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This study focusses on the design and scale-up of industrial lactic acid production by fermentation of dairy cheese whey permeate based on standard methodological parameters. The aim was to address the shortcomings of standard scale-up methodologies and provide a framework for fermenter scale-up that enables the accurate estimation of energy consumption by suitable selection of turbine and speed for industrial deployment. Moreover, life cycle assessment (LCA) was carried out to identify the potential impacts and possibilities to reduce the operation associated emissions at an early stage. The findings showed that a 3000 times scale-up strategy assuming constant geometric dimensions and specific energy consumption (P/Vw) resulted in lower impeller speed and energy demand. The Rushton turbine blade (RTB) and LightninA315 four-blade hydrofoil (LA315) were found to have the highest and lowest torque output, respectively, at a similar P/Vw of 2.8 kWm−3, with agitation speeds of 1.33 and 2.5 s−1, respectively. RTB demonstrating lower shear damage towards cells (up to 1.33 s−1) was selected because it permits high torque, low-power and acceptable turbulence. The LCA results showed a strong relation between the number of impellers installed and associated emissions suggesting a trade-off between mixing performance and environmental impacts.

An abstract presented at the 2020 European Association for the Study of Diabetes (EASD) suggests that, in future, we might be able to monitor longer term exposure to glucose through our tears. The study measured glycated albumin (GA) in lacrimal fluid and found this to be strongly correlated to glycated albumin in blood, an indicator of glycaemia over a 2 week period.

IntroductionTo report the observations of point-of-care (POC) glycated hemoglobin (HbA1c) testing in people with non-diabetic hyperglycemia (NDH; HbA1c 42–47 mmol/mol (6.0%–6.4%)), applied in community settings, within the English National Health Service Diabetes Prevention Programme (NHS DPP).Research design and methodsA service evaluation assessing prospectively collected national service-level data from the NHS DPP, using data from the first referral received in June 2016–October 2018. Individuals were referred to the NHS DPP with a laboratory-measured HbA1c in the NDH range and had a repeat HbA1c measured at first attendance of the program using one of three POC devices: DCA Vantage, Afinion or A1C Now+. Differences between the referral and POC HbA1c and the SD of the POC HbA1c were calculated. The factors associated with the difference in HbA1c and the association between POC HbA1c result and subsequent attendance of the NHS DPP were also evaluated.ResultsData from 73 703 participants demonstrated a significant mean difference between the referral and POC HbA1c of −2.48 mmol/mol (−0.23%) (t=157, pConclusionPOC HbA1c testing in community settings was associated with significantly lower HbA1c values when compared with laboratory-measured referrals. Acknowledging effects of regression to the mean, we found that these differences were also associated with POC method, location, individual patient factors and time between measurements. Compared with POC HbA1c values in the NDH range, normoglycemic POC HbA1c values were associated with lower subsequent intervention attendance.

OBJECTIVE To assess weight and HbA1c changes in the Healthier You: National Health Service Diabetes Prevention Programme (NHS DPP), the largest DPP globally to achieve universal population coverage. RESEARCH DESIGN AND METHODS A service evaluation assessed intervention effectiveness for adults with nondiabetic hyperglycemia (HbA1c 42–47 mmol/mol [6.0–6.4%] or fasting plasma glucose 5.5–6.9 mmol/L) between program launch in June 2016 and December 2018, using prospectively collected, national service–level data in England. RESULTS By December 2018, 324,699 people had been referred, 152,294 had attended the initial assessment, and 96,442 had attended at least 1 of 13 group-based intervention sessions. Allowing sufficient time to elapse, 53% attended an initial assessment, 36% attended at least one group-based session, and 19% completed the intervention (attended >60% of sessions). Of the 32,665 who attended at least one intervention session and had sufficient time to finish, 17,252 (53%) completed: intention-to-treat analyses demonstrated a mean weight loss of 2.3 kg (95% CI 2.2, 2.3) and an HbA1c reduction of 1.26 mmol/mol (1.20, 1.31) (0.12% [0.11, 0.12]); completer analysis demonstrated a mean weight loss of 3.3 kg (3.2, 3.4) and an HbA1c reduction of 2.04 mmol/mol (1.96, 2.12) (0.19% [0.18, 0.19]). Younger age, female sex, Asian and black ethnicity, lower socioeconomic status, and normal baseline BMI were associated with less weight loss. Older age, female sex, black ethnicity, lower socioeconomic status, and baseline overweight and obesity were associated with a smaller HbA1c reduction. CONCLUSIONS Reductions in weight and HbA1c compare favorably with those reported in recent meta-analyses of pragmatic studies and suggest likely future reductions in participant type 2 diabetes incidence.

This article provides an in-depth and comparative analysis of the accommodation of Islamic mortgage-alternatives under Irish law. It draws on results from two surveys of Ireland’s Muslim community and uses a comparative approach with the UK to highlight continuing gaps in the legal framework relevant to Ireland’s Islamic finance market.

This article looks at some of the key factors that can affect an individual's ability to take their medicine as prescribed, and asks what health professionals can do to address some of these concerns. Health professionals need to give patients the right information and support to facilitate the best choice. They should work differently to engage more effectively with patients and utilize the tools that are available to deliver effective prescribing.

Low-fat diets and regular physical activity are recommended for good health, but U.K. household expenditure on butter, sugar, preserves, and soft drinks has risen steadily; fewer than half of men (46%) and women (37%) report walking for 10 min at least once per month and 67% of men and 57% of women are overweight or obese (1). With 86% of people with type 2 diabetes and 62% of those with type 1 diabetes being overweight or obese (1), their lifestyles are likely to be influenced by the overall societal trend for busy lives, quick meals, and little physical activity. The global second Diabetes Attitudes, Wishes and Needs (DAWN2) study was a multi-stakeholder survey conducted in 17 countries (2), exploring factors affecting diabetes self-management and support for people with diabetes. Nearly half of the people with diabetes surveyed (45%) reported diabetes-related distress and ∼14% had likely depression (3). Emotional support from health care professionals was reported by only 32% of people with diabetes (3). Global DAWN2 results demonstrated notable differences in findings concerning people with diabetes among participating countries (3). Here, we provide a descriptive analysis of key U.K. DAWN2 data examining potential barriers to active and optimal self-management among people with diabetes. DAWN2 (ClinicalTrials.gov identifier NCT01507116) methodology has been published previously (2). Data were generated through stakeholder-specific questionnaires, including standardized instruments …

Knife Fights: A Memoir of Modern War in Theory and Practice John A Nagl Penguin Press, 2014Commissioned into the US Army in 1988, John Nagl led an armoured platoon in Operation Desert Storm, return...