Pilot study of the SPRINT glycemic control protocol in a Hungarian medical intensive care unit.

Stress-induced hyperglycemia increases morbidity and mortality. Tight control can reduce mortality but has proven difficult to achieve. The SPRINT (Specialized Relative Insulin and Nutrition Tables) protocol is the only protocol that reduced both mortality and hypoglycemia by modulating both insulin and nutrition, but it has not been tested in independent hospitals. SPRINT was used for 12 adult intensive care unit patients (949 h) at Kálmán Pándy Hospital (Gyula, Hungary) as a clinical practice assessment. Insulin recommendations (0-6 U/h) were administered via constant infusion rather than bolus delivery. Nutrition was administered per local standard protocol, weaning parenteral to enteral nutrition, but was modulated per SPRINT recommendations. Measurement was every 1 to 2 h, per protocol. Glycemic performance is assessed by percentage of blood glucose (BG) measurements in glycemic bands for the cohort and per patient. Safety from hypoglycemia is assessed by numbers of patients with BG < 2.2 (severe) and %BG < 3.0 and < 4.0 mmol/liter (moderate and light). Clinical effort is assessed by measurements per day. Results are median (interquartile range). There were 742 measurements over 1088 h of control (16.4 measurements/day), which is similar to clinical SPRINT results (16.2/day). Per-patient hours of control were 65 (50-95) h. Initial per-patient BG was 10.5 (7.9-11.2) mmol/liter. All patients (100%) reached 6.1 mmol/liter. Cohort BG was 6.3 (5.5-7.5) mmol/liter, with 42.2%, 65.1% and 77.6% of BG in the 4.0-6.1, 4.0-7.0, and 4.0-8.0 mmol/liter bands. Per-patient, median percentage time in these bands was 40.2 (26.7-51.5)%, 62.5 (46.0-75.7)%, and 74.7 (61.6.8-87.8)%, respectively. No patients had BG < 2.2 mmol/liter, and the %BG < 4.0 mmol/liter was 1.9%. These results were achieved using 3.0 (3.0-5.0) U/h of insulin with 7.4 (4.4-10.2) g/h of dextrose administration (all sources) for the cohort. Per-patient median insulin administration was 3.0 (3.0-3.0) U/h and 7.1 (3.4-9.6) g/h dextrose. Higher carbohydrate nutrition formulas than were used in SPRINT are offset by slightly higher insulin administration in this study. The glycemic performance shows that using the SPRINT protocol to guide insulin infusions and nutrition administration provided very good glycemic control in initial pilot testing, with no severe hypoglycemia. The overall design of the protocol was able to be generalized with good compliance and outcomes across geographically distinct clinical units, patients, and clinical practice. © 2012 Diabetes Technology Society

SPRINT, STAR: Két Hatékony Kezelési Protokoll Az Intenzív Osztályon Kezelt Betegek Vércukorszintjének Normoglikémiás Tartományban Tartásához

(In Hungarian) Paper P0

Variability of insulin sensitivity during the first 4 days of critical illness

1-pageSafe, effective tight glycaemic control (TGC) can improve outcomes in critical care patients, but is difficult to achieve consistently. Insulin sensitivity defines the metabolic balance between insulin concentration and insulin mediated glucose disposal. Hence, variability of insulin sensitivity can cause variable glycaemia. This study investigates the daily evolution of model-based insulin sensitivity level and variability for critical care patients receiving TGC during the first four days of their ICU stay

No evidence of association between either Modic change or disc degeneration and five circulating inflammatory proteins.

INTRODUCTION: Intervertebral disc degeneration and Modic change are the main spinal structural changes associated with chronic low back pain (LBP). Both conditions are thought to manifest local inflammation and if inflammatory proteins translocate to the blood circulation could be detected systemically. The work here assesses whether the presence of disc degeneration is associated with detectable blood level changes of five inflammatory markers and whether chronic LBP is associated with these changes. MATERIALS AND METHODS: Two hundred and forty TwinsUK cohort participants with both MRI disc degeneration grade and Modic change extent, and IL-6, IL-8, IL-8 TNF, and CX3CL1 protein blood concentration measurements were included in this work. Linear mixed effects models were used to test the association of blood cytokine concentration with disc degeneration score and Modic change volumetric score. Association of chronic LBP status from questionnaires with disc degeneration, Modic change, and cytokine blood concentration was also tested. RESULTS: No statistically significant association between disc degeneration or Modic change with cytokine blood concentration was found. Instead, regression analysis pointed strong association between cytokine blood concentration with body mass index for IL-6 and with age for IL-6 and TNF. Mild association was found between IL-8 blood concentration and body mass index. Additionally, LBP status was associated with Modic change volumetric score but not associated with any cytokine concentration. CONCLUSIONS: We found no evidence that Modic change and disc degeneration are able to produce changes in tested blood cytokine concentration. However, age and body mass index have strong influence on cytokine concentration and both are associated with the conditions studied which may confound associations found in the literature. It is then unlikely that cytokines produced in the disc or vertebral bone marrow induce chronic LBP

Endogenous insulin secretion in critically ill patients

1-pageGlucose-insulin system models can be used for improved glycemic control of critically ill patients. A key component of glucose-insulin models is pancreatic insulin secretion. There is limited data in the literature quantifying insulin secretion in critically ill patients at physiologic levels. This study presents a model pancreatic insulin secretion in critically ill patients based on data from a critically ill population

Linear and non linear response in the aging regime of the 1D trap model

We investigate the behaviour of the response function in the one dimensional trap model using scaling arguments that we confirm by numerical simulations. We study the average position of the random walk at time tw+t given that a small bias h is applied at time tw. Several scaling regimes are found, depending on the relative values of t, tw and h. Comparison with the diffusive motion in the absence of bias allows us to show that the fluctuation dissipation relation is, in this case, valid even in the aging regime.Comment: 5 pages, 3 figures, 3 references adde

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

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

peer reviewe

‘He wasn’t nice to our country’: children’s discourses about the ‘glocalized’ nature of political events in the Global North

The accessibility of new media combined with emerging patterns of migration are challenging current definitions of community as we see a shift from close-knit face-to-face interactions to more diverse ‘glocalized’ networks that defines community as a social rather than a spatial dimension. These changes mean that social connections, and fundamentally a person’s sense of belonging, have moved beyond a local neighbourhood to depend upon global networks. This was the case for the children in the current longitudinal ethnographic study that followed one class in a diverse primary school in the north of England every 2 years from their Reception year to Year 6. This article draws upon data collected while the children were in Year 6, aged 10 to 11. It uncovers the range of linguistic and semiotic resources that the children used to communicate with their school peers about two recent political events in the Global North, namely, the United Kingdom’s European Union (EU) Referendum in 2016 that has resulted in Brexit and the US Presidential Election in late 2016 and Donald Trump’s Inauguration in early 2017. Unearthing the ‘glocalized’ discourses in the children’s narratives, this article uncovers the connections that the children made between these political events and their nuclear family’s experiences living in the United Kingdom and their extended family’s experiences in their countries of origin. In providing an account of the children’s discourses surrounding these political events, this article uncovers the ways in which sociopolitical events of global significance become meaningful for this group of children and reveals that the children understand the global as situated, constructed within specific contexts and influenced by local interpretations. As the children orientate themselves to media depictions of these events, their shifting perceptions of global politics alongside their intersecting experiences of racial, national and religious inequalities come to the fore in their peer interactions at school

Localization properties of the anomalous diffusion phase x tμx ~ t^{\mu} in the directed trap model and in the Sinai diffusion with bias

We study the anomalous diffusion phase $x ~ t^{\mu}$ with $0<\mu<1$ which exists both in the Sinai diffusion at small bias, and in the related directed trap model presenting a large distribution of trapping time $p(\tau) \sim 1/\tau^{1+\mu}$. Our starting point is the Real Space Renormalization method in which the whole thermal packet is considered to be in the same renormalized valley at large time : this assumption is exact only in the limit $\mu \to 0$ and corresponds to the Golosov localization. For finite $\mu$, we thus generalize the usual RSRG method to allow for the spreading of the thermal packet over many renormalized valleys. Our construction allows to compute exact series expansions in $\mu$ of all observables : at order $\mu^n$, it is sufficient to consider a spreading of the thermal packet onto at most $(1+n)$ traps in each sample, and to average with the appropriate measure over the samples. For the directed trap model, we show explicitly up to order $\mu^2$ how to recover the diffusion front, the thermal width, and the localization parameter $Y_2$. We moreover compute the localization parameters $Y_k$ for arbitrary $k$, the correlation function of two particles, and the generating function of thermal cumulants. We then explain how these results apply to the Sinai diffusion with bias, by deriving the quantitative mapping between the large-scale renormalized descriptions of the two models.Comment: 33 pages, 3 eps figure