Modeling of Effect of Glucose Sensor Errors on Insulin Dosage and Glucose Bolus Computed by LOGIC-Insulin

BACKGROUND: Effective and safe glycemic control in critically ill patients requires accurate glucose sensors and adequate insulin dosage calculators. The LOGIC-Insulin calculator for glycemic control has recently been validated in the LOGIC-1 randomized controlled trial. In this study, we aimed to determine the allowable error for intermittent and continuous glucose sensors, on the basis of the LOGIC-Insulin calculator. METHODS: A gaussian simulation model with a varying bias (0%-20%) and CV (-20% to +20%) simulated blood glucose values from the LOGIC-1 study (n = 149 patients) in 10 Monte Carlo steps. A clinical error grid system was developed to compare the simulated LOGIC-Insulin-directed intervention with the nominal intervention (0% bias, 0% CV). The severity of error measuring the clinical effect of the simulated LOGIC-Insulin intervention was graded as type B, C, and D errors. Type D errors were classified as acutely life-threatening (0% probability preferred). RESULTS: The probability of all types of errors was lower for continuous sensors compared with intermittent sensors. The maximum total error (TE), defined as the first TE introducing a type B/C/D error, was similar for both sensor types. To avoid type D errors, TEs <15.7% for intermittent sensors and <17.8% for continuous sensors were required. Mean absolute relative difference thresholds for type C errors were 7.1% for intermittent and 11.0% for continuous sensors. CONCLUSIONS: Continuous sensors had a lower probability for clinical errors than intermittent sensors at the same accuracy level. These simulations demonstrated the suitability of the LOGIC-Insulin control system for use with continuous, as well as intermittent, sensors.status: publishe

Towards implementation of robust monitoring technologies alongside freshwater improvement policy in Aotearoa New Zealand

International studies point out that some freshwater policy objectives are not achieved. This study describes that this is in part caused by shortcomings that include: the lack of targeted monitoring schemes to measure impact; a too small range of specific technologies rather than a wider suite of integrated multiple technologies; a too tight focus on sub-sets of stakeholders instead of the involvement of the wider range of end users; and poor trust building and technology explanations to end users. As an example, the New Zealand government is addressing widespread concern over the deterioration of the national freshwater resource by supporting a diverse portfolio of land and riparian management actions. Efforts to assess the effectiveness of these interventions and establish an evidence-based framework for future policies are however limited by the existing regional-scale freshwater monitoring infrastructure. Such hydrometric networks were established largely to assess the broader-scale regional ‘state’ of the environment and are generally out-of-phase with freshwater improvement actions that are implemented more typically at edge-of-field, farm or sub-catchment scales. Recent and rapid evolution in sensor technologies have created new opportunities to deliver information tuned to the appropriate parameters and frequencies needed to evaluate improvement actions. Despite this, the necessary transformative change in freshwater monitoring has yet to gather pace. In this study we explore barriers and solutions with the objective to better understand what is needed for successful integration of innovative monitoring technologies in a transitional environmental policy setting, using recent New Zealand policy directives as a case study. We use expert surveys and scenario testing to explore barriers to adoption to more robust and comprehensive monitoring required to establish the success, or otherwise, of freshwater improvement actions. This process reveals that rather than further innovations in technology, change in the practice of environmental monitoring is limited instead by the development of defensible and accepted guidelines on the application and effective deployment of existing sensors and methods. We demonstrate that improved knowledge exchange between engineers, scientists and practitioners can be addressed and propose a new decision support and communication tool to enable the selection of monitoring technologies and solutions fit-for-purpose to evaluate freshwater improvement outcomes on multiple scales involving multiple stakeholders

Physiological modeling, tight glycemic control, and the ICU clinician: what are models and how can they affect practice?

Critically ill patients are highly variable in their response to care and treatment. This variability and the search for improved outcomes have led to a significant increase in the use of protocolized care to reduce variability in care. However, protocolized care does not address the variability of outcome due to inter- and intra-patient variability, both in physiological state, and the response to disease and treatment. This lack of patient-specificity defines the opportunity for patient-specific approaches to diagnosis, care, and patient management, which are complementary to, and fit within, protocolized approaches

Tick-borne encephalitis virus in dogs - is this an issue?

The last review on Tick-borne encephalitis (TBE) in dogs was published almost ten years ago. Since then, this zoonotic tick-borne arbovirus has been geographically spreading and emerging in many regions in Eurasia and continues to do so. Dogs become readily infected with TBE virus but they are accidental hosts not capable to further spread the virus. They seroconvert upon infection but they seem to be much more resistant to the clinical disease than humans. Apart from their use as sentinels in endemic areas, however, an increasing number of case reports appeared during the last decade thus mirroring the rising public health concerns. Owing to the increased mobility of people travelling to endemic areas with their companion dogs, this consequently leads to problems in recognizing and diagnosing this severe infection in a yet non-endemic area, simply because the veterinarians are not considering TBE. This situation warrants an update on the epidemiology, clinical presentation and possible preventions of TBE in the dog

International recommendations for glucose control in adult non diabetic critically ill patients

The purpose of this research is to provide recommendations for the management of glycemic control in critically ill patients.Comparative StudyJournal ArticleResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishedPour la Société Française d'Anesthésie-Réanimation (SFAR); Société de Réanimation de langue Française (SRLF) and the Experts grou

Theoretical and Experimental Studies of Radiative Shocks

International audienceThis paper deals with the radiative shock from both theoretical and numerical points of view. It is based on the whole experimental results obtained at Laboratoire d'Utilisation des Lasers Intenses (LULI, École Polytechnique). Radiative shocks are high-Mach number shocks with a strong coupling between radiation and hydrodynamics which leads to a structure governed by a radiative precursor. These shocks are involved in various astrophysical systems: stellar accretion shocks, pulsating stars, interaction between supernovae and the interstellar medium. In laboratory, these radiative shocks are generated using high power lasers. New diagnostics have been implemented to study the geometrical shape of the shock and the front shock density. Data were obtained varying initial conditions for different laser intensities and temperature. The modeling of these phenomena is mainly performed through numerical simulations (1D and 2D) and analytical studies. We exhibit results obtained from several radiative hydrodynamics codes. As a result, it is possible to discuss about the influence of the geometry and physical parameters introduced in the 1D and 2D models