Insulin requirements and carbohydrate to insulin ratio in normal weight, overweight, and obese women with type 1 diabetes under pump treatment during pregnancy: a lesson from old technologies

Aim:The primary aim of this study was to assess insulin requirements and carbohydrateto insulin ratio (CHO/IR) in normal weight, overweight, and obese pregnant women withtype 1 diabetes across early, middle, and late pregnancy.Methods:In this multicenter, retrospective, observational study we evaluated 86 of 101pregnant Caucasian women with type 1 diabetes under pump treatment. The womenwere trained to calculate CHO/IR daily by dividing CHO grams of every single meal byinsulin units injected. Since the purpose of the study was to identify the CHO/IR able toreach the glycemic target, we only selected the CHO/IR obtained when glycemic valueswere at target. Statistics: SPSS 20.Results:We studied 45 normal weight, 31 overweight, and 10 obese women. Insulinrequirements increased throughout pregnancy (p < 0.0001 and <0.001 respectively) inthe normal and overweight women, while it remained unchanged in the obese women.Insulin requirements were different between groups when expressed as an absolute value,but not when adjusted for body weight. Breakfast CHO/IR decreased progressivelythroughout pregnancy in the normal weight women, from 13.3 (9.8–6.7) at thefirst stageof pregnancy to 6.2 (3.8–8.6) (p = 0.01) at the end stage, and in the overweight womenFrontiers in Endocrinology | www.frontiersin.orgFebruary 2021 | Volume 12 | Article 6108771Edited by:Elena Succurro,University of Magna Graecia, ItalyReviewed by:Cristina Bianchi,Azienda Ospedaliero-UniversitariaPisana, ItalyMaria Grazia Dalfra’,University of Padua, Italy*Correspondence:Camilla [email protected] section:This article was submitted toObesity,a section of the journalFrontiers in EndocrinologyReceived:27 September 2020Accepted:14 January 2021Published:25 February 2021Citation:Festa C,Fresa R,Visalli N,Bitterman O,Giuliani C,Suraci C,Bongiovanni M andNapoli A (2021)Insulin Requirements andCarbohydrate to Insulin Ratio inNormal Weight, Overweight, andObese Women With Type 1Diabetes Under Pump TreatmentDuring Pregnancy: A LessonFrom Old Technologies.Front. Endocrinol. 12:610877.doi: 10.3389/fendo.2021.610877ORIGINAL RESEARCHpublished: 25 February 2021doi: 10.3389/fendo.2021.610877 from 8.5 (7.1–12.6) to 5.2 (4.0–8.1) (p = 0.001), while in the obese women it remainedstable, moving from 6.0 (5.0–7.9) to 5.1 (4.1–7.4) (p = 0.7). Likewise, lunch and dinnerCHO/IR decreased in the normal weight and overweight women (p < 0.03) and not in theobese women. The obese women gained less weight than the others, especially in earlypregnancy when they even lost a median of 1.25 (−1−1.1) kg (p = 0.005). In earlypregnancy, we found a correlation between pregestational BMI and insulin requirements(IU/day) or CHO/IR at each meal (p < 0.001 and p = 0.001, respectively). In latepregnancy, a relationship between pre-gestational BMI and CHO/IR change was found(P = 0.004), as well as between weight gain and CHO/IR change (p=0.02). Thesignificance was lost when both variables were included in the multiple regressionanalysis. There was no difference in pregnancy outcomes except for a higher pre-termdelivery rate in the obese women.Conclusion:Pre-gestational BMI and weight gain may play a role in determining CHO/IRduring pregnancy in women with type 1 diabetes under pump treatment

¿Qué es la violencia para vos?: narrativas y producción de subjetividad

Este trabajo se propone indagar en la problemática de la violencia y su inscripción en la subjetividad contemporánea a partir de ciertas narrativas de diferentes actores sociales del barrio “El Futuro” de Melchor Romero. Estos pequeños relatos fueron relevados en el marco de los proyectos de investigación –acción de la Facultad de Psicología, UNLP (PMP-PPID/S017) en los cuales se observan distintas expresiones y modalidades de experiencias violentas, en especial la violencia de género y simbólica. Aspiramos en esta presentación, a mostrar algunas conceptualizaciones teóricas sobre las violencias, como sus consecuencias políticas dado que es un fenómeno que alcanza el territorio de la vida, luego reflexionamos acerca de la construcción de la violencia en ese “espacio biográfico” (Arfuch, 2002), en tanto trama simbólica y epocal para el análisis de la producción de subjetividad. Este recorrido pretende articular lo discursivo y lo social considerando los modos de enunciación, los sujetos y sus interacciones, las ideologías, la relación entre lo personal y colectivo, en pos de propiciar debates y re lecturas que permitan pensar estrategias de intervención comunitarias en territorios vulnerados y signados por prácticas sociales violentas.This work aims to investigate the problem of violence and its inscription in contemporary subjectivity from certain narratives of different social actors in the neighborhood "El Futuro" by Melchor Romero. These small stories were surveyed in the framework of research projects -action of the Faculty of Psychology, UNLP (PMP-PPID / S017) in which different expressions and modalities of violent experiences are observed, especially gender and symbolic violence. We aspire in this presentation, to show some theoretical conceptualizations about violence, as its political consequences given that it is a phenomenon that reaches the territory of life, then we reflect on the construction of violence in that "biographical space" (Arfuch, 2002 ), as a symbolic and epochal plot for the analysis of the production of subjectivity. This course aims to articulate the discursive and the social considering the modes of enunciation, the subjects and their interactions, the ideologies, the relationship between the personal and the collective, in order to encourage debates and re-readings that allow thinking of community intervention strategies in violated territories and signed by violent social practices.Facultad de Psicologí

¿Qué es la violencia para vos?: narrativas y producción de subjetividad

Este trabajo se propone indagar en la problemática de la violencia y su inscripción en la subjetividad contemporánea a partir de ciertas narrativas de diferentes actores sociales del barrio “El Futuro” de Melchor Romero. Estos pequeños relatos fueron relevados en el marco de los proyectos de investigación –acción de la Facultad de Psicología, UNLP (PMP-PPID/S017) en los cuales se observan distintas expresiones y modalidades de experiencias violentas, en especial la violencia de género y simbólica. Aspiramos en esta presentación, a mostrar algunas conceptualizaciones teóricas sobre las violencias, como sus consecuencias políticas dado que es un fenómeno que alcanza el territorio de la vida, luego reflexionamos acerca de la construcción de la violencia en ese “espacio biográfico” (Arfuch, 2002), en tanto trama simbólica y epocal para el análisis de la producción de subjetividad. Este recorrido pretende articular lo discursivo y lo social considerando los modos de enunciación, los sujetos y sus interacciones, las ideologías, la relación entre lo personal y colectivo, en pos de propiciar debates y re lecturas que permitan pensar estrategias de intervención comunitarias en territorios vulnerados y signados por prácticas sociales violentas.This work aims to investigate the problem of violence and its inscription in contemporary subjectivity from certain narratives of different social actors in the neighborhood "El Futuro" by Melchor Romero. These small stories were surveyed in the framework of research projects -action of the Faculty of Psychology, UNLP (PMP-PPID / S017) in which different expressions and modalities of violent experiences are observed, especially gender and symbolic violence. We aspire in this presentation, to show some theoretical conceptualizations about violence, as its political consequences given that it is a phenomenon that reaches the territory of life, then we reflect on the construction of violence in that "biographical space" (Arfuch, 2002 ), as a symbolic and epochal plot for the analysis of the production of subjectivity. This course aims to articulate the discursive and the social considering the modes of enunciation, the subjects and their interactions, the ideologies, the relationship between the personal and the collective, in order to encourage debates and re-readings that allow thinking of community intervention strategies in violated territories and signed by violent social practices.Facultad de Psicologí

¿Qué es la violencia para vos?: narrativas y producción de subjetividad

Este trabajo se propone indagar en la problemática de la violencia y su inscripción en la subjetividad contemporánea a partir de ciertas narrativas de diferentes actores sociales del barrio “El Futuro” de Melchor Romero. Estos pequeños relatos fueron relevados en el marco de los proyectos de investigación –acción de la Facultad de Psicología, UNLP (PMP-PPID/S017) en los cuales se observan distintas expresiones y modalidades de experiencias violentas, en especial la violencia de género y simbólica. Aspiramos en esta presentación, a mostrar algunas conceptualizaciones teóricas sobre las violencias, como sus consecuencias políticas dado que es un fenómeno que alcanza el territorio de la vida, luego reflexionamos acerca de la construcción de la violencia en ese “espacio biográfico” (Arfuch, 2002), en tanto trama simbólica y epocal para el análisis de la producción de subjetividad. Este recorrido pretende articular lo discursivo y lo social considerando los modos de enunciación, los sujetos y sus interacciones, las ideologías, la relación entre lo personal y colectivo, en pos de propiciar debates y re lecturas que permitan pensar estrategias de intervención comunitarias en territorios vulnerados y signados por prácticas sociales violentas.This work aims to investigate the problem of violence and its inscription in contemporary subjectivity from certain narratives of different social actors in the neighborhood "El Futuro" by Melchor Romero. These small stories were surveyed in the framework of research projects -action of the Faculty of Psychology, UNLP (PMP-PPID / S017) in which different expressions and modalities of violent experiences are observed, especially gender and symbolic violence. We aspire in this presentation, to show some theoretical conceptualizations about violence, as its political consequences given that it is a phenomenon that reaches the territory of life, then we reflect on the construction of violence in that "biographical space" (Arfuch, 2002 ), as a symbolic and epochal plot for the analysis of the production of subjectivity. This course aims to articulate the discursive and the social considering the modes of enunciation, the subjects and their interactions, the ideologies, the relationship between the personal and the collective, in order to encourage debates and re-readings that allow thinking of community intervention strategies in violated territories and signed by violent social practices.Facultad de Psicologí

Goals of Care Documentation: Insights from A Pilot Implementation Study

ContextThe Life Sustaining Treatment Decision Initiative is a national effort by the Veterans Health Administration to ensure goals of care documentation occurs among all patients at high risk of life-threatening events. ObjectivesExamine likelihood to receive goals of care documentation and explore associations between documentation and perceived patient care experience at the individual and site level. MethodsRetrospective, quality improvement analysis of initiative pilot data from four geographically diverse Veterans Affairs (VA) sites (Fall 2014-Winter 2016) before national roll-out. Goals of care documentation according to gender, marital status, urban/rural status, race/ethnicity, age, serious health condition, and Care Assessment Needs scores. Association between goals of care documentation and perceived patient care experience analyzed based on Bereaved Family Survey outcomes of overall care, communication, and support. ResultsVeterans were more likely to have goals of care documentation if widowed, urban residents, and of white race. Patients older than 65-years and those with a higher Care Assessment Needs score were twice as likely as a frail patient to have goals of care documented. One pilot site demonstrated a positive association between documentation and perceived support. Pilot site was a statistically significant predictor of the occurrence of goals of care documentation and Bereaved Family Survey scores. ConclusionOlder and seriously ill patients were most likely to have goals of care documented. Association between a documented goals of care conversation and perceived patient care experience were largely unsupported. Site-level largely contributed to understanding the likelihood of documentation and care experience

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Residential exposure to petroleum refining and stroke in the southern United States

The southern United States (US) sustains a disproportionate burden of incident stroke and associated mortality, compared to other parts of the US. A large proportion of this risk remains unexplained. Petroleum production and refining (PPR) is concentrated within this region and emits multiple pollutants implicated in stroke pathogenesis. The relationship between residential PPR exposure and stroke has not been studied. We aimed to investigate the census tract-level association between residential PPR exposure and stroke prevalence for adults (⩾18 years) in seven southern US states in 2018. We conducted spatial distance- and generalized propensity score-matched analysis that adjusts for sociodemographic factors, health behavioral factors, and unmeasured spatial confounding. PPR was measured as inverse-distance weighted averages of petroleum production within 2.5 km or 5 km from refineries, which was strongly correlated with measured levels of sulfur dioxide, a byproduct of PPR. The prevalence of self-reported stroke ranged from 0.4% to 12.7% for all the census tracts of the seven states. People with low socioeconomic status and of Hispanic ethnicity resided closer to petroleum refineries. The non-Hispanic Black population was exposed to higher PPR, while the non-Hispanic White population was exposed to lower PPR. Residential PPR exposure was significantly associated with stroke prevalence. One standard deviation increase in PPR within 5 km from refineries was associated with 0.22 (95% confidence interval: 0.09, 0.34) percentage point increase in stroke prevalence. PPR explained 5.6% (2.4, 8.9) of stroke prevalence in the exposed areas. These values differed by states: 1.1% (0.5, 1.7) in Alabama to 11.7% (4.9, 18.6) in Mississippi, and by census tract-level: 0.08% (0.03, 0.13) to 25.3% (10.6, 40.0). PPR is associated with self-reported stroke prevalence, suggesting possible links between pollutants emitted from refineries and stroke. The increased prevalence due to PPR may differ by sociodemographic factors

Integration of Motion Responses Underlying Directional Motion Anisotropy in Human Early Visual Cortical Areas

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