Automatic physical activity pattern recognition and meal intake modelling in type 1 diabetes for their inclusion in artificial pancreas systems

La diabetes comprende un conjunto de enfermedades metabólicas que se caracterizan por concentraciones de glucosa en sangre anormalmente altas. En el caso de la diabetes tipo 1 (T1D, por sus siglas en inglés), esta situación es debida a una ausencia total de secreción endógena de insulina, lo que impide a la mayoría de tejidos usar la glucosa. En tales circunstancias, se hace necesario el suministro exógeno de insulina para preservar la vida del paciente; no obstante, siempre con la precaución de evitar caídas agudas de la glucemia por debajo de los niveles recomendados de seguridad. Además de la administración de insulina, las ingestas y la actividad física son factores fundamentales que influyen en la homeostasis de la glucosa. En consecuencia, una gestión apropiada de la T1D debería incorporar estos dos fenómenos fisiológicos, en base a una identificación y un modelado apropiado de los mismos y de sus sorrespondientes efectos en el balance glucosa-insulina. En particular, los sistemas de páncreas artificial –ideados para llevar a cabo un control automático de los niveles de glucemia del paciente– podrían beneficiarse de la integración de esta clase de información. La primera parte de esta tesis doctoral cubre la caracterización del efecto agudo de la actividad física en los perfiles de glucosa. Con este objetivo se ha llevado a cabo una revisión sistemática de la literatura y meta-análisis que determinen las respuestas ante varias modalidades de ejercicio para pacientes con T1D, abordando esta caracterización mediante unas magnitudes que cuantifican las tasas de cambio en la glucemia a lo largo del tiempo. Por otro lado, una identificación fiable de los periodos con actividad física es un requisito imprescindible para poder proveer de esa información a los sistemas de páncreas artificial en condiciones libres y ambulatorias. Por esta razón, la segunda parte de esta tesis está enfocada a la propuesta y evaluación de un sistema automático diseñado para reconocer periodos de actividad física, clasificando su nivel de intensidad (ligera, moderada o vigorosa); así como, en el caso de periodos vigorosos, identificando también la modalidad de ejercicio (aeróbica, mixta o de fuerza). En este sentido, ambos aspectos tienen una influencia específica en el mecanismo metabólico que suministra la energía para llevar a cabo el ejercicio y, por tanto, en las respuestas glucémicas en T1D. En este trabajo se aplican varias combinaciones de técnicas de aprendizaje máquina y reconocimiento de patrones sobre la fusión multimodal de señales de acelerometría y ritmo cardíaco, las cuales describen tanto aspectos mecánicos del movimiento como la respuesta fisiológica del sistema cardiovascular ante el ejercicio. Después del reconocimiento de patrones se incorpora también un módulo de filtrado temporal para sacar partido a la considerable coherencia temporal presente en los datos, una redundancia que se origina en el hecho de que en la práctica, las tendencias en cuanto a actividad física suelen mantenerse estables a lo largo de cierto tiempo, sin fluctuaciones rápidas y repetitivas. El tercer bloque de esta tesis doctoral aborda el tema de las ingestas en el ámbito de la T1D. En concreto, se propone una serie de modelos compartimentales y se evalúan éstos en función de su capacidad para describir matemáticamente el efecto remoto de las concetraciones plasmáticas de insulina exógena sobre las tasas de eleiminación de la glucosa atribuible a la ingesta; un aspecto hasta ahora no incorporado en los principales modelos de paciente para T1D existentes en la literatura. Los datos aquí utilizados se obtuvieron gracias a un experimento realizado por el Institute of Metabolic Science (Universidad de Cambridge, Reino Unido) con 16 pacientes jóvenes. En el experimento, de tipo ‘clamp’ con objetivo variable, se replicaron los perfiles individuales de glucosa, según lo observado durante una visita preliminar tras la ingesta de una cena con o bien alta carga glucémica, o bien baja. Los seis modelos mecanísticos evaluados constaban de: a) submodelos de doble compartimento para las masas de trazadores de glucosa, b) un submodelo de único compartimento para reflejar el efecto remoto de la insulina, c) dos tipos de activación de este mismo efecto remoto (bien lineal, bien con un punto de corte), y d) diversas condiciones iniciales. ABSTRACT Diabetes encompasses a series of metabolic diseases characterized by abnormally high blood glucose concentrations. In the case of type 1 diabetes (T1D), this situation is caused by a total absence of endogenous insulin secretion, which impedes the use of glucose by most tissues. In these circumstances, exogenous insulin supplies are necessary to maintain patient’s life; although caution is always needed to avoid acute decays in glycaemia below safe levels. In addition to insulin administrations, meal intakes and physical activity are fundamental factors influencing glucose homoeostasis. Consequently, a successful management of T1D should incorporate these two physiological phenomena, based on an appropriate identification and modelling of these events and their corresponding effect on the glucose-insulin balance. In particular, artificial pancreas systems –designed to perform an automated control of patient’s glycaemia levels– may benefit from the integration of this type of information. The first part of this PhD thesis covers the characterization of the acute effect of physical activity on glucose profiles. With this aim, a systematic review of literature and metaanalyses are conduced to determine responses to various exercise modalities in patients with T1D, assessed via rates-of-change magnitudes to quantify temporal variations in glycaemia. On the other hand, a reliable identification of physical activity periods is an essential prerequisite to feed artificial pancreas systems with information concerning exercise in ambulatory, free-living conditions. For this reason, the second part of this thesis focuses on the proposal and evaluation of an automatic system devised to recognize physical activity, classifying its intensity level (light, moderate or vigorous) and for vigorous periods, identifying also its exercise modality (aerobic, mixed or resistance); since both aspects have a distinctive influence on the predominant metabolic pathway involved in fuelling exercise, and therefore, in the glycaemic responses in T1D. Various combinations of machine learning and pattern recognition techniques are applied on the fusion of multi-modal signal sources, namely: accelerometry and heart rate measurements, which describe both mechanical aspects of movement and the physiological response of the cardiovascular system to exercise. An additional temporal filtering module is incorporated after recognition in order to exploit the considerable temporal coherence (i.e. redundancy) present in data, which stems from the fact that in practice, physical activity trends are often maintained stable along time, instead of fluctuating rapid and repeatedly. The third block of this PhD thesis addresses meal intakes in the context of T1D. In particular, a number of compartmental models are proposed and compared in terms of their ability to describe mathematically the remote effect of exogenous plasma insulin concentrations on the disposal rates of meal-attributable glucose, an aspect which had not yet been incorporated to the prevailing T1D patient models in literature. Data were acquired in an experiment conduced at the Institute of Metabolic Science (University of Cambridge, UK) on 16 young patients. A variable-target glucose clamp replicated their individual glucose profiles, observed during a preliminary visit after ingesting either a high glycaemic-load or a low glycaemic-load evening meal. The six mechanistic models under evaluation here comprised: a) two-compartmental submodels for glucose tracer masses, b) a single-compartmental submodel for insulin’s remote effect, c) two types of activations for this remote effect (either linear or with a ‘cut-off’ point), and d) diverse forms of initial conditions.

Natural regeneration in mediterranean mixed forests: effect of environmental conditions on the physiological optimum niche of the species = Regeneración natural en masas mixtas mediterráneas: efecto de las condiciones ambientales en el nicho óptimo fisiológico de las especies

Los montes Mediterráneos han experimentado múltiples cambios en las últimas décadas (tanto en clima como en usos), lo que ha conducido a variaciones en la distribución de especies. El aumento previsto de las temperaturas medias junto con la mayor variabilidad intra e inter anual en cuanto a la ocurrencia de eventos extremos o disturbios naturales (como periodos prolongados de sequía, olas de frío o calor, incendios forestales o vendavales) pueden dañar significativamente al regenerado, llevándolo hasta la muerte, y jugando un papel decisivo en la composición de especies y en la dinámica del monte. La amplitud ecológica de muchas especies forestales puede verse afectada, de forma que se esperan cambios en sus nichos actuales de regeneración. Sin embargo, la migración latitudinal de las especies en busca de mejores condiciones, podría ser una explicación demasiado simplista de un proceso mucho más complejo de interacción entre la temperatura y la precipitación, que afectaría a cada especie de un modo distinto. En este sentido tanto la capacidad de adaptación al estrés ambiental de una determinada especie, así como su habilidad para competir por los recursos limitados, podría significar variaciones dentro de una comunidad. Las características fisiológicas y morfológicas propias de cada especie se encuentran fuertemente relacionadas con el lugar donde cada una puede surgir, qué especies pueden convivir y como éstas responden a las condiciones ambientales. En este sentido, el conocimiento sobre las distintas respuestas ecofisiológicas observadas ante cambios ambientales puede ser fundamentales para la predicción de variaciones en la distribución de especies, composición de la comunidad y productividad del monte ante el cambio global. En esta tesis investigamos el grado de tolerancia y sensibilidad que cada una de las tres especies de estudio, coexistentes en el interior peninsular ibérico (Pinus pinea, Quercus ilex y Juniperus oxycedrus), muestra ante los factores abióticos de estrés típicos de la región Mediterránea. Nuestro trabajo se ha basado en la definición del nicho óptimo fisiológico para el regenerado de cada especie a través de la investigación en profundidad del efecto de la sequía, la temperatura y el ambiente lumínico. Para ello, hemos desarrollado un modelo de predicción de la tasa de asimilación de carbono que nos ha permitido identificar las condiciones óptimas ambientales donde el regenerado de cada especie podría establecerse con mayor facilidad. En apoyo a este trabajo y con la idea de estudiar el efecto de la sequía a nivel de toda la planta hemos desarrollado un experimento paralelo en invernadero. Aquí se han aplicado dos regímenes hídricos para estudiar las características fisiológicas y morfológicas de cada especie, sobre todo a nivel de raíz y crecimiento del tallo, y relacionarlas con las diferentes estrategias en el uso del agua de las especies. Por último, hemos estudiado los patrones de aclimatación y desaclimatación al frio de cada especie, identificando los periodos de sensibilidad a heladas, así como cuellos de botella donde la competencia entre especies podría surgir. A pesar de que el pino piñonero ha sido la especie objeto de la gestión de estas masas durante siglos, actualmente se encuentra en la posición más desfavorable para combatir el cambio global, presentado el nicho fisiológico más estrecho de las tres especies. La encina sin embargo, ha resultado ser la especie mejor cualificada para afrontar este cambio, seguida muy de cerca por el enebro. Nuestros resultados sugieren una posible expansión en el rango de distribución de la encina, un aumento en la presencia del enebro y una disminución progresiva del pino piñonero a medio plazo en estas masas. ABSTRACT Mediterranean forests have undergone multiple changes over the last decades (in both climate and land use), which have lead to variations in the distribution of species. The expected increase in mean annual temperature together with the greater inter and intra-annual variability in extreme events and disturbances occurrence (such as prolonged drought periods, cold or heat waves, wildfires or strong winds) can significantly damage natural regeneration, up to causing death, playing a decisive role on species composition and forest dynamics. The ecological amplitude for adaptation of many species can be affected in such a way that changes in the current regeneration niches of many species are expected. However, the forecasted poleward migration of species seeking better conditions could be an oversimplification of what is a more complex phenomenon of interactions among temperature and precipitation, that would affect different species in different ways. In this regard, either the ability to adapt to environmental stresses or to compete for limited resources of a single species in a mixed forest could lead to variations within a community. The ecophysiological and morphological traits specific to each species are strongly related to the place where each species can emerge, which species can coexist, and how they respond to environmental conditions. In this regard, the understanding of the ecophysiological responses observed against changes in environmental conditions can be essential for predicting variations in species distribution, community composition, and forest productivity in the context of global change. In this thesis we investigated the degree of tolerance and sensitivity that each of the three studied species, co-occurring in central of the Iberian Peninsula (Pinus pinea, Quercus ilex and Juniperus oxycedrus), show against the typical abiotic stress factors in the Mediterranean region. Our work is based on the optimal physiological niche for regeneration of each species through in-depth research on the effect of drought, temperature and light environment. For this purpose, we developed a model to predict the carbon assimilation rate which allows us to identify the optimal environmental conditions where regeneration from each species could establish itself more easily. To obtain a better understanding about the effect of low temperature on regeneration, we studied the acclimation and deacclimation patterns to cold of each species, identifying period of frost sensitivity, as well as bottlenecks where competition between species can arise. Finally, to support our results about the effect of water availabilty, we conducted a greenhouse experiment with a view of studying the drought effect at the whole plant level. Here, two watering regimes were applied in order to study the physiological and morphological traits of each species, mainly at the level of the root system and stem growth, and so relate them to the different water use strategies of the species. Despite the fact that stone pine has been the target species for centuries, nowadays this species is in the most unfavorable position to cope with climate change. Holm oak, however, resulted the species that is best adapted to tolerate the predicted changes, followed closely by prickly juniper. Our results suggest a feasible expansion of the distribution range in holm oak, an increase in the prickly juniper presence and a progressive decreasing of stone pine presence in the medium term in these stone pine-holm oak-prickly juniper mixed forests.

Some recent applications of non-linear models to the engineering practice

The Department of Structural Analysis of the University of Santander has been for a longtime involved in the solution of the country´s practical engineering problems. Some of these have required the use of non-conventional methods of analysis, in order to achieve adequate engineering answers. As an example of the increasing application of non-linear computer codes in the nowadays engineering practice, some cases will be briefly presented. In each case, only the main features of the problem involved and the solution used to solve it will be shown

Study of the influence of actin-binding proteins using linear analyses of cell deformability

The actin cytoskeleton plays a key role in the deformability of the cell and in mechanosensing. Here we analyze the contributions of three major actin cross-linking proteins, myosin II, a-actinin and filamin, to cell deformability, by using micropipette aspiration of Dictyostelium cells. We examine the applicability of three simple mechanical models: for small deformation, linear viscoelasticity and drop of liquid with a tense cortex; and for large deformation, a Newtonian viscous fluid. For these models, we have derived linearized equations and we provide a novel, straightforward methodology to analyze the experiments. This methodology allowed us to differentiate the effects of the cross-linking proteins in the different regimes of deformation. Our results confirm some previous observations and suggest important relations between the molecular characteristics of the actin-binding proteins and the cell behavior: the effect of myosin is explained in terms of the relation between the lifetime of the bond to actin and the resistive force; the presence of a-actinin obstructs the deformation of the cytoskeleton, presumably mainly due to the higher molecular stiffness and to the lower dissociation rate constants; and filamin contributes critically to the global connectivity of the network, possibly by rapidly turning over crosslinks during the remodeling of the cytoskeletal network, thanks to the higher rate constants, flexibility and larger size. The results suggest a sophisticated relationship between the expression levels of actinbinding proteins, deformability and mechanosensing.

Analysis of linear trade models and relation to scale economies

We discuss linear Ricardo models with a range of parameters. We show that the exact boundary of the region of equilibria of these models is obtained by solving a simple integer programming problem. We show that there is also an exact correspondence between many of the equilibria resulting from families of linear models and the multiple equilibria of economies of scale models.

Revisiting the effect of foundation embedment on elastic settlement: A new approach

The effect of foundation embedment on settlement calculation is a widely researched topic in which there is no scientific consensus regarding the magnitude of settlement reduction. In this paper, a non-linear three dimensional Finite Element analysis has been performed with the aim of evaluating the aforementioned effect. For this purpose, 1800 models were run considering different variables, such as the depth and dimensions of the foundation and the Young’s modulus and Poisson’s ratio of the soil. The settlements from models with foundations at surface level and at depth were then compared and the relationship between them established. The statistical analysis of this data allowed two new expressions, with a mean maximum error of 1.80%, for the embedment influence factor of a foundation to be proposed and these to be compared with commonly used corrections. The proposed equations were validated by comparing the settlements calculated with the proposed influence factors and the true settlements measured in several real foundations. From the comprehensive study of all modelled cases, an improved approach, when compared to those proposed by other authors, for the calculation of the true elastic settlements of an embedded foundation is proposed.

No effect of unemployment on intimate partner-related femicide during the financial crisis: a longitudinal ecological study in Spain

Background: Spain’s financial crisis has been characterized by an increase in unemployment. This increase could have produced an increase in deaths of women due to intimate partner-related femicides (IPF). This study aims to determine whether the increase in unemployment among both sexes in different regions in Spain is related to an increase in the rates of IPF during the current financial crisis period. Methods: An ecological longitudinal study was carried out in Spain’s 17 regions. Two study periods were defined: pre-crisis period (2005–2007) and crisis period (2008–2013). IPF rates adjusted by age and unemployment rates for men and women were calculated. We fitted multilevel linear regression models in which observations at level 1 were nested within regions according to a repeated measurements design. Results: Rates of unemployment have progressively increased in Spain, rising above 20 % from 2008 to 2013 in some regions. IPF rates decreased in some regions during crisis period with respect to pre-crisis period. The multilevel analysis does not support the existence of a significant relationship between the increase in unemployment in men and women and the decrease in IPF since 2008. Discussion: The increase in unemployment in men and women in Spain does not appear to have an effect on IPF. The results of the multilevel analysis discard the hypothesis that the increase in the rates of unemployment in women and men are related to an increase in IPF rates. Conclusions: The decline in IPF since 2008 might be interpreted as the result of exposure to other factors such as the lower frequency of divorces in recent years or the medium term effects of the integral protection measures of the law on gender violence that began in 2005.

The effect of extreme cold temperatures on the risk of death in the two major Portuguese cities

It is well known that meteorological conditions influence the comfort and human health. Southern European countries, including Portugal, show the highest mortality rates during winter, but the effects of extreme cold temperatures in Portugal have never been estimated. The objective of this study was the estimation of the effect of extreme cold temperatures on the risk of death in Lisbon and Oporto, aiming the production of scientific evidence for the development of a real-time health warning system. Poisson regression models combined with distributed lag non-linear models were applied to assess the exposure-response relation and lag patterns of the association between minimum temperature and all-causes mortality and between minimum temperature and circulatory and respiratory system diseases mortality from 1992 to 2012, stratified by age, for the period from November to March. The analysis was adjusted for over dispersion and population size, for the confounding effect of influenza epidemics and controlled for long-term trend, seasonality and day of the week. Results showed that the effect of cold temperatures in mortality was not immediate, presenting a 1–2-day delay, reaching maximumincreased risk of death after 6–7 days and lasting up to 20–28 days. The overall effect was generally higher and more persistent in Lisbon than in Oporto, particularly for circulatory and respiratory mortality and for the elderly. Exposure to cold temperatures is an important public health problem for a relevant part of the Portuguese population, in particular in Lisbon.

Masking odour when regrouping rabbit does: Effect on aggression, stress and lesions.

Regrouping female rabbits (Oryctolagus cuniculus) in group housing systems is a common management practice in Swiss rabbit breeding which may, however, induce agonistic interactions resulting in social stress and severe lesions. On farms using artificial insemination, does are usually kept singly for 12 days after parturition to avoid pseudopregnancy and fighting for nests. The integration of new group members usually occurs after this isolation phase. This study was conducted with 128 gravid does of the Hycole hybrid, housed in pens covering a floor area of 5.7 m2 that was bedded with straw and furnished with elevated areas, hiding places and eight compartments with nest boxes. In the experiment, the fur of 16 groups of 8 does each was sprayed with either alcohol or vinegar to mask the pre-existing group odours, or with water (control groups) shortly before regrouping. Lesion scores, stress parameters (body temperature and blood glucose level) and behaviour were assessed before and after the isolation phase. Effects of treatment and time on all collected parameters were analysed using mixed models. On the second day after regrouping 43% of the does showed new lesions. In the first five days after regrouping, new lesions occurred in 60% of the does; 32% had severe lesions. After regrouping, more agonistic interactions were observed and body temperature and blood glucose levels were higher than before regrouping (P<0.001 each). Body temperature increased less in groups treated with vinegar compared to the other two treatments on the first day after regrouping (P=0.017). In all other parameters no influence of the treatment with alcohol or vinegar was found. These findings suggest that masking the group odours with alcohol or vinegar had little effect on lesions, stress and agonistic interactions. Therefore, alternative management procedures need to be developed to reduce lesions and stress caused by aggressive behaviour.

Effect of the initial acceleration upon the wave resistance of ship models / by John V. Wehausen.

Mode of access: Internet.

Regional adjustments in grain production : a linear programming analysis : mathematical models, proofs, methods of data collection and estimation, and supplementary tables /

Cover title.

The effect of linear loading capacitances upon the switching transient of colemanite.

"NAVORD report 5922, NOLC report 413."

Effect of mutual coupling on the interference rejection capabilities of linear and circular arrays in CDMA systems

This paper is concerned with assessing the interference rejection capabilities of linear and circular array of dipoles that can be part of a base station of a code-division multiple-access cellular communication system. The performance criteria for signal-to-interference ratio (SIR) improvement employed in this paper is the spatial interference suppression coefficient. We first derive an expression for this figure of merit and then analyze and compare the SIR performance of the two types of arrays. For a linear array, we quantitatively assess the degradation in SIR performance, as we move from array broadside to array end-fire direction. In addition, the effect of mutual coupling is taken into account.

Frequency and temporal effects in linear optical quantum computing

Typically linear optical quantum computing (LOQC) models assume that all input photons are completely indistinguishable. In practice there will inevitably be nonidealities associated with the photons and the experimental setup which will introduce a degree of distinguishability between photons. We consider a nondeterministic optical controlled-NOT gate, a fundamental LOQC gate, and examine the effect of temporal and spectral distinguishability on its operation. We also consider the effect of utilizing nonideal photon counters, which have finite bandwidth and time response.