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OBJECTIVE: The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS: The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS: This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS: This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.

Spinal cord injuries lead to impairment of the central regulation of respiratory muscle activity. This impairs the cough response, which can increase the risk of complications if infected with coronavirus disease 2019. This case describes a 32-yr-old man with an acute traumatic motor incomplete spinal cord injury, C4 American Spinal cord Injury Association Impairment Scale D D, in an inpatient rehabilitation facility who presented with only a fever. Initial infectious workup was negative, and he continued to have elevated temperatures with no other symptoms. He was then tested for coronavirus disease 2019 and found to be positive. This is the first documented case that identifies this potentially lethal disease in an acute motor incomplete spinal cord injury in an inpatient rehabilitation setting. We further discuss how physiatrists need to be aware of milder presentation of coronavirus disease 2019 in patients with spinal cord injuries. Inability to recognize this disease can lead to delayed diagnosis and asymptomatic spread in an inpatient rehabilitation setting.

The theory of finite-rank perturbations allows for the determination of spectral information for broad classes of operators using the tools of analytic function theory. In this work, finite-rank perturbations are applied to powers of the derivative operator, providing a full account from self-adjoint boundary conditions to computing aspects of the operators' matrix-valued spectral measures. In particular, the support and weights of the Clark (spectral) measures are computed via the connection between matrix-valued contractive analytic functions and matrix-valued nonnegative measures through the Herglotz Representation Theorem. For operators associated with several powers of the derivative, explicit formulae for these measures are included. While eigenfunctions and eigenvalues for these operators with fixed boundary conditions can often be computed using direct methods from ordinary differential equations, this approach provides a more complete picture of the spectral information.

We show that all self-adjoint extensions of semi-bounded Sturm--Liouville operators with general limit-circle endpoint(s) can be obtained via an additive singular form bounded self-adjoint perturbation of rank equal to the deficiency indices, say $d\in\{1,2\}$. This characterization generalizes the well-known analog for semi-bounded Sturm--Liouville operators with regular endpoints. Explicitly, every self-adjoint extension of the minimal operator can be written as \begin{align*} \boldsymbol{A}_\Theta=\boldsymbol{A}_0+{\bf B}\Theta{\bf B}^*, \end{align*} where $\boldsymbol{A}_0$ is a distinguished self-adjoint extension and $\Theta$ is a self-adjoint linear relation in $\mathbb{C}^d$. The perturbation is singular in the sense that it does not belong to the underlying Hilbert space but is form bounded with respect to $\boldsymbol{A}_0$, i.e. it belongs to $\mathcal{H}_{-1}(\boldsymbol{A}_0)$. The construction of a boundary triple and compatible boundary pair for the symmetric operator ensure that the perturbation is well-defined and self-adjoint extensions are in a one-to-one correspondence with self-adjoint relations $\Theta$. As an example, self-adjoint extensions of the classical symmetric Jacobi differential equation (which has two limit-circle endpoints) are obtained and their spectra are analyzed with tools both from the theory of boundary triples and perturbation theory., Comment: 29 pages, 1 figure

This study investigated the evolution of physical and technical performances in the English Premier League (EPL), with special reference to league ranking. Match performance observations (n = 14,700) were collected using a multiple-camera computerised tracking system across seven consecutive EPL seasons (2006–07 to 2012–13). Final league rankings were classified into Tiers: (A) 1st–4th ranking (n = 2519), (B) 5th–8th ranking (n = 2965), (C) 9th–14th ranking (n = 4448) and (D) 15th–20th ranking (n = 4768). Teams in Tier B demonstrated moderate increases in high-intensity running distance while in ball possession from the 2006–07 to 2012–13 season (P < 0.001; effect size [ES]: 0.68), with Tiers A, C and D producing less pronounced increases across the same period (P < 0.005; ES: 0.26, 0.41 and 0.33, respectively). Large increases in sprint distance were observed from the 2006–07 to 2012–13 season for Tier B (P < 0.001; ES: 1.21), while only moderate increases were evident for Tiers A, C and D (P < 0.001; ES: 0.75, 0.97 and 0.84, respectively). Tier B demonstrated large increases in the number of passes performed and received in 2012–13 compared to 2006–07 (P < 0.001; ES: 1.32–1.53) with small-to-moderate increases in Tier A (P < 0.001; ES: 0.30–0.38), Tier C (P < 0.001; ES: 0.46–0.54) and Tier D (P < 0.001; ES: 0.69–0.87). The demarcation line between 4th (bottom of Tier A) and 5th ranking (top of Tier B) in the 2006–07 season was 8 points, but this decreased to just a single point in the 2012–13 season. The data demonstrate that physical and technical performances have evolved more in Tier B than any other Tier in the EPL and could indicate a narrowing of the performance gap between the top two Tiers.

Objectives: The aim of this study was to examine the evolution of physical and technical performances in elite soccer. Design: Retrospective study. Methods: Soccer match performance observations (n=14700) collected using a multiple-camera computerized tracking system over seven seasons and controlled for season, phase of season, position and standard were analysed for emergent trends. Results: Total distance covered during a match was ~2% lower in 2006-07 compared to 2012-13. Across seven seasons, high-intensity running distance increased by ~30% (890±299 vs 1151 ± 337 m, p0.6), whereas the number of long passes varied little between seasons (p

Purpose: To investigate match-to-match variability of physical and technical performances in English Premier League players and quantify the influence of positional and contextual factors. Methods: Match data (N = 451) were collected using a multicamera computerized tracking system across multiple seasons (2005–06 to 2012–13). The coefficient of variation (CV) was calculated from match to match for physical and technical performances in selected positions across different match contexts (location, standard, and result). Results: Wide midfielders demonstrated the greatest CVs for total distance (4.9% ± 5.9%) and central midfielders the smallest (3.6% ± 2.0%); nevertheless, all positions exhibited CVs P > .05, effect size [ES] 0.1–0.3). Central defenders demonstrated the greatest CVs and wide midfielders the lowest for both high-intensity running (20.2% ± 8.8% and 13.7% ± 7.7%, P < .05, ES 0.4–0.8) and sprint distance (32.3% ± 13.8% and 22.6% ± 11.2%, P < .05, ES 0.5–0.8). Technical indicators such as tackles (83.7% ± 42.3%), possessions won (47.2% ± 27.9%), and interceptions (59.1% ± 37.3%) illustrated substantial variability for attackers compared with all other positions (P < .05, ES 0.4–1.1). Central defenders demonstrated large variability for the number of times tackled per match (144.9% ± 58.3%) and passes attempted and received compared with other positions (39.2% ± 17.5% and 46.9% ± 20.2%, P < .001, ES 0.6–1.8). Contextual factors had limited impact on the variability of physical and technical parameters. Conclusions: The data demonstrate that technical parameters varied more from match to match than physical parameters. Defensive players (fullbacks and central defenders) displayed higher CVs for offensive technical variables, while attacking players (attackers and wide midfielders) exhibited higher CVs for defensive technical variables. Physical and technical performances are variable per se regardless of context.

In ITER, each heating neutral beam injector (HNB) will deliver about 16.5 MW heating power by accelerating a 40 A deuterium negative ion beam up to the energy of 1 MeV. The ions are generated inside a caesiated negative ion source, where the injected H2/D2 is ionized by a radio frequency electromagnetic field. The SPIDER test bed, currently being manufactured, is going to be the ion source test facility for the full size ion source of the HNBs and of the diagnostic neutral beam injector of ITER. The SPIDER beam source comprises an ion source with 8 radio-frequency drivers and a three-grid system, providing an overall acceleration up to energies of about 100 keV [1]. SPIDER represents a substantial step forward between the half ITER size ion source, which is currently being tested at the ELISE test bed in IPP-Garching, and the negative ion sources to be used on ITER, in terms of layout, dimensions and operating parameters. The SPIDER beam source will be housed inside a vacuum vessel which will be equipped with a beam dump and a graphite diagnostic calorimeter. The manufacturing design of the main parts of the SPIDER beam source has been completed and many of the tests on the prototypes have been successfully passed. The most complex parts, from the manufacturing point of view, of the ion source and the accelerator, developed by galvanic deposition of copper are being manufactured. The manufacturing phase will be completed within 2015, when the assembly of the device will start at the PRIMA site, in Padova (I). The paper describes the status of the procurement, the adaptations operated on the design of the beam source for the fabrication, with particular emphasis to the engineering development to enable the fulfillment of the tight requirements set in the technical specifications. Moreover the tests performed on the prototypes are reported.

This study aimed to investigate position-specific evolution of physical and technical performance parameters in the English Premier League (EPL). Match performance observations (n = 14700) were collected using a multiple-camera computerized tracking system across seven seasons (2006–07 to 2012–13). Data were analyzed relative to five playing positions: central defenders (n = 3792), full backs (n = 3420), central midfielders (n = 3200), wide midfielders (n = 2136) and attackers (n = 2152). High-intensity running distance increased in the final season versus the first season in all playing positions (p < .05, ES: 0.9–1.3) with full backs displaying the greatest increase (∼36% higher in 2012–13). Similar trends were observed for sprint distance with full backs demonstrating the most pronounced increase across the seven seasons (36–63%, p < .001, ES: 0.8–1.3). Central players (central defenders and midfielders) illustrated the most pronounced increases in total passes and pass success rate (p < .05, ES: 0.7–0.9) whilst wide players (full backs and wide midfielders) demonstrated only small-moderate increases in total passes and pass success rate (p < .05, ES: 0.6–0.8). The data demonstrates that evolving tactics in the EPL have impacted on the physical demands of wide players and the technical requirements of central players. These findings could be used for talent identification or position-specific physical and technical training.

It is well established nowadays the benefits that physical activity can have on the health of individuals. Walking is considered a fundamental method of movement and using a backpack is a common and economical manner of carrying load weight. Nevertheless, the shock wave produced by the impact forces when carrying a backpack can have detrimental effects on health status. Therefore, the aim of this study was to investigate differences in the accelerations placed on males and females whilst carrying different loads when walking. Twenty nine sports science students (16 males and 13 females) participated in the study under 3 different conditions: no weight, 10% and 20% body weight (BW) added in a backpack. Accelerometers were attached to the right shank and the centre of the forehead. Results showed that males have lower accelerations than females both in the head (2.62 ± 0.43G compared to 2.83 + 0.47G) and shank (1.37 ± 0.14G compared to 1.52 ± 0.15G; p0.05). The body acts as a natural shock absorber, reducing the amount of force that transmits through the body between the foot (impact point) and head. Anthropometric and body mass distribution differences between males and females may result in women receiving greater impact acceleration compared to men when the same load is carried.

This study investigated the longitudinal match performance characteristics in the English Premier League\ud (EPL), with special reference to player nationality (UK vs. non-UK). Match observations (n = 14700) were\ud 10 collected using a multi-camera computerised tracking system across 7 consecutive EPL seasons (2006–2007 to\ud 2012–2013). Player nationality referred to their birthplace, with players born in England, Scotland, Wales or\ud Northern Ireland classified as the UK players and other nationalities considered non-UK. The non-UK players\ud demonstrated the most pronounced increases in high-intensity running distance across the 7 seasons\ud compared with UK players (P < 0.001, ES: 0.91 vs. 0.73). The UK players covered more high-intensity running\ud 15 distance in 2006–2007 (P < 0.001, ES: 0.24 [CI 0.17–0.31]), however by 2012–2013 both populations covered\ud similar distances (P > 0.05, ES: 0.08 [CI 0.01–0.15]). In contrast, the non-UK players performed more passes in\ud 2006–2007 compared with the UK players (P < 0.001, ES: 0.23 [CI 0.16–0.3]), however by 2012–2013, passing\ud performance between the UK and non-UK players was equal (P > 0.05, ES: 0.05 [CI −0.01–0.13]). The data\ud demonstrates that the longitudinal match performance characteristics in the EPL are similar between the UK\ud 20 and non-UK populations.