Glucometer accuracy and implications for clinical studies

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Validation of a virtual patient and virtual trials method for accurate prediction of tight glycemic control protocol performance

Peer reviewe

Does tight glycemic control positively impact on patient mortality?

peer reviewe

Pulmonary embolism diagnostics from the driver function

Ventricular driver functions are not readily measured in the ICU, but can clearly indicate the development of pulmonary embolism (PE) otherwise difficult to diagnose. Recent work has developed accurate methods of measuring these driver functions from readily available ICU measurements. This research tests those methods by assessing the ability of these driver functions to diagnose the evolution of PE

Enhanced insulin sensitivity variability in the first 3 days of ICU stay: implications for tight glycemic control

Effective tight glycemic control (TGC) can improve outcomes, particularly in cardiovascular surgery, but is difficult to achieve. Variability in insulin sensitivity/resistance resulting from the level and evolution of stress response, particularly early in a patient’s stay, can lead to hyperglycemia and variability, which are associated with mortality. This study quantifies the daily evolution of the variability of insulin sensitivity for cardiovascular surgical and all other ICU patients

Model-based diagnosis of acute pulmonary embolism and septic shock in porcine trials

peer reviewe

Model-based cardiovascular monitoring of large pore hemofiltration during endotoxic shock in pigs

peer reviewe

Endogenous insulin secretion and suppression during and after sepsis in critically ill patients: implications for tight glycemic control protocols

Introduction: Insulin infusions over 2 U/hr can suppress endogenous insulin secretion in healthy subjects 30-45% [1]. Virtually all tight glycaemic control (TGC) protocols deliver insulin via infusion. This study examines the impact of bolus delivery of insulin in TGC on the endogenous insulin secretion of critically ill patients. Methods: 18 patients from the Christchurch Hospital ICU enrolled in a prospective clinical trial studying sepsis each had two sets of blood samples assayed for insulin and C-peptide. The first set was taken at the commencement of the SPRINT TGC protocol for patients with suspected sepsis. The second set was taken when their SIRS score was consistently below 2. Each set had 4 samples taken at: -1, 10, 40 and 60 min following bolus delivery of insulin as required by SPRINT to capture endogenous insulin secretion during the bolus profile. Bolus size was dictated by the protocol, but was in the range 2-6 units. Model-based methods [2] were used to calculate the endogenous insulin secretion rate for each set of samples. The level of suppression was calculated as the ratio of the secretion rate between 5-15 mins (just after peak plasma insulin) and average of the 0-5 min (basal) and 15-60 min (return to basal) secretion rates identified

Spike-Timing Theory of Working Memory

Working memory (WM) is the part of the brain's memory system that provides temporary storage and manipulation of information necessary for cognition. Although WM has limited capacity at any given time, it has vast memory content in the sense that it acts on the brain's nearly infinite repertoire of lifetime long-term memories. Using simulations, we show that large memory content and WM functionality emerge spontaneously if we take the spike-timing nature of neuronal processing into account. Here, memories are represented by extensively overlapping groups of neurons that exhibit stereotypical time-locked spatiotemporal spike-timing patterns, called polychronous patterns; and synapses forming such polychronous neuronal groups (PNGs) are subject to associative synaptic plasticity in the form of both long-term and short-term spike-timing dependent plasticity. While long-term potentiation is essential in PNG formation, we show how short-term plasticity can temporarily strengthen the synapses of selected PNGs and lead to an increase in the spontaneous reactivation rate of these PNGs. This increased reactivation rate, consistent with in vivo recordings during WM tasks, results in high interspike interval variability and irregular, yet systematically changing, elevated firing rate profiles within the neurons of the selected PNGs. Additionally, our theory explains the relationship between such slowly changing firing rates and precisely timed spikes, and it reveals a novel relationship between WM and the perception of time on the order of seconds