Issues of cause and control in patient accounts of Type 2 diabetes

Patients experience considerable difficulties in making and sustaining health-related lifestyle changes. Many Type 2 diabetes patients struggle to follow disease risk-management advice even when they receive extensive information and support. Drawing on a qualitative study of patients with Type 2 diabetes, the paper uses discourse analysis to examine their accounts about disease causation and disease management, and the implications for how they respond to their condition and health services advice. As it is a multifactorial disease, biomedical discourse around Type 2 diabetes is complex. Patients are encouraged to grasp the complicated message that both cause and medical outcomes related to their condition are partly, but not wholly, within their control. Discursive constructions identified from respondent accounts indicate how these two messages are deployed variously by respondents when accounting for disease causation and management. While these constructions (identified in respondent accounts as 'Up to me' and 'Down to them') are a valuable resource for patients, equally they may be deployed in a selective and detrimental way. We conclude that clear messages from health professionals about effective disease management may help patients to position themselves more effectively in relation to their condition. More importantly, they might serve to hinder the availability of inappropriate and potentially harmful patient positions where patients either relinquish responsibility for disease management or reject all input from health professionals. © The Author 2005. Published by Oxford University Press. All rights reserved.

Public ownership and control in the private sector

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Learner centred control in computer based training

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Quality control in Midland industry

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Regularization and complexity control in feed-forward networks

In this paper we consider four alternative approaches to complexity control in feed-forward networks based respectively on architecture selection, regularization, early stopping, and training with noise. We show that there are close similarities between these approaches and we argue that, for most practical applications, the technique of regularization should be the method of choice.

Interocular suppression and contrast gain control in human vision

The human visual system combines contrast information from the two eyes to produce a single cyclopean representation of the external world. This task requires both summation of congruent images and inhibition of incongruent images across the eyes. These processes were explored psychophysically using narrowband sinusoidal grating stimuli. Initial experiments focussed on binocular interactions within a single detecting mechanism, using contrast discrimination and contrast matching tasks. Consistent with previous findings, dichoptic presentation produced greater masking than monocular or binocular presentation. Four computational models were compared, two of which performed well on all data sets. Suppression between mechanisms was then investigated, using orthogonal and oblique stimuli. Two distinct suppressive pathways were identified, corresponding to monocular and dichoptic presentation. Both pathways impact prior to binocular summation of signals, and differ in their strengths, tuning, and response to adaptation, consistent with recent single-cell findings in cat. Strikingly, the magnitude of dichoptic masking was found to be spatiotemporally scale invariant, whereas monocular masking was dependent on stimulus speed. Interocular suppression was further explored using a novel manipulation, whereby stimuli were presented in dichoptic antiphase. Consistent with the predictions of a computational model, this produced weaker masking than in-phase presentation. This allowed the bandwidths of suppression to be measured without the complicating factor of additive combination of mask and test. Finally, contrast vision in strabismic amblyopia was investigated. Although amblyopes are generally believed to have impaired binocular vision, binocular summation was shown to be intact when stimuli were normalized for interocular sensitivity differences. An alternative account of amblyopia was developed, in which signals in the affected eye are subject to attenuation and additive noise prior to binocular combination.

Computer-assisted production scheduling, planning and control in foundries

The present study describes a pragmatic approach to the implementation of production planning and scheduling techniques in foundries of all types and looks at the use of `state-of-the-art' management control and information systems. Following a review of systems for the classification of manufacturing companies, a definitive statement is made which highlights the important differences between foundries (i.e. `component makers') and other manufacturing companies (i.e. `component buyers'). An investigation of the manual procedures which are used to plan and control the manufacture of components reveals the inherent problems facing foundry production management staff, which suggests the unsuitability of many manufacturing techniques which have been applied to general engineering companies. From the literature it was discovered that computer-assisted systems are required which are primarily `information-based' rather than `decision based', whilst the availability of low-cost computers and `packaged-software' has enabled foundries to `get their feet wet' without the financial penalties which characterized many of the early attempts at computer-assistance (i.e. pre-1980). Moreover, no evidence of a single methodology for foundry scheduling emerged from the review. A philosophy for the development of a CAPM system is presented, which details the essential information requirements and puts forward proposals for the subsequent interactions between types of information and the sub-system of CAPM which they support. The work developed was oriented specifically at the functions of production planning and scheduling and introduces the concept of `manual interaction' for effective scheduling. The techniques developed were designed to use the information which is readily available in foundries and were found to be practically successful following the implementation of the techniques into a wide variety of foundries. The limitations of the techniques developed are subsequently discussed within the wider issues which form a CAPM system, prior to a presentation of the conclusions which can be drawn from the study.

A converter compensator for power factor control in 3-phase induction machines

The advent of the harmonic neutralised shunt Converter Compensator as a practical means of reactive power compensation in power transmission systems has cleared ground for wider application of this type of equipment. An experimental 24-pulse voltage sourced convector has been successfully applied in controlling the terminal power factor of a 1.5kW, 240V three phase cage rotor induction motor, whose winding has been used in place of the usual phase shifting transformers. To achieve this, modifications have been made to the conventional stator winding of the induction machine. These include an unconventional phase spread and facilitation of compensator connections to selected tapping points between stator coils to give a three phase winding with a twelve phase connection to the twenty four pulse converter. Theoretical and experimental assessments of the impact of these modifications and attachment of the compensator have shown that there is a slight reduction in the torque developed at a given slip and in the combined system efficiency. There is also an increase in the noise level, also a consequence of the harmonics. The stator leakage inductance gave inadequate coupling reactance between the converter and the effective voltage source, necessitating the use of external inductors in each of the twelve phases. The terminal power factor is fully controllable when the induction machine is used either as a motor or as a generator.

Mode control in multimode optical fibre and its applications

This thesis describes an investigation into methods for controlling the mode distribution in multimode optical fibres. The major contributions presented in this thesis are summarised below. Emerging standards for Gigabit Ethernet transmission over multimode optical fibre have led to a resurgence of interest in the precise control, and specification, of modal launch conditions. In particular, commercial LED and OTDR test equipment does not, in general, comply with these standards. There is therefore a need for mode control devices, which can ensure compliance with the standards. A novel device consisting of a point-load mode-scrambler in tandem with a mode-filter is described in this thesis. The device, which has been patented, may be tuned to achieve a wide range of mode distributions and has been implemented in a ruggedised package for field use. Various other techniques for mode control have been described in this work, including the use of Long Period Gratings and air-gap mode-filters. Some of the methods have been applied to other applications, such as speckle suppression and in sensor technology. A novel, self-referencing, sensor comprising two modal groups in the Mode Power Distribution has been designed and tested. The feasibility of a two-channel Mode Group Diversity Multiplexed system has been demonstrated over 985m. A test apparatus for measuring mode distribution has been designed and constructed. The apparatus consists of a purpose-built video microscope, and comprehensive control and analysis software written in Visual Basic. The system may be fitted with a Silicon camera or an InGaAs camera, for measurement in the 850nm and 130nm transmission windows respectively. A limitation of the measurement method, when applied to well-filled fibres, has been identified and an improvement to the method has been proposed, based on modelled Laguerre Gauss field solutions.

Reaction-driven surface restructuring and selectivity control in allylic alcohol catalytic aerobic oxidation over Pd

Synchronous, time-resolved DRIFTS/MS/XAS cycling studies of the vapor-phase selective aerobic oxidation of crotyl alcohol over nanoparticulate Pd have revealed surface oxide as the desired catalytically active phase, with dynamic, reaction-induced Pd redox processes controlling selective versus combustion pathways.

Value of glycaemic control in diabetes

Full text: Several Lancet publications have questioned the value of glycaemic control in diabetic patients. For example, in their Comment (Sept 29, p 1103),1 John Cleland and Stephen Atkin state that “Improved glycaemic control is not a surrogate for effective care of patients who have diabetes”, and Victor Montori and colleagues (p 1104)2 claim that “HbA1c loses its validity as a surrogate marker when patients have a constellation of metabolic abnormalities”. We are concerned that the reaction against “glucocentricity” in the field of diabetes has gone too far. Even the UK's National Prescribing Centre website, carrying the National Health Service logo, includes comments that undermine the value of glycaemic control. For example, referring to the United Kingdom Prospective Diabetes Study (UKPDS), this site states that “Compared with ‘conventional control’ there was no benefit from tight control of blood glucose with sulphonylureas or insulin with regard to total mortality, diabetes-related death, macrovascular outcomes or microvascular outcomes, including all the most serious ones such as blindness or kidney failure”.3 It is well established that better glycaemic control reduces long-term microvascular complications in type 1 and type 2 diabetes.4 In type 2 diabetes, the UKPDS reported that a composite microvascular endpoint (retinopathy requiring photocoagulation, vitreous haemorrhage, and fatal or non-fatal renal failure) was reduced by 25% in patients randomised to intensive glucose control (p=0·0099).4 To imply that these are not patient-relevant outcomes is to distort the evidence. Many studies have also found that improved glycaemic control reduces macrovascular complications.5 Do not be misled: glycaemic control remains a crucial component in the care of people with diabetes. The authors have received research support and undertaken ad hoc consultancies and speaker engagements for several pharmaceutical companies.