DEFINING SUCCESS: REEVALUATING DISEASE MANAGEMENT METRICS IN PEDIATRIC PATIENTS WITH TYPE 1 DIABETES

Despite advancements in diabetes devices and management technologies, pediatric patients with type 1 diabetes (T1D) are still struggling to meet standards for glycemic goals. With the inability to appropriately control glucose levels, studies have shown that there are definite increases in diabetes-related complications and potentially life-threatening consequences. Currently, diabetes success is measured by having a hemoglobin A1c (HbA1c) value that is less than or equal to the national target of 7.5%. Recognizing that a disappointing percentage of patients are actually meeting these glycemic targets, researchers have attempted to narrow the gap between patients achieving and not achieving metabolic control. While it has been suggested that the glycemic profile is not being evaluated in its entirety, this thesis project examined the need to integrate other metrics when evaluating a patient’s actual degree of glycemic control and resultant diabetes success. The project focus was directed to time in range values, rather than HbA1c levels, as a defining outcome of glycemic control. Data was collected on pediatric patients with type 1 diabetes who were using continuous glucose monitoring (CGM). Parameters such as HbA1c levels, time in range, average sensor glucose, scored levels of compliance to six specific self-management behaviors, along with basic demographic information were included in the final data set. The primary relationship between the effect adherence to six self-management habits had on time in range values was closely analyzed. A final sample size of 654 T1D pediatric patients using CGM were included for review. Results from regression analyses indicated that patients who performed the self-management habits were more likely to have higher time in range values. As patients increased their adherence to the six habits by performing more than one behavior, time in range values also increased. In spite of the promising relationship identified between these two variables, still only 18.8% of the CGM cohort met the current goals for time in range (≥60%). In the same cohort, only 32.9% of patients met the standard HbA1c target. Disproportionate access to CGM may play a role in the statistical findings of this cohort with regard to meeting glycemic targets, as time in range is most easily retrieved from CGM devices when evaluating metabolic control. Discovering a correlation between time in range and self-management habits is only one of many steps to reevaluate how diabetes success is defined. Combining time in range information with current HbA1c testing could facilitate the development of more realistic management plans for patients with type 1 diabetes. Introducing the importance of time in range and its positive associations with reduced disease-related complications and improved glycemic control is vital to initiate a more encompassing review of diabetes success. Future research is still needed to further investigate the relationship between time in range and compliance with self-management behaviors in a larger population of patients with type 1 diabetes. Having scientific data to support other metrics and methods to aid in disease management could offer patients with type 1 diabetes a new hope for success

POSTURAl CONTROL STRATEGIES IN DANCERS AND NON DANCERS

Postural stability is typically measured by assessing total excursions of either the center of pressure or whole body center of mass. One problem with measures such as these is that interpretations or postural stability are typically made without references to any stability boundaries. Further, postural control studies are typically on'y conducted on individuals with balance impairments and compared to healthy controls. Little research has been conducted on athletes with high levels of postural control. This study compares the postural dynamics of elite balancers with matched control subjects using stability measures that take into account the stability boundaries of different postures

Methods for modeling degradation of electrical engineering components for lifetime prognosis

Reliability of electrical components is an issue studied to improve the quality of products, and to plan maintenance in case of failure. Reliability is measured by studying the causes of failure and the mean time to failure. One of the methods applied in this field is the study of component aging, because failure often occurs after degradation. The objective of this thesis is to model the degradation of components in electrical engineering, in order to estimate their lifetime. More specifically, this thesis will study large area organic white light sources (OLEDs). These sources offer several advantages in the world of lighting thanks to their thinness, their low energy consumption and their ability to adapt to a wide range of applications. The second components studied are electrical insulators applied to pairs of twisted copper wires, which are commonly used in low voltage electrical machines. First, the degradation and failure mechanisms of the various electrical components, including OLEDs and insulators, are studied. This is done to identify the operational stresses for including them in the aging model. After identifying the main causes of aging, general physical models are studied to quantify the effects of operational stresses. Empirical models are also presented when the physics of degradation is unknown or difficult to model. Next, methods for estimating the parameters of these models are presented, such as multilinear and nonlinear regression, as well as stochastic methods. Other methods based on artificial intelli­gence and online diagnosis are also presented, but they will not be studied in this thesis. These methods are applied to degradation data of organic LEDs and twisted pair insulators. For this purpose, accelerated and multifactor aging test benches are designed based on factorial experimental designs and response surface methods, in order to optimize the cost of the experiments. Then, a measurement protocol is described, in order to optimize the inspection time and to collect periodic data. Finally, estimation methods tackle unconstrained deterministic degradation models based on the measured data. The best empirical model of the degradation trajectory is then chosen based on model selection criteria. In a second step, the parameters of the degradation trajectories are modeled based on operational constraints. The parameters of the aging factors and their interactions are estimated by multilinear regression and according to different learning sets. The significance of the parameters is evaluated by statistical methods if possible. Finally, the lifetime of the experiments in the validation sets is predicted based on the parameters estimated by the different learning sets. The training set with the best lifetime prediction rate is considered the best

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Feasibility and efficacy of bypassing the right ventricle and pulmonary circulation to treat right ventricular failure: an experimental study

<p>Abstract</p> <p>Background</p> <p>Right ventricular failure (RVF) and -support is associated with poor results. We aimed for a new approach of right - sided assistance bypassing the right ventricle and pulmonary circulation in order to better decompress the right ventricle and optimize left ventricular filling.</p> <p>Methods</p> <p>From a microaxial pump (Abiomed), a low resistance oxygenator (Maquet and Novalung) and two cannulas (28 and 27 Fr) a system was set up and evaluated in an ovine model (n = 7). Connection with the heart was the right and left atrium. One hour the system was operated without RVF and turned of again. Then a RVF was induced and the course with the system running was evaluated. Complete hemodynamic monitoring was performed as well as echocardiography, flow measurement and blood gas analysis.</p> <p>Results</p> <p>The overall performance of the system was reliable. Without RVF no relevant changes of hemodynamics occurred; blood gases were supra normal. In RVF a cardiogenic shock developed (MAP 35 ± 13 mmHg, CO 1,1 ± 0,7 l/min). Immediately after starting the system the circulation normalized (significant increase of MAP to 85 ± 13 mmHg, of CO to 4,5 ± 1,9). Echocardiography also revealed right ventricular recovery. After stopping the system, RVF returned.</p> <p>Conclusions</p> <p>Bypassing the right ventricle and pulmonary circulation with an oxygenating assist device, which may offer the advantages of enhanced right ventricular decompression and augmented left atrial filling, is feasible and effective in the treatment of acute RVF. Long time experiments are needed.</p

Circular RNAs in urine of kidney transplant patients with acute T Cell-mediated allograft rejection

BACKGROUND: Circular RNAs (circRNAs) have recently been described as novel noncoding regulators of gene expression. They are detectable in the blood of patients with acute kidney injury. We tested whether circRNAs were present in urine and could serve as new predictors of outcome in renal transplant patients with acute rejection. METHODS: A global circRNA expression analysis using RNA from urine of patients with acute T cell-mediated renal allograft rejection and control transplant patients was performed. Dysregulated circRNAs were confirmed in a cohort of 62 patients with acute rejection, 10 patients after successful antirejection therapy, 18 control transplant patients without rejection, and 13 stable transplant patients with urinary tract infection. RESULTS: A global screen revealed several circRNAs to be altered in urine of patients with acute rejection. Concentrations of 2 circRNAs including hsa_circ_0001334 and hsa_circ_0071475 were significantly increased. These were validated in the whole cohort of patients. hsa_circ_0001334 was upregulated in patients with acute rejection compared with controls. Concentrations of hsa_circ_0001334 normalized in patients with acute rejection following successful antirejection therapy. hsa_circ_0001334 was associated with higher decline in glomerular filtration rate 1 year after transplantation. CONCLUSIONS: CircRNA concentrations are significantly dysregulated in patients with acute rejection at subclinical time points. Urinary hsa_circ_0001334 is a novel biomarker of acute kidney rejection, identifying patients with acute rejection and predicting loss of kidney function

Degradation of the luminance and impedance evolution analysis of an OLED under thermal and electrical stress

Organic light emitting diodes are one of the most innovative light sources. They do not require semiconductor fabrication techniques like the LED family, they are simple to construct and are used in many original applications. The inconvenient of this product is that it does not have a long lasting useful life with more then 10000 hours. Therefore, this paper will present a parametric method to design an aging model of the OLED based on luminance decay and electrical impedance evolution. Accelerated tests using thermal factor and currentdensity will be applied to large warm white OLED panels. A log-normal model for the luminance decay will be merged withdesign of experiments method to include the stress factors as well as impedance characteristics resulting in an effective degradation model that can estimate the lifetime of the OLED