Waterloo Uncovered is a ground-breaking conflict archaeology project, on the Waterloo battlefield in Belgium. Established in 2015 (the battle's bicentenary year) to learn more about the battle that shaped modern Europe, it supports Serving Personnel and Veterans (SPV) in their well-being, recovery (from mental and physical injury), education, vocation and transition into civilian life. This project brings together professional archaeologists, students, SPV and volunteers, in a mutually beneficial collaboration. It has five founding partner organisations: SPW (Service Public de Wallonie), The Centre for Battlefield Archaeology (University of Glasgow), L - P : Archaeology, ORBit team, Department of Soil Management (Ghent University), University College Roosevelt (Utrecht University).The charity is also dedicated to educating the general public about its findings; these are changing the way we understand both the Battle of Waterloo, and how we support our armed forces. This paper discusses the project so far, and our future research goals.
AIM: To compare bolus insulin delivery patterns during closed-loop home studies in adults with suboptimally [HbA1c 58-86 mmol/mol (7.5%-10%)] and well-controlled [58 mmol/mol (< 7.5%)] Type 1 diabetes. METHODS: Retrospective analysis of daytime and night-time insulin delivery during home use of closed-loop over 4 weeks. Daytime and night-time controller effort, defined as amount of insulin delivered by closed-loop relative to usual basal insulin delivery, and daytime bolus effort, defined as total bolus insulin delivery relative to total daytime insulin delivery were compared between both cohorts. Correlation analysis was performed between individual bolus behaviour (bolus effort and frequency) and daytime controller efforts, and proportion of time spent within and below sensor glucose target range. RESULTS: Individuals with suboptimally controlled Type 1 diabetes had significantly lower bolus effort (P = 0.038) and daily bolus frequency (P < 0.001) compared with those with well-controlled diabetes. Controller effort during both daytime (P = 0.007) and night-time (P = 0.005) were significantly higher for those with suboptimally controlled Type 1 diabetes. Time when glucose was within the target range (3.9-10.0 mmol/L) during daytime correlated positively with bolus effort (r = 0.37, P = 0.016) and bolus frequency (r = 0.33, P = 0.037). Time when glucose was below the target range during daytime was comparable in both groups (P = 0.36), and did not correlate significantly with bolus effort (r = 0.28, P = 0.066) or bolus frequency (r = -0.21, P = 0.19). CONCLUSION: More frequent bolusing and higher proportion of insulin delivered as bolus during hybrid closed-loop use correlated positively with time glucose was in target range. This emphasises the need for user input and educational support to benefit from this novel therapeutic modality. ; Seventh Framework Programme of the European Union (ICT FP7- 247138). Additional support for the Artificial Pancreas work by JDRF, National Institute for Health Research Cambridge Biomedical Research Centre, Wellcome Strategic Award (100574/Z/12/Z), EC Horizon 2020 (H2020-SC1-731560), NIDDK (DP3DK112176 and 1UC4DK108520-01), Efficacy and Mechanism Evaluation Programme of National Institute for Health Research (14/23/09) and Helmsley Trust (2016PG-T1D045 and #2016PG-T1D046).
This paper was published in the journal Applied Ergonomics and the definitive published version is available at http://dx.doi.org/10.1016/j.apergo.2016.08.034. ; This paper focuses on the challenges of meeting agency requirements as it pertains to the application of human factors in the medical device development (MDD) process. Individual case studies of the design and development process for 18 medical device manufacturers located in the US and EU were analysed and compared using a multiple case study design. The results indicate that there are four main challenges in implementing international standards. These include a lack of direct access to users for the purposes of device development; a lack of understanding by users with regards to the impact of their feedback on the development process; contract formalities limiting user exchanges; and the attitude of clinical users directly impacting on the device developer's invitation to participate in the development processes. The barriers presented in this research have the potential to be resolved but only with greater commitment by both medical device users and developers.
The release of chemicals or chemical incidents can have dramatic consequences on human health and the environment. Health care professionals can provide invaluable help to respond to these events but appropriate training is limited in human health degrees in the European Union. Academics from De Montfort University (DMU, UK) and the University of Alcalá (UAH, Spain) are developing training to provide basic skills to future professionals to respond to chemical incidents. We comprehensively modified a successful previous training programme tested with pharmacists at UAH and created two research-led workshops with different levels of difficulty for the 2016/17 course at DMU: basic for Medical Science bachelor degree students; the other more specialised for Advanced Biomedical Science Master's students. The basic training consisted of selecting public health interventions to control urban environmental contamination. Master's students developed a complete plan to respond to a chemical incident including remediation of the environment using the novel recovery tools developed by Public Health England (UK). All undergraduate students highlighted that they learnt how to identify public health interventions to protect the public and 84% of the Master's students reported that they learnt how to tailor an appropriate recovery programme. The research-led workshops, methods and tools used facilitated the acquisition of skills to respond to future minor scale chemical incidents.
$\textbf{Objectives}$: We evaluated patterns of meal intake, insulin bolus delivery, and fingerstick glucose measurements during hybrid closed-loop and sensor-augmented pump (SAP) therapy, including associations with glucose control. $\textbf{Methods}$: Data were retrospectively analyzed from pump-treated adults with type 1 diabetes who underwent, in random order, 12 weeks free-living closed-loop (n = 32) and 12 weeks SAP (n = 33) periods. We quantified daily patterns of main meals, snacks, prandial insulin boluses, correction boluses, and fingerstick glucose measurements by analyzing data recorded on the study glucometer and on study insulin pump. $\textbf{Results}$: We analyzed 1942 closed-loop days and 2530 SAP days. The total number of insulin boluses was reduced during closed-loop versus SAP periods by mean 1.0 per day (95% confidence interval 0.6–1.4, P < 0.001) mainly because of a reduced number of correction boluses by mean 0.7 per day (0.4–1.0, P < 0.001). Other behavioral patterns were unchanged. The carbohydrate content of snacks but not the number of snacks was positively correlated with (1) glycemic variability as measured by standard deviation of sensor glucose (closed-loop P < 0.05; SAP P < 0.01), (2) mean sensor glucose (P < 0.05), and (3) postintervention HbA1c (P < 0.05). Behavioral patterns explained 47% of between-subject variance in glucose variability during SAP period and 30%–33% of variance of means sensor glucose and postintervention HbA1c. $\textbf{Conclusion}$: Fewer correction boluses are delivered during closed-loop period. The size of snacks appears to worsen glucose control possibly because of carbohydrate-rich content of snacks. Modifiable behavioral patterns may be important determinants of glucose control. ; We acknowledge support by the staff at the Addenbrooke's Wellcome Trust Clinical Research Facility. Josephine Hayes (University of Cambridge) provided administrative support. Karen Whitehead (University of Cambridge) provided laboratory support. We acknowledge support by the staff at Profil Institut, Krisztina Schmitz-Grozs provided support as a research physician, Martina Haase supported the study as an insulin pump expert, and Maren Luebkert, Kirstin Kuschma, and Elke Przetak provided administrative, coordinating, and documentation support. Barbara Semlitsch and Markus Schauer (both from Medical University of Graz) supported the study as insulin pump experts. Funding was by Seventh Framework Programme of the European Union (ICT FP7-247138). Additional support for the Artificial Pancreas work was by JDRF, National Institute for Health Research Cambridge Biomedical Research Centre, Wellcome Strategic Award (100574/Z/12/Z), EC Horizon 2020 (H2020-SC1-731560), NIDDK (DP3DK112176 and 1UC4DK108520-01), Efficacy and Mechanism Evaluation Programme of National Institute for Health Research (14/23/09), and Helmsley Trust (Nos. 2016PG-T1D045 and 2016PG-T1D046). Abbott Diabetes Care supplied discounted continuous glucose monitoring devices, sensors, and communication protocol to facilitate real-time connectivity.
We aimed to evaluate the relationship between insulin pharmacodynamics and glycaemic outcomes during closed-loop insulin delivery and sensor-augmented pump therapy. We retrospectively analysed data from a multicentre randomized control trial involving 32 adults with type 1 diabetes receiving day-and-night closed-loop insulin delivery and sensor-augmented pump therapy over 12 weeks. We estimated time-to-peak insulin action (t$_{max,IA}$) and insulin sensitivity ($_Ix}$) during both interventions, and correlated these with demographic factors and glycaemic outcomes. During both interventions, t$_{max,IA}$ was positively correlated with pre- and post-intervention HbA1c (r = 0.50-0.52, P < .01) and mean glucose (r = 0.45-0.62, P < .05), and inversely correlated with time sensor glucose, which was in target range 3.9 to 10 mmol/L (r = -0.64 to -0.47, P < .05). Increased body mass index was associated with higher t$_{max,I}$ and lower S I (both P < .05). During closed-loop insulin delivery, t$_{max, IA}$, was positively correlated with glucose variability ( P < .05). Faster insulin action is associated with improved glycaemic control during closed-loop insulin delivery and sensor-augmented pump therapy. ; Seventh Framework Programme of the European Union (ICT FP7- 247138). Additional support for the Artificial Pancreas work by JDRF, National Institute for Health Research Cambridge Biomed ical Research Centre and Wellcome Strategic Award (100574/Z/12/Z). Abbott Diabetes Care supplied discounted continuous glucose-monitoring devices, sensors, and communication protocol to facilitate real-time connectivity.
This is an Open Access Paper. It is published by Design Research Society under the Creative Commons Attribution‐NonCommercial 4.0 Unported Licence (CC BY-NC). Full details of this licence are available at: http://creativecommons.org/licenses/by-nc/4.0/ ; In order to alleviate poverty throughout the World government and nongovernment organisations provide aid in the form of essential household products. These products typically include cook stoves, water filters and LED lights. However, evidence suggests that these products are not always suitable for Low Income Economies (LIEs) which has resulted in a number of high profile product failures. In response to the growing need for appropriate New Product Development (NPD), this paper presents the development of a tool to assist industrial designers create appropriate and long lasting solutions for those in poverty. Data was collected from the analysis of existing products, a survey, interviews with NGOs & industrial designers and a field trip to Myanmar. The results were used to identify attributes required for effective, long‐lasting product design. This was used to create a tool for designers which was found to enhance understanding of appropriate NPD for LIEs.
In order to alleviate poverty throughout the World government and non‐ government organisations provide aid in the form of essential household products. These products typically include cook stoves, water filters and LED lights. However, evidence suggests that these products are not always suitable for Low Income Economies (LIEs) which has resulted in a number of high profile product failures. In response to the growing need for appropriate New Product Development (NPD), this paper presents the development of a tool to assist industrial designers create appropriate and long lasting solutions for those in poverty. Data was collected from the analysis of existing products, a survey, interviews with NGOs & industrial designers and a field trip to Myanmar. The results were used to identify attributes required for effective, long‐lasting product design. This was used to create a tool for designers which was found to enhance understanding of appropriate NPD for LIEs.
In order to alleviate poverty throughout the World government and non‐government organisations provide aid in the form of essential household products. These products typically include cook stoves, water filters and LED lights. However, evidence suggests that these products are not always suitable for Low Income Economies (LIEs) which has resulted in a number of high profile product failures. In response to the growing need for appropriate New Product Development (NPD), this paper presents the development of a tool to assist industrial designers create appropriate and long lasting solutions for those in poverty. Data was collected from the analysis of existing products, a survey, interviews with NGOs & industrial designers and a field trip to Myanmar. The results were used to identify attributes required for effective, long‐lasting product design. This was used to create a tool for designers which was found to enhance understanding of appropriate NPD for LIEs.
This research-based book outlines career models for artists, methods of creative engagement, artistic options including individuality and branding, production practices, the realities of being a musician in the new industries, and implications for popular music education. Due to the profound effects of the digitisation of music, the music industries have undergone rapid transformation. The former record label dominated industry has been supplanted by new industries, including digital aggregators, strategists and online platforms. These new music industries now facilitate 'direct' access to both artists and their music. While such accessibility and the potential for artist exposure have never been greater, the challenge to stand out or to even navigate a musical career pathway is formidable. A useful resource for musicians and educators, this text highlights the ways in which the new music industries facilitate increased opportunities for 21st Century popular musicians to collaborate, communicate and interact with others interested in their music. Associate Professor Diane Hughes is a lecturer in Vocal Studies and Music at Macquarie University, Australia. Her research areas include the singing voice, pedagogy, film and sound, recording practices, the music industries, and popular music and song. She is currently the National President of the Australian National Association of Teachers of Singing Ltd. Professor Mark Evans is the Head of the School of Communication at the University of Technology, Sydney, Australia. He is Series Editor for Genre, Music and Sound and is currently Editor for The International Encyclopedia of Film Music and Sound. He holds an Australian Research Council (ARC) grant to design an artistic and environmental map of the Shoalhaven basin in New South Wales, Australia. Dr Guy Morrow is a lecturer in Arts Industries and Management at Macquarie University, Australia. He focuses on understanding how artists are managed, both in terms of direct artist management and also through cultural policies. By examining the relationship between artists and managers, Guy generates core-related insights in the creative industries. He is currently the Secretary of the International Music Business Research Association. Dr Sarah Keith is a lecturer in Music and Media at Macquarie University, Australia. Her research areas includes popular music studies, Korean and Japanese popular music, other East Asian popular musics, the music industries, music and ...
Drawing on the insights of some of the world's leading authorities in public policy analysis, this important book offers a distinct and critical showcase of emerging forms of discovery for policy-making. Chapter by chapter this expert group of social scientists showcase their chosen method or approach, showing the context, the method's key features and how it can be applied in practice, including the scope and limitations of its application and value to policy makers. Arguing that it is not just econometric analysis, cost benefit or surveys that can do policy work, the contributors demonstrate a range of other methods that can provide evidenced-based policy insights and how they can help facilitate progressive policy outcomes. The book will be ideal for upper level undergraduate students as well as Public Policy post-graduates, and can be used as the basis of an intensive learning experience for policy makers
BACKGROUND: Interleukin-2 (IL-2) has an essential role in the expansion and function of CD4+ regulatory T cells (Tregs). Tregs reduce tissue damage by limiting the immune response following infection and regulate autoreactive CD4+ effector T cells (Teffs) to prevent autoimmune diseases, such as type 1 diabetes (T1D). Genetic susceptibility to T1D causes alterations in the IL-2 pathway, a finding that supports Tregs as a cellular therapeutic target. Aldesleukin (Proleukin; recombinant human IL-2), which is administered at high doses to activate the immune system in cancer immunotherapy, is now being repositioned to treat inflammatory and autoimmune disorders at lower doses by targeting Tregs. METHODS AND FINDINGS: To define the aldesleukin dose response for Tregs and to find doses that increase Tregs physiologically for treatment of T1D, a statistical and systematic approach was taken by analysing the pharmacokinetics and pharmacodynamics of single doses of subcutaneous aldesleukin in the Adaptive Study of IL-2 Dose on Regulatory T Cells in Type 1 Diabetes (DILT1D), a single centre, non-randomised, open label, adaptive dose-finding trial with 40 adult participants with recently diagnosed T1D. The primary endpoint was the maximum percentage increase in Tregs (defined as CD3+CD4+CD25highCD127low) from the baseline frequency in each participant measured over the 7 d following treatment. There was an initial learning phase with five pairs of participants, each pair receiving one of five pre-assigned single doses from 0.04 × 106 to 1.5 × 106 IU/m2, in order to model the dose-response curve. Results from each participant were then incorporated into interim statistical modelling to target the two doses most likely to induce 10% and 20% increases in Treg frequencies. Primary analysis of the evaluable population (n = 39) found that the optimal doses of aldesleukin to induce 10% and 20% increases in Tregs were 0.101 × 106 IU/m2 (standard error [SE] = 0.078, 95% CI = -0.052, 0.254) and 0.497 × 106 IU/m2 (SE = 0.092, 95% CI = 0.316, 0.678), respectively. On analysis of secondary outcomes, using a highly sensitive IL-2 assay, the observed plasma concentrations of the drug at 90 min exceeded the hypothetical Treg-specific therapeutic window determined in vitro (0.015-0.24 IU/ml), even at the lowest doses (0.040 × 106 and 0.045 × 106 IU/m2) administered. A rapid decrease in Treg frequency in the circulation was observed at 90 min and at day 1, which was dose dependent (mean decrease 11.6%, SE = 2.3%, range 10.0%-48.2%, n = 37), rebounding at day 2 and increasing to frequencies above baseline over 7 d. Teffs, natural killer cells, and eosinophils also responded, with their frequencies rapidly and dose-dependently decreased in the blood, then returning to, or exceeding, pretreatment levels. Furthermore, there was a dose-dependent down modulation of one of the two signalling subunits of the IL-2 receptor, the β chain (CD122) (mean decrease = 58.0%, SE = 2.8%, range 9.8%-85.5%, n = 33), on Tregs and a reduction in their sensitivity to aldesleukin at 90 min and day 1 and 2 post-treatment. Due to blood volume requirements as well as ethical and practical considerations, the study was limited to adults and to analysis of peripheral blood only. CONCLUSIONS: The DILT1D trial results, most notably the early altered trafficking and desensitisation of Tregs induced by a single ultra-low dose of aldesleukin that resolves within 2-3 d, inform the design of the next trial to determine a repeat dosing regimen aimed at establishing a steady-state Treg frequency increase of 20%-50%, with the eventual goal of preventing T1D. TRIAL REGISTRATION: ISRCTN Registry ISRCTN27852285; ClinicalTrials.gov NCT01827735. ; JDRF (Grant ID: 9-2011-253), Wellcome Trust (Grant IDs: 091157, 089989, 097997/Z/11/Z), National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre, European Union's 7th Framework Programme (FP7/2007-2013) (Grant ID: 241447 (NAIMIT)), Sir Jules Thorn Charitable Trust (Grant ID: 13/JTA), Medical Research Council (Grant ID: G0800860), The Cambridge Institute for Medical Research (CIMR) is in receipt of a Wellcome Trust Strategic Award (Grant ID: 100140) ; This is the final version of the article. It first appeared from the Public Library of Science via http://dx.doi.org/10.1371/journal.pmed.1002139