Parents' Place of Maryland

Background: Previous InPen decision tree modeling (DTM) in adults indicated that missed meal dosing was a major modifiable factor associated with TIR (70-180mg/dL) . We used DTM to find characteristics/use-behaviors associated with TIR for InPen+CGM users <18 years of age. Methods: InPen+CGM data from youth (N=883) with T1D starting InPen between 7/20 and 6/21 were used to identify characteristics (prior delivery method, diabetes duration) and use-behaviors (frequency of missed/correction doses, priming/bolus count, meal therapy mode, InPen bolus calculator use, app reminders, time settings, and report generation) associated with TIR. A variance inflation factor >10 was used to reduce multicollinearity for feature importance. Those with insufficient CGM and/or bolus data and lack of consistent insulin therapy settings were excluded. Results: DTM of users determined 1) diabetes duration, 2) frequency of missed meal doses, 3) bolus count and 4) correction frequency as the top variables associated with TIR (Figure) . Highest average TIR (68.0%) was observed in newly diagnosed (≤1 year) users. Users with >2 years diabetes duration, <5.5 boluses/day, and >35.1% missed dose frequency demonstrated lowest average TIR (35%) . Conclusions: DTM is a novel application for understanding glycemic outcomes due to modifiable and non-modifiable factors. Disclosure M. Smith: Employee; Medtronic. G. Im: Employee; Medtronic. A. Gaetano: None. S. Thanasekaran: None. J. Macleod: Employee; Medtronic. R. A. Vigersky: Employee; Medtronic.

Abstract An important factor in evaluating the visibility of pedestrians at night is the contrast they offer an observer. This paper investigates and quantifies the influence of various parameters on contrast. An experiment was conducted using pedestrians and surrogate human models positioned along a grid in relation to the illuminated headlights of vehicles positioned on a dry asphalt roadway with no additional overhead lighting. As part of this experiment, headlight illuminance was mapped, and pedestrian luminance data were comprehensively collected to provide parametric data necessary to evaluate patterns affecting contrast. Luminance and illuminance data are presented in the form of three-dimensional plots and further related to visibility levels using the Adrian model. The results of this study highlight and quantify important factors present in night visibility of pedestrians. These include position of the pedestrian both longitudinally and laterally, reflectivity of the clothing, vertical variations in luminance and illuminance, the background, and headlamp characteristics. They emphasize that three-dimensional modeling of headlight illuminance and pedestrian luminance enhances the understanding of pedestrian contrast and visibility.

The ultimate goal of implantable electrochemical, aptamer-based (E-AB) sensors is to enable the continuous and precise monitoring of clinically and physiologically important targets in the body for prolonged periods.

Compared with a pulmonary artery catheter (PAC), transthoracic echocardiography (TTE) has been shown to have good agreement in cardiac output (CO) measurement in nonsurgical populations. Our hypothesis is that the feasibility and accuracy of CO measured by TTE (CO-TTE), relative to CO measured by PAC thermodilution (CO-PAC), is different in surgical intensive care unit patients (SP) and nonsurgical patients (NSP). Surgical patients with PAC for hemodynamic monitoring and NSP undergoing right heart catheterization were prospectively enrolled. Cardiac output was measured by CO-PAC and CO-TTE. Pearson coefficients were used to assess correlation. Bland-Altman analysis was used to determine agreement. Over 18 months, 84 patients were enrolled (51 SP, 33 NSP). Cardiac output TTE could be measured in 65% (33/51) of SP versus 79% (26/33) of NSP; p = 0.17. Inability to measure the left ventricular outflow tract diameter was the primary reason for failure in both groups; 94% (17/18) in SP versus 86% (6/7) NSP; p = 0.47. Velocity time integral could be measured in all patients. In both groups, correlation between PAC and TTE measurement was strong; SP (r = 0.76; p < 0.0001), NSP (r = 0.86; p < 0.0001). Bland-Altman analysis demonstrated bias of -0.1 L/min, limits of agreement of -2.5 and +2.3 L/min, percentage error (PE) of 40% for SP, and bias of +0.4 L/min, limits of agreement of -1.8 and +2.5 L/min, and PE of 40% for NSP. There was strong correlation and moderate agreement between TTE and PAC in both SP and NSP. In both patient populations, inability to measure the left ventricular outflow tract diameter was a limiting factor. Diagnostic tests or criteria, level III.

Women with pregnancy complications benefit from closer monitoring postpartum and beyond. Increased postpartum emergency room (ER) use may indicate unmet need for outpatient obstetrics and primary care. The purpose of this study was to evaluate whether women with pregnancy complications (gestational diabetes [GDM], gestational hypertension, and preeclampsia) have increased ER use in the first 6 months postpartum, compared with women without these complications. We conducted a retrospective population-based cohort study using a 2003-2010 Maryland Medicaid managed care claims data set, linked with U.S. Census data. Data included claims for outpatient and ER visits for women aged 12-45 years who were continuously enrolled in Medicaid for at least 100 days of pregnancy and 90 days postpartum. We used logistic regression to calculate the association between pregnancy complications and having ≥1 ER visit in the 6 months postpartum. We identified 26,074 pregnancies, of which 20% were complicated by GDM, gestational hypertension, or preeclampsia. Of these complicated pregnancies, 42.1% had GDM, 35.4% had gestational hypertension, and 42.5% had preeclampsia (diagnoses were not mutually exclusive). In the 6 months postpartum, 25% of women had ≥1 ER visits. Of the complicated pregnancy group, 27.7% had ≥1 ER visit, versus 23.6% of the comparison group (p<0.0001). In adjusted analyses, women with a pregnancy complication were more likely to have ≥1 ER visit compared with women without these complications (odds ratio [OR]1.14, 95% confidence interval [CI] 1.05-1.23). The strength of association was highest in women under age 25 (OR 1.20, 95% CI 1.09-1.33). Preconception medical comorbidities (type 2 diabetes, chronic hypertension, obesity, asthma, mental health, and substance abuse diagnoses) were also strongly associated with postpartum ER use (OR 1.61, 95% CI 1.51-1.73). Pregnancy complications increased ER utilization during the 6 months postpartum, especially among women under age 25 years. Interventions that improve discharge planning and early postpartum care may decrease ER use.

Purpose:Multiple brain metastases are a frequent indication for stereotactic radiosurgery (SRS). There is concern that as radiation doses to normal brain increase, neurocognitive toxicity increases too. In this report, we estimate how many lesions and what total volume of tumor(s) can be irradiated before a whole brain dose of 8 Gy is reached.Methods:Multiple tumor SRS was simulated in Matlab (Mathworks, Inc) using pre‐calculated dose distributions (kernels) created from single isocenter shots for 4mm, 8mm and 16mm targets, and composite shots for 24mm and 36mm targets in GammaPlan (Elekta, Inc Sweden). Tumors of varying size from 1–36mm were randomly placed throughout the brain and covered with dose until the mean normal brain dose reached 8Gy. Selection of tumor size, dose coverage, selectivity, normalization, and maximum dose were based off NYU Gamma Knife clinical metastases database. Scenarios were run both for mixed tumor sizes and a select few fixed tumors sizes.Results:The mean number of tumors treated, V12, and total tumor volume treated using mixed tumor size distribution were 40.1±8.6, 180.2±28.8cc, and 41.1±12.7cc. For the simulation runs utilizing tumor size fixed ranges of 0–4mm, 4–8mm, 8–16mm, 16–24mm, 24–36mm, the average contribution per tumor to a whole brain dose was 0.045Gy, 0.097Gy, 0.359Gy, 0.635Gy, and 1.203Gy, respectively.Conclusion:GK SRS would require an average of 6.7 24–36mm tumors, 177.3 0–4mm tumors, or 40.1 tumors of mixed sizes to be treated to reach 8 Gy whole normal brain dose for a single session. Therefore, this study alleviates the concern that radiosurgery for a large number of tumors or treating additional newly formed metastases after previous SRS can lead to high whole brain doses. The ability to safely retreat enables the physician to consider new SRS instead of whole brain radiotherapy when additional metastases appear.

We describe some emerging technologies that are being investigated for the realization of next generation wireless networks capable of supporting multiple standards and meeting capacity demands. The challenges associated with their efficient integration in a converged wireless/optical network are also discussed.