Control In Adult Research Articles

778-P: The Impact of Self-Management Blood Glucose (SMBG) Real-Time Decision Support on Glycemic Control in Adult with T1D in China

Objective: To assess the effect of use frequency of SMBG real-time decision support in a diabetes app on glycemic control in adult with T1D. Methods: T1D users from TangTangQuan® App meeting the following criteria will be selected: physician diagnosed T1D with aged≥18 years old, T1D duration ≥1 year. Frequency of uploading SMBG was be calculated in 2018. Patients were divided into two groups according to frequency of uploading SMBG (high engagement group (HE, ≥15 days/month; and control group<15 days/month). The changes in HbA1c, incidence of hyper- and hypo-glycemia from baseline to 12 months after using app were compared. Results: Of 3474 users over 1 year, 562 eligible patients had complete set of HbA1c records. At baseline, the mean age was 26.6±7.3 years, 33.5% were male, the mean HbA1c was 6.5±0.9%. Change in HbA1c from baseline improved in the HE group than that in control [-0.3 (-0.6, 0.2) vs. -0.1 (-0.8, 0.5) %, p=0.023]. Furthermore, Incidence of hyperglycemia at 12 months was significantly decrease in HE group than control, while no difference in Hypoglycemia between two groups (Table 1). Engagement intensity was significantly and independently associated with changes in HbA1c after adjustment by multiple regression analysis [-0.4 (-0.7, -0.0), p=0.036]. Conclusions: High engagement in SMBG real-time decision support may benefit for glycemic control in Chinese T1D adult. Disclosure Z. Liu: None. C. Wang: None. X. Zheng: None. S. Luo: None. D. Yang: None. J. Yan: None. J. Weng: None. Funding National Key Research and Development Program of China (2018YFC1314100)

03 Standing Postural Control in the Older Adult using Proposed Virtual Light Touch Contact System

Abstract Background We proposed a novel standing-function evaluation system based on Virtual Light Touch Contact (VLTC). In this approach, virtual partition with virtual inertia, viscosity, stiffness is set around the subject. When the subject touches the virtual partition, virtual force is estimated. And virtual force is feed backed to fingertip in the form of vibrotactile stimulation. Random on/off control of virtual forces from the virtual partition enabled evaluation of standing function based on the presence or absence of somatic sensory stimulation to the fingers. Purpose The purpose of this study was to investigate the adults’ postural control during quiet standing using our VLTC system. Method The participants were 60 adults (72.7±7.6 y/o). We used our proposed vibrotactile stimulation device and a Kinect 2 sensor (Microsoft) and a Wii Balance Board (Nintendo) are utilized to determine the centre of pressure (COP). We measured quiet standing with closed eyes and legs using a VLTC system. We compered body sway using total sway length (TSL), rectangular area (RA), average velocity (AVel), and average vector (AVec) of COP in each of the 60's, (22 participants) 70's (28 participants), 80's (10 participants). Results The TSL and AVel in the 60’s was significantly smaller than that in the 80’s (p<0.05). And the TLS and AVel in the 70's tended to be smaller than that in the 80's (p=0.07). The other parameters were non-significant. Conclusion We showed that body sway increased when the old adults were quiet standing with VLTC system. Stability of the human posture by LTC is due to an increased amount of feedback, especially from the somatosensory system, among the system required for postural adjustment. Authors assume that the old adults could not depend on VTC system due to the decreased in fingertip somatosensory function, and the old adult’s body sway was increased.

Hypertension Treatment and Control in Older Adult at Tanjung Sari Primary Health Care

Background : Hypertension is considered as a major health problem in Indonesia, especially in older adult population because of its prevalence increases by age. Treatment strategy and control management of hypertension in Public Health Center (Pusat Kesehatan Masyarakat, Puskesmas) as primary health care should be enhanced to overcome this issue. This study aimed to describe the pattern of antihypertensive agent in older adults. Methods : This was a descriptive study with total sampling method for data collection. Data were collected from medical record of older adult patients with diagnosis of hypertension at Puskesmas Tanjung Sari from January to December 2013. The variables observed were gender, number of visits, the degree of hypertension, types of antihypertensive drug, combinations of antihypertensive drugs, and blood pressure control. Results : The number of older adults with hypertension was 180 people. Some of which, 120 women (66.7%) participated, 152 (84.4%) had hypertension stage 2, 100 (55.6%) had just one visit, and 80 (44.4%) had more than one visit. Among 80 participants with more than one visit, 8 had achieved target blood pressure. There were 166 participants (92.2%) who received single antihypertensive agent (captopril was given the most), and 14 participants (7.8%) who received the combination of two antihypertensive agent (combination of captopril and HCT (hydrochlorothiazide)) were given the most). Conclusions : More than 75% of older adult with hypertension have stage 2 hypertension and are treated by single antihypertensive agent. Ninety percent of the patient have uncontrolled blood pressure. [AMJ.2016;3(1):17–21] DOI: 10.15850/amj.v3n1.699

Multicenter Validation of a Computer-Based Clinical Decision Support Tool for Glucose Control in Adult and Pediatric Intensive Care Units

Hyperglycemia during critical illness is common, and intravenous insulin therapy (IIT) to normalize blood glucose improves outcomes in selected populations. Methods differ widely in complexity, insulin dosing approaches, efficacy, and rates of hypoglycemia. We developed a simple bedside-computerized decision support protocol (eProtocol-insulin) that yields promising results in the development center. We examined the effectiveness and safety of this tool in six adult and five pediatric intensive care units (ICUs) in other centers. We required attending physicians of eligible patients to independently intend to use intravenous insulin to normalize blood glucose. We used eProtocol-insulin for glucose control for a duration determined by the clinical caregivers. Adults had an anticipated length of stay of 3 or more days. In pediatric ICUs, we also required support or intended support with mechanical ventilation for greater than 24 hours or with a vasoactive infusion. We recorded all instances in which eProtocol-insulin instructions were not accepted and all blood glucose values. An independent data safety and monitoring board monitored study results and subject safety. Bedside nurses were selected randomly to complete a paper survey describing their perceptions of quality of care and workload related to eProtocol-insulin use. Clinicians accepted 93% of eProtocol-insulin instructions (11,773/12,645) in 100 adult and 48 pediatric subjects. Forty-eight percent of glucose values were in the target range. Both of these results met a priori-defined efficacy thresholds. Only 0.18% of glucose values were < or =40 mg/dl. This is lower than values reported in prior IIT studies. Although nurses reported eProtocol-insulin required as much work as managing a mechanical ventilator, most nurses felt eProtocol-insulin had a low impact on their ability to complete non-IIT nursing activities. A multicenter validation demonstrated that eProtocol-insulin is a valid, exportable tool that can assist clinicians in achieving control of glucose in critically ill adults and children.

3.15 Microgravity: Return to an egocentric spatial orientation control in adult

This study evaluated the cognitive mapping abilities of rats that spent part of their early development in a microgravity environment. Litters of male and female Sprague-Dawley rat pups were launched into space aboard the National Aeronautics and Space Administration space shuttle Columbia on postnatal day 8 or 14 and remained in space for 16 days. These animals were designated as FLT groups. Two age-matched control groups remained on Earth: those in standard vivarium housing (VIV) and those in housing identical to that aboard the shuttle (AGC). On return to Earth, animals were tested in three different tasks that measure spatial learning ability, the Morris water maze (MWM), and a modified version of the radial arm maze (RAM). Animals were also tested in an open field apparatus to measure general activity and exploratory activity. Performance and search strategies were evaluated in each of these tasks using an automated tracking system. Despite the dramatic differences in early experience, there were remarkably few differences between the FLT groups and their Earth-bound controls in these tasks. FLT animals learned the MWM and RAM as quickly as did controls. Evaluation of search patterns suggested subtle differences in patterns of exploration and in the strategies used to solve the tasks during the first few days of testing, but these differences normalized rapidly. Together, these data suggest that development in an environment without gravity has minimal long-term impact on spatial learning and memory abilities. Any differences due to development in microgravity are quickly reversed after return to earth normal gravity.

Postural Control in the Older Adult

Age-related changes in the neural, sensory, and musculoskeletal systems can lead to balance impairments that have a tremendous impact on the ability to move about safely. The many complex substrates of the posture control system subserve a common functional goal: regulation of the relationship between the center of mass and the base of support. Traditional approaches, which have focused on the control of the center-of-mass displacement, have documented age-related changes in "feet-in-place" responses: during quiet standing, during volitional movement, or in response to applied perturbation. Recently, increasing attention has been directed toward the control of the base of support, that is, compensatory leg and arm movement, as an important element of the postural repertoire, and early results suggest profound age-related impairment in the control of compensatory stepping movements. For both feet-in-place and stepping responses, control of lateral stability appears to be a major problem associated with increased risk of falling. In view of age-related differences in ability to adapt postural responses under predictable task conditions, future work will likely benefit by mimicking, as much as possible, the varied and unpredictable nature of the events that often precipitate falls in daily life, in order to draw connections between the laboratory or clinic and "real-life" stability.

Visual, Vestibular and Somatosensory Contributions to Balance Control in the Older Adult

Age-and pathology-related changes in the relative contributions of visual and somatosensory inputs to dynamic balance control were evaluated. Young adults (mean age = 25, SD = 4) were compared to older adults (mean age = 68, SD = 5,). Electromyographic responses were collected when subjects' balance was perturbed on a movable platform. The amounts of visual information and of somatosensory input at the ankle were manipulated. Muscle response latencies, losses of balance, and muscle sequencing were analyzed. Muscle response latencies did not differ across age groups. Loss of balance data indicated that older adults were less stable under conditions in which peripheral vision was occluded and ankle somatosensation was limited (only foveal vision and vestibular input remaining). Older adults showed more antagonist muscle activation and used muscle sequences not seen in young adults (e.G., hip strategy). These effects were exaggerated among subjects in whom borderline pathology had been diagnosed.

Visual, vestibular and somatosensory contributions to balance control in the older adult.

Age- and pathology-related changes in the relative contributions of visual and somatosensory inputs to dynamic balance control were evaluated. Young adults (mean age = 25, SD = 4) were compared to older adults (mean age = 68, SD = 5). Electromyographic responses were collected when subjects' balance was perturbed on a movable platform. The amounts of visual information and of somatosensory input at the ankle were manipulated. Muscle response latencies, losses of balance, and muscle sequencing were analyzed. Muscle response latencies did not differ across age groups. Loss of balance data indicated that older adults were less stable under conditions in which peripheral vision was occluded and ankle somatosensation was limited (only foveal vision and vestibular input remaining). Older adults showed more antagonist muscle activation and used muscle sequences not seen in young adults (e.g., hip strategy). These effects were exaggerated among subjects in whom borderline pathology had been diagnosed.

A Methodology for Assessing Central Determinants of Behavioral Motor Control in the Aging Adult

A Methodology for Assessing Central Determinants of Behavioral Motor Control in the Aging Adult