance Variations from 1874 to 1988

Enhanced emission from bright solar faculae is a source of significant variation in the sun's total irradiance. Relative to the emission from the quiet sun, facular emission is known to be considerably greater at UV wavelengths than at visible wavelengths. Determining the spectral dependence of facular emission is of interest for the physical insight this may provide to the origin of the sun's irradiance variations. It is also of interest because solar radiation at lambda less than 300 nm is almost totally absorbed in the Earth's atmosphere. Depending on the magnitude of the UV irradiance variations, changes in the sun's irradiance that penetrates to the Earth's surface may not be equivalent to total irradiance variations measured above the Earth's atmosphere. Using an empirical model of total irradiance variations which accounts separately for changes caused by bright faculae from those associated with dark sunspots, the contribution of UV irradiance variations to changes in the sun's total irradiance is estimated during solar cycles 12 to 21

Dirac groupoids and Dirac bialgebroids

We describe infinitesimally Dirac groupoids via geometric objects that we call Dirac bialgebroids. In the two well-understood special cases of Poisson and presymplectic groupoids, the Dirac bialgebroids are equivalent to the Lie bialgebroids and IM-$2$-forms, respectively. In the case of multiplicative involutive distributions on Lie groupoids, we find new properties of infinitesimal ideal systems.Comment: New expanded version; the construction of the Manin pair associated to an LA-Dirac structure has moved from arXiv:1209.6077 to here. Added background on double vector bundles, VB-algebroids and 2-term representations up to homotop

Improving the efficacy of the lean index through the quantification of qualitative lean metrics

Multiple lean metrics representing performance for various aspects of lean can be consolidated into one holistic measure for lean, called the lean index, of which there are two types. In this article it was established that the qualitative based lean index are subjective while the quantitative types lack scope. Subsequently, an appraisal is done on techniques for quantifying qualitative lean metrics so that the lean index is a hybrid of both, increasing the confidence in the information derived using the lean index. This ensures every detail of lean within a system is quantified, allowing daily tracking of lean. The techniques are demonstrated in a print packaging manufacturing case

The Geometrisation of N\mathbb N-manifolds of degree 2

This paper describes an equivalence of the canonical category of $\mathbb N$-manifolds of degree $2$ with a category of involutive double vector bundles. More precisely, we show how involutive double vector bundles are in duality with double vector bundles endowed with a linear metric. We describe then how special sections of the metric double vector bundle that is dual to a given involutive double vector bundle are the generators of a graded manifold of degree $2$ over the double base. We discuss how split Poisson $\mathbb N$-manifolds of degree $2$ are equivalent to \emph{self-dual representations up to homotopy} and so, following Gracia-Saz and Mehta, to linear splittings of a certain class of VB-algebroids. In other words, the equivalence of categories above induces an equivalence between so called \emph{Poisson involutive double vector bundles}, which are the dual objects to metric VB-algebroids, and Poisson $\mathbb N$-manifolds of degree $2$.Comment: This is the improved and completed first part of the paper arXiv:1504.00880 (N-manifolds of degree 2 and metric double vector bundles). The improved second and third parts will be uploaded here in due time. v2: inconsistencies fixed in Example 3.18, as well as some typos. v3: Section 3.4.2 had a faulty formula that is now fixe

Towards an Operational Definition of Lean Construction Onsite

Through literature review and drawing from a combined professional experience of over 20 years of lean construction implementation, this paper investigates the key success factor for the automotive industry’s uptake of lean production to see what the construction industry can derive from it. The paper concludes that there exist a variety of definitions of lean, but no existing definition is yet satisfactory to describe lean construction in a rigorously testable method. This is a major obstacle to the successful deployment of lean construction especially when the industry does not have a standard benchmark of “what a lean site looks like”. It recommends a small-scale replication of the International Motor Vehicle Programme (IMVP) led International Automotive Plant Study (IAPS) in construction. This will be in aid of developing an operational definition of lean construction, in line with Deming’s understanding, in the form of a lean site assessment tool contributing to a Lean Index. A statistical study is also suggested to establish correlation between the degrees of lean application (Lean Index) and project performanc

Flight techniques for the measurement of stability derivatives and aircraft response

A method of obtaining aircraft frequency-response from transient response data by Fourier analysis is currently being investigated. This report describes progress that has been made between the commencement of the contract (1st December, 1964) and the time of writing (October, 1965). The dynamic response characteristics of a Hawker Siddeley Dore' aircraft are being determined from flight measurements using the Fourier method of analysis. At present attention is centred on the longitudinal response as the short-period mode of the aircraft is well damped and should be defined by a simple transfer function. The aircraft transient responses to various pilot-applied control inputs are recorded and the Fourier analysis of these transients is being carried out on a Ferranti Pegasus digital computer. Three development flights have been completed to date, and some preliminary results have been obtained, although the detailed analysis of the flight data is awaiting the incorporation of the instrumentation calibration into the computer programme. This last procedure will speed up the analysis of future data

Manufacturing System Lean Improvement Design Using Discrete Event Simulation

Lean manufacturing (LM) has been used widely in the past for the continuous improvement of existing production systems. A Lean Assessment Tool (LAT) is used for assessing the overall performance of lean practices within a system, while a Discrete Event Simulation (DES) can be used for the optimization of such systems operations. Lean improvements are typically suggested after a LAT has been deployed, but validation of such improvements is rarely carried out. In the present article a methodology is presented that uses DES to model lean practices within a manufacturing system. Lean improvement scenarios are then be simulated and investigated prior to implementation, thereby enabling a systematic design of lean improvements

Moving on - beyond lean thinking

Lean Thinking is currently often positioned as the underlying theory of lean production among practitioners and academics, although its originators, Womack and Jones, seem not to have presented it as a theory. This paper endeavors to analyze whether Lean Thinking can be viewed as a theory of lean production. For this purpose, a critical assessment of Lean Thinking is carried out. Lean Thinking is argued to lack an adequate conceptualization of production, which has led to imprecise concepts, such as the term “value”. The five principles of Lean Thinking do not orderly cover value generation, and they do not always encapsulate the core topics in their respective areas. The failure to trace the origin of lean concepts and principles reduces the opportunity to justify and explain them. Despite claims for generality, the application area of the five lean principles is limited to the transformation of mass production, with, for instance, one-of-a-kind production and construction being largely out of scope. It is concluded that it is opportune to move on beyond Lean Thinking, towards a generic theory of production, for acquiring a solid foundation for designing, operating and improving production systems