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Background: Attaining optimal glucose control in type 2 diabetes (T2DM) is essential to minimise complications, but difficult to achieve in practice with declining β-cell function in patients. Aim: To evaluate the efficacy and feasibility of a protocol-led, treat-to-target approach emphasising earlier oral hypoglycaemic agent (OHA) combination and insulin use to target basal and prandial glucose in primary care. Methods: T2DM patients aged 40-75 years, with glycosylated haemoglobin (HbA_1C) 6.4-10.0% on diet or oral monotherapy in 7 practices were asked to participate in a protocol-led, target-driven programme of care using early OHA and insulin therapy combinations to target basal and prandial glucose. Recruited patients were randomised to pre-specified algorithms with monthly therapy adjustment aiming for fasting plasma glucose values (FPG) <6mmol/L and 2-hour post-prandial (PPG) <8mmol/L. Isophane or humalog insulin was added where glucose targets were not attained. All patients were reviewed at one year. Glucose, weight and cardiovascular (CVS) risk factor outcomes were measured and the feasibility, acceptability and safety of the programme evaluated with validated questionnaires. Results: 345 patients were studied. 60 participated in the glucose study and 285 received standard care. 65% of recruited patients were male, with mean (SD) age 61.0 (8.2) years, BMI 29.8 (5.3) kg/m2, HbA_1C 7.5 (0.9)% and median (IQR) T2DM duration 3 (1-5) years. 41 completed the study. Glucose control was significantly improved in recruited compared to non-recruited patients with a mean overall 0.8% HbA_1C reduction and 72% patients achieving HbA_1C<7% and 64% <6.5% at 1 year. Therapy use was also significantly increased with 50% requiring 3 therapies, 30% 2 and 10% monotherapy. 24 (59%) of recruited patients received isophane and 16 (39%) humalog to achieve targets. Glucose optimisation was achieved without significant hypoglycaemia or adverse events and patient quality of life (QoL) and therapy satisfaction remained high. CVS risk was reduced in recruited patients. Conclusions: A more structured, target-driven approach to glucose optimisation can successfully achieve normoglycaemia in a selected primary care T2DM population without significant adverse events, hypoglycaemia. or QoL impairment in patients. A principal barrier to wider implementation of this programme appears to be practice and patient participation.

Naturally occurring pressure fluctuations have been observed in two-phase flows by a number of researchers for example Matsui [1984]. This thesis investigates the nature of these pressure fluctuations within vertically upward bubbly two-phase flows with a view to developing a novel non-intrusive pressure correlation technique for use downhole to monitor the area average dispersed phase velocity, Vg. To date non-intrusive correlation flow monitoring techniques suitable for use downhole exhibit a non-uniform field sensitivity characteristic which when correlated between two points reflects the velocity of the dispersed phase within the stronger sensing region. Four sources of pressure fluctuations were Identified In the present study, these being temporal variations in the average gas void fraction a(t), variations in the convected pressure field surrounding a moving bubble, turbulence generated by the wake of a bubble and background turbulence in the continuous phase. Magnitudes and structure length scales of these pressure sources were evaluated differentially at two points in a continuous fluid using simple models and it was found that pressure fluctuations associated with a bubbles motion close to the measurement points dominate the pressure signal. It was also found that the magnitude of pressure fluctuations associated with a bubble's motion decreases rapidly with increasing distance from the bubble and the structure length scale caused by this effect Is of the order of the tapping separation distance. Using numerical simulation techniques and a recirculating air/water flow loop with a test section diameter of 77.8mm, (both of which were developed in this thesis) differential pressure fluctuations generated by an upwardly flowing bubbly two-phase flow w ere studied. Superficial gas and liquid velocities up to 0.35m/s and 1.5m/s respectively and-. average gas void fractions up to 25% were covered. It was concluded that pressure fluctuations caused by bubble motion near the pipe wall dominate the differential pressure signal. The autocorrelogram of these signals is considered to be related to the bubble velocity within the entrapped bubble layer near the pipe wall, which are observed to travel at an almost constant velocity independent of the continuous phase velocity. Cross correlation of two pressure signals are indicated to be related to the convected bubble velocity of bubbles outside the entrapped bubble layer which is related to Vg.

Each winter, Britain spends up to £120 million spreading approximately 2 million tonnes of rock salt on our roads to keep them free of ice and snow. This thesis shows that it would be possible to significantly reduce the amount of salt spread, by improving the accuracy of the Road Danger Warnings issued to Highway Authorities. Each day in winter, the maintenance engineer receives a Road Danger Warning from his local weather centre. Unfortunately these Warnings are not very accurate because they are based on forecasts of minimum air temperature alone, rather than using road surface temperatures. During the winter of 1982/83, of 102 Road Danger Warnings issued to Hereford and Worcester County Council, only 32 were correct in predicting icy conditions on the MS motorway. This thesis presents a computer model to predict ice formation on roads up to 24 hours ahead. During the winter of 1978/79 instruments were installed in the M4 motorway to measure road surface temperature and wetness. The computer model has been tested retrospectively for 30 nights when the road surface temperature fell below 5°C. The predicted minimum road surface temperature has a root mean square error of 0.9°C. During the winters of 1982/83 and 1983/84, the model was tested in 'real time' against road surface temperatures measured automatically on the M5 and M6 motorways, giving a root mean square error of 1.5°C for 80 nights during 1.982/83, and 1.3°c for 120 nights during 1983/84. The form of the issued Road Danger Warnings has been changed from a simple sentence issued over the telephone or using telex, to a graph of predicted road surface temperature and wetness. An optimistic and a pessimistic graph is issued to give the maintenance engineer an idea of the certainty of the forecast. The thesis proposes a national network of automatic road surface monitoring sites. Each site would be linked to microcomputers in local weather centres, which would then run the prediction model and issue Road Danger Warnings accordingly. The information could then be sent to maintenance engineers using Prestel.

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The use of optical techniques in biomedical monitoring and diagnosis is becoming increasingly widespread, primarily because of the non-invasive nature of optically derived measurements. Physiological analysis is usually achieved by characterisation of the spectral or temporal properties of the interaction between light and the anatomy. Although some optical measurements require complex instrumentation and protocols, recent technological advances have resulted in robust and compact equipment that is now used routinely in a multitude of clinical contexts. Unfortunately, these measurements are inherently sensitive to corruption from dynamic physical conditions or external sources of light, inducing signal artefact. Artefact is the primary restriction in the applicability of many optical measurements, especially for ambulatory monitoring and tele-medicine. The most widely used optical measurement is photoplethysmography, a technique that registers dynamic changes in blood volume throughout the peripheral vasculature and can be used to screen for a number of venous disorders, as well as monitoring the cardio-vascular pulse wave. Although photoplethysmographic devices are now incorporated into many patient-monitoring systems, the prevalent application is a measurement known as pulse oximetry, which utilises spectral analysis of the peripheral blood to estimate the arterial haernoglobin oxygen saturation. Pulse oximetry is well established as an early warning for hypoxia and is now mandatory under anaesthesia in many countries. The problem of artefact is prominent in these continuous monitoring techniques, where it is often impossible to control the physical conditions during use. This thesis investigates the possibility of reducing artefact corruption of photoplethysmographic signals in real time, using an electronic processing methodology that is based upon inversion of a physical artefact model. The consequences of this non-linear artefact reduction technique for subsequent signal analysis are discussed, culminating in a modified formulation for pulse oximetry that not only has reduced sensitivity to artefact but also possesses increased generality. The design and construction of a practical electronic system is then used to explore both the implementation issues and the scope of this technique. The performance of artefact reduction obtained is then quantified under realistic experimental conditions, demonstrating that this methodology is successful in removing or reducing a large proportion of artefact encountered in clinically relevant situations. It is concluded that non-linear artefact reduction can be applied to any photoplethysmographic technology, reducing interpretation inaccuracies that would otherwise be induced by signal artefact. It is also speculated that this technology could enable the use of photoplethysmographic systems in applications that are currently precluded by the inherent severity of artefact.

Many cities in North America have stated goals in their Official Plans, Transportation Plans, and other municipal documents related to cycling. A common objective is to increase the number and proportion of cyclists for either utilitarian or both utilitarian and recreational trips. To determine whether they are progressing towards achieving their goals, it is necessary that cities periodically and accurately monitor and measure their levels of cycling. This thesis aims to assess the different methods used for monitoring cycling in Canadian cities, as well as individual cities’ overall monitoring programs. The advantages and disadvantages of different methodologies and technologies are discussed, and best practices are provided. Four case study cities: Vancouver, Halifax, Calgary and Toronto are assessed according to a list of best practices developed by Hudson et al. (2010). Themes and patterns emerge and the cities are compared and contrasted. A summary of Canadian cities’ efforts is presented and the cities are ranked in the following order: #1 Vancouver; #2 Toronto; #3 Calgary; and #4 Halifax. In addition, the results of two surveys from the Greater Toronto and Hamilton Area are compared at the census tract (CT) level to assess their reliability. The Bicycling Share of Work Trips (BSWT) from the Transportation Tomorrow Survey (TTS) and Statistics Canada’s Canadian Census (the Census) is examined to identify whether research from different sources is producing the same results. Geographic Information Systems are used to examine and compare the spatial patterns of the survey results and descriptive statistics are used to quantify the differences. It was found that the surveys are producing significantly different results and that there appears to be little spatial pattern in the difference between them. This research allows Canadian cities and other interested parties to learn about the various methods for monitoring cycling, to see which methods are being used in Canadian cities, to decide which methods are best for their specific needs, and to more comprehensively understand the BSWT from the Census and the TTS.

Thesis (M.S.)--University of Hawaii at Manoa, 2005. / Includes bibliographical references (leaves 88-90). / xii, 90 leaves, bound ill. (some col.) 29 cm