Failure of glycated hemoglobin drop after continuous subcutaneous insulin infusion initiation may indicate patients who discontinue: a 4-year follow-up study in children and adolescents with type 1 diabetes

Abstract Continuous subcutaneous insulin infusion (CSII) is effective and safe in children and adults with type 1 diabetes. Notwithstanding, some patients decide to discontinue using CSII. We evaluated the discontinuation rate, and its related factors, in a large group of children and adolescents with type 1 diabetes using CSII in Italy. Data on all patients with type 1 diabetes younger than 18 years were collected by 28 Pediatric Diabetologic referral Centers located throughout Italy. The primary endpoint was to measure the discontinuation rate using CSII. Among the study population (n = 6,644), 985 (14.8%) were using CSII. Sixty patients discontinued using CSII, representing the 6.1%. The discontinuation rate significantly increased (P = 0.002) with age: 0-6 years, 1/84 (1.2%), 7-11 years, 8/262 (3.1%), 12-18 years, 51/579 (8.8%). The average time to discontinuation was 1.8 ± 1.4 years. The average age of patients who discontinued using CSII was higher than in patients still on CSII (12.1 ± 3.2 vs. 10.3 ± 3.8, P = 0.0001), while their diabetes duration was significantly shorter (8.6 ± 2.7 vs. 10.2 ± 3.7, P = 0.0001). HbA1c decreased only in patients still on CSII (8.7 ± 1.3% vs. 7.8 ± 1.3%, P = 0.02), but not in patients who discontinued using CSII (8.5 ± 1.6% vs. 8.2 ± 1.3%, P = 0.213). HbA1c might be one important indicator helpful to identify patients at higher risk discontinuing using CSII.Continuous subcutaneous insulin infusion (CSII) is effective and safe in children and adults with type 1 diabetes. Notwithstanding, some patients decide to discontinue using CSII. We evaluated the discontinuation rate, and its related factors, in a large group of children and adolescents with type 1 diabetes using CSII in Italy. Data on all patients with type 1 diabetes younger than 18 years were collected by 28 Pediatric Diabetologic referral Centers located throughout Italy. The primary endpoint was to measure the discontinuation rate using CSII. Among the study population (n = 6,644), 985 (14.8%) were using CSII. Sixty patients discontinued using CSII, representing the 6.1%. The discontinuation rate significantly increased (P = 0.002) with age: 0-6 years, 1/84 (1.2%), 7-11 years, 8/262 (3.1%), 12-18 years, 51/579 (8.8%). The average time to discontinuation was 1.8 ± 1.4 years. The average age of patients who discontinued using CSII was higher than in patients still on CSII (12.1 ± 3.2 vs. 10.3 ± 3.8, P = 0.0001), while their diabetes duration was significantly shorter (8.6 ± 2.7 vs. 10.2 ± 3.7, P = 0.0001). HbA1c decreased only in patients still on CSII (8.7 ± 1.3% vs. 7.8 ± 1.3%, P = 0.02), but not in patients who discontinued using CSII (8.5 ± 1.6% vs. 8.2 ± 1.3%, P = 0.213). HbA1c might be one important indicator helpful to identify patients at higher risk discontinuing using CSII. © 2011 Springer-Verlag

Vision-Depth Landmarks and Inertial Fusion for Navigation in Degraded Visual Environments

This paper proposes a method for tight fusion of visual, depth and inertial data in order to extend robotic capabilities for navigation in GPS-denied, poorly illuminated, and texture-less environments. Visual and depth information are fused at the feature detection and descriptor extraction levels to augment one sensing modality with the other. These multimodal features are then further integrated with inertial sensor cues using an extended Kalman filter to estimate the robot pose, sensor bias terms, and landmark positions simultaneously as part of the filter state. As demonstrated through a set of hand-held and Micro Aerial Vehicle experiments, the proposed algorithm is shown to perform reliably in challenging visually-degraded environments using RGB-D information from a lightweight and low-cost sensor and data from an IMU.Comment: 11 pages, 6 figures, Published in International Symposium on Visual Computing (ISVC) 201

Diet management, lifestyle factors and education needs by target attainment in Italian youth with type 1 diabetes from the Global TEENs study

Background and aims: TEENs is an international, cross-sectional observational study, conducted in 20 countries in order to assess T1D management and psychosocial parameters in 8-25-year-olds (y/o). Data on diet management, lifestyle factors and education needs by target HbA1c attainment from the Italian cohort are reported. Materials and methods: Data were collected at 23 centres by participant interview, medical record review and participant/parent survey from 1,009 Italian youth (46% female) in three age groups: 8-12 y/o (n=330), 13-18 y/o (n=490), and 19-25 y/o (n=189). HbA1c was measured uniformly using A1cNow™ with target HbA1c defined as <7.5% (58 mmol/mol) for ≤18 y/o (ISPAD) and <7% (53 mmol/mol) for >18 y/o (ADA). Results: Overall, 40% of participants met HbA1c targets. Measuring food intake based on experience was the most common method used by all age groups, followed by carbohydrate counting (Table). Of the participants who used carbohydrate counting, a higher percentage met target HbA1c than did not in all age groups, with a significant effect on target attainment due to carbohydrate counting compared with other methods observed in 13-18 y/o (p=0.035). Avoiding sugars was the least common method used in all age groups. Across all age groups, participants who did not undertake any exercise were numerically less likely to reach HbA1c target; on the contrary, participants who exercised 1-2 days/week were numerically more likely to reach HbA1c target. Performing exercise had a significant effect on target HbA1c attainment in 8-12 y/o (p=0.012). The majority of participants were in the underweight/normal body mass index (BMI) category in all age groups, with no clear pattern between BMI class and the proportion of patients reaching HbA1c target. Participants of all ages commonly requested education on diet, carbohydrate counting, how to manage T1D during illness, and how to manage blood glucose levels with exercise. Conclusion: Carbohydrate counting and exercising at least twice per week help to attain HbA1c target across all age groups. Assessment of lifestyle factors suggests that efforts targeting carbohydrate counting and exercise could promote successful health outcomes and help more patients with T1D to reach the recommended HbA1c target. Supported by: Sanof

Insulin pump failures in Italian children with Type 1 diabetes: retrospective 1-year cohort study

AimsInsulin pump failure and/or malfunction requiring replacement have not been thoroughly investigated. This study evaluated pump replacement in children and adolescents with Type 1 diabetes using insulin pump therapy.MethodsData were collected for all participants younger than 19 years, starting insulin pump therapy before 31 December 2013. For each child, age, disease duration, date of insulin pump therapy initiation, insulin pump model, failure/malfunction/replacement yes/no and reason were considered for the year 2013.ResultsData were returned by 40 of 43 paediatric centres belonging to the Diabetes Study Group of the Italian Society of Paediatric Endocrinology and Diabetology. In total, 1574 of 11 311 (13.9%) children and adolescents with Type 1 diabetes were using an insulin pump: 29.2% Animas VIBE, 9.4% Medtronic MiniMed 715/515, 34.3% Medtronic MiniMed VEO, 24.3% Accu-Check Spirit Combo and 2.8% other models. In 2013, 0.165 insulin pump replacements per patient-year (11.8% due to pump failure/malfunction and 4.7% due to accidental damage) were recorded. Animas VIBE (22.1%) and Medtronic MiniMed VEO (17.7%) were the most replaced.ConclusionsIn a large cohort of Italian children and adolescents with Type 1 diabetes, insulin pump failure/malfunction and consequent replacement are aligned with rates previously reported and higher in more sophisticated pump models

How digital is agriculture in a subset of countries from South America? Adoption and limitations

Digital agriculture (DA) can contribute solutions to meet an increase in healthy, nutritious, and affordable food demands in an efficient and sustainable way. South America (SA) is one of the main grain and protein producers in the world but the status of DA in the region is unknown. A systematic review and case studies from Brazil, Argentina, Uruguay, and Chile were conducted to address the following objectives: (1) quantify adoption of existing DA technologies, (2) identify limitations for DA adoption; and (3) summarise existing metrics to benchmark DA benefits. Level of DA adoption was led by Brazil and Argentina followed by Uruguay and at a slower rate, Chile. GPS guidance systems, mapping tools, mobile apps and remote sensing were the most adopted DA technologies in SA. The most reported limitations to adoption were technology cost, lack of training, limited number of companies providing services, and unclear benefits from DA. Across the case studies, there was no clear definition of DA. To mitigate some of these limitations, our findings suggest the need for a DA educational curriculum that can fulfill the demand for job skills such as data processing, analysis and interpretation. Regional efforts are needed to standardise these metrics. This will allow stakeholders to design targeted initiatives to promote DA towards sustainability of food production in the region

Real-time smart and standalone vision/IMU navigation sensor

In this paper, we present a smart, standalone, multi-platform stereo vision/IMU-based navigation system, providing ego-motion estimation. The real-time visual odometry algorithm is run on a nano ITX single-board computer (SBC) of 1.9 GHz CPU and 16-core GPU. High-resolution stereo images of 1.2 megapixel provide high-quality data. Tracking of up to 750 features is made possible at 5 fps thanks to a minimal, but efficient, features detection–stereo matching–feature tracking scheme runs on the GPU. Furthermore, the feature tracking algorithm benefits from assistance of a 100 Hz IMU whose accelerometer and gyroscope data provide inertial features prediction enhancing execution speed and tracking efficiency. In a space mission context, we demonstrate robustness and accuracy of the real-time generated 6-degrees-of-freedom trajectories from our visual odometry algorithm. Performance evaluations are comparable to ground truth measurements from an external motion capture system

Dual-regulated lentiviral vector for gene therapy of X-linked chronic granulomatosis

Regulated transgene expression may improve the safety and efficacy of hematopoietic stem cell (HSC) gene therapy. Clinical trials for X-linked chronic granulomatous disease (X-CGD) employing gammaretroviral vectors were limited by insertional oncogenesis or lack of persistent engraftment. Our novel strategy, based on regulated lentiviral vectors (LV), targets gp91(phox) expression to the differentiated myeloid compartment while sparing HSC, to reduce the risk of genotoxicity and potential perturbation of reactive oxygen species levels. Targeting was obtained by a myeloid-specific promoter (MSP) and posttranscriptional, microRNA-mediated regulation. We optimized both components in human bone marrow (BM) HSC and their differentiated progeny in vitro and in a xenotransplantation model, and generated therapeutic gp91(phox) expressing LVs for CGD gene therapy. All vectors restored gp91(phox) expression and function in human X-CGD myeloid cell lines, primary monocytes, and differentiated myeloid cells. While unregulated LVs ectopically expressed gp91(phox) in CD34(+) cells, transcriptionally and posttranscriptionally regulated LVs substantially reduced this off-target expression. X-CGD mice transplanted with transduced HSC restored gp91(phox) expression, and MSP-driven vectors maintained regulation during BM development. Combining transcriptional (SP146.gp91-driven) and posttranscriptional (miR-126-restricted) targeting, we achieved high levels of myeloid-specific transgene expression, entirely sparing the CD34(+) HSC compartment. This dual-targeted LV construct represents a promising candidate for further clinical development

Carbono da biomassa microbiana e respiração basal em solo sob integração lavoura pecuária floresta.

Este trabalho objetivou avaliar a atividade da comunidade microbiana total de solos sob o sistema de integração lavoura pecuária floresta, por meio dos teores de Carbono da Biomassa Microbiana e Respiração Basal.FertBio 2010

Avaliação da atividade enzimática em solo sob integração lavoura pecuária floresta.

Sistemas de produção que integram agricultura e pecuária, bem como agricultura pecuária e floresta são práticas de manejo que buscam maximizar a utilização da área, integrando grandes culturas, como milho, soja e feijão, com braquiária e floresta, estes sistemas vêm ganhando espaço na atual atividade agrícola do país. Este trabalho objetivou quantificar a atividade das enzimas fosfatase ácida e alcalina em solo sob integração Lavoura Pecuária Floresta (iLPF), em período de chuva, Março, e período de seca, Outubro, de 2010. Os tratamentos T1, T2 e T3, consistiram em iLPF com linhas simples, dupla e tripla, respectivamente, de eucalipto e nas entrelinhas plantio rotacionado de soja, milho e braquiária, T4 consistiu em área de mata nativa, e T5 área de plantio convencional com rotação de soja, milho e braquiária. Os melhores resultados, para ambas as atividades, se deram no período de seca, sendo que os sistemas apresentaram resultados estatísticos maiores em relação à área de mata nativa, sugerindo sustentabilidade e estabilidade dos mesmos