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The purpose of this article is to identify the main leverage points that can accelerate the results of the resocialization program via prison work implemented in one of the states of Brazil. The research method was design science research. The main research technique was a systemic analysis, a technique belonging to the field of knowledge of the soft systems methodology. The systemic analysis mapped and listed in closed loops the factors of major influence on the program's results. The sources of information were meetings with specialists from the prison public administration and a survey of the state population. The main deliverable of the study is a systemic map with the identification of two leverage points that, if addressed by the public administration, can remove the main obstacles to the program, the insufficient funds for investment in justice structures, and the skepticism of a large part of the population. The team of public agents responsible for managing the program validated the conclusions. [ABSTRACT FROM AUTHOR]

In a brain-computer interface (BCI) system, the testing of decoding algorithms, tasks, and their parameters is critical for optimizing performance. However, conducting human experiments can be costly and time-consuming, especially when investigating broad sets of parameters. Attempts to utilize previously collected data in offline analysis lack a co-adaptive feedback loop between the system and the user present online, limiting the applicability of the conclusions obtained to real-world uses of BCI. As such, a number of studies have attempted to address this cost-wise middle ground between offline and live experimentation with real-time neural activity simulators. We present one such system which generates motor imagery electroencephalography (EEG) via forward modeling and novel motor intention encoding models for conducting sensorimotor rhythm (SMR)-based continuous cursor control experiments in a closed-loop setting. We use the proposed simulator with 10 healthy human subjects to test the effect of three decoder and task parameters across 10 different values. Our simulated approach produces similar statistical conclusions to those produced during parallel, paired, online experimentation, but in 55% of the time. Notably, both online and simulated experimentation expressed a positive effect of cursor velocity limit on performance regardless of subject average performance, supporting the idea of relaxing constraints on cursor gain in online continuous cursor control. We demonstrate the merits of our closed-loop motor imagery EEG simulation, and provide an open-source framework to the community for closed-loop SMR-based BCI studies in the future. All code including the simulator have been made available on GitHub. [ABSTRACT FROM AUTHOR]

Vibration stimulation has been shown to have the potential to improve the activation pattern of unilateral motor imagery (MI) and to promote motor recovery. However, in the widely used left and right hand MI brain-computer interface (BCI) paradigm, the vibration stimuli cannot be directly applied to the imaginary side due to the spontaneity of imagery. In this study, we proposed a method of phase-dependent closed-loop vibration stimulation to be applied on both hands, and explored the effects of different vibration stimuli on the left and right hand MI-BCI. Eighteen healthy subjects were recruited and asked to perform, in sequence, MI tasks under three different conditions of vibratory feedback, which were no vibration stimulus (MI), phase-dependent closed-loop vibration stimulus (PDS), and continuous vibration stimulus (CS). Then the performance of the left and right hand MI-BCI and the patterns of brain oscillation were compared and analyzed under these different stimulation conditions. The results showed that vibration stimulation effectively boosted the activation of the sensorimotor cortex and enhanced the functional connectivity among sensorimotor-related brain regions during MI. The closed-loop stimulation evoked stronger event-related desynchronization patterns on the contralateral side of the imagined hand compared to continuous stimulation. There was a more obvious distinction between left hand task and right hand task. In addition, phase-dependent closed-loop vibration stimulation increased classification accuracy by approximately 7% (paired t-test, p=0.004, n=18) compared to MI alone, while continuous vibration stimulation only increased it by 4% (paired t-test, p=0.067, n=18). This result further demonstrated the effectiveness of the phase-dependent closed-loop vibration stimulation method in improving the overall performance of the MI paradigm and is expected to be further applied in areas such as stroke rehabilitation in the future. [ABSTRACT FROM AUTHOR]

Advanced diabetes technologies have produced increasingly favorable outcomes compared to older treatments. Disparities in practice resources have led to a treatment disparity by clinical setting, where endocrinologists typically prescribe far more such technologies than primary care providers (PCPs). Fully automated artificial pancreas systems (APS), which combine technologies to deliver and adjust insulin dosing continuously in response to automatic and continuous glucose monitoring, may be more straightforward for PCPs to prescribe and manage, therefore extending their benefit to more patients. We aimed to assess willingness of PCPs to prescribe advanced diabetes technologies through a cross-sectional survey of PCPs from 4 geographically diverse centers. While respondents were uncomfortable initiating (63 of 72, 88%) or adjusting (64 of 72, 89%) traditional insulin pumps, their views on APS were quite different: 71 of 76 (93%) saw advantages to prescribing APS by PCPs rather than only endocrinologists. Most would consider prescribing APS for type 1 diabetes (58 of 76, 76%) and type 2 diabetes (52 of 76, 68%). No differences were seen among attendings, residents, or nurse practitioners. APS were much more acceptable than traditional insulin pumps among this primary care sample. If successful, primary care management of closed-loop APS would greatly increase access to such therapies and reduce disparities among those patients who face more difficulty accessing subspecialty care than they do primary care.

ABSTRACT: The purpose of this article is to identify the main leverage points that can accelerate the results of the resocialization program via prison work implemented in one of the states of Brazil. The research method was design science research. The main research technique was a systemic analysis, a technique belonging to the field of knowledge of the soft systems methodology. The systemic analysis mapped and listed in closed loops the factors of major influence on the program’s results. The sources of information were meetings with specialists from the prison public administration and a survey of the state population. The main deliverable of the study is a systemic map with the identification of two leverage points that, if addressed by the public administration, can remove the main obstacles to the program, the insufficient funds for investment in justice structures, and the skepticism of a large part of the population. The team of public agents responsible for managing the program validated the conclusions.

• Recent advances in triboelectric nanogenerators, biofuel cells, and hydrovoltaic generators for human motion energy harvesting. • Integration strategies for wearable applications in textiles, clothing, accessories, and implantable biomedical devices. • Prospects of hybrid energy harvesting, self-powered sensing, closed-loop bioelectronic systems, and eco-friendly materials. Recent advancements in wearable electronics and implantable devices have driven the demand for sustainable and autonomous energy sources, with human motion energy emerging as a promising candidate. This review provides a comprehensive overview of the latest developments in electrochemical human motion energy harvesting technologies, focusing on the sources and characteristics of human body energy, key electrochemical transduction mechanisms, and integration strategies for practical applications. The review delves into the working principles, material and structural designs, and performance enhancements of triboelectric nanogenerators (TENGs), biofuel cells (BFCs), and hydrovoltaic effect generators (HEGs), highlighting their potential for converting mechanical, chemical, and thermal energy from human motion into electrical energy. Furthermore, the challenges and future prospects of these technologies are discussed, emphasizing the importance of hybridization, self-powered sensing, closed-loop bioelectronic systems, and eco-friendly materials. This review aims to provide valuable insights and inspiration for researchers and engineers working towards the development of efficient, sustainable, and autonomous energy solutions for wearable and implantable devices. [ABSTRACT FROM AUTHOR]

Closed-loop (artificial pancreas) systems for automated insulin delivery have been likened to the holy grail of diabetes management. The first iterations of glucose-responsive insulin delivery were pioneered in the 1960s and 1970s, with the development of systems that used venous glucose measurements to dictate intravenous infusions of insulin and dextrose in order to maintain normoglycemia. Only recently have these bulky, bedside technologies progressed to miniaturized, wearable devices. These modern closed-loop systems use interstitial glucose sensing, subcutaneous insulin pumps, and increasingly sophisticated algorithms. As the number of commercially available hybrid closed-loop systems has grown, so too has the evidence supporting their efficacy. Future challenges in closed-loop technology include the development of fully closed-loop systems that do not require user input for meal announcements or carbohydrate counting. Another evolving avenue in research is the addition of glucagon to mitigate the risk of hypoglycemia and allow more aggressive insulin dosing. [ABSTRACT FROM AUTHOR]

Background: Loop is an open-source automated insulin delivery (AID) system, used by more than 9,000 people with type 1 diabetes. Understanding the pros and cons of Loop use may help improve disease management and support population level innovation. Methods: Focus groups revealed 72 new and existing users' perspectives on Loop uptake, use, and persistence. A subsample of participants from a mixed-methods, observational cohort study shared first-hand accounts of their experiences using Loop. Participants were predominately white (95%), male (50%), privately insured (94%), and reported annual household income ≥$100K (73%) and education exceeding a bachelor's degree (87%) with a mean HbA1c of 6.6% ± 0.8%. Data were analyzed and synthesized by a multidisciplinary team. Results: Participants detailed their experiences with (1) Loop technical support and troubleshooting, (2) decreased mental/behavioral burden, (3) technical issues with parts of the system, (4) glycemic control, (5) personalizing settings, and (6) providers while using Loop. Decreased burden was the most endorsed benefit defined by less worry, stress, and cognitive effort and less time spent on diabetes management tasks. Participants highlighted the benefits of Loop overnight and their introduction to "Loop communities" during use. The most discussed challenges involved technical issues. A range of provider attitudes and knowledge about Loop complicated users' clinical experiences and disclosure. Conclusions: This sample of new and experienced Loop users reported benefits to quality of life and glycemic control that outweighed challenges of setting up system components, customizing the system to suit one's lifestyle and habits, and adjusting system settings. Challenges related to system setup and calibrating settings are remediable and, if addressed, may better serve Loop users. Users reported feeling empowered by the customizability of and the educational effects facilitated by the open-source AID system. Loop helped users learn more about their chronic illness and physiology in an acceptable format. Clinical Trial Registration number: NCT03838900. [ABSTRACT FROM AUTHOR]

Insulin and AHCL were initiated in auto mode (algorithm glucose target 100-120 mg/dl (5.5-6.7 mmol/l), AIT 2-4 h and automated bolus correction ON) and was used continuously for 12 weeks of the study. Keywords: Type 1 diabetes; Continuous subcutaneous insulin infusion; Continuous glucose monitoring; Diabetes education; Closed-loop systems EN Type 1 diabetes Continuous subcutaneous insulin infusion Continuous glucose monitoring Diabetes education Closed-loop systems 743 746 4 04/12/22 20220501 NES 220501 Introduction One of the latest automated insulin Delivery (AID) systems is the advanced hybrid closed-loop (AHCL), the MiniMed 780G system (Medtronic, Northridge, CA, USA), which automatically delivers basal insulin with a customizable glucose target in addition to automated bolus correction, as required. Type 1 diabetes, Continuous glucose monitoring, Diabetes education, Closed-loop systems, Continuous subcutaneous insulin infusion. [Extracted from the article]

Bar-Coded Medication Administration systems (BCMA) are often used with workarounds. These workarounds are usually judged against standard operating procedures or the use of the technology as ‘designers’ intended’. However, some workarounds may be reasonable and justified to prevent safety errors. In this conceptual paper, we clarify BCMA safety mechanisms and provide a framework to identify workarounds with BCMA that nullify the error prevention mechanisms inherent in the technology design and process. We also highlight the importance of understanding the purpose behind a nurse’s workaround in BCMA, focusing on the notion of mindful (thoughtful) workarounds that have the potential to improve patient safety. [ABSTRACT FROM AUTHOR]

Keeping cognitive stress at a healthy range can improve the overall quality of life: helping subjects to decrease their high levels of arousal, which will make them relaxed, and elevate their low levels of arousal, which could increase their engagement. With recent advances in wearable technologies, collected skin conductance data provides us with valuable information regarding ones’ cognitive stress-related state. In this research, we aim to create a simulation environment to control a cognitive stress-related state in a closed-loop manner. Toward this goal, by analyzing the collected skin conductance data from different subjects, we model skin conductance response events as a function of simulated environmental stimuli associated with cognitive stress and relaxation. Then, we estimate the hidden stress-related state by employing Bayesian filtering. Finally, we design a fuzzy control structure to close the loop in the simulation environment. Particularly, we design two classes of controllers: (1) an inhibitory controller for reducing cognitive stress and (2) an excitatory controller for increasing cognitive stress. We extend our previous work by implementing the proposed approach on multiple subjects’ profiles. Final results confirm that our simulated skin conductance responses are in agreement with experimental data. In a simulation study based on experimental data, we illustrate the feasibility of designing both excitatory and inhibitory closed-loop wearable-machine interface architectures to regulate the estimated cognitive stress state. Due to the increased ubiquity of wearable devices capable of measuring cognitive stress-related variables, the proposed architecture is an initial step to treating cognitive disorders using non-invasive brain state decoding.

Closed-loop (artificial pancreas) systems for automated insulin delivery have been likened to the holy grail of diabetes management. The first iterations of glucose-responsive insulin delivery were pioneered in the 1960s and 1970s, with the development of systems that used venous glucose measurements to dictate intravenous infusions of insulin and dextrose in order to maintain normoglycemia. Only recently have these bulky, bedside technologies progressed to miniaturized, wearable devices. These modern closed-loop systems use interstitial glucose sensing, subcutaneous insulin pumps, and increasingly sophisticated algorithms. As the number of commercially available hybrid closed-loop systems has grown, so too has the evidence supporting their efficacy. Future challenges in closed-loop technology include the development of fully closed-loop systems that do not require user input for meal announcements or carbohydrate counting. Another evolving avenue in research is the addition of glucagon to mitigate the risk of hypoglycemia and allow more aggressive insulin dosing.

Background: The objective of this study was to evaluate the glycemic outcomes in children and adolescents with Type 1 Diabetes (T1D) previously treated with Multiple Daily Injections (MDI) using a structured initiation protocol for the Advanced Hybrid Closed Loop (AHCL) Minimed 780G insulin pump system. Methods: In this prospective open label single-arm, single-center, clinical investigation, we recruited children and adolescents (aged 7–17 years) with T1D on MDI therapy and HbA1c below 12.5%. All participants followed a 10-day structured initiation protocol which included 4 steps: step 1: AHCL system assessment; step 2: AHCL system training; step 3: Sensor augmented pump therapy (SAP) for 3 days; step 4: AHCL system use for 12 weeks, successfully completing the training from MDI to AHCL in 10 days. The primary outcome of the study was the change in the time spent in the target in range (TIR) of 70–180 mg/dl and HbA1c from baseline (MDI + CGM, 1 week) to study phase (AHCL, 12 weeks). The paired student t-test was used for statistical analysis and a value < 0.05 was considered statistically significant. Results: Thirty-four participants were recruited and all completed the 12 weeks study. TIR increased from 42.1 ± 18.7% at baseline to 78.8 ± 6.1% in the study phase (p < 0.001). HbA1c decreased from 8.6 ± 1.7% (70 ± 18.6 mmol/mol) at baseline, to 6.5 ± 0.7% (48 ± 7.7 mmol/mol) at the end of the study (p = 0.001). No episodes of severe hypoglycemia or DKA were reported. Conclusion: Children and adolescents with T1D on MDI therapy who initiated the AHCL system following a 10-days structured protocol achieved the internationally recommended goals of glycemic control with TIR > 70% and a HbA1c of < 7%. [ABSTRACT FROM AUTHOR]

Complex networks of information processing systems, or information supply chains, present challenges for performance analysis. We establish a mathematical setting, in which a process within an information supply chain can be analyzed in terms of the functionality of the system’s components. Principles of this methodology are rigorously defended and induce a model for determining the reliability for the various products in these networks. Our model does not limit us from having cycles in the network, as long as the cycles do not contain negation. It is shown that our approach to reliability resolves the nonuniqueness caused by cycles in a probabilistic Boolean network. An iterative algorithm is given to find the reliability values of the model, using a process that can be fully automated. This automated method of discerning reliability is beneficial for systems managers. As a systems manager considers systems modification, such as the replacement of owned and maintained hardware systems with cloud computing resources, the need for comparative analysis of system reliability is paramount. The model is extended to handle conditional knowledge about the network, allowing one to make predictions of weaknesses in the system. Finally, to illustrate the model’s flexibility over different forms, it is demonstrated on a system of components and subcomponents. [ABSTRACT FROM AUTHOR]

In this article, we study closed-loop digital predistortion (DPD) systems and associated learning algorithms. Specifically, we propose various low-complexity approaches to estimate and manipulate the inverse of the input data covariance matrix (CM) and combine them with the so-called self-orthogonalized (SO) learning rule. The inherent simplicity of the SO algorithm, combined with the proposed solutions, allows for remarkably reduced complexity in the DPD system while maintaining similar linearization performance compared to other state-of-the-art methods. This is demonstrated with thorough over-the-air (OTA) mmW measurement results at 28 GHz, incorporating a state-of-the-art 64-element active antenna array, and very wide channel bandwidths up to 800 MHz. In addition, complexity analyses are carried out, which together with the measured linearization performance demonstrates favorable performance–complexity tradeoffs in linearizing mmW active array transmitters through the proposed solutions. The techniques can find application in systems where the power amplifier (PA) nonlinearities are time-varying and thus frequent or even constant updating of the DPD is required, good examples being mmW adaptive antenna arrays as well as terminal transmitters in 5G and beyond networks. [ABSTRACT FROM AUTHOR]

We retrospectively evaluated outcomes of the Minimed Medtronic 670G system in an academic urban safety-net population of adults with type 1 diabetes, between September 2016 and January 2020. Among 32 patients prescribed the 670G, the majority were female (69%), white (69%), achieved advanced degrees (56%), were commercially insured (94%), and were experienced pump users (84%). Patients who initiated auto-mode demonstrated significant improvement in A1c after 1 year. However, 31% of patients never initiated auto-mode. Black and Hispanic patients comprised 50% of this group, despite similar insurance coverage, diabetes duration, educational level, and prior pump use. Hence, traditional barriers to technology use do not explain these racial/ethnic disparities. Of 22 patients who initiated auto-mode, 5 discontinued within 1 year. The most common reason for discontinuation was frustration with pump-sensor interactions. Future studies identifying barriers to and strategies for increasing use of advanced insulin delivery systems in underserved populations are needed. [ABSTRACT FROM AUTHOR]

Abstract Background With the rapid development of technologies for type 1 diabetes, economic evaluations are integral in guiding cost-effective clinical and policy decisions. We therefore aimed to review and synthesise the current economic literature for available diabetes management technologies and outline key determinants of cost-effectiveness. Methods A systematic search was conducted in April 2019 that focused on modelling or trial based economic evaluations. Searched databases included Medline, Medline in-process and other non-indexed citations, EMBASE, PubMed, All Evidenced Based Medicine Reviews, EconLit, Cost-effectiveness analysis Registry, Research Papers in Economics, Web of Science, PsycInfo, CINAHL, and PROSPERO from inception. We assessed quality of included studies with the Questionnaire to Assess Relevance and Credibility of Modeling Studies for Informing Health Care Decision Making an ISPOR-AMCP-NPC good practice task force report. Screening of abstracts and full-texts, appraisal, and extraction were performed by two independent researches. Results We identified 16,772 publications, of which 35 were analysed and included 11 health technologies. Despite a lack of consensus, most studies reported that insulin pumps (56%) or interstitial glucose sensors (62%) were cost-effective, although incremental cost-effectiveness ratios ranged widely ($14,266–$2,997,832 USD). Cost-effectiveness for combined insulin pumps and glucose sensors was less clear. Determinants of cost-effectiveness included treatment effects on glycosylated haemoglobin and hypoglycaemia, costing of technologies and complications, and measures of utility. Conclusions Insulin pumps or glucose sensors appeared cost-effective, particularly in populations with higher HbA1c levels and rates of hypoglycaemia. However, cost-effectiveness for combined insulin pumps and glucose sensors was less clear. Registration The study was registered with PROSPERO, number CRD42017077221.

The geothermal industry is fronted by a fundamental decade to grow and become an energy supplier in transitioning to a sustainable energy system. The introduction of Closed-Loop Geothermal energy systems (CLG) can overcome the negative social response and increase the attractiveness of geothermal developments. The present work aims to investigate and compare the performance of CLG systems. For the comparison, the case study of Campi Flegrei was chosen. The maximum depth was fixed at 2000 m, and the two configurations were set up to analyse the performance and evaluate the best operational configuration. Both CLG configurations showed decay in the output temperature of the working fluid during the production time. For a U-shaped design, it is possible to find a working condition that allows constant thermal power over time. The DBHE specific power was always more significant, up to 350 kW/m, compared to the U-shaped, which attained a maximum of 300 W/m (15%). The comparison with Beckers et al. analysis highlights the similarity of our results with their base case. The consideration of the CLG system’s length is related to the heat exchange and investment costs. For longer exchangers, there are higher investments and lower specific power.

Background: The Omnipod ® 5 Automated Insulin Delivery System was associated with favorable glycemic outcomes for people with type 1 diabetes (T1D) in two pivotal clinical trials. Real-world evidence is needed to explore effectiveness in nonstudy conditions. Methods: A retrospective analysis of the United States Omnipod 5 System users (aged ≥2 years) with T1D and sufficient data (≥90 days of data; ≥75% of days with ≥220 continuous glucose monitor readings/day) available in Insulet Corporation's device and person-reported datasets as of July 2023 was performed. Target glucose setting usage (i.e., 110-150 mg/dL in 10 mg/dL increments) was summarized and glycemic outcomes were examined. Subgroup analyses of those using the lowest average glucose target (110 mg/dL) and stratification by baseline characteristics (e.g., age, prior therapy, health insurance coverage) were conducted. Results: In total, 69,902 users were included. Multiple and higher glucose targets were more commonly used in younger age groups. Median percentage of time in range (TIR; 70-180 mg/dL) was 68.8%, 61.3%, and 53.6% for users with average glucose targets of 110, 120, and 130-150 mg/dL, respectively, with minimal time <70 mg/dL (all median <1.13%). Among those with an average glucose target of 110 mg/dL ( n  = 37,640), median TIR was 65.0% in children and adolescents (2-17 years) and 69.9% in adults (≥18 years). Subgroup analyses of users transitioning from Omnipod DASH or multiple daily injections and of Medicaid/Medicare users demonstrated favorable glycemic outcomes among these groups. Conclusion: These glycemic outcomes from a large and diverse sample of nearly 70,000 children and adults demonstrate effective use of the Omnipod 5 System under real-world conditions.

Artificial intelligence (AI) has been applied in healthcare for diagnosis, treatments, disease management, and for studying underlying mechanisms and disease complications in diseases like diabetes and metabolic disorders. This review is a comprehensive overview of various applications of AI in the healthcare system for managing diabetes. A literature search was conducted on PubMed to locate studies integrating AI in the diagnosis, treatment, management and prevention of diabetes. As diabetes is now considered a pandemic now so employing AI and machine learning approaches can be applied to limit diabetes in areas with higher prevalence. Machine learning algorithms can visualize big datasets, and make predictions. AI-powered mobile apps and the closed-loop system automated glucose monitoring and insulin delivery can lower the burden on insulin. AI can help identify disease markers and potential risk factors as well. While promising, AI's integration in the medical field is still challenging due to privacy, data security, bias, and transparency. Overall, AI's potential can be harnessed for better patient outcomes through personalized treatment., Competing Interests: The authors declare that they have no financial conflict of interest with regard to the content of this report.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Glycemia risk index (GRI) is a novel composite metric assessing overall glycemic risk, accounting for both hypoglycemia and hyperglycemia and weighted toward extremes. Data assessing GRI as an outcome measure in closed-loop studies and its relation with conventional key continuous glucose monitoring (CGM) metrics are limited., Methods: A post hoc analysis was performed to evaluate the sensitivity of GRI in assessing glycemic quality in adults with type 1 diabetes randomized to 26 weeks hybrid closed-loop (HCL) or manual insulin delivery (control). The primary outcome was GRI comparing HCL with control. Comparisons were made with changes in other CGM metrics including time in range (TIR), time above range (TAR), time below range (TBR), and glycemic variability (standard deviation [SD] and coefficient of variation [CV])., Results: GRI with HCL (N = 61) compared with control (N = 59) was significantly lower (mean [SD] 33.5 [11.7] vs 56.1 [14.4], respectively; mean difference -22.8 [-27.2, -18.3], P = .001). The mean increase in TIR was +14.8 (11.0, 18.5)%. GRI negatively correlated with TIR for combined arms ( r = -.954; P = .001), and positively with TAR >250 mg/dL ( r = .901; P = .001), TBR < 54 mg/dL ( r = .416; P = .001), and glycemic variability (SD [ r = .916] and CV [ r = .732]; P = .001 for both)., Conclusions: Twenty-six weeks of HCL improved GRI, in addition to other CGM metrics, compared with standard insulin therapy. The improvement in GRI was proportionally greater than the change in TIR, and GRI correlated with all CGM metrics. We suggest that GRI may be an appropriate primary outcome for closed-loop trials., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MHL has received speaker honoraria from Medtronic. DNO. has served on advisory boards for Abbott Laboratories, Medtronic, Merck Sharp & Dohme, Novo Nordisk, Roche, and Sanofi; received research support from Medtronic, Novo Nordisk, Roche, Eli Lilly and Company, and Sanofi; and received travel support from Novo Nordisk and Merck Sharp & Dohme. SV and TWJ have nothing to disclose.

In the context of underactuated Hamiltonian systems defined by simple Hamiltonian functions, the matching conditions of the energy shaping method split into two decoupled subsets of equations: the kinetic and potential equations. The unknown of the kinetic equation is a metric on the configuration space of the system, while the unknown of the potential equation are the same metric and a positive-definite function around some critical point of the Hamiltonian function. In this paper, assuming that a solution of the kinetic equation is given, we find conditions (in the category) for the existence of positive-definite solutions of the potential equation and, moreover, we present a procedure to construct, up to quadratures, some of these solutions. In order to illustrate such a procedure, we consider the subclass of systems with one degree of underactuation, where we find in addition a concrete formula for the general solution of the kinetic equation. As a byproduct, new global and local expressions of the matching conditions are presented in the paper. [ABSTRACT FROM AUTHOR]

The maximum likelihood detection theory improves the error rate of a sub-optimal but cheaper, coded symbol recovery loop using oversampling proposed as an alternate solution for the decoding problem without the log-likelihood ratio computation. The former implementation delivers the output data in one-symbol delay, and the required transistor count makes this approach attractive for ultra-low-energy wireless applications. The proposed hardware upgrade includes an analog to digital converter and fixed-point accumulation logic to compute the soft values, replacing a trigger used as a hard detector. This work investigates the soft decoding in the presence of binary and non-binary source symbols. Simulation results show that the soft approach improves the signal-to-noise ratio by 3 dB and 2.5 dB when the encoding rates are 1/3 and 2/3. [ABSTRACT FROM AUTHOR]

Artificial lung (AL) systems provide respiratory support to patients with severe lung disease, but none can adapt to the changing respiratory needs of the patients. Precisely, none can automatically adjust carbon dioxide (CO2) removal from the blood in response to changes in patient activity or disease status. Because of this, all current systems limit patient comfort, activity level, and rehabilitation. A portable servoregulation controller that automatically modulates CO2 removal in ALs to meet the real-time metabolic demands of the patient is described. The controller is based on a proportional-integral-derivative (PID) based closed-loop feedback control system that modulates sweep gas (air) flow through the AL to maintain a target exhaust gas CO2 partial pressure (target EGCO2 or tEGCO2). The presented work advances previous research by (1) using gas-side sensing that avoids complications and clotting associated with blood-based sensors, (2) incorporating all components into a portable, battery-powered package, and (3) integrating smart moisture removal from the AL to enable long term operation. The performance of the controller was tested in vitro for ∼12 h with anti-coagulated bovine blood and 5 days with distilled water. In tests with blood, the sweep gas flow was automatically adjusted by the controller rapidly (CO2 level when confronted with changes in inlet blood partial pressure of CO2 (pCO2) levels at various AL blood flows. Overall, the CO2 removal from the AL showed a strong correlation with blood flow rate and blood pCO2 levels. The controller successfully operated continuously for 5 days when tested with water. This study demonstrates an important step toward ambulatory AL systems that automatically modulate CO2 removal as required by lung disease patients, thereby allowing for physiotherapy, comfort, and activity.

This paper deals with the territorial dimension of a circular economy. We review the territorial factors shaping closed-loop systems, upon which a territorial definition of a circular economy is developed. We consider six categories of territorial factors: (1) Land-based factors emphasize the significance of physical endowment to satisfy the growing demand of secondary and biotic materials in a circular economy; (2) agglomeration factors are important determinants for a circular economy, as these provide circular businesses with the necessary access to resources, knowledge and collaboration, as well as viable markets; some of these functions are enabled by (3) hard territorial factors, in particular by accessibility and connectivity infrastructures as well as by (4) access to state-of-the-art technologies; softer territorial factors, including (5) knowledge-related factors and (6) governance and institutional arrangements, support collaboration among companies and between them, as well as among consumers and public institutions. Our review shows that agglomeration and land-based factors contribute to define the framework conditions of circular transformations, the harder territorial factors (accessibility and technologies) enable the circular economy in practice, and the softer factors (knowledge, awareness, governance and milieus) contribute to catalyse circular transformations. These findings base and complement research done in the ESPON CIRCTER project. [ABSTRACT FROM AUTHOR]

Within civil engineering, the inclusion of control strategies is confined to limited application areas due to the practical overhead and an alleged conservatism. This paper presents a simple yet flexible framework for experimental testing of closed‐loop structural systems. Compared to alternative existing solutions, the proposed framework requires limited programming knowledge, which heavily simplifies the implementation for the operator and thus reduces the associated practical overhead. The feasibility of the framework is demonstrated through two experimental case studies in which control strategies are used to, respectively, design and implement a hybrid tuned mass damper (TMD) and conduct closed‐loop model updating. The case studies exemplify the diversity of control applications within civil engineering, and it is noted that while hybrid TMDs are used in the civil engineering industry, limited experimental application studies exist on closed‐loop model updating of structural systems. It is concluded that the presented framework can be applied to cover a variety of structural control applications within civil engineering and the successful implementation of the framework in the two case studies highlights the benefits of feedback control within these applications. [ABSTRACT FROM AUTHOR]

Background: Studies of closed-loop control (CLC) in patients with type 1 diabetes (T1D) consistently demonstrate improvements in glycemic control as measured by increased time-in-range (TIR) 70-180 mg/dL. However, clinical predictors of TIR in users of CLC systems are needed. Materials and Methods: We analyzed data from 100 children aged 6-13 years with T1D using the Tandem Control-IQ CLC system during a randomized trial or subsequent extension phase. Continuous glucose monitor data were collected at baseline and during 12-16 weeks of CLC use. Participants were stratified into quartiles of TIR on CLC to compare clinical characteristics. Results: TIR for those in the first, second, third, and fourth quartiles was 54%, 65%, 71%, and 78%, respectively. Lower baseline TIR was associated with lower TIR on CLC (r = 0.69, P < 0.001). However, lower baseline TIR was also associated with greater improvement in TIR on CLC (r = -0.81, P < 0.001). During CLC, participants in the highest versus lowest TIR-quartile administered more user-initiated boluses daily (8.5 ± 2.8 vs. 5.8 ± 2.6, P < 0.001) and received fewer automated boluses (3.5 ± 1.0 vs. 6.0 ± 1.6, P < 0.001). Participants in the lowest (vs. the highest) TIR-quartile received more insulin per body weight (1.13 ± 0.27 vs. 0.87 ± 0.20 U/kg/d, P = 0.008). However, in a multivariate model adjusting for baseline TIR, user-initiated boluses and insulin-per-body-weight were no longer significant. Conclusions: Higher baseline TIR is the strongest predictor of TIR on CLC in children with T1D. However, lower baseline TIR is associated with the greatest improvement in TIR. As with open-loop systems, user engagement is important for optimal glycemic control. [ABSTRACT FROM AUTHOR]

Traditional approaches for neurological rehabilitation of patients affected with movement disorders, such as Parkinson's disease (PD), dystonia, and essential tremor (ET) consist mainly of oral medication, physical therapy, and botulinum toxin injections. Recently, the more invasive method of deep brain stimulation (DBS) showed significant improvement of the physical symptoms associated with these disorders. In the past several years, the adoption of feedback control theory helped DBS protocols to take into account the progressive and dynamic nature of these neurological movement disorders that had largely been ignored so far. As a result, a more efficient and effective management of PD cardinal symptoms has emerged. In this paper, we review closed-loop systems for rehabilitation of movement disorders, focusing on PD, for which several invasive and noninvasive methods have been developed during the last decade, reducing the complications and side effects associated with traditional rehabilitation approaches and paving the way for tailored individual therapeutics. We then present a novel, transformative, noninvasive closed-loop framework based on force neurofeedback and discuss several future developments of closed-loop systems that might bring us closer to individualized solutions for neurological rehabilitation of movement disorders.

Accessibility, adaptability, and transparency of Brain-Computer Interface (BCI) tools and the data they collect will likely impact how we collectively navigate a new digital age. This discussion reviews some of the diverse and transdisciplinary applications of BCI technology and draws speculative inferences about the ways in which BCI tools, combined with machine learning (ML) algorithms may shape the future. BCIs come with substantial ethical and risk considerations, and it is argued that open source principles may help us navigate complex dilemmas by encouraging experimentation and making developments public as we build safeguards into this new paradigm. Bringing open-source principles of adaptability and transparency to BCI tools can help democratize the technology, permitting more voices to contribute to the conversation of what a BCI-driven future should look like. Open-source BCI tools and access to raw data, in contrast to black-box algorithms and limited access to summary data, are critical facets enabling artists, DIYers, researchers and other domain experts to participate in the conversation about how to study and augment human consciousness. Looking forward to a future in which augmented and virtual reality become integral parts of daily life, BCIs will likely play an increasingly important role in creating closed-loop feedback for generative content. Brain-computer interfaces are uniquely situated to provide artificial intelligence (AI) algorithms the necessary data for determining the decoding and timing of content delivery. The extent to which these algorithms are open-source may be critical to examine them for integrity, implicit bias, and conflicts of interest.

Insulin pump training has traditionally been performed in-person. The coronavirus disease 2019 (COVID-19) pandemic necessitated vast increases in the number of virtual pump trainings for Tandem t:slim X2 insulin pump starts. A customized structured pump training curriculum specifically tailored to virtual learning was deployed in early 2020, and included (1) preparation for training with use of the t:simulator app, (2) use of the teach-back method during video training, and (3) automating data uploads for follow-up. Retrospective analysis from >23,000 pump training sessions performed from January 1, 2020 to July 28, 2020 showed sensor time-in-range for up to 6 months after training was 72% (60%-81%) for virtual training versus 67% (54%-78%) for in-person training. Higher user satisfaction (4.78 ± 0.52 vs. 4.64 ± 0.68; P < 0.01) and higher user confidence (4.61 ± 0.75 vs. 4.47 ± 0.0.85; P < 0.01) were reported after the virtual sessions. Virtual pump training was well received and proved safe and effective with the new virtual training curriculum. [ABSTRACT FROM AUTHOR]

Introduction: Hybrid closed-loop systems increase time-in-range (TIR) and reduce glycemic variability. Person-reported outcomes (PROs) are essential to assess the utility of new devices and their impact on quality of life. This article focuses on the PROs for pediatric participants (ages 6-13 years) with type 1 diabetes (T1D) and their parents during a trial using the Tandem Control-IQ system, which was shown to increase TIR and improve other glycemic metrics. Research Design and Methods: One hundred and one children 6 to 13 years old with T1D were randomly assigned to closed-loop control (CLC) or sensor-augmented pump (SAP) in a 16-week randomized clinical trial with extension to 28 weeks during which the SAP group crossed over to CLC. Health-related quality of life and treatment satisfaction measures were obtained from children and their parents at baseline, 16 weeks, and 28 weeks. Results: Neither the children in the CLC group nor their parents had statistically significant changes in PRO outcomes compared with the SAP group at the end of the 16-week randomized controlled trial and the 28-week extension. Parents in the CLC group reported nonsignificant improvements in some PRO scores when compared with the SAP group at 16 weeks, which were sustained at 28 weeks. Sleep scores for parents improved from "poor sleep quality" to "adequate sleep quality" between baseline and 16 weeks, however, the change in scores was not statistically different between groups. Conclusions: Children with T1D who used the Control-IQ system did not experience increased burden compared with those using SAP based on person-reported outcomes from the children and their parents. Clinical Trials Registration: NCT03844789. [ABSTRACT FROM AUTHOR]

Ensuring the maneuverability of forest track machinery is of great interest to the forest industry in reducing the negative impact on the soil and increasing the productivity of forestry operations. This work aims to develop an improved impulse steering control technology to improve forest-tracked machinery maneuverability. The "diagonal" steering control system combined with the 5-15 Hz pressure impulse width modulation in the hydraulic steering control system was employed. Various modulator designs and steering control system parameters were selected, serving as the basis for developing an experimental prototype of the steering control system. The results of the experiment showed that the proposed technology allows creating conditions suitable for applying the impulse steering technology with minimal changes in the transmission design. The obtained results demonstrate the reliability and stability of the machine's steering system with an onboard gearbox in all parameters during shifting and turning operations. These results may be useful in designing steering control systems of tracked vehicles. The future study can focus on developing and testing the control system for a modernized skidder chassis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of a 1-year hybrid closed-loop (HCL) system on glycemic control in children and adolescents with type 1 diabetes (T1D) previously treated with multiple daily injections (MDI). Methods: This was a 1-year observational study, as a continuation of the previous 3 months prospective study of pediatric patients with T1D conducted at Sidra Medicine in Qatar. The study enrolled individuals aged 7–18 years with T1D > 1 year, on MDI with self-monitoring of blood glucose or continuous glucose monitoring, with no prior pump experience, and with an HbA1c level < 12.5% (< 113 mmol/mol). After the first 3 months of HCL use, patients were followed at 6, 9 and 12 months, where HbA1c was obtained and pump data were collected. Results: All 30 participants (age 10.24 ± 2.6 years) who initiated HCL completed 12 months of HCL system use in Auto Mode. The participants used the sensor 88.4 ± 6.5% of the time with Auto Mode usage 85.6 ± 7.4% during 12 months of HCL system use. HbA1c decreased from 8.2 ± 1.4% (66 ± 15.3 mmol/mol) at baseline, to 6.7 ± 0.5% (50 ± 5.5 mmol/mol) at 3 months (p = 0.02) and remained stable to 7.1 ± 0.6 (54 ± 6.6 mmol/mol) at 12 months (p = 0.02). TIR (70–180 mg/dL) increased from 46.9% at baseline to 71.9% at 1 month and remained above 70% during the 12 months of HCL use. Conclusion: HCL system (MiniMed 670G) in children and adolescents previously treated with MDI significantly improves glycemic outcomes (HbA1c and Time in Ranges) immediately during the first month. This improved glycemic control was maintained over the 1 year following Auto Mode initiation. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability to do face-to-face training on advanced diabetes management technologies. In the United States, Medtronic Diabetes shifted from occasional to 100% virtual training on all diabetes devices in mid-March 2020. We studied the outcomes of virtual training on the MiniMed™ 670 G hybrid closed-loop system in type 1 diabetes. Methods: From March 20, 2020, to April 22, 2020 (intra-COVID-19), virtual training on the MiniMed 670 G system was completed using Zoom with satisfaction captured through online post-training surveys. Training efficiency was measuring by the days between the date of product shipment and the date of the first and final trainings. Patient satisfaction with training on the MiniMed 670 G was determined by Net Promotor Score® (NPS®). Uploads from CareLink™ Personal and CareLink Professional and calls to the Medtronic 24-h technical support team requesting educational/software assistance and/or help with health care provider telehealth visits were recorded. Continuous glucose monitoring (CGM) results were measured using the CareLink Personal database. All results except for the Zoom satisfaction survey were compared with data from January 20, 2020, to February 22, 2020, (Pre-COVID-19) when training was performed in-person. Results: The CGM metrics were comparable between pre- and intra-COVID-19 training. The Zoom video conferencing application had 98% satisfaction. The NPS rose from 78 to 84. The time between the pump shipment and the first and last (automode) training was significantly reduced from 14 ± 7 days to 11 ± 5 days (P < 0.001) and from 19 ± 7 days to 15 ± 15 days (P < 0.01), respectively. There was a decrease in the calls for educational assistance to the technical support team but an increase in requests for login and software installation support. Conclusions: Virtual training of individuals with diabetes on the MiniMed 670 G system resulted in high satisfaction and short-term glycemic results comparable with in-person training. [ABSTRACT FROM AUTHOR]

Background: This study assessed the efficacy and safety of ultrarapid insulin Fiasp® in the hybrid closed-loop MiniMed™ 670G system. Methods: This was a pilot randomized double-blinded crossover study among established MiniMed™ 670G users comparing percentage time in range (TIR) and hypoglycemia for Novolog® and Fiasp. After 2 weeks optimization with their home insulin, participants were randomized to receive Novolog or Fiasp for 2 weeks, followed by the other insulin for the next 2 weeks. Data from the second week of blinded insulin use were analyzed to allow 1 week for 670G adaptation. During the second week, individuals were asked to eat the same breakfast for 3 days to assess differences in meal pharmacodynamics. Results: Nineteen adults were recruited with mean age of 40 ± 18 years, diabetes duration of 27 ± 12 years, and median hemoglobin A1c of 7.1% (6.9, 7.5), using 0.72 (0.4, 1.2) units/(kg·day). For Novolog and Fiasp, respectively, the %TIR (70-180 mg/dL) was 75.3 ± 9.5 and 78.4 ± 9.3; %time <70 mg/dL was 3.1 ± 2.1 and 2.3 ± 2.0; %time >180 mg/dL was 21.6 ± 9.0 and 19.3 ± 8.9; mean glucose was 147 ± 12 and 146 ± 12 mg/dL; coefficient of variation was 28.6% ± 4.5% and 26.8% ± 4.4%; %time in auto mode 86.4 ± 9.2 and 84.4 ± 9.2. All comparisons were nonsignificant for insulin type. Total daily dose (Novolog 48.8 ± 28.4 vs. Fiasp 52.4 ± 31.7 units; P = 0.01) and daily basal (Novolog 17.6 [15.5, 33.8] vs. Fiasp 19.1 [15.3, 38.5] units; P = 0.07) correlated with TIR and %time >180 mg/dL. For insulin delivery in auto mode there was no statistical difference in total daily dose or daily basal between arms. Paired analysis for matched breakfast meals revealed no significant differences in time to maximum glucose, peak glucose, or glucose excursion. Conclusions: In this pilot study, the use of either Novolog or Fiasp in a commercially available MiniMed 670G system operating in auto mode resulted in clinically similar glycemic outcomes, with a slight increase in daily insulin requirements using Fiasp. [ABSTRACT FROM AUTHOR]

In this article, we study digital predistortion (DPD)-based linearization with a specific focus on millimeter-wave (mmW) active antenna arrays. Due to the very large-channel bandwidths and beam-dependence of nonlinear distortion in such systems, we present a closed-loop DPD learning architecture, lookup table (LUT)-based memory DPD models, and low-complexity sign-based estimation algorithms such that even continuous DPD learning could be technically feasible. To this end, three different learning algorithms—sign, signed regressor, and sign–sign—are formulated for the LUT-based DPD models such that the potential rank deficiencies, experienced in earlier methods, are avoided while facilitating greatly reduced learning complexity. The injection-based LUT DPD structure is also shown to allow for low numbers and reduced dynamic range of the involved LUT entries. Extensive RF measurements utilizing a state-of-the-art mmW active antenna array system at 28 GHz are carried out and reported to validate the methods, incorporating very wide channel bandwidths of 400 and 800 MHz while pushing the array close to saturation. In addition, the processing and learning complexities of the considered techniques are analyzed, which, together with the measured linearization performance figures, allows to assess the complexity–performance tradeoffs of the proposed solutions. Overall, the results show that efficient mmW array linearization can be obtained through the proposed methods at very low complexity. [ABSTRACT FROM AUTHOR]

Background: To evaluate the long-term safety and effectiveness of the Omnipod ® 5 Automated Insulin Delivery (AID) System in very young children with type 1 diabetes with up to 2 years of use. Methods: Following a 13-week single-arm, multicenter, pivotal trial that took place after 14 days of standard therapy data collection, participating children (2-5.9 years of age at study enrollment) were provided the option to continue use of the AID system in an extension phase. HbA1c was measured every 3 months, up to 15 months of total use, and continuous glucose monitor metrics were collected through the completion of the extension study (for up to 2 years). Results: Participants ( N  = 80) completed 18.2 [17.4, 23.4] (median [interquartile range]) total months of AID, inclusive of the 3-month pivotal trial. During the pivotal trial, HbA1c decreased from 7.4% ± 1.0% (57 ± 10.9 mmol/mol) to 6.9% ± 0.7% (52 ± 7.7 mmol/mol, P  < 0.0001) and was maintained at 7.0% ± 0.7% (53 ± 7.7 mmol/mol) after 15 months total use ( P  < 0.0001 from baseline). Time in target range (70-180 mg/dL) increased from 57.2% ± 15.3% during standard therapy to 68.1% ± 9.0% during the pivotal trial ( P  < 0.0001) and was maintained at 67.2% ± 9.3% during the extension phase ( P  < 0.0001 from standard therapy). Participants spent a median 97.1% of time in Automated Mode during the extension phase, with one episode of severe hypoglycemia and one episode of diabetic ketoacidosis. Conclusion: This evaluation of the Omnipod 5 AID System indicates that long-term use can safely maintain improvements in glycemic outcomes with up to 2 years of use in very young children with type 1 diabetes. Clinical Trials Registration Number: NCT04476472.

Background: Benefits of hybrid closed-loop (HCL) systems in a high-risk group with type 1 diabetes and impaired awareness of hypoglycemia (IAH) have not been well-explored., Methods: Adults with Edmonton HYPO scores ≥1047 were randomized to 26-weeks HCL (MiniMed™ 670G) vs standard therapy (multiple daily injections or insulin pump) without continuous glucose monitoring (CGM) (control). Primary outcome was percentage CGM time-in-range (TIR; 70-180 mg/dL) at 23 to 26 weeks post-randomization. Major secondary endpoints included magnitude of change in counter-regulatory hormones and autonomic symptom responses to hypoglycemia at 26-weeks post-randomization. A post hoc analysis evaluated glycemia risk index (GRI) comparing HCL with control groups at 26 weeks post-randomization., Results: Nine participants (median [interquartile range (IQR)] age 51 [41, 59] years; 44% male; enrolment HYPO score 1183 [1058, 1308]; Clarke score 6 [6, 6]; n = 5 [HCL]; n = 4 [control]) completed the study. Time-in-range was higher using HCL vs control (70% [68, 74%] vs 48% [44, 50%], P = .014). Time <70 mg/dL did not differ (HCL 3.8% [2.7, 3.9] vs control 6.5% [4.3, 8.6], P = .14) although hypoglycemia episode duration was shorter (30 vs 50 minutes, P < .001) with HCL. Glycemia risk index was lower with HCL vs control (38.1 [30.0, 39.2] vs 70.8 [58.5, 72.4], P = .014). Following 6 months of HCL use, greater dopamine (24.0 [12.3, 27.6] vs -18.5 [-36.5, -4.8], P = .014), and growth hormone (6.3 [4.6, 16.8] vs 0.5 [-0.8, 3.0], P = .050) responses to hypoglycemia were observed., Conclusions: Six months of HCL use in high-risk adults with severe IAH increased glucose TIR and improved GRI without increased hypoglycemia, and partially restored counter-regulatory responses., Clinical Trial Registration: ACTRN12617000520336., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M.H.L and B.P. have received speaker honoraria from Medtronic. R.J.M. reports research grants from Novo Nordisk, Servier, Medtronic, and Grey Innovation; received honoraria for lectures from Eli Lilly and Company, Novo Nordisk, Sanofi, AstraZeneca, Merck Sharp & Dohme, Norvartis, and Boehringer Ingelheim; received travel support from Novo Nordisk, Sanofi, and Boehringer Ingelheim; is on the advisory boards for Novo Nordisk, Sanofi, Boehringer Ingelheim and Lilly Diabetes Alliance, and AstraZeneca; and has been a principal investigator for industry-sponsored clinical trials run by Novo Nordisk, Bayer, Janssen-Cilag, and AbbVie Inc. S.A.M. reports institutional support for research from Medtronic, speaker honoraria from Roche and Sanofi, and has served on an advisory board for Medtronic. J.S. has served on advisory boards for Medtronic, Roche Diabetes Care, and Sanofi Diabetes; her research group (Australian Centre for Behavioural Research in Diabetes) has received honoraria for this advisory board participation and has also received unrestricted educational grants and/or in-kind support from Abbott Diabetes Care, AstraZeneca, Medtronic, Roche Diabetes Care, and Sanofi Diabetes; has received sponsorship to attend educational meetings from Medtronic, Roche Diabetes Care, and Sanofi Diabetes; and has received consultancy income or speaker fees from Abbott Diabetes Care, AstraZeneca, Medtronic, Novo Nordisk, Roche Diabetes Care, and Sanofi Diabetes. A.J.J. has received research support from Medtronic, Sanofi, Abbott Laboratories, and Mylan; and has served on advisory boards for Medtronic, Sanofi, and Abbott Diabetes Care. D.N.O. has served on advisory boards for Abbott Laboratories, Medtronic, Merck Sharp & Dohme, Novo Nordisk, Roche, and Sanofi; received research support from Medtronic, Novo Nordisk, Roche, Eli Lilly and Company, and Sanofi; and received travel support from Novo Nordisk and Merck Sharp & Dohme. The remaining authors have nothing to disclose.

This review focuses on virtual coaching systems that were designed to enhance healthcare interventions, combining the available sensing and system-user interaction technologies. In total, more than 1,200 research papers have been retrieved and evaluated for the purposes of this review, which were obtained from three online databases (i.e.,PubMed, Scopus and IEEE Xplore) using an extensive set of search keywords. After applying exclusion criteria, the remaining 41 research papers were used to evaluate the status of virtual coaching systems over the past 10 years and assess current and future trends in this field. The results suggest that in home coaching systems were mainly focused in promoting physical activity and a healthier lifestyle, while a wider range of medical domains was considered in systems that were evaluated in lab environment. In home patient monitoring with IoT devices and sensors was mostly limited to activity trackers, pedometers and heart rate monitoring. Real-time evaluations and personalized patient feedback was also found to be rather lacking in home coaching systems and this is the most alarming find of this analysis. Feasibility studies in controlled environment and an ongoing active research on Horizon 2020 funded projects, show that the future trends in this field are aiming to close the loop with automated patient monitoring, real-time evaluations and more precise interventions.

In this paper, a controller design methodology is proposed for a CLLLC-type bidirectional resonant converter. The soft switching of all devices in this topology and the very high operating frequency lead to increased overall system efficiency. However, the dynamic nature of this converter is highly dependent on loading conditions, which proves challenging when designing the voltage and current closed-loop controllers. System instability is mainly due to the high-Q resonant peaking, which is observed in the open-loop bode-plots. In this paper, the controller design methodology is proposed, which accounts for the dynamics behavior due to load variations. The controller stability will be evaluated against the entire range of operating switching frequency. Both battery charging and regeneration modes will be described and analyzed. The focal contribution of this paper will focus on defining the worst operating scenarios for the converter using system-level modeling and analysis. In addition, the controller will be defined based on these operating points. To validate and verify the controller design methodology proposed, a 3.5-kW converter is designed with the appropriate output voltage and current loop controllers. The step response verified a stable system designed and thus proving the proposed controller design methodology.

Objective: To assess the impact of initiation of closed-loop control (CLC) on glycemic metrics in older adults with type 1 diabetes (T1D) in the real world. Methods: Retrospective analysis of electronic health records from a single tertiary diabetes center of older adults prescribed CLC between January and December 2020. Results: Forty-eight patients (mean age 70 ± 4 years, T1D duration 42 ± 14 years) were prescribed CLC and 39/48 started on the CLC. Among the CLC starters, 97.5% and 95% were prior pump and continuous glucose monitoring (CGM) users, respectively. CGM metrics showed an increase in time-in-range (62% ± 13% to 76% ± 9%; P < 0.001), a reduction in both time spent <70 mg/dL [2% (1%-3%) to 1% (1%-2%); P = 0.03] and >180 mg/dL (30% ± 11% to 20% ± 9%; P < 0.001) at 3 months. Conclusion: In this real-world data most of the older patients with T1D initiating CLC were prior pump and CGM users. Initiation of CLC improved glycemic control and reduced time spent in hypoglycemia compared with prior therapy. [ABSTRACT FROM AUTHOR]

This article shows both theoretical and experimental analyses of a fully integrated CMOS active gate driver (AGD) developed to control the high dv/dt of GaN transistors for both 48 and 400 V applications. To mitigate negative effects in the high-frequency spectrum emission, an original technique is proposed to reduce the dv/dt with lower switching losses compared to classical solutions. The AGD technique is based on a subnanosecond delay feedback loop, which reduces the gate current only during the dv/dt sequence of the switching transients. Hence, the dv/dt and di/dt can be actively controlled separately, and the tradeoff between the dv/dt and EON switching energy is optimized. Since GaN transistors have typical voltage switching times on the order of a few nanoseconds, introducing a feedback loop from the high voltage drain to the gate terminal is quite challenging. In this article, we successfully demonstrate the active gate driving of GaN transistors for both 48 and 400 V applications, with initial open-loop voltage switching times of 3 ns, due to a full CMOS integration. Other methods for dv/dt active control are further discussed. The limits of these methods are explained based on both experimental and simulation results. The AGD showed a clear reduction in the peak dv/dt from –175 to –120 V/ns for the 400 V application. [ABSTRACT FROM AUTHOR]

Background: With the rapid development of technologies for type 1 diabetes, economic evaluations are integral in guiding cost-effective clinical and policy decisions. We therefore aimed to review and synthesise the current economic literature for available diabetes management technologies and outline key determinants of cost-effectiveness. Methods: A systematic search was conducted in April 2019 that focused on modelling or trial based economic evaluations. Searched databases included Medline, Medline in-process and other non-indexed citations, EMBASE, PubMed, All Evidenced Based Medicine Reviews, EconLit, Cost-effectiveness analysis Registry, Research Papers in Economics, Web of Science, PsycInfo, CINAHL, and PROSPERO from inception. We assessed quality of included studies with the Questionnaire to Assess Relevance and Credibility of Modeling Studies for Informing Health Care Decision Making an ISPOR-AMCP-NPC good practice task force report. Screening of abstracts and full-texts, appraisal, and extraction were performed by two independent researches. Results: We identified 16,772 publications, of which 35 were analysed and included 11 health technologies. Despite a lack of consensus, most studies reported that insulin pumps (56%) or interstitial glucose sensors (62%) were cost-effective, although incremental cost-effectiveness ratios ranged widely ($14,266–$2,997,832 USD). Cost-effectiveness for combined insulin pumps and glucose sensors was less clear. Determinants of cost-effectiveness included treatment effects on glycosylated haemoglobin and hypoglycaemia, costing of technologies and complications, and measures of utility. Conclusions: Insulin pumps or glucose sensors appeared cost-effective, particularly in populations with higher HbA1c levels and rates of hypoglycaemia. However, cost-effectiveness for combined insulin pumps and glucose sensors was less clear. Registration: The study was registered with PROSPERO, number CRD42017077221. [ABSTRACT FROM AUTHOR]

Objective: To assess the safety and efficacy of a simplified initialization for the Tandem t:slim X2 Control-IQ hybrid closed-loop system, using parameters based on total daily insulin ("MyTDI") in adolescents with type 1 diabetes under usual activity and during periods of increased exercise. Research Design and Methods: Adolescents with type 1 diabetes 12-18 years of age used Control-IQ for 5 days at home using their usual parameters. Upon arrival at a 60-h ski camp, participants were randomized to either continue Control-IQ using their home settings or to reinitialize Control-IQ with MyTDI parameters. Control-IQ use continued for 5 days following camp. The effect of MyTDI on continuous glucose monitoring outcomes were analyzed using repeated measures analysis of variance (ANOVA): baseline, camp, and at home. Results: Twenty participants were enrolled and completed the study; two participants were excluded from the analysis due to absence from ski camp (1) and illness (1). Time in range was similar between both groups at home and camp. A tendency to higher time <70 mg/dL in the MyTDI group was present but only during camp (median 3.8% vs. 1.4%, P = 0.057). MyTDI users with bolus/TDI ratios >40% tended to show greater time in the euglycemic range improvements between baseline and home than users with ratios <40% (+16.3% vs. -9.0%, P = 0.012). All participants maintained an average of 95% time in closed loop (84.1%-100%). Conclusions: MyTDI is a safe, effective, and easy way to determine insulin parameters for use in the Control-IQ artificial pancreas. Future modifications to account for the influence of carbohydrate intake on MyTDI calculations might further improve time in range. [ABSTRACT FROM AUTHOR]

The deployment of advanced sensors has strengthened the monitoring capability of power plants. In the context of the cogeneration process, the plant cooling is performed by the cooling towers using the condensation process on exhaust steam. However, the computer networks and industrial control systems built on this sensor-based digital layer may become vulnerable to cyberattacks. This may eventually raise a concern on the performance and security of these energy utilities. To resolve this issue, an inoculated subobserver-based fusion filter is proposed. It improves the resilience against malicious attacks in combined cycle power plants with desalination units, which are usually functioning in a closed-loop environment and infected with injected attacks. A time-delay-based state representation is considered for the system. To access latency in a closed-loop environment, a subsystem-based set of subobservers are introduced. Information from each sensor is then gathered using the interacting-multiple-model-based fusion process. The stability of the system has been proved and kept in-check at two different implementation levels of the procedure using functional equivalence and Lyapunov stability criteria, respectively. Performance evaluation is then conducted on a water-level system. Results show that the proposed scheme accurately extracted the system parameters from the contaminated measurements in the presence of multiple system disturbances and cyber intervention. [ABSTRACT FROM AUTHOR]

Background: Clinicians mediate access to closed-loop technology for people with diabetes. Consequently, their attitudes regarding appropriate levels of closed-loop usage will play a key role in future adoption processes. This study aimed to explore clinician attitudes toward future mainstream closed-loop usage in England. Materials and Methods: We conducted 36 semistructured interviews with clinicians from a range of professional backgrounds working in outpatient clinics in England. Interview topics included clinicians' views on future pathways for closed-loop use and attitudes toward the predictability of users' technology experiences, a key factor in eligibility decision making. We analyzed transcripts using thematic and framework approaches. Results: Clinicians exhibited a range of opinions regarding future eligibility for closed-loop technology. We identified three key strands of clinician opinion, envisaging (1) tighter access for closed loop (n = 10), citing funding challenges and issues arising from user overconfidence or negative technology attitudes; (2) similar access to closed loop as for current diabetes technologies (n = 15), on the grounds that future funding and access pathways will be similar to current arrangements; and (3) wider access for closed-loop technologies (n = 9), given the potential for significant and widespread benefits arising from closed-loop usage, including downstream cost savings alongside improved glycemic control. Conclusions: Clinicians expressed a range of opinions encompassing continuity with current diabetes technologies, while others envisaged either tighter or more liberal access for closed-loop systems. To optimize technology adoption and equitable uptake, future implementation pathways should consider clinician attitudes toward technology use and access. [ABSTRACT FROM AUTHOR]

The dynamic output feedback control for a class of semi‐linear distributed parameter systems with a non‐constant (spatially‐varying) diffusion rate described by partial differential equations is studied. The considered system is endowed with boundary actuation available and boundary feedback controllers are designed. Meanwhile, both domain‐averaged and boundary‐valued measurements, two different ways of output measurements, are taken into account. Based on these two different methods of measurements, the corresponding boundary feedback control laws are designed, respectively. Using Wirtinger's inequality, the resulting closed‐loop systems depending on observers and controllers are obtained in terms of the Lyapunov method. With the sufficient conditions of the linear matrix inequality, the stability of the system is subsequently obtained by the designed observer and controller. The final numerical simulations are given to illustrate the validity of the results graphically. [ABSTRACT FROM AUTHOR]

A new demagnetization correction method is explained in this article. Since a magnetization curve in an open magnetic circuit is considerably affected by the demagnetizing field which depends on the shape of the magnetic material, the demagnetization correction is significantly important to evaluate the magnetic properties of magnetic materials. In the new demagnetization correction method, a proper closed magnetic circuit curve is obtained in a way that a curve defined as a mathematical function is repeatedly modified in a computer feedback loop. In the method, the distribution of the demagnetizing field inside the magnetic material is taken into account by using the finite-element method in the computer calculation. Some calculation results about rare-earth permanent magnets are shown, and it is revealed that the new demagnetization correction method is able to reproduce the measured curves in the closed magnetic circuit with much higher accuracy than that of the classical demagnetization correction method. [ABSTRACT FROM AUTHOR]

This study focuses on the problem of event‐triggered control for positive switched systems without/with input saturation in both continuous‐time and discrete‐time contexts. First, a 1‐norm based event‐triggering mechanism is established for continuous‐time positive switched systems. By means of the matrix decomposition technique, an event‐triggered controller for the systems is designed by decomposing controller gain matrix into non‐positive and non‐negative components. Under the designed controller, the resulting closed‐loop systems are positive and stable. For the systems with input saturation, the saturation term is transformed into interval form under the event‐triggering condition. Then, an event‐triggered controller gain matrix and a cone domain of attraction gain matrix are designed for the corresponding interval systems in terms of linear programming, respectively. Furthermore, the presented approaches are extend to discrete‐time positive switched systems without/with input saturation. Compared with existing results on positive switched systems, the designed event‐triggered controller can reduce sampling frequency and save resources. Finally, two numerical examples are provided to verify the effectiveness of the obtained results. [ABSTRACT FROM AUTHOR]