Continuous Monitoring Research Articles

The relationship between serum anion gap levels and short-, medium-, and long-term all-cause mortality in ICU patients with congestive heart failure: a retrospective cohort study

Background There hasn’t been research done on the connection between serum anion gap (AG) levels and long-, medium-, and short-term all-cause mortality in congestive heart failure (CHF) patients. This study aims to investigate the association between serum anion gap levels and all-cause mortality in CHF patients after adjusting for other covariates. Methods For each patient, we gather demographic information, comorbidities, laboratory results, vital signs, and scoring data using the ICU (Intensive Care Unit) Admission Scoring System from the MIMIC-III database. The connection between baseline AG and long-, medium-, and short-term all-cause mortality in critically ill congestive heart failure patients was investigated using Kaplan-Meier survival curves, subgroup analysis, restricted cubic spline, and Cox proportional risk analysis. Results 4840 patients with congestive heart failure in total were included in this study. With a mean age of 72.5 years, these patients had a gender split of 2567 males and 2273 females. After adjusting for other covariates, a multiple regression analysis revealed that, in critically ill patients with congestive heart failure, all-cause mortality increased significantly with rising AG levels. In the fully adjusted model, we discovered that AG levels were strongly correlated with 4-year, 365-day, 90-day, and 30-day all-cause mortality in congestive heart failure patients with HRs (95% CI) of 1.06 (1.04, 1.08); 1.08 (1.05, 1.10); and 1.08 (1.05, 1.11) (p-value < 0.05). Our subgroup analysis’s findings demonstrated a high level of consistency and reliability. K-M survival curves demonstrate that high serum AG levels are associated with a lower survival probability. Conclusion Our research showed the association between CHF patients’ all-cause mortality and anion gap levels was non-linear. Elevated anion gap levels are associated with an increased risk of long-, medium-, and short-term all-cause death in patients with congestive heart failure. Continuous monitoring of changes in AG levels may have a clinical predictive role.

Romantic relationships and type 2 diabetes: The role of invisible social control.

This study aimed to determine whether invisible social control provided by a romantic partner is associated with improved objective glucose outcomes for patients with Type 2 diabetes. Social control reflects a partner's attempt to modify or influence a patient's health behaviors. We hypothesized that the best outcome for all continuous glucose monitoring measures would be captured by an interaction condition reflecting invisible social control. Patients with Type 2 diabetes and their partners (N = 63 couples) completed an 8-day daily diary period between 2016 and 2017. Self-report measures of social control receipt and provision were obtained each evening from patients and partners and patients wore a continuous glucose monitor throughout the diary period. Outcomes of daily glucose mean, standard deviation, time in range, and coefficient of variation were computed and two-way interactions between social control receipt and social control provision were probed and plotted. The two-way interaction significantly predicted daily glucose mean, standard deviation, and time in range, such that when patients reported no social control receipt, but partners reported social control provision, patients showed improvements in objective glucose measures. We found no significant effect for coefficient of variation. This study was the first to use an invisible social control framework to examine the daily dyadic associations between partner social control provision, patient social control receipt, and four objectively measured continuous glucose monitoring outcomes. Findings suggest that the visibility of social control provided by a romantic partner may be predictive of glycemic control in patients with Type 2 diabetes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Optimizing time-in-target-range assessment for blood pressure: insights from a large-scale study with continual cuffless monitoring.

Blood pressure (BP) time-in-target-range (TTR) is an emerging predictor of cardiovascular risk. Conventional BP methods are fundamentally unable to provide an optimal assessment of TTR, using irregular measurements separated by lengthy intervals. We investigated the optimal duration and frequency for reliable, practical TTR assessment in clinical settings using continual monitoring. This retrospective study analyzed 2.3 million BP readings from 5,189 European home users (55 ± 11 years, 82% male, BMI 28.0 ± 5.8) using a cuffless BP monitor (Aktiia SA). Systolic BP (SBP) data over 15 consecutive days were assessed (29 ± 11 readings/subject/24-h; 434 + 132 readings/subject/15-day). Subjects were classified into risk-related TTR groups based on 15-day SBP data (24-h, target 90-125 mmHg; ≥6 daytime readings). Various measurement frequencies and durations (1-14 days; 24-h/daytime; 2, 4 or ≥ 6 readings/day) were compared to this reference. Two specific configurations paralleling ambulatory ("One-Day-24 h") and home ("One-Week-Daytime") BP monitoring were selected for detailed analysis. The reference TTR classified 63.0% of the subjects as high risk, 19.0% intermediate, and 18.0% low. "One-Day-24 h" schedule inaccurately classified 26% of subjects compared to the reference TTR, and "One-Week-Daytime" schedule inaccurately classified 45%. Classification accuracy with both schedules was high for subjects with very low or very high reference TTR, but poor otherwise. Accuracy of ≥90% in TTR classification only occurred with 7 days of continual 24-h monitoring. For the first time, with the benefit of a cuffless device that measures BP with sufficient frequency and duration, practical use of TTR is enabled as a potentially enhanced metric to manage hypertension.

Improving Diabetic Care Through Education and Innovation

Background:Despite the innovative advancements in diabetes care, providers may not recognize patients with type 2 diabetes mellitus (T2DM) who qualify for a continuous glucose monitoring (CGM) device or the benefits of a telemedicine program for improving self-management behaviors.Objective:This quality improvement (QI) project aimed to determine if an advanced practice registered nurse (APRN)-led telemedicine program using CGM could improve glycemic control and self-management in patients with insulin-dependent T2DM.Methods:A 6-week telemedicine program was developed and implemented using the CGM’s time-in-range to deliver patient-specific education. Clinical metrics were collected at each visit. All patients completed a pre- and postintervention Diabetes Self-Management Questionnaire-Revised (DSMQ-R) survey.Results:A repeated measures analysis of variance revealed that the telemedicine program had a statistically significant impact on time-in-range outcomes,F(2, 14) = 18.203,p&lt; .001. Paired-samplesttests indicate that APRN-led education improved body mass index,t(8) = 4.232,p= .002; decreased systolic blood pressure,t(8) = 2.90,p= .010, and diastolic blood pressure,t(8) = 3.21,p= .007; and increased self-management skills as evidenced by DSMQ-R,t(8) = −5.498,p&lt; .001.Conclusions:This QI project highlights multiple interventions for improving diabetes management in a primary care facility.Implications for Nursing:An APRN-led telemedicine program integrating CGM time-in-range data can improve glycemic control and self-management skills in patients with T2DM who administer insulin.

Feasibility of anticoagulation on demand after percutaneous coronary intervention in high-bleeding risk patients with paroxysmal atrial fibrillation The INTERMITTENT Registry

Abstract Aims This study evaluated the feasibility of the intermittent use of direct oral anticoagulants (DOACs) guided by continuous rhythm monitoring via a clinically validated wearable smart device in high-bleeding risk (HBR) patients with symptomatic paroxysmal atrial fibrillation (AF) otherwise subjected to chronic anticoagulation after percutaneous coronary intervention (PCI). Methods and results The INTERMITTENT registry was a 3-year prospective observational study at 8 Italian centers. Inclusion criteria were elective or urgent PCI, Academic Research Consortium HBR criteria, history of symptomatic 12-lead ECG detected paroxysmal AF episodes, indication to DOACs, and use of a wearable smart device (Apple WatchTM). Thirty days after PCI, patients free of AF episodes discontinued DOAC. However, if an AF episode lasting&amp;gt;6 minutes or a total AF burden&amp;gt;6 hours over 24 hours was detected, DOAC was initiated for 30 consecutive days, and withdrawn afterwards if no further AF episodes occurred. At the discretion of the referring physician, intermittent anticoagulation was offered to 89 patients, whereas continuous treatment with DOACs was prescribed to 151 patients. During a follow-up of 298+87 days, the average duration of oral anticoagulation was significantly shorter in the intermittent anticoagulation group (176+43 days, p=0.0001), representing a 40% reduction in anticoagulation time compared to the continuous group. Ischemic and bleeding end-points were not significantly different between the two groups. Propensity score-matching resulted in a total of 69 matched patients with intermittent versus continuous anticoagulation, respectively. During a follow-up of 291+63 days, there was a significant 46% reduction in anticoagulation time in the intermittent compared to the continuous group (p=0.0001). Conclusion In high-bleeding risk patients with a history of paroxysmal AF episodes who underwent PCI, intermittent anticoagulation guided by continuous rhythm monitoring with a wearable device was feasible and decreased significantly the duration of anticoagulation.

Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study: study protocol for a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes.

Background The Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study is a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes (T2D). The study aims to test the efficacy of a personalized behavioral approach for dietary management of moderately-controlled T2D, versus a standardized behavioral intervention that uses one-size-fits-all dietary recommendations, versus a usual care control (UCC). The primary outcome will compare the impact of each intervention on the mean amplitude of glycemic excursions (MAGE). Methods Eligible participants are between 21 to 80 years of age diagnosed with moderately-controlled T2D (HbA1c: 6.0-8.0%), and managed on lifestyle alone or lifestyle plus metformin. Participants must be willing and able to attend virtual counseling sessions and log meals into a dietary tracking smartphone application (DayTwo), and wear a continuous glucose monitor (CGM) for up to 12 days. Participants are randomized with equal allocation (n = 255, n = 85 per arm) to one of three arms: 1) Personalized , 2) Standardized , or 3) UCC . Measurements occur at 0 (baseline), 3, and 6 months. All participants receive isocaloric energy and macronutrients targets to meet Mediterranean diet guidelines plus 14 intervention contacts over 6 months (4 weekly then 10 biweekly) to cover diabetes self-management education. The first 4 UCC intervention contacts are delivered via synchronous videoconferences followed by educational video links. Participants in Standardized receive the same education content as UCC on the same schedule. However, all intervention contacts are conducted via synchronous videoconferences, paired with Social Cognitive Theory (SCT)-based behavioral counseling, plus dietary self-monitoring of planned meals using a mobile app that provides real-time feedback on calories and macronutrients. Participants in the Personalized arm receive all elements of the Standardized intervention, plus real-time feedback on predicted post-prandial glycemic response (PPGR) to meals and snacks logged into the mobile app. Discussion The DiaTeleMed study will address an important gap in the current landscape of precision nutrition by determining the contributions of behavioral counseling and personalized nutrition recommendations on glycemic control in individuals with T2D. The fully remote methodology of the study allows for scalability and innovative delivery of personalized dietary recommendations at a population level. Trial registration: The DiaTeleMed Study is registered with ClinicalTrials.gov (Identifier: NCT05046886).

A Eurasian otter &lt;i&gt;Lutra lutra&lt;/i&gt; (Linnaeus 1758) (Carnivora: Mustelidae) in the Tiber basin near Rome: relict or range expansion?

The Eurasian otter Lutra lutra faced a significant decline in Italy during the 20th century, leading to local extinctions. After fifty years of otter disappearance from the Tiber basin, this study documents a sighting near Rome, obtained during a long-term trail camera monitoring. The study area, Rio Moscio, offers a habitat rich in hygrophilous vegetation and diverse fauna, including other protected species such as the Italian wolf, the European wildcat, and the European polecat. The observed otter could either mark a potential range expansion or could challenge the presumed extinctions in this region, since it could be in dispersal from the closer known populations or an individual from a Tiber basin relict population. The study emphasises the need for continued monitoring and prompt future genetic analyses to obtain necessary insights for conserving otters in Central Italy.

Phylogenetic and mutational analysis of H10N3 avian influenza A virus in China: potential threats to human health.

In recent years, the avian influenza virus has emerged as a significant threat to both human and public health. This study focuses on a patient infected with the H10N3 subtype of avian influenza virus, admitted to the Third People's Hospital of Kunming City on March 6, 2024. Metagenomic RNA sequencing and polymerase chain reaction (PCR) analysis were conducted on the patient's sputum, confirming the H10N3 infection. The patient presented severe pneumonia symptoms such as fever, expectoration, chest tightness, shortness of breath, and cough. Phylogenetic analysis of the Haemagglutinin (HA) and neuraminidase (NA) genes of the virus showed that the virus was most closely related to a case of human infection with the H10N3 subtype of avian influenza virus found in Zhejiang Province, China. Analysis of amino acid mutation sites identified four mutations potentially hazardous to human health. Consequently, this underscores the importance of continuous and vigilant monitoring of the dynamics surrounding the H10N3 subtype of avian influenza virus, utilizing advanced genomic surveillance techniques.

The effect of continuous electronic fetal monitoring on mode of delivery and neonatal outcome among low-risk laboring mothers at Debre Markos comprehensive specialized hospital, Northwest Ethiopia.

Electronic fetal heart rate monitoring (EFM) has been widely used in obstetric practice for over 40 years to improve perinatal outcomes. Its popularity is growing in Ethiopia and other sub-Saharan African countries to reduce high perinatal morbidity and mortality rates. However, its impact on delivery mode and perinatal outcomes in low-risk pregnancies remains controversial. This study aimed to assess the effect of continuous EFM on delivery mode and neonatal outcomes among low-risk laboring mothers at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. A prospective follow-up study was conducted from November 20, 2023, to January 10, 2024. All low-risk laboring mothers meeting the inclusion criteria were included. Data were collected via pretested structured questionnaires and observation, then analyzed using Epi-data 4.6 and SPSS. The incidences of cesarean delivery and continuous EFM were compared using the chi-squared test and Fisher's exact test. The study found higher rates of instrumental-assisted vaginal delivery (7% vs. 2.4%) and cesarean sections (16% vs. 2%) due to unsettling fetal heart rate patterns in the continuous EFM group compared to the intermittent auscultation group. However, there were no differences in immediate neonatal outcomes between the groups. When compared to intermittent auscultation with a Pinard fetoscope, the routine use of continuous EFM among low-risk laboring mothers was associated with an increased risk of cesarean sections and instrumental vaginal deliveries, without significantly improving immediate newborn outcomes. However, it is important to note that our study faced significant logistical constraints due to the limited availability of EFM devices, which influenced our ability to use EFM comprehensively. Given these limitations, we recommend avoiding the routine use of continuous EFM for low-risk laboring mothers to help reduce the rising number of operative deliveries, particularly cesarean sections. Our findings should be interpreted with caution, and further research with adequate resources is needed to draw definitive conclusions.

Deep-Learning-Based Automatic Sinkhole Recognition: Application to the Eastern Dead Sea

Sinkholes can cause significant damage to infrastructures, agriculture, and endanger lives in active karst regions like the Dead Sea’s eastern shore at Ghor Al-Haditha. The common sinkhole mapping methods often require costly high-resolution data and manual, time-consuming expert analysis. This study introduces an efficient deep learning model designed to improve sinkhole mapping using accessible satellite imagery, which could enhance management practices related to sinkholes and other geohazards in evaporite karst regions. The developed AI system is centered around the U-Net architecture. The model was initially trained on a high-resolution drone dataset (0.1 m GSD, phase I), covering 250 sinkhole instances. Subsequently, it was additionally fine-tuned on a larger dataset from a Pleiades Neo satellite image (0.3 m GSD, phase II) with 1038 instances. The training process involved an automated image-processing workflow and strategic layer freezing and unfreezing to adapt the model to different input scales and resolutions. We show the usefulness of initial layer features learned on drone data, for the coarser, more readily-available satellite inputs. The validation revealed high detection accuracy for sinkholes, with phase I achieving a recall of 96.79% and an F1 score of 97.08%, and phase II reaching a recall of 92.06% and an F1 score of 91.23%. These results confirm the model’s accuracy and its capability to maintain high performance across varying resolutions. Our findings highlight the potential of using RGB visual bands for sinkhole detection across different karst environments. This approach provides a scalable, cost-effective solution for continuous mapping, monitoring, and risk mitigation related to sinkhole hazards. The developed system is not limited only to sinkholes however, and can be naturally extended to other geohazards as well. Moreover, since it currently uses U-Net as a backbone, the system can be extended to incorporate super-resolution techniques, leveraging U-Net based latent diffusion models to address the smaller-scale, ambiguous geo-structures that are often found in geoscientific data.

Dynamic antimicrobial resistance and phylogenomic structure of Salmonella Typhimurium from 2007 to 2019 in Shanghai, China.

Our study uncovered a widespread distribution of Salmonella enterica serovar Typhimurium isolates in Shanghai accompanied by the increase in antimicrobial resistance (AMR) especially MDR during a 10-year period, which filled in the gap about a long period of continuous monitoring of AMR in this pathogen in Shanghai. Meanwhile, we identified a new clade ST34C2 of S. Typhimurium with the acquisition of IncI (Gamma)-like plasmids mediated by extended-spectrum β-lactamase gene blaCTX-M-14 as well as gyrA 87 mutation, which had not been reported before. It was noted that IncI (Gamma)-like plasmids were reported in S. Typhimurium for the first time and conjugation could accelerate the spread of antimicrobial resistance gene blaCTX-M-14. These findings on the epidemic, antimicrobial resistance, and phylogenomic characterization for S. Typhimurium provide valuable insights into its potential risk to public health and also the basis for AMR prevention and control strategies in Shanghai in the future.

A Highly Stretchable, Conductive, and Transparent Bioadhesive Hydrogel as a Flexible Sensor for Enhanced Real-Time Human Health Monitoring.

Real-time continuous monitoring of non-cognitive markers is crucial for the early detection and management of chronic conditions. Current diagnostic methods are often invasive and not suitable for at-home monitoring. An elastic, adhesive, and biodegradable hydrogel-based wearable sensor with superior accuracy and durability for monitoring real-time human health is developed. Employing a supramolecular engineering strategy, a pseudo-slide-ring hydrogel is synthesized by combining polyacrylamide (pAAm), β-cyclodextrin (β-CD), and poly 2-(acryloyloxy)ethyltrimethylammonium chloride (AETAc) bio ionic liquid (Bio-IL). This novel approach decouples conflicting mechano-chemical effects arising from different molecular building blocks and provides a balance of mechanical toughness (1.1 × 106 Jm-3), flexibility, conductivity (≈0.29 S m-1), and tissue adhesion (≈27kPa), along with rapid self-healing and remarkable stretchability (≈3000%). Unlike traditional hydrogels, the one-pot synthesis avoids chemical crosslinkers and metallic nanofillers, reducing cytotoxicity. While the pAAm provides mechanical strength, the formation of the pseudo-slide-ring structure ensureshigh stretchability and flexibility. Combining pAAm with β-CD and pAETAc enhances biocompatibility and biodegradability, as confirmed by in vitro and in vivo studies. The hydrogel also offers transparency, passive-cooling, ultraviolet (UV)-shielding, and 3D printability, enhancing its practicality for everyday use. The engineered sensor demonstratesimproved efficiency, stability, and sensitivity in motion/haptic sensing, advancing real-time human healthcare monitoring.

A sensitive system based on radon amplification at soil-air interface: Aiming to advance earthquake precursor research

Radon, a natural radioactive gas, serves as a valuable tracer in geophysical research and atmospheric science such as detecting stress induced signal in bedrock. However, the conventional radon monitoring methods often lack the sensitivity required to accurately capture such signals. This limitation, coupled with interference from meteorological effects, poses challenges in distinguishing genuine stress-induced signals. In this study, we propose a novel approach utilizing radon concentration gradients at the soil-air interface to enhance sensitivity and detect stress induced radon signals more effectively. Drawing from pressure diffusion models, we demonstrate how seismic stress accumulation in bedrock alters radon profiles in the sub-soil, providing insights into the mechanisms underlying stress-induced radon variations. Building upon this theoretical framework, we introduce the “Bhabha Radon Observatory for Seismic Application (BhaROSA)," a remote sensing, solar-powered radon observatory designed for widespread deployment and continuous unattended monitoring for big database generation. Field experiments comparing BhaROSA's performance to conventional soil probe techniques validate and confirm the superior sensitivity in line with theoretical predictions. This innovative approach holds promise for improving our understanding of stress dynamics in bedrock and has potential applications in various geophysical and atmospheric science such as earthquake precursory research, geo-genic radon potential and risk assessment. To progress, we propose international alliance and application of deep learning to a big database of precursor signals, which may lead to more informed conclusions on earthquake predictability-an enduring and unsolved challenge for humanity.

Japanese candlestick charts for diabetes.

Continuous glucose monitoring (CGM) is a popular technology among the diabetic population, especially in patients with type 1 diabetes and those with type 2 diabetes treated with insulin. The American Diabetes Association recommends standardization of CGM reports with visual cues, such as the ambulatory glucose profile. Nevertheless, interpreting this report requires training and time for CGM to be cost-efficient. In this work it has been proposed to incorporate Japanese candlestick charts in glucose monitoring. These graphs are used in price analysis in financial markets and are easier to view. Each candle provides extra information to make prudent decisions since it reports the opening, maximum, minimum and closing glucose levels of the chosen time frame, usually the daily one. The Japanese candlestick chart is an interesting tool to be considered in glucose control. This graphic representation allows identification of glucose trends easily through the colors of the candles and maximum and minimum glucose values.

The method for calculating phase angle between exciter force of vibration exciter and roller displacement

Introduction. In the process of soil compaction it is important to have information about the current density of the layer, as it enables to quickly adjust the load on the compacted material. The field methods of compaction quality assessment do not cope with this task, as they make point estimation within the pavement area. Therefore, continuous compaction monitoring systems installed on vibratory road rollers are becoming increasingly common. The systems developed by BOMAG and AMMANN require, among other things, the phase angle between the exciter force and the roller movement to calculate the compaction quality index. The phase angle is determined by the unbalance position sensor, which is very labor-intensive. In addition, continuous compaction monitoring systems include an accelerometer. The purpose of this paper is to develop an indirect method for calculating the phase angle from accelerometer readings.The method of research. In order to achieve the purpose of the work, a roller-soil single-mass model in a typical mode for vibratory rollers (periodic loss of contact) has been studied. As a result of modeling it has been found that the reaction of the compacted material has the main influence on the vertical component of a roller acceleration and practically does not affect the horizontal component. This is confirmed by the experimental data.Results. The phase angle can be determined by mutual correlation of the horizontal and vertical acceleration signals of the roller obtained with the accelerometer.Conclusion. The study proposes a new method of calculating the phase angle between the exciter force and the roller displacement, which eliminates the direct measurement of this angle. The calculation of the angle is based on the readings of a two-axis accelerometer installed on the road roller. The proposed method enables to simplify the system of continuous compaction control and reduce the labor intensity of phase angle measurement.

Enhancing Teacher Motivation: Leadership Strategies in Panabo City Public Senior High Schools

Effective school leadership plays a crucial role in addressing challenges, inspiring teachers, and creating an environment conducive to teachers. This study delved into the motivational techniques employed by public school heads in Panabo City. Teacher motivation is pivotal in improving educational outcomes and fostering a positive learning environment. This research employed a qualitative approach focusing on a single case to explore the various motivational techniques and strategies implemented by Public Secondary Senior High School Heads regarding their effectiveness and the challenges encountered in the context of Panabo City. Seven (7) key informants were chosen using a purposive sampling technique and underwent an in-depth interview. The gathered data were analyzed using a thematic analysis. The major themes identified pivots around rewards and recognition, professional development, collaboration, and open communication. The technique's effectiveness is measured through performance metrics, feedback mechanisms, and retention rates. The significant challenges experienced by the school heads include sustainability of motivation, tailoring techniques to different individuals, and requiring sufficient support and resources. On the other hand, the emergent themes in motivational strategies include resource allocation and institutional support, school community building, and an inclusive approach. Implementing motivational strategies successfully entails addressing the limited resources, resistance to change, and ensuring sustainability through continuous monitoring and institutional support. The themes were thoroughly discussed, defined, and reinforced with existing studies and literature. Moreover, the insights emphasized the importance of empathy, consistency, and a long-term vision. Recommendations include strengthening the techniques and strategies utilized, being updated on new trends in motivational strategy and improvement, and addressing challenges. By implementing the implications into practice and ensuring sustained effectiveness, school leaders must seek continuous feedback, establish performance metrics, remain adaptable to changes, and address challenges with flexible, tailored strategies that emphasize consistency, empathy, and understanding. This study has the potential to provide valuable perspectives for policymakers in education, as well as school administrators and teachers seeking to enhance teacher motivation and ultimately improve the quality of education.

Glycemic variability through the perspective of the glycemia risk index and time in range and their association with glycated hemoglobin A1c in pediatric patients on sensor-augmented pump therapy.

From the introduction of continuous glucose monitoring (CGM) in treatments of type 1 diabetes, particularly its integration with insulin pumps, there has been a quest for new parameters that describe optimal glycemic control. As of the consensus reached in 2019, the ambulatory glucose profile (AGP) has become the standard, with time in range (TIR) emerging as a fundamental parameter for metabolic control assessment. However, with technological advancements, new parameters, such as the glycemia risk index (GRI), have been introduced and clinically utilized. Therefore, exploring the relationships between traditional and novel parameters to understand metabolic control comprehensively is imperative. This study was conducted at the Pediatric Clinic of the University Hospital of the Republic of Srpska Banja Luka between January and July 2023. The participants were randomly selected, with the inclusion criteria specifying an age greater than eight years and a diabetes type 1 duration exceeding two years. All participants were required to use a sensor-augmented insulin pump for the next three months (90 days), irrespective of prior use, with the suspend-before-low option activated. Of the 35 participants, 30 completed the study, 14 (46.7%) of whom were male. The mean age of the subjects was 14.90 ± 2.88 years, and the mean duration of diabetes was 7.83 ± 4.76 years. Over the 90-day period, HbA1c increased to an average of 7.31%. The analysis revealed significant effects of TIR (β=-0.771) and GRI (β=0.651) on HbA1c. Furthermore, GRI and TIR strongly correlated (β=-0.953). New parameters generated from the ambulatory glucose profile (AGP) can help clinicians create a complete picture of a patient's metabolic control in relation to HbA1c levels. Additionally, the GRI is a mathematically tailored parameter that incorporates all components of the ambulatory glucose profile and demonstrates strong correlations with laboratory-measured HbA1c and TIR. The GRI potentially can become a valuable statistical parameter for evaluating and managing patients in routine clinical practice.

Bismuth Film along with dsDNA-Modified Electrode Surfaces as Promising (bio)Sensors in the Analysis of Heavy Metals in Soils.

Heavy metals constitute pollutants that are particularly common in air, water, and soil. They are present in both urban and rural environments, on land, and in marine ecosystems, where they cause serious environmental problems since they do not degrade easily, remain almost unchanged for long periods, and bioaccumulate. The detection and especially the quantification of metals require a systematic process. Regular monitoring is necessary because of seasonal variations in metal levels. Consequently, there is a significant need for rapid and low-cost metal determination methods. In this study, we compare and analytically validate absorption spectrometry with a sensitive voltammetric method, which uses a bismuth film-plated electrode surface and applies stripping voltammetry. Atomic absorption spectroscopy (AAS) represents a well-established analytical technique, while the applicability of anodic stripping voltammetry (ASV) in complicated sample matrices such as soil samples is currently unknown. This sample-handling challenge is investigated in the present study. The results show that the AAS and ASV methods were satisfactorily correlated and showed that the metal concentration in soils was lower than the limit values but with an increasing trend. Therefore, continuous monitoring of metal levels in the urban complex of a city is necessary and a matter of great importance. The limits of detection of cadmium (Cd) were lower when using the stripping voltammetry (SWASV) graphite furnace technique compared with those obtained with AAS when using the graphite furnace. However, when using flame atomic absorption spectroscopy (flame-AAS), the measurements tended to overestimate the concentration of Cd compared with the values found using SWASV. This highlights the differences in sensitivity and accuracy between these analytical methods for detecting Cd. The SWASV method has the advantage of being cheaper and faster, enabling the simultaneous determination of heavy elements across the range of concentrations that these elements can occur in Mediterranean soils. Additionally, a dsDNA biosensor is suggested for the discrimination of Cu(I) along with Cu(II) based on the oxidation peak of guanine, and adenine residues can be applied in the redox speciation analysis of copper in soil, which represents an issue of great importance.

Reduced Rate of Hospitalizations for Acute Diabetes Events Before and After FreeStyle Libre® System Initiation in Some People With Type 2 Diabetes on Insulin-Secretagogue Oral Drug Therapy Without Insulin in France.

Objective: Glycemic management in people with type 2 diabetes mellitus (T2DM) on insulin-secretagogue regimens without insulin is of importance, as this group still represents a significant proportion of patients. Risks for acute diabetes events (ADEs), including diabetic ketoacidosis (DKA) or hypoglycemia, using insulin-secretagogue drugs are well established. Few studies have suggested that continuous glucose monitoring (CGM) could be useful for monitoring glucose dynamics associated with the use of such therapies. To document this point an exploratory analysis was conducted in a group of individuals with noninsulin treated T2DM in France who are managed with oral insulin-secretagogues and initiating the FreeStyle Libre® system (FSL). Methods: A retrospective study of the French national SNDS reimbursement claims database (≈66 million French people) was conducted to identify people with T2DM on oral insulin-secretagogues and receiving a first reimbursement of FSL between August 1, 2017 and December 31, 2018. The analysis included data for the 12 months before and up to 24 months after FSL initiation. Hospitalizations for diabetes-related acute events were identified using ICD-10 codes as main or related diagnosis, for: hypoglycemic events; DKA events; comas; and hyperglycemia-related admissions. Results: A total of 1272 people with T2DM on insulin-secretagogues without insulin initiated FSL during the selection period. Of these, 7.15% had at least one hospitalization for any ADE in the year before FSL initiation, compared with 2.52% at 12 months and 2.83% at 24 months following FSL initiation. Reductions in ADEs were driven by -73% fewer admissions for ADEs related to diabetic ketoacidosis (DKA) or other hyperglycemia-related events. These patterns of reduced ADEs persisted after 2 years. Conclusions: This study suggests the value of the FSL system in reducing ADEs in some people with T2DM in France being treated with insulin-secretagogues without insulin. Characteristics of these patients remain to be documented.

Pollution concentration monitoring using a new Birnbaum–Saunders control chart

AbstractAir pollution monitoring is an important issue in environmental science. The Birnbaum–Saunders (BS) distribution, originally applied to describe product failure time distribution to fatigue failures and general random wear failures, is also well to describe the pollutant concentration data due to accumulations of various pollutants in the air over time. Sulfur dioxide (SO2) is a critical factor in air pollution. Hence, it is important to monitor its concentration variation for air pollution prevention. Due to the complexity of its distribution form, there is no reliable and easy‐to‐use control chart for monitoring pollutant concentrations based on the BS distribution. We found that the SO2 concentration data follows the BS distribution. In this study, we propose a new median control chart based on the exact sampling distribution of the monitoring statistic to detect shifts in the median of BS distribution. Thus, given the false alarm rate, the control limits for such control charts can be obtained precisely satisfying a preset in‐control average run length using Monte Carlo simulations. The out‐of‐control average run lengths are calculated by simulation to evaluate the detection performance of the proposed chart when the median shifts occur. We further compare the detection performance of the proposed chart and those of the existing control charts based on asymptotic sampling distributions. In order to improve the detection ability of the proposed chart for small median shifts, an exponentially weighted moving average (EWMA) control chart is constructed. The results of numerical analyses demonstrated that the proposed EWMA chart performs much better than all existing control charts for monitoring the median of BS distribution. Finally, the proposed control charts are applied to monitor the median of SO2 concentrations for air pollution control, showing that both charts can effectively detect a shift in the median of SO2 concentrations. The proposed EWMA control chart even detects out a small shift in the median of SO2 concentrations. The results provide a continuous monitoring solution for air pollution prevention.