Insulin Glargine U100 Utilization in Patients with Type 2 Diabetes in an Italian Real-World Setting: A Retrospective Study

Background. This study is aimed at estimating the proportion of type 2 diabetes mellitus (T2DM) patients treated with basal insulin (insulin glargine U100) and at evaluating daily insulin dose, treatment pattern, and adherence to treatment of these patients. Methods. Data from administrative and laboratory databases of 3 Italian Local Health Units were retrospectively collected and analyzed. All patients with a diagnosis of T2DM between 01/01/2012 and 31/12/2012 were considered, and those with at least a prescription of insulin glargine between 01/01/2013 and 31/12/2014 were included and followed up for one year. For each patient, we evaluated HbA1c levels both at baseline and during the follow-up period and the daily average dose of insulin. Medication adherence was defined by using medication possession ratio (MPR) and reported as proportion of patients with MPR≥80%. Results. 7,422 T2DM patients were available for the study. According to the antidiabetic medication prescribed, patients were categorized into four groups: insulin glargine only, insulin glargine plus oral glucose-lowering drugs, insulin glargine plus rapid-acting insulin, and insulin glargine plus DPP-4 inhibitors. Median daily dose of insulin among insulin glargine only patients was higher than in other groups (35 IU vs. 20 IU, p<0.05), and a higher percentage of them achieved a target HbA1c value of less than 7.0% (53.8% vs. 30%, p<0.001). Adherence to insulin treatment was lowest (41%) in the insulin glargine only group compared to other groups (ranging from 58.4% to 64.4%), p<0.001. Conclusions. A large proportion of T2DM patients treated with insulin fail in achieving the glycemic target of HbA1c level<7%, irrespective of treatment regimen; however, basal insulin only is associated with lower therapeutic unsuccess. Adherence to antidiabetes medications is also suboptimal in these patients and should be addressed to improve long-term outcomes of reducing and preventing microvascular and macrovascular complications

Psychological activities in neurorehabilitation: From research to clinical practice

The goal of the present review was to present a critical description of psychological research and practice in neurorehabilitation with regard to the efficacy of treatments proposed in the clinical and neuropsychological field. PubMed, Web of Science and Cochrane databases were searched by using the keywords "psychological intervention" and one of the following neurological diseases: "stroke", "TBI", " Parkinson", "ALS", "multiple sclerosis", "dementia". Randomized and pseudo-randomized trials, reviews and single case studies were included. We identified 134 papers: 54 concerning dementia, 24 stroke, 20 multiple sclerosis, 16 Parkinson, 13 TBI and 7 ALS. Most of these papers concern the evaluation of the effectiveness of psychological treatments in chronic or progressive neurological diseases. However, they are often characterized by methodological limitations, such as a small sample size, absence of a follow-up study or a control group. Further, high quality studies could help better understand treatment effects. There was some evidence for effectiveness of cognitive-behavioural and cognitive therapies, often applied both in clinical and neuropsychological interventions. Evidence coming from individualized treatment and single case studies are also described. In line with the data collected, we summarize some evidence available for psychological testing and treatment and argue that a multidisciplinary approach and a multidimensional evaluation should be adopted. According to this position, both randomized trials and single-case studies could be taken into account. Finally, it is proposed that in order to establish the efficacy of a given treatment, both standardized and individualized measures are to be used. © PI-ME, Pavia 2011

Photochemistry of tris(pyrazolyl)borate titanium(IV) complexes.

The electronic features and photochemistry of TpTiCl3 (1) (Tp = hydrotris(pyrazol-1-yl)borate) and Tp*TiCl3 (2) (Tp* = hydrotris( 3,5-dimethylpyrazol-1-yl)borate) were studied in THF. Reactive decay of the excited states produced either HBpz3· (or HBpz3°* and metal center Ti(III) radicals via homolytic cleavage of the Tp -Ti (Tp* - Ti) bond. Cleavage of the Tp - Ti and the Tp*- Ti bond as a primary photoprocess is shown to be consistent with LMCT Tp - Ti and Tp*- Ti excitation. TpTiCl2(THF) (3) and Tp*TiCl2(THF) (4) were also prepared by stoichiometric reduction of 1 and 2 with Li3N. The THF ligand in 3 and 4 was replaced by the stable nitroxyl radical TEMPO (2,2,6,6-tetramethyl-1-piperidinyloxy) to provide the new complexes TpTiCl2-(TEMPO) (5) and Tp*TiCl2(TEMPO) (6) in which the TEMPO ligand is eta1 coordinated to Ti(IV). Photolysis of 5 and 6 generate Ti(III) and the TEMPO radical in the primary photochemical step

Un nuovo modello organizzativo per l'Azienda Ospedaliero-Universitaria di Parma: gestione e applicazione all'area ortopedica

Il presente articolo ha lo scopo di descrivere il processo di cambiamento che ha condotto ad nuovo assetto organizzativo dell\u2019area ortopedica di un\u2019azienda ospedaliera universitaria, che modifica la gestione degli asset produttivi e il knowledge management privilegiando la condivisione della conoscenza tra i professionisti e perseguendo la separazione tra attivit\ue0 di emergenza (traumatologia) ed elezione. L\u2019obiettivo \ue8 quello di creare il contesto per lo sviluppo e la crescita delle competenze cliniche dei professionisti e un modello che prevede la gestione delle risorse basata sulla tipologia di attivit\ue0 svolta (emergenza o elezione). Il modello \ue8 stato realizzato procedendo per gradi e perseguendo cinque step fondamentali: Riorganizzazione dell\u2019attivit\ue0 degli ambulatori ortopedici e costituzione gruppi del sapere; Separazione logistica dei percorsi di degenza traumatologica ed elettiva; Costituzione dei centri di costo logistici; Incontri settimanali di programmazione delle sale operatorie; Creazione del percorso ortogeriatrico. Per verificare gli effetti di tale attivit\ue0 sono stati monitorati alcuni indicatori per l\u2019anno 2013

Comparing RTL and Behavioral Design Methodologies in the Case of a 2M Transistors ATM Shaper

This paper describes the experience and the lessons learned during the design of an ATM traffic shaper circuit using behavioral synthesis. The experiment is based on the comparison of the results of two parallel design flows starting from the same specification. The first used a classical design method based on RTL synthesis. The second design flow is based on behavioral synthesis. The experiment has shown that behavioral synthesis is able to produce efficient design in terms of gate count and timing while bringing three-fold reduction in design effort when compared to RTL design methodology

The theory of bipolar disorder as an illness of accelerated aging: Implications for clinical care and research

Bipolar Disorder (BD) has been conceptualized as both a cyclic and a progressive disorder. Mechanisms involved in neuroprogression in BD remain largely unknown although several non-mutually exclusive models have been proposed as explanatory frameworks. in the present paper, we propose that the pathophysiological changes observed in BD (e.g. brain structural alterations, cognitive deficits, oxidative stress imbalance, amyloid metabolism, immunological deregulation, immunosenescence, neurotrophic deficiencies and telomere shortening) converge on a model of accelerated aging (AA). Aging can be understood as a multidimensional process involving physical, neuropsychological, and social changes, which can be highly variable between individuals. Determinants of successful aging (e.g environmental and genetic factors), may also confer differential vulnerability to components of BD pathophysiology and contribute to the clinical presentation of BD. Herein we discuss how the understanding of aging and senescence can contribute to the search for new and promising molecular targets to explain and ameliorate neuroprogression in BD. We also present the strengths and limitations of this concept. (c) 2014 Elsevier B.V. All rights reserved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Heart & Stroke Foundation Centre for Stroke RecoveryToronto Rehabilitation InstituteUniversidade Federal de São Paulo, Dept Psychiat, Program Recognit & Intervent Individuals Risk Men, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Interdisciplinary Lab Clin Neurosci LINC, São Paulo, BrazilUniv Hlth Network, Mood Disorders Psychopharmacol Unit, Toronto, ON, CanadaUniv Toronto, Sunnybrook Res Inst, Toronto, ON, CanadaUniversidade Federal de São Paulo, Dept Morphol & Genet, São Paulo, BrazilPontificia Univ Catolica Rio Grande do Sul, Inst Biomed Res, Porto Alegre, RS, BrazilPontificia Univ Catolica Rio Grande do Sul, Fac Biosci, Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Program Recognit & Intervent Individuals Risk Men, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Interdisciplinary Lab Clin Neurosci LINC, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Morphol & Genet, São Paulo, BrazilWeb of Scienc