Incorporating an Exercise Detection,Grading, and Hormone Dosing Algorithm Into the Artificial Pancreas Using Accelerometry and Heart Rate

In this article, we present several important contributions necessary for enabling an artificial endocrine pancreas (AP) system to better respond to exercise events. First, we show how exercise can be automatically detected using body-worn accelerometer and heart rate sensors. During a 22 hour overnight inpatient study, 13 subjects with type 1 diabetes wearing a Zephyr accelerometer and heart rate monitor underwent 45 minutes of mild aerobic treadmill exercise while controlling their glucose levels using sensor-augmented pump therapy. We used the accelerometer and heart rate as inputs into a validated regression model. Using this model, we were able to detect the exercise event with a sensitivity of 97.2% and a specificity of 99.5%. Second, from this same study, we show how patients’ glucose declined during the exercise event and we present results from in silico modeling that demonstrate how including an exercise model in the glucoregulatory model improves the estimation of the drop in glucose during exercise. Last, we present an exercise dosing adjustment algorithm and describe parameter tuning and performance using an in silico glucoregulatory model during an exercise event.     

Efficacy of a beta-lactamase inhibitor combination for serious intraabdominal infections.

A double-blind trial was conducted in 385 patients with suspected bacterial intra-abdominal infections to compare the efficacy and safety of ampicillin-sulbactam with cefoxitin. Patients were randomized to receive either 3 g ampicillin-sulbactam (2 g ampicillin-1 g sulbactam), or 2 g cefoxitin, every 6 hours. To be evaluable, patients had to demonstrate positive culture evidence of peritoneal infection at the time of operation. A total of 197 patients were evaluable for clinical efficacy. The two treatment groups were comparable in demographic features and in the presence of risk factors for infection. Clinical success (absence of infection and of adverse drug reaction) was observed in 86% of patients in the ampicillin-sulbactam group and 78% in the cefoxitin group. Eradication of infection occurred in 88% of the ampicillin-sulbactam group and 79% of the cefoxitin group. There were no differences in the nature or frequency of side effects observed in the two groups. Ampicillin-sulbactam demonstrated no difference in safety or efficacy when compared with cefoxitin in the treatment of serious intra-abdominal infections of bacterial origin.     

Prospective evaluation of abdominal sonography for the diagnosis of bowel obstruction.

OBJECTIVE: The authors determined the utility of sonography compared with plain x-rays in the diagnosis of bowel obstruction. In a contemporaneous group of patients, they compared the cost of operative versus nonoperative management of small bowel obstruction. SUMMARY BACKGROUND DATA: Nonoperative treatment of simple bowel obstruction usually succeeds. However, because of the difficulty in assured diagnosis and the possibility of strangulation or other complication, exploration of suspected bowel obstruction is recommended. Most of these explorations could be avoided if diagnostic accuracy were better, yielding a desirable decrease in the overall cost of managing bowel obstruction. METHODS: Fifty patients whose clinical or plain x-ray findings suggested bowel obstruction underwent prospective evaluation by abdominal sonography and by flat and upright abdominal x-rays. Presence or absence of bowel obstruction was determined at laparotomy and by clinical evolution of the abdominal episode. Direct costs of care were determined from the hospital and physician bills of 54 patients treated contemporaneously with the sonography study. RESULTS: Sonography demonstrated bowel obstruction by showing fluid-filled dilated bowel loops proximal to collapsed bowel in 22 patients with one false-positive and three false-negative examinations. X-rays demonstrated bowel obstruction in 32 patients with nine false-positive and one false-negative examination. Cost data showed that operative treatment of simple bowel obstruction increased costs nearly eightfold. CONCLUSIONS: Sonography is as sensitive but more specific than plain x-rays in the diagnosis of bowel obstruction. Management based on sonographic findings has the potential to reduce costs of surgical care.     

Value of wearing head protection gear while playing hurling.

One of the three national games of Ireland, hurling is a contact team sport (15 a side) played with a metre long ash stick and a small hard leather ball. Over a 12 month period, 413 players were treated for hurling-related injuries at Cork Regional Hospital. While hand and facial trauma predominate, the proportion between the two sites has changed substantially from previous reports with a reduction in the level of facial injuries. The wearing of a helmet, and optionally a supplementary faceguard, is seen to have contributed to this trend. Despite this welcome reduction of facial injuries, a certain resistance to the use of protective headgear is evident, particularly among older players.     

Retrograde Axonal Transport and Lesion-Induced Upregulation of the TrkA High-Affinity NGF Receptor

Long-term physiological responses of nerve growth factor (NGF) and other neurotrophins require gene regulation and likely depend on retrograde axonal transport of NGF or a signaling molecule activated by ligand-receptor interaction. The low-affinity neurotrophin receptor p75^LANR is retrogradely transported, but this receptor is not sufficient for NGF-dependent cell survival or differentiation. In this study we examined the distribution and transport of the TrkA NGF receptor using two anti-peptide polyclonal antibodies and a monoclonal antibody, all of which are TrkA specific. We find that (1) in the adult rat brain TrkA-like immunoreactivity is similar with all antibodies in striatal and basal forebrain neurons, (2) TrkA is upregulated in neuronal and nonneuronal cells near the sites of injury, and (3) TrkA immunoreactivity builds up within the proximal and distal segments of transected fimbrial axons, which is consistent with its transport in the anterograde and retrograde directions. Thus, TrkA may itself be, or be a component of, the neurotrophic intraaxonal messenger by which NGF regulates gene expression in sensitive neurons.