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Background Controlling postprandial blood glucose without the benefit of an appropriately sized premeal insulin bolus has been challenging given the delays in absorption and action of subcutaneously injected insulin during conventional and artificial pancreas (AP) system diabetes treatment. We aim to understand the impact of accelerating insulin and increasing aggressiveness of the AP controller as potential solutions to address the postprandial hyperglycemia challenge posed by unannounced meals through a simulation study. Methods Accelerated rapid-acting insulin analogue is modeled within the UVA/Padova simulation platform by uniformly reducing its pharmacokinetic time constants (α multiplier) and used with a model predictive control, where the controller's aggressiveness depends on α. Two sets of single-meal simulations were performed (1) where we only tune the controller's aggressiveness and (2) where we also accelerate insulin absorption and action to assess postprandial glycemic control during each intervention. Results Mean percent of time spent within the 70 to 180 mg/dL postprandial glycemic range is significantly higher in set (2) than in set (1) 79.9, 95% confidence interval [77.0, 82.7] vs 88.8 [86.8, 90.9] ([Note to typesetter Set all unnecessary math in text format and insert appropriate spaces between operators.] P less then .05) for α = 2, and 81.4 [78.6, 84.3] vs 94.1 [92.6, 95.6] (P less then .05) for α = 3. A decrease in percent of time below 70 mg/dL is also detected 0.9 [0.4, 2.2] vs 0.6 [0.2, 1.4] (P = .23) for α = 2 and 1.4 [0.7, 2.8] vs 0.4 [0.1, 1.4] (P less then .05) for α = 3. Conclusion These proof-of-concept simulations suggest that an AP without prandial insulin boluses combined with significantly faster insulin analogues could match the glycemic performance obtained with an optimal hybrid AP.Background In response to the public health emergency created by the COVID-19 pandemic, American Heart Association volunteers and staff aimed to rapidly develop and launch a resource for the medical and research community to expedite scientific advancement through shared learning, quality improvement, and research. In less than 4 weeks after it was first announced on April 3, 2020, AHA's COVID-19 CVD Registry powered by Get With The Guidelines® (GWTG) received its first clinical records. Methods and Results Participating hospitals are enrolling consecutive hospitalized patients with active COVID-19 disease, regardless of CVD status. This hospital quality improvement program will allow participating hospitals and health systems to evaluate patient-level data including mortality rates, intensive care unit (ICU) bed days, and ventilator days from individual review of electronic medical records of sequential adult patients with active COVID-19 infection. Participating sites can leverage these data for onsite, rapid quality improvement and benchmarking versus other institutions. After 9 weeks, more than 130 sites have enrolled in the program and more than 4,000 records have been abstracted in the national dataset. Additionally, the aggregate dataset will be a valuable data resource for the medical research community. Conclusions The AHA COVID-19 CVD Registry will support greater understanding of the impact of COVID-19 on cardiovascular disease and will inform best practices for evaluation and management of patients with COVID-19.Purpose Flourishing and mental health in the prediction of health behaviors such as exercise has been understudied. Positive emotions may promote, and negative emotions hinder protective health behaviors; however, the direction of these associations is unclear. The objective here was to investigate possible associations prospectively. https://www.selleckchem.com/products/turi.html Design Longitudinal cohort study. Setting National. Sample The Biopsychosocial Religion and Health Study of Seventh-day Adventists provided longitudinal data from 2006 to 2007 and 2010 to 2011 (n = 5789). Measures Flourishing was based on 6 measures of social functioning (positive social exchanges, negative social exchanges, religious emotional support given, received, and anticipated, and negative interactions) and 4 measures of psychological functioning (mastery, self-esteem, spiritual meaning, and perceived stress). The positivity ratio was the ratio of positive to negative emotions assessed with the Positive and Negative Affect Schedule. Analysis Linear multiple regression and mediation. Results Flourishing worked indirectly through the positivity ratio to predict a later increase in exercise over the course of 3 to 5 years. Tests of mediation suggest that the association of flourishing with later exercise was indirect through an increased ratio of positive to negative affect. Initial exercise frequency was also associated with later improved flourishing and positivity ratio scores over the same period. Conclusion The association of mental health and exercise is likely bidirectional. Exercise improves mental health, and those that have better psychosocial functioning have better mood and are more likely to increase exercise behaviors over time. Exercise is likely integral to mental health in mid to late life.The aims of the study were to evaluate the responsiveness of Hospital Anxiety and Depression Scale-Anxiety (HADS-A) subscale and HADS-Depression (HADS-D) subscale to pulmonary rehabilitation (PR) in patients with bronchiectasis compared to a matched group of patients with chronic obstructive pulmonary disease (COPD) and provide estimates of the minimal clinically important difference (MCID) of HADS-A and HADS-D in bronchiectasis. Patients with bronchiectasis and at least mild anxiety or depression (HADS-A ≥ 8 or/and HADS-D ≥ 8), as well as a propensity score-matched control group of patients with COPD, underwent an 8-week outpatient PR programme (two supervised sessions per week). Within- and between-group changes were calculated in response to PR. Anchor- and distribution-based methods were used to estimate the MCID. HADS-A and HADS-D improved in response to PR in both patients with bronchiectasis and those with COPD (median (25th, 75th centile)/mean (95% confidence interval) change HADS-A change bronchiectasis -2 (-5, 0), COPD -2 (-4, 0); p = 0.
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