Percent Reduction In Time Research Articles

A Novel Composite Glucose Index (COGI) for Evaluating Closed-Loop Performance in Type 1 Diabetes

Presently, no single index exists that summarizes key aspects of continuous glucose monitoring (CGM) data. Such an index may be useful in evaluating outcomes in closed-loop (CL) as well as other novel diabetes technology studies utilizing CGM. Here we present a novel composite glucose index (COGI), encompassing three key elements of CGM (Table). The total index ranges from 0 to 100, where 100 approximates glucose profile of people without diabetes. One percent reduction of time <70mg/dl is equivalent to 4.7% increase in time in range (TIR) and 9mg/dl reduction in standard deviation of CGM is equivalent to 3% increase in TIR. We used the COGI to assess the incremental benefits of day-and-night hybrid CL on glucose control compared to insulin pump therapy during a previously reported randomized cross-over, 4-week study in adults with well-controlled type 1 diabetes (n=28, mean, baseline HbA1c 6.9% (52 mmol/mol), age 41 years, duration of diabetes 24 years). Mean (SD) of COGI was 60(11) (range 41 to 80) during the control period, which improved to 75 (7) (range 58 to 86) during CL (paired difference: +15, p<0.0001, 95% CI +11 to +18). We demonstrate a novel composite glucose index based on CGM which improved considerably during CL, even in those with optimal HbA1c. A composite CGM-based metric may thus have a role in evaluating glycemic control attributable to CL and other novel technologies beyond HbA1c.Composition of the COGI and relative contributions of its three componentsGlucose AreaCGM metricRange and scoring of the metricRelative Contribution to COGI(%)Time in range (TIR)Percent time spent between 70 to 180mg/dlTIR from 0% to 100% where 0% TIR is given 0 points and 100% TIR is given 100 points50Time in hypoglycemia (TIH)Percent time spent below 70mg/dlTIH from 0% to 15% where 0% TIH is given 100 points and TIH 15% and above is given 0 points35Glucose variability (GV)Standard deviation (SD)SD from 18 to 108mg/dl where SD 18mg/dl and below is given 100 points and SD 108mg/dl and above is given 0 points15 Disclosure L. Leelarathna: Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Insulet Corporation, Medtronic MiniMed, Inc.. Advisory Panel; Self; Roche Diabetes Care Health and Digital Solutions, Abbott. H. Thabit: None. L. Bally: None. M.E. Wilinska: None. J.K. Mader: Speaker's Bureau; Self; Roche Diabetes Care Health and Digital Solutions, Novo Nordisk A/S. Advisory Panel; Self; Eli Lilly and Company. Consultant; Self; Becton, Dickinson and Company. Speaker's Bureau; Self; Sanofi. Research Support; Self; ConvaTec Inc., Menarini Group. Speaker's Bureau; Self; Medtronic. Research Support; Self; Novo Nordisk A/S, Sanofi. T.R. Pieber: Consultant; Self; Arecor, AstraZeneca, Eli Lilly and Company, Novo Nordisk A/S, Sanofi. Employee; Self; CBmed. Research Support; Self; Novo Nordisk A/S, AstraZeneca. M. Evans: Advisory Panel; Self; Novo Nordisk A/S, Eli Lilly and Company, Cellnovo, Roche Pharma. Speaker's Bureau; Self; Abbott, Novo Nordisk A/S. R. Hovorka: Speaker's Bureau; Self; Novo Nordisk A/S. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Eli Lilly and Company, AstraZeneca. Other Relationship; Self; B. Braun Medical Inc.. Research Support; Self; Medtronic. Other Relationship; Self; Medtronic. Research Support; Self; Abbott, JDRF, Diabetes UK, National Institute of Diabetes and Digestive and Kidney Diseases.

Fifty Percent Reduction in Time Between Patient Check-In and Needle Stick for Thyroid FNA Due to Workflow Redesign

Optimizing workflow efficiency is key to improving the performance of any system. Optimized workflows in health care benefit patients by reducing unnecessary waits and delays. Additionally, optimized workflows benefit health care organizations by allowing the production of more units during a fixed period of time and with fixed resources.

Effects of a laboratory-based skills curriculum on laparoscopic proficiency: A randomized trial

Objective: The purpose of this study was to determine the effect and validity of an intensive laboratory-based laparoscopic skills training curriculum on operative proficiency in obstetrics and gynecology residents. Study design: This was a prospective, randomized, block-design trial of postgraduate year 3 and 4 residents. The following study schedule was used: week 1 (prerandomization) included an orientation to study objectives, the administration of a laparoscopic experience questionnaire, timed video-laparoscopic drills (5 total), and the performance of a video-recorded laparoscopic partial salpingectomy; during weeks 2 and 3, the skills group residents repeated the laparoscopic drills 30 minutes daily for 10 days, and the control group residents had no formal practice sessions; during week 4, the week 1 evaluation was repeated. Operative proficiency was quantified by the Global Skills Assessment Tool through blinded, independent scoring of videotapes. Results: Twenty-six residents (skills group, 12; control group, 14) consented to the trial. Patient-related issues excluded 8 residents (30%). At week 1, no significant differences existed in previous laparoscopic experience, timed video skills, or resident operative proficiency (Global Skills Assessment Tool score) between cohorts. At week 4, both groups significantly improved their timed drill test scores. The percent reduction in time from baseline was of greater magnitude in the skills group versus control group (51% vs 18%,P < .0001). Laparoscopic performance also improved in both cohorts (P = .002). However, only the skills group demonstrated significant intracohort improvement from baseline (mean, 4.9 points; P = .015; 95% CI, 1–7.5). Conclusion: A core curriculum of intensive video laparoscopic skills training improves not only technical but also operative performance among postgraduate year 3 and 4 residents. (Am J Obstet Gynecol 2002;186:836-42.)

An Optimization Strategy for Maximizing Coordinate Measuring Machine Productivity, Part 2: Problem Formulation, Solution, and Experimental Results

In this, the second of two papers focused on optimizing CMM productivity, a strategy is presented for obtaining operating speeds that maximize CMM throughput. The strategy involves posing the objective and constraints in terms of a nonlinear programming problem. The objective is to minimize measuring time, and constraints are on measurement quality, available motor power and other machine specific characteristics. Solutions to various measurement scenarios are given, computed with a generalized conjugate gradient method that uses a golden section acceptable search method. Also, a sensitivity study is presented that utilizes the optimization strategy to determine how change to a CMM’s design will affect overall productivity. In the final section, experimental results utilizing the optimally computed trajectories for both single axis and multiple axis motion are given. In addition, an example is presented to demonstrate the implementation of the optimization strategy in an actual measuring application. In the example, a connecting-rod is measured at three speeds: the machine’s default speed, a speed constrained by available motor power, and the optimized speed (constrained additionally by measurement quality). The experiment demonstrates a 27 percent reduction in time for the optimized speed compared to the default speed using the Bartlett test for comparing variances in the dimensional data obtained.

Control of Flexible Structures With the Confinement of Vibrations

A novel control strategy for the simultaneous suppression and confinement of vibrations in flexible structures is proposed. The key idea is to alter the original modes by appropriate feedback forces to allow parts of a flexible structure to reach their steady states at fast rates. It has been demonstrated that the convergence of these parts to zero is improved at the expense of slowing down the settling of the remaining parts to their steady states. The proposed control strategy can be applied in the rapid removal of vibration energy in sensitive parts of a flexible structure for safety or performance reasons. Such parts include communication antennas in light space structures and payloads of flexible robot manipulators. In order to gain insight into the viability of the proposed control strategy, the latter is compared with a classical feedback control strategy under the same input bound constraint. It has been shown that the new control strategy brings the sensitive parts to rest with approximately 50 percent reduction in time.