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Kids are drawn to dolls and dump trucks, and crashing the two together might just be a child's favorite pastime. Who knew such a simple pleasure could serve as an accessible, compelling phenomenon for instigating investigations of force and motion. With a few inexpensive materials straight out of the toy box (literally, a doll, a dump truck, a ramp, and some weights), teachers can set up and facilitate a whole suite of Crash Test Physics investigations that are easily adaptable, and that have been effectively piloted in classrooms, festivals, and outreach events alike with student populations that range from preschool to pre-service elementary teachers. [ABSTRACT FROM AUTHOR]

ENT is a consistently under-represented specialty in medical school curricula. With social distancing measures limiting face-to-face (FtF) teaching and clinical opportunities, we created an e-Learning platform to consolidate and improve knowledge on common ENT emergencies. Following invitation to medical students undergoing their rotation in ENT at University Hospital Wales (UHW) Cardiff, five focus groups were shown an e-Learning module and interviewed between June and July 2021. 13 medical students participated in total (9 female, 4 male, median age 22 years). These structured interviews were recorded and transcribed. Transcripts were analysed using the qualitative data analysis software NVivo (QSR International, UK). The modules were found to be concise, clinically relevant and beneficial to student confidence in recognising and managing ENT emergencies. While e-Learning will likely never replace face-to-face learning, it was perceived to be a beneficial resource both academically and practically- especially in the context of limited clinical opportunities. [ABSTRACT FROM AUTHOR]

Cancer immunotherapy approaches target signaling pathways that are highly synonymous between CD4 and CD8 T-cell subsets and, therefore, often stimulate nonspecific lymphocyte activation, resulting in cytotoxicity to otherwise healthy tissue. The goal of our study was to identify intrinsic modulators of basic T lymphocyte activation pathways that could discriminately bolster CD8 anti-tumor effector responses. Using a Tbc1d10c null mouse, we observed marked resistance to a range of tumor types conferred by Tbc1d10c deficiency. Moreover, tumor-bearing Tbc1d10c null mice receiving PD-1 or CTLA-4 monotherapy exhibited a 33% or 90% cure rate, respectively. While Tbc1d10c was not expressed in solid tumor cells, Tbc1d10c disruption selectively augmented CD8 T-cell activation and cytotoxic effector responses and adoptive transfer of CD8 T cells alone was sufficient to recapitulate Tbc1d10c null tumor resistance. Mechanistically, Tbc1d10c suppressed CD8 T-cell activation and anti-tumor function by intersecting canonical NF-κB pathway activation via regulation of Map3k3-mediated IKKβ phosphorylation. Strikingly, none of these cellular or molecular perturbations in the NF-κB pathway were featured in Tbc1d10c null CD4 T cells. Our findings identify a Tbc1d10c-Map3k3-NF-κB signaling axis as a viable therapeutic target to promote CD8 T-cell anti-tumor immunity while circumventing CD4 T cell-associated cytotoxicity and NF-κB activation in tumor cells. [ABSTRACT FROM AUTHOR]

In this article, we introduce and analyze learning experiences made possible by a teaching framework that we have developed and call digital spatial story lines (DSSLs). DSSLs offer a novel approach to learning on the move by engaging learners with related conceptual practices of archival curation, digital mapping, and the production of public history. Learners collaborate to make and follow map-based story lines that bridge archival media they curate in public libraries and museums onto city neighborhoods these media describe. Story lines can be followed as tours to explore under- or untold stories about a city's public history at walking scale. To illustrate and study learning within the DSSL framework, we describe and analyze one design iteration from a larger, multi-year research project with local museum, library, and high school partners. Our analysis shows how making and following story lines provided opportunities for pre-service social studies teachers to engage with and learn about the public history of racial segregation, Civil Rights Movement activism, and American Roots Music in Nashville, Tennessee (aka the "Music City"). Our analysis focuses on using archival material to create and share public history as a mobile experience of being both "here-and-then"—a form of palimpsest in which learning on the move layers together historic places and the voices of different historical actors. We end with a discussion of who speaks for the public history of city neighborhoods and the prospects and limitations for teaching and learning with the DSSL framework. [ABSTRACT FROM AUTHOR]

Objectives: To compare retinal thickness before and after treatment with the fluocinolone acetonide (FAc) 190 µg intravitreal implant in people with diabetic macular edema (DME) using data from the Iluvien Clinical Evidence study in the UK (ICE-UK). Methods: For this retrospective cohort study, data on people attending any one of 13 participating ophthalmology departments and treated with FAc intravitreal implant between April 1, 2013 and April 15, 2015 were collected for 12 months prior to and at least 12 months after implantation. Cross-sectional and longitudinal patterns of central foveal thickness (CFT) were compared before and after FAc implant. Results: There were 208 people who contributed data from 233 individual eyes treated with the FAc implant. Mean age was 68.1 years and 62% were male. Median (interquartile range) CFT decreased from 462 µm (354–603 µm) at time of implant to 309 µm (222–433 µm) at 12 months post-implant (p < .001). Over the same period, a reduction of ≥10%, ≥25%, and ≥50% in CFT was observed in 113 (65%), 87 (50%), and 37 (21%) treated eyes, respectively. Eyes with a CFT of ≥400 µm at the time of implant were significantly more likely to achieve a reduction in CFT of ≥10%, ≥25%, and ≥50% at 12 months (all p < .001) compared with eyes with a CFT of <400 µm at implant. Both retinal thickness and changes in retinal thickness were loosely correlated with visual acuity. Conclusion: A marked reduction in retinal thickness was observed in people following FAc intravitreal implant for DME. The response was related to the degree of retinal thickness prior to treatment. [ABSTRACT FROM AUTHOR]

Objectives: To compare visual and anatomical outcomes between eyes treated with fluocinolone acetonide (FAc) 190 µg intravitreal implant for clinically significant chronic diabetic macular edema (DME) and fellow eyes not treated with FAc implant using data from the Iluvien Clinical Evidence study in the UK (ICE-UK) study. Methods: In this retrospective cohort study, data on people attending hospital eye services and treated with the FAc implant between April 1, 2013 and April 15, 2015 were collected. Changes in visual acuity (VA), central foveal thickness (CFT) and intraocular pressure (IOP) were compared between study eyes (intervention) and fellow eyes. Results: A total of 208 people were selected. Mean age was 68.1 years and 62% were male. Mean change in VA was −0.09 LogMAR units for study eyes and 0.04 LogMAR units for fellow eyes at 12 months post-implant (p < .001). Over the same period, ≥5 letter, ≥10 letter and ≥15 letter improvements in Early Treatment Diabetic Retinopathy Study (ETDRS) score were achieved by more FAc treated eyes than by fellow eyes (41% versus 23%, p < .001; 28% versus 11%, p < .001; and 18% versus 4%, p < .001 at 12 months, respectively). Differences in the mean change in CFT (−113 µm versus −13 µm, p < .001) and IOP (3.2 mmHg versus −0.2 mmHg, p < .001) were also observed between study and fellow eyes at 12 months. Conclusion: Visual acuity improved in study eyes over the 12 months following FAc implant and worsened in fellow eyes. Over the same period, study eyes showed a larger improvement in central foveal thickness. Intraocular pressure worsened in study eyes only. Change in visual acuity, central foveal thickness and intraocular pressure between FAc implant and the end of the 12-month follow-up period differed significantly between study and fellow eyes. [ABSTRACT FROM AUTHOR]

Objective: The aim of the Iluvien Clinical Evidence study in the UK (ICE-UK) was to assess the real-world effectiveness of fluocinolone acetonide (FAc) 190 μg intravitreal implant for the treatment of clinically significant chronic diabetic macular edema (DME) in routine clinical practice. Methods: This retrospective study collected data from patient medical records in 13 ophthalmology centers for people with DME prescribed FAc intravitreal implant between April 1, 2013 and April 15, 2015. Visual acuity (VA) and intraocular pressure (IOP) measurements were collected for 12 months prior to and after implant. Results: Two hundred and eight people, contributing 233 eyes, treated with FAc implant were included. Mean age was 68.1 years and 62% were male. In the 12 months prior to FAc implant, VA declined. Median (interquartile range, IQR) VA was 0.66 (0.48–1.00) LogMAR units (equivalent to 52.0 ETDRS letters) at implant, improving to 0.60 (0.38–0.90) LogMAR units (55.0 letters) at 12 months post-implant (p<0.001). In total, 44%, 30%, and 18% of people achieved an improvement in ETDRS score of ≥5, ≥10, and ≥15 letters, respectively, over the same period. A small but significant (p<.001) increase in median IOP was observed (median = 15.0, IQR = 13.0–18.0 mmHg at implant to 18.0, 15.0–21.0 mmHg at 12 months). In the 12 months following implant, additional IOP-lowering therapy was prescribed in 15% of subjects previously not requiring such therapy. Conclusion: Following FAc implant, an overall significant improvement in VA was observed over a period of 12 months, accompanied by a significant but small increase in IOP. [ABSTRACT FROM AUTHOR]

Objectives: To assess healthcare resource use and costs of treating people with clinically significant diabetic macular edema (DME) with fluocinolone acetonide (FAc) 190 µg intravitreal implant in routine clinical practice. Methods: The retrospective Iluvien Clinical Evidence (ICE-UK) study collected data on people prescribed the FAc implant in any one of 13 ophthalmology centers between April 1, 2013 and April 15, 2015. Data were collected for 12 months before and after implantation. Standard UK costs were attributed to healthcare resource use. Results: In total, 208 people contributing 233 FAc-treated eyes were selected. Mean age was 68.1 years and 62% were male. The mean (standard deviation, SD) number of anti-vascular endothelial growth factor (anti-VEGF) injections per FAc treated eye in the 12 months prior to implant was 2.8 (2.5), decreasing to 0.6 (1.4) for the same period after implant (p < .001). The corresponding figures for other steroid injections (dexamethasone and triamcinolone) were 0.14 (0.4) before and 0.08 (0.4) after implant (p = .016). There was no statistically significant difference in the number of laser therapies required in the 12 months before and after FAc implant (mean = 0.12 vs 0.11, respectively; p = .626). Overall, mean (SD) healthcare costs were £2,691 (£1,850) before and £1,239 (£1,203) after FAc implant (p < .001). The unit drug and administration cost per FAc implant was £5,680. Conclusions: Excluding the cost of the FAc implant, healthcare costs were significantly reduced in the 12 months post-implant. FAc implant has a duration of 3 years. This needs to be considered when interpreting the cost associated with the FAc implant. [ABSTRACT FROM AUTHOR]

Objectives: To compare retinal thickness before and after treatment with the fluocinolone acetonide (FAc) 190 µg intravitreal implant in people with diabetic macular edema (DME) using data from the Iluvien Clinical Evidence study in the UK (ICE-UK).Methods: For this retrospective cohort study, data on people attending any one of 13 participating ophthalmology departments and treated with FAc intravitreal implant between April 1, 2013 and April 15, 2015 were collected for 12 months prior to and at least 12 months after implantation. Cross-sectional and longitudinal patterns of central foveal thickness (CFT) were compared before and after FAc implant.Results: There were 208 people who contributed data from 233 individual eyes treated with the FAc implant. Mean age was 68.1 years and 62% were male. Median (interquartile range) CFT decreased from 462 µm (354-603 µm) at time of implant to 309 µm (222-433 µm) at 12 months post-implant (p < .001). Over the same period, a reduction of ≥10%, ≥25%, and ≥50% in CFT was observed in 113 (65%), 87 (50%), and 37 (21%) treated eyes, respectively. Eyes with a CFT of ≥400 µm at the time of implant were significantly more likely to achieve a reduction in CFT of ≥10%, ≥25%, and ≥50% at 12 months (all p < .001) compared with eyes with a CFT of <400 µm at implant. Both retinal thickness and changes in retinal thickness were loosely correlated with visual acuity.Conclusion: A marked reduction in retinal thickness was observed in people following FAc intravitreal implant for DME. The response was related to the degree of retinal thickness prior to treatment. [ABSTRACT FROM AUTHOR]

Objectives: To compare visual and anatomical outcomes between eyes treated with fluocinolone acetonide (FAc) 190 µg intravitreal implant for clinically significant chronic diabetic macular edema (DME) and fellow eyes not treated with FAc implant using data from the Iluvien Clinical Evidence study in the UK (ICE-UK) study.Methods: In this retrospective cohort study, data on people attending hospital eye services and treated with the FAc implant between April 1, 2013 and April 15, 2015 were collected. Changes in visual acuity (VA), central foveal thickness (CFT) and intraocular pressure (IOP) were compared between study eyes (intervention) and fellow eyes.Results: A total of 208 people were selected. Mean age was 68.1 years and 62% were male. Mean change in VA was -0.09 LogMAR units for study eyes and 0.04 LogMAR units for fellow eyes at 12 months post-implant (p < .001). Over the same period, ≥5 letter, ≥10 letter and ≥15 letter improvements in Early Treatment Diabetic Retinopathy Study (ETDRS) score were achieved by more FAc treated eyes than by fellow eyes (41% versus 23%, p < .001; 28% versus 11%, p < .001; and 18% versus 4%, p < .001 at 12 months, respectively). Differences in the mean change in CFT (-113 µm versus -13 µm, p < .001) and IOP (3.2 mmHg versus -0.2 mmHg, p < .001) were also observed between study and fellow eyes at 12 months.Conclusion: Visual acuity improved in study eyes over the 12 months following FAc implant and worsened in fellow eyes. Over the same period, study eyes showed a larger improvement in central foveal thickness. Intraocular pressure worsened in study eyes only. Change in visual acuity, central foveal thickness and intraocular pressure between FAc implant and the end of the 12-month follow-up period differed significantly between study and fellow eyes. [ABSTRACT FROM AUTHOR]

It is often maintained that practical freedom is a capacity to act on our view of what we ought to do and in particular on our view of what it would be best to do. Here, I discuss an important exception to that claim, namely habitual agency. Acting out of habit is widely regarded as a form of reflex or even as compulsive behaviour but much habitual agency is both intentional and free. Still it is true that, in so far as we act out of habit, we have no capacity to determine what we do by making a judgement about whether we ought to be doing it. Habitual agency is nonetheless free because we have the capacity to determine whether we act out of habit by making a judgement about whether or not the habit is a virtue. I develop this view of habit by contrasting habitual agency with action on policy and I argue that much virtuous agency is best understood as a form of habitual agency rather than as a form of action on policy. [ABSTRACT FROM PUBLISHER]

The article discusses right screening time for diabetic retinopathy (DR) begin for children with type 1 diabetes. Topics discussed include visual impairment and blindness as a complication associated with diabetes, the American Academy of ophthalmology recommending for annual screening for all people with diabetes for more than five years and International Society for Pediatric and Adolescent Diabetes recommending screening for DR with two years of diabetes and from the age of 11 onwards.

The article discusses author David Owens reply to commentators Daniel Markovits, Christopher Bennett and Stan Husi for offering their views, exposition and claims about his book "Shaping". According to the article, Daniel Markovits makes Evaluative Claim and Explanatory Claim, Bennett claims that normative interests can be only thought of and Stan Husi talks about breach of promise and social obligation.

Motivated by the commonly encountered problem in which tracking is only required at selected intermediate points within the time interval, a general optimisation-based iterative learning control (ILC) algorithm is derived that ensures convergence of tracking errors to zero whilst simultaneously minimising a specified quadratic objective function of the input signals and chosen auxiliary (state) variables. In practice, the proposed solutions enable a repeated tracking task to be accurately completed whilst simultaneously reducing undesirable effects such as payload spillage, vibration tendencies and actuator wear. The theory is developed using the well-known norm optimal ILC (NOILC) framework, using general linear, functional operators between real Hilbert spaces. Solutions are derived using feedforward action, convergence is proved and robustness bounds are presented using both norm bounds and positivity conditions. Algorithms are specified for both continuous and discrete-time state-space representations, with the latter including application to multi-rate sampled systems. Experimental results using a robotic manipulator confirm the practical utility of the algorithms and the closeness with which observed results match theoretical predictions. [ABSTRACT FROM AUTHOR]

Objectives: To explore the experiences of patients with chronic physical illness in relation to suicidal behaviours and ideas. Design: A qualitative study using semi-structured interviews. Methods: Fourteen patients with either multiple sclerosis or stage 5 chronic kidney disease were interviewed. Grounded theory was used to analyse the data. Results: Suicidal ideation was commonly reported by the study participants, and the relationship between the impact of a chronic physical illness, suicidality and risk factors was described. Several participants reported having planned suicide attempts as a consequence of finding living with their illness intolerable, and some had used non-adherence to treatment as a deliberate method to end their life. Conclusion: The findings suggest suicidality may be a relatively common experience in those with chronic illness facing a future of further losses, and that alongside passive thoughts of not being alive this may also include active thoughts about suicide. Health professionals should be alert to intentional non-adherence to treatment as an attempt to end one's life. [ABSTRACT FROM AUTHOR]

The paper describes a substantial extension of norm optimal iterative learning control (NOILC) that permits tracking of a class of finite dimensional reference signals whilst simultaneously converging to the solution of a constrained quadratic optimisation problem. The theory is presented in a general functional analytical framework using operators between chosen real Hilbert spaces. This is applied to solve problems in continuous time where tracking is only required at selected intermediate points of the time interval but, simultaneously, the solution is required to minimise a specified quadratic objective function of the input signals and chosen auxiliary (state) variables. Applications to the discrete time case, including the case of multi-rate sampling, are also summarised. The algorithms are motivated by practical need and provide a methodology for reducing undesirable effects such as payload spillage, vibration tendencies and actuator wear whilst maintaining the desired tracking accuracy necessary for task completion. Solutions in terms of NOILC methodologies involving both feedforward and feedback components offer the possibilities of greater robustness than purely feedforward actions. Results describing the inherent robustness of the feedforward implementation are presented and the work is illustrated by experimental results from a robotic manipulator. [ABSTRACT FROM PUBLISHER]

Advances in insulin therapy have made a positive contribution to improving disease management in both Type 1 and Type 2 diabetes. The development of insulin analogs with time-action characteristics has made it easier to mimic physiological insulin secretion. The parallel improvement in delivery devices has also made insulin therapy more convenient, flexible and acceptable. The inevitable progression of Type 2 diabetes means that the majority of those people will also require insulin therapy at some point in their disease course. Current treatment options are many; when to initiate insulin and which regimen to choose are among the major questions confronting physicians in today's rapidly evolving environment. This article summarizes the current strategies for initiating and optimizing the use of the basal insulin analog, insulin glargine, in Type 2 diabetes, leading to the intermediate stage of insulin therapy with the introduction of meal-related, rapid-acting insulin analogs in a stepwise manner prior to a full replacement basal-bolus regimen. [ABSTRACT FROM AUTHOR]

Based on the observation that iterative learning control (ILC) can be based on the inverse plant but that the approach can be degraded by modelling errors, particularly at high frequencies, this article investigates the construction and properties of a multi-parameter parameter-optimal ILC algorithm that uses an approximate polynomial representation of the inverse with natural high-frequency attenuation. In its simplest form, the algorithm replicates the original work of Owens and Feng but, more generally, it is capable of producing significant improvements to the observed convergence rate. As the number of parameters increases, convergence rates approach that of the ideal plant inverse algorithm. Introducing compensation into the algorithm provides a formal link to previously published gradient and norm-optimal ILC algorithms and indicates that the polynomial approach can be regarded as approximations to those control laws. Simulation examples verify the theoretical performance predictions. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the effectiveness of either a standard care programme (n = 9) or a 12-week supported exercise programme (n = 10) on glycaemic control, β-cell responsiveness, insulin resistance, and lipid profiles in newly diagnosed Type 2 diabetes patients. The standard care programme consisted of advice to exercise at moderate to high intensity for 30 min five times a week; the supported exercise programme consisted of three 60-min supported plus two unsupported exercise sessions per week. Between-group analyses demonstrated a difference for changes in low-density lipoprotein cholesterol only (standard care programme 0.01 mmol · L-1, supported exercise programme -0.6 mmol · L-1; P = 0.04). Following the standard care programme, within-group analyses demonstrated a significant reduction in waist circumference, whereas following the supported exercise programme there were reductions in glycosylated haemoglobin (6.4 vs. 6.0%; P = 0.007), waist circumference (101.4 vs. 97.2 cm; P = 0.021), body mass (91.7 vs. 87.9 kg; P = 0.007), body mass index (30.0 vs. 28.7 kg · m-2; P = 0.006), total cholesterol (5.3 vs. 4.6 mmol · L-1; P = 0.046), low-density lipoprotein cholesterol (3.2 vs. 2.6 mmol · L-1; P = 0.028), fasting β-cell responsiveness (11.5 × 10-9 vs. 7.0 × 10-9 pmol · kg-1 · min-1; P = 0.009), and insulin resistance (3.0 vs. 2.1; P = 0.049). The supported exercise programme improved glycaemic control through enhanced β-cell function associated with decreased insulin resistance and improved lipid profile. This research highlights the need for research into unsupported and supported exercise programmes to establish more comprehensive lifestyle advice for Type 2 diabetes patients. [ABSTRACT FROM AUTHOR]

Success in academic medicine requires scientific and clinical aptitude and the ability to lead a team effectively. Although combined MD/PhD training programs invest considerably in the former, they often do not provide structured educational opportunities in leadership, especially as applied to investigative medicine. To fill a critical knowledge gap in physician-scientist training, the Vanderbilt Medical Scientist Training Program (MSTP) developed a biennial two-day workshop in investigative leadership. MSTP students worked in partnership with content experts to develop a case-based curriculum and deliver the material. In its initial three offerings in 2006, 2008, and 2010, the workshop was judged by MSTP student attendees to be highly effective. The Vanderbilt MSTP LeadershipWorkshop offers a blueprint for collaborative student-faculty interactions in curriculum design and a new educational modality for physician-scientist training. [ABSTRACT FROM AUTHOR]

The subject of this article is the modelling of the influence of non-minimum phase discrete-time system dynamics on the performance of norm optimal iterative learning control (NOILC) algorithms with the intent of explaining the observed phenomenon and predicting its primary characteristics. It is established that performance in the presence of one or more non-minimum phase plant zeros typically has two phases. These consist of an initial fast monotonic reduction of the L2 error norm (mean square error) followed by a very slow asymptotic convergence. Although the norm of the tracking error does eventually converge to zero, the practical implications over a finite number of trials is apparent convergence to a non-zero error. The source of this slow convergence is identified using the singular value distribution of the system's all pass component. A predictive model of the onset of slow convergence behaviour is developed as a set of linear constraints and shown to be valid when the iteration time interval is sufficiently long. The results provide a good prediction of the magnitude of error norm where slow convergence begins. Formulae for this norm and associated error time series are obtained for single-input single-output systems with several non-minimum phase zeros outside the unit circle using Lagrangian techniques. Numerical simulations are given to confirm the validity of the analysis. [ABSTRACT FROM AUTHOR]

This article considers iterative learning control (ILC) for linear systems with convex control input constraints. First, the constrained ILC problem is formulated in a novel successive projection framework. Then, based on this projection method, two algorithms are proposed to solve this constrained ILC problem. The results show that, when perfect tracking is possible, both algorithms can achieve perfect tracking. The two algorithms differ, however, in that one algorithm needs much less computation than the other. When perfect tracking is not possible, both algorithms can exhibit a form of practical convergence to a 'best approximation'. The effect of weighting matrices on the performance of the algorithms is also discussed and finally, numerical simulations are given to demonstrate the effectiveness of the proposed methods. [ABSTRACT FROM AUTHOR]

This article develops switched linear controllers for periodic exogenous signals using the framework of a continuous-time model predictive control. In this framework, the control signal is generated by an algorithm that uses receding horizon control principle with an on-line optimisation scheme that permits inclusion of operational constraints. Unlike traditional repetitive controllers, applying this method in the form of switched linear controllers ensures bumpless transfer from one controller to another. Simulation studies are included to demonstrate the efficacy of the design with or without hard constraints. [ABSTRACT FROM AUTHOR]

This article proposes a novel technique for accelerating the convergence of the previously published norm-optimal iterative learning control (NOILC) methodology. The basis of the results is a formal proof of an observation made by D.H. Owens, namely that the NOILC algorithm is equivalent to a successive projection algorithm between linear varieties in a suitable product Hilbert space. This leads to two proposed accelerated algorithms together with well-defined convergence properties. The results show that the proposed accelerated algorithms are capable of ensuring monotonic error norm reductions and can outperform NOILC by more rapid reductions in error norm from iteration to iteration. In particular, examples indicate that the approach can improve the performance of NOILC for the problematic case of non-minimum phase systems. Realisation of the algorithms is discussed and numerical simulations are provided for comparative purposes and to demonstrate the numerical performance and effectiveness of the proposed methods. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to determine if pulsatile ocular blood flow (POBF) measurements could distinguish between type 2 diabetes mellitus (DM) subjects with and without diabetic retinopathy (DR). Methods: Ninety-eight DM subjects were recruited. POBF was measured using an Ocular Blood Flow tonometer and retinopathy was assessed using retinal digital photography. The duration of diabetes, blood pressure, glycosylated haemoglobin and plasma glucose level were also recorded. Results: Seventy-two subjects had no DR and 26 subjects exhibited mild to moderate non-proliferative DR. POBF was higher in those subjects with non-proliferative DR but did not reach significance. Those subjects receiving insulin treatment had a significantly longer duration of DM, higher HbA1c and plasma glucose levels and greater incidence of non-proliferative DR compared to subjects receiving oral hypoglycaemic agents, who in turn demonstrated higher levels of these parameters than those who were controlled by diet alone (ANOVA p < 0.05 in all cases). POBF was found to increase with level of management but not significantly so. Conclusions: A single measurement of POBF does not distinguish between subjects with and without mild/moderate non-proliferative DR. [ABSTRACT FROM AUTHOR]

Aims: To examine the effect of frequent cannabis use at various times during the lifetime upon the development of psychotic symptoms and of schizophrenia. Design: Cannabis use was examined within the Edinburgh High Risk Study (EHRS), a prospective study of young people at enhanced genetic risk for schizophrenia. Participants: High risk and control subjects of the EHRS. Measurements: Childhood Behaviour Checklist; sub‐scales of the Present State Examination; self report of substances use, particularly of cannabis. Findings: Within the group at high genetic risk, there was a strong association between illness onset and frequent cannabis use just prior to onset. Cannabis use at earlier times showed no such association. The effect, however, was considerably weakened once various childhood behaviours, particularly social withdrawal and aggressiveness, were taken into account. Those who fell ill with schizophrenia and who used cannabis frequently showed higher levels of some symptoms than those who fell ill and did not use cannabis frequently. Conclusions: Social problems and aggressiveness aged between 13 and 16 mostly account for both cannabis use and illness onset. Heavy use is, however, associated with high levels of symptoms and may act as a trigger carrying a vulnerable person over a threshold into psychotic illness. [ABSTRACT FROM AUTHOR]

Glycated haemoglobin (HbA1c) is regarded as the gold standard of glucose homeostasis assessment in diabetes. There has been much discussion in recent medical literature of experimental results concerning the relative contribution of fasting and post-prandial glucose levels to the value of HbA1c. A mathematical model of haemoglobin glycation is derived and investigated to address this issue. [ABSTRACT FROM AUTHOR]

This paper considers the problem of positive real control for two-dimensional (2-D) discrete systems described by the Roesser model and also discrete linear repetitive processes, which are another distinct sub-class of 2-D linear systems of both systems theoretic and applications interest. The purpose of this paper is to design a dynamic output feedback controller such that the resulting closed-loop system is asymptotically stable and the closed-loop system transfer function from the disturbance to the controlled output is extended strictly positive real. We first establish a version of positive realness for 2-D discrete systems described by the Roesser state space model, and then a sufficient condition for the existence of the desired output feedback controllers is obtained in terms of four LMIs. When these LMIs are feasible, an explicit parameterization of the desired output feedback controllers is given. We then apply a similar approach to discrete linear repetitive processes represented in their equivalent 1-D state-space form. Finally, we provide numerical examples to demonstrate the applicability of the approach. [ABSTRACT FROM AUTHOR]

In practice, most control systems are partially controlled. When a system is only partially controlled, the performance of the uncontrolled part of the system becomes worse than that of the corresponding part of the fully controlled system. To describe the performance degradation, a performance factorization is obtained. It is shown that the partial control performance is a product of the full control performance and a performance degradation factor. This factor is a submatrix of a left null-space projection determined by the measurement selection. The performance degradation factor provides an efficient tool for performance assessment and measurement selection. The theoretical results are applied to a highly integrated chemical plant - the HDA process. [ABSTRACT FROM AUTHOR]

The variety and number of courses and educational materials designed for the elderly is on the increase. Yet, learning among older adults has received comparatively little research attention. Most learning research has been carried out with young learners and it is not clear to what extent its findings can be generalized regarding older adult learning. This article reviews current findings of empirical research on older adult learning, notes key differences in how older adults and young people learn, and suggests strategies which could be used to enhance the effectiveness and efficiency of instruction designed for the elderly. [ABSTRACT FROM PUBLISHER]

The State Hospital, Carstairs, is the maximum security psychiatric facility for Scotland and Northern Ireland. This study describes the cohort of patients there (N = 241) between 1992 and 1994. Case-notes were examined to ascertain demographic details and information on psychiatric, medical, drug, forensic, family and personal histories. Diagnoses were made by application of the St Louis criteria (Feighner et al 1972). Standardized interviews were held with each patient and the responsible medical officer. Patients were on average 34 years old and had spent 9 years in psychiatric hospitals. There were 169 (70.1%) who had a principal diagnosis of schizophrenia. Approximately half were admitted following an offence and over 80% had a history of criminal activity. Physical health problems were present in more than 50% of patients. Adverse childhood events of diverse kinds were frequently reported. Psychotic symptoms continued to occur in many patients despite extensive treatment. More than half were said not to require the full security of the State Hospital. It was concluded that these patients represent a severely ill and relatively young population, and are likely to require substantial care in the future. A range of secure facilities needs to be developed in Scotland so that patients are held in the minimum appropriate degree of security. [ABSTRACT FROM PUBLISHER]

Deliberate self-harm services in the UK are frequently unplanned and delivered without a coherent view of their function. This is unfortunate because the evidence is that-contrary to popular misconception-psychiatric intervention after parasuicide is worthwhile. To improve this state of affairs, interventions need to be aimed at groups of patients with clearly identified needs, using techniques of known effectiveness which are delivered by specific deliberate self-harm teams. Health service planners have a duty: to develop such services; to monitor the phenomenon of deliberate self-harm in their locality; and to ensure inter-district and inter-agency collaboration in the evaluation of those services. [ABSTRACT FROM AUTHOR]

The state of North Carolina, amid much discussion and controversy, established a regional resource management program for the protection of its coastal resources in 1974. Through the successful resolution of several critical issues, including creating a local land use planning process and managing oceanfront development, the program has built its credibility, its popular and political support, and its ability to address remaining critical management needs. [ABSTRACT FROM AUTHOR]