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Propper-Lewinsohn T, Elran-Barak R, Gillon-Keren M, Yackobovitch-Gavan M, Liberman A, Phillip M, Shalitin S. Disordered Eating Behaviors Among Adolescents and Young Adults with Type 1 Diabetes Treated with Insulin Pumps and Hybrid Closed-Loop Systems. Diabetes Technol Ther 2024; 26:229-237. [PMID: 38090768 DOI: 10.1089/dia.2023.0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Background and Aims: Disordered eating behaviors (DEB) are more common among individuals with type 1 diabetes (T1D) compared to those without, and for insulin pump users may be associated with higher hemoglobin A1c (HbA1c). We investigated DEB risk factors among insulin pump-treated individuals with T1D and clinical characteristics of hybrid closed-loop (HCL) systems' users by DEB level. Methods: An observational, cross-sectional study of 167 insulin pump-treated individuals with T1D, 13-21 years of age. Data were obtained from patients' medical charts with additional self-reported questionnaires, including assessment of DEB. Results: DEB were found in 71 (42.5%) individuals, and positively associated with female sex (β = 2.98 [standard error (SE) = 1.31], P = 0.025), body mass index (BMI)-Z-score (β = 2.12 [SE = 0.64], P = 0.001), HbA1c (β = 1.40 [SE = 0.45], P = 0.02), and higher rate of pump discontinuation (β = 4.48 [SE = 1.99], P = 0.026). The use of HCL systems compared to insulin pumps was associated with higher BMI-Z-score (odds ratio [OR]: 3.46 [95% confidence interval, CI: 1.52-7.87], P = 0.003) and tendency to lower HbA1c level (OR: 0.44 [95% CI: 0.18-1.09], P = 0.078) among individuals without DEB, and with lower HbA1c level (OR: 0.29 [95% CI: 0.10-0.83], P = 0.022) and higher socioeconomic status (OR: 1.73 [95% CI: 1.09-2.74], P = 0.020) among individuals with DEB. Conclusions: DEB are common among individuals with T1D treated with insulin pumps and are associated with higher HbA1c levels. Among T1D individuals with DEB, HCL system use is associated with lower HbA1c compared to insulin pump treatment. Our findings highlight the importance of regular screening for DEB and its risk factors to improve pump treatment and diabetes management. Moreover, individuals with DEB using HCL systems may benefit from reduced HbA1c levels.
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Affiliation(s)
- Tamar Propper-Lewinsohn
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Roni Elran-Barak
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Michal Gillon-Keren
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Sciences, Kibbutzim College of Education Technology and the Arts, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Liberman
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Moshe Phillip
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Shalitin
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Liberman A, Barnard-Kelly K. Diabetes Technologies and the Human Factor. Diabetes Technol Ther 2024; 26:S201-S211. [PMID: 38441452 DOI: 10.1089/dia.2024.2513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Alon Liberman
- Jesse and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Nir J, Liberman A, Yackobovitch-Gavan M, Fraser D, Phillip M, Oron T. Nondisclosure of Type 1 Diabetes in Adolescence: A Single-Center Experience. Diabetes Spectr 2023; 37:124-129. [PMID: 38756425 PMCID: PMC11093764 DOI: 10.2337/ds23-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Objective The aim of this study was to assess the extent of nondisclosure of type 1 diabetes in adolescents and investigate its association with several psychosocial parameters and clinical outcomes. Research design and methods This was a cross-sectional study based on data collected from 69 adolescents with type 1 diabetes who were 12-18 years of age and followed at our diabetes clinic. The degree of disclosure, demographics, diabetes management, and psychosocial issues were assessed via questionnaires. Clinical parameters were derived from medical records. Associations between nondisclosure status and clinical and psychosocial study variables were assessed. Results Fifty-three participants (77%) reported some extent of nondisclosure. Nondisclosure was associated with low self-esteem, reduced friend support, and increased diabetes-related worries. Nondisclosure was also found to be associated with diminished self-care behaviors related to insulin administration and with elevated A1C. Conclusion Our results demonstrate that nondisclosure of type 1 diabetes in adolescents may be more common than initially recognized and is likely associated with unfavorable psychological outcomes and reduced self-care and diabetes management. Our results emphasize the importance of social interactions and disclosure in adolescents and may serve as a potential stepping stone to address other social barriers hindering diabetes management.
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Affiliation(s)
- Judith Nir
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Liberman
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Michal Yackobovitch-Gavan
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Drora Fraser
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheeba, Israel
| | - Moshe Phillip
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Oron
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Propper-Lewinsohn T, Gillon-Keren M, Shalitin S, Elran-Barak R, Yackobovitch-Gavan M, Fayman G, David M, Liberman A, Phillip M, Oron T. Disordered eating behaviours in adolescents with type 1 diabetes can be influenced by their weight at diagnosis and rapid weight gain subsequently. Diabet Med 2023; 40:e15166. [PMID: 37313860 DOI: 10.1111/dme.15166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/15/2023]
Abstract
AIMS To assess the prevalence and disease-related risk factors for disordered eating behaviours among adolescents with type 1 diabetes and also to search for risk factors at disease diagnosis that can predict the development of disordered eating behaviours. METHODS A retrospective observational study of 291 adolescents aged 15-19 years with type 1 diabetes who completed the Diabetes Eating Problem Survey-Revised (DEPS-R) as is routine in our diabetes clinic. The prevalence of disordered eating behaviours and risk factors for their development was assessed. RESULTS In 84 (28.9%) adolescents, disordered eating behaviours were found. Disordered eating behaviours were positively associated with female sex (β = 3.01 [SE = 0.97], p = 0.002), higher BMI-Z score (β = 2.08 [SE = 0.49], p < 0.001), higher HbA1c (β = 0.19 [SE = 0.03], p < 0.001) and treatment with multiple daily injections of insulin (β = 2.19 [SE = 1.02], p = 0.032). At type 1 diabetes diagnosis, higher BMI-Z score (β = 1.54 [SE = 0.63], p = 0.016) for those diagnosed before age 13 years and increased weight gain at 3 months post-diagnosis (β = 0.88 [SE = 0.25], p = 0.001) in females diagnosed at age 13 years or older were found to be risk factors for disordered eating behaviours. CONCLUSIONS Disordered eating behaviours are common among adolescents with type 1 diabetes and are associated with various parameters, including BMI at diagnosis and the rate of weight gain at 3 months post-diagnosis in females. Our findings highlight the need for early preventive efforts for disordered eating behaviours and interventions to avoid late diabetes complications.
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Affiliation(s)
- Tamar Propper-Lewinsohn
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | - Michal Gillon-Keren
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Sciences, Kibbutzim College of Education Technology and the Arts, Tel Aviv, Israel
| | - Shlomit Shalitin
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Michal Yackobovitch-Gavan
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gila Fayman
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Maayan David
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Alon Liberman
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Moshe Phillip
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Oron
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Liberman A, Shenker MN, Bello R, Yackobovitch-Gavan M, Shachar-Lavie I, Wójcik M, Starmach A, Starzyk JB, Kostopoulou E, Chrysis D, Phillip M. Fear of hyperglycemia in parents of children with type 1 diabetes mellitus - a multi-center multi-national study. Diabet Med 2023:e15114. [PMID: 37052607 DOI: 10.1111/dme.15114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Study aims: (1) developing and validating a novel questionnaire for measuring fear of hyperglycemia among parents of children with type 1 diabetes (T1D) - the Hyperglycemia Fear Survey - Parent version (FoHyper-P); (2) investigating correlations between parental fear of hyperglycemia and objective measures of glycemic control. RESEARCH DESIGN AND METHODS A multi-center, multi-national study of 152 parents of children with T1D was conducted in three large diabetes clinics from Israel, Poland, and Greece. Inclusion criteria were parents of children aged 6-16 years, at least 6 months from diagnosis, at least 3 months of CGM use and parental involvement in care. Parents filled the FoHyper-P and the Hypoglycemia Fear Survey - Parent Version (HFS-P). Patient data were obtained via electronic medical records and informative questionnaires. Bonferroni correction was performed to counteract multiple comparisons. RESULTS Significant strong-moderate correlations were found between FoHyper-P and HFS-P including total questionnaires scoring (r=0.747, PBonf. <0.001), worries subscales (r=0.735, PBonf <0.001), and behavior subscales (r=0.532, PBonf <0.001). Using linear regression models we found a positive association between the worry subscale and HbA1C. Weak correlations (P<0.05, not significant after Bonferroni correction) were found between time in range, time above range and parental fear of hyperglycemia as well as between worry subscales and a higher HbA1C in the past year, percent of hyperglycemia and lower TIR. CONCLUSIONS The FoHyper-P is a novel, validated tool for assessing parental fear of hyperglycemia. Integrating it into clinical practice addresses an underestimated aspect of parental diabetes management, enabling better care for children with T1D.
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Affiliation(s)
- Alon Liberman
- Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
| | - Michal Nevo Shenker
- Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
| | - Rachel Bello
- Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
| | - Michal Yackobovitch-Gavan
- Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Shachar-Lavie
- Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Children's University Hospital, Kraków, Poland
| | - Anna Starmach
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Children's University Hospital, Kraków, Poland
| | - Jerzy B Starzyk
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Children's University Hospital, Kraków, Poland
| | - Eirini Kostopoulou
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University General Hospital of Patras, Rio, Greece
| | - Dionisios Chrysis
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University General Hospital of Patras, Rio, Greece
| | - Moshe Phillip
- Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Liberman A, Barnard-Kelly K. Diabetes Technology and the Human Factor. Diabetes Technol Ther 2023; 25:S191-S200. [PMID: 36802189 DOI: 10.1089/dia.2023.2512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Alon Liberman
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Gillon-Keren M, Propper-Lewinsohn T, David M, Liberman A, Phillip M, Oron T. Exacerbation of disordered eating behaviors in adolescents with type 1 diabetes during the COVID-19 pandemic: reply. Acta Diabetol 2022; 59:1397-1398. [PMID: 35941248 PMCID: PMC9360647 DOI: 10.1007/s00592-022-01926-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Michal Gillon-Keren
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, 4920235, Petah Tikva, Israel.
- Faculty of Sciences, Kibbutzim College of Education Technology and the Arts, 6250769, Tel Aviv, Israel.
| | - Tamar Propper-Lewinsohn
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, 4920235, Petah Tikva, Israel
| | - Maayan David
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, 4920235, Petah Tikva, Israel
| | - Alon Liberman
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, 4920235, Petah Tikva, Israel
| | - Moshe Phillip
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, 4920235, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Tal Oron
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, 4920235, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
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Gillon-Keren M, Propper-Lewinsohn T, David M, Liberman A, Phillip M, Oron T. Exacerbation of disordered eating behaviors in adolescents with type 1 diabetes during the COVID-19 pandemic. Acta Diabetol 2022; 59:981-983. [PMID: 35253109 PMCID: PMC8898653 DOI: 10.1007/s00592-022-01867-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/07/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Michal Gillon-Keren
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, 4920235, Israel.
- Faculty of Sciences, Kibbutzim College of Education Technology and the Arts, Tel Aviv, 6250769, Israel.
| | - Tamar Propper-Lewinsohn
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, 4920235, Israel
| | - Maayan David
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, 4920235, Israel
| | - Alon Liberman
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, 4920235, Israel
| | - Moshe Phillip
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, 4920235, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Tal Oron
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, 4920235, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
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Liberman A, Barnard-Kelly K. Diabetes Technologies and the Human Factor. Diabetes Technol Ther 2022; 24:S173-S183. [PMID: 35475691 DOI: 10.1089/dia.2022.2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alon Liberman
- The Jesse Z and Sara Lea Shaffer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Liberman A, Barnard-Kelly K. Diabetes Technology and the Human Factor. Diabetes Technol Ther 2021; 23:S169-S178. [PMID: 34061641 DOI: 10.1089/dia.2021.2512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Alon Liberman
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Mitchell AK, Liberman A, Sela E, Affleck I. SO(5) Non-Fermi Liquid in a Coulomb Box Device. Phys Rev Lett 2021; 126:147702. [PMID: 33891454 DOI: 10.1103/physrevlett.126.147702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
Non-Fermi liquid (NFL) physics can be realized in quantum dot devices where competing interactions frustrate the exact screening of dot spin or charge degrees of freedom. We show that a standard nanodevice architecture, involving a dot coupled to both a quantum box and metallic leads, can host an exotic SO(5) symmetry Kondo effect, with entangled dot and box charge and spin. This NFL state is surprisingly robust to breaking channel and spin symmetry, but destabilized by particle-hole asymmetry. By tuning gate voltages, the SO(5) state evolves continuously to a spin and then "flavor" two-channel Kondo state. The expected experimental conductance signatures are highlighted.
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Affiliation(s)
- Andrew K Mitchell
- School of Physics, University College Dublin, Belfield, Dublin 4, Ireland
- Centre for Quantum Engineering, Science, and Technology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Alon Liberman
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eran Sela
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ian Affleck
- Department of Physics and Astronomy and Stewart Blusson Quantum Matter Institute, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
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Hirschfield G, Jones D, Carbone M, Bowlus CL, Nevens F, Kremer AE, Liberman A, MacConell L, Hansen BE. A43 LONG-TERM EFFICACY AND SAFETY OF OBETICHOCLIC ACID IN PRIMARY BILIARY CHOLANGITIS: RESPONDER ANALYSIS OF OVER 5 YEARS OF TREATMENT IN THE POISE TRIAL. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Obeticholic acid (OCA), a potent farnesoid X receptor agonist, is approved as second-line treatment for primary biliary cholangitis (PBC) in patients with an incomplete response or intolerance to ursodeoxycholic acid.
Aims
We evaluated the effect of OCA in PBC patients enrolled in the POISE trial, comparing those who did or did not achieve the POISE response criteria.
Methods
The phase 3, randomized, double-blind, 1-year POISE trial evaluated the efficacy and safety of OCA 5 and 10 mg vs placebo in patients with PBC; a 5-year open-label extension followed in which all patients received OCA. This analysis evaluated longer-term efficacy and safety in patients who achieved the POISE primary endpoint of alkaline phosphatase (ALP) <1.67 × upper limit of normal (ULN), total bilirubin <ULN, and ALP decrease >15% from baseline after 1 year of OCA and in patients who were incomplete responders.
Results
The analysis included 86 patients who achieved the POISE primary endpoint at year 1 of OCA treatment and 107 incomplete responders (mean baseline ALP, 268 vs 356 U/L, respectively; P<0.0001). Mean change from baseline in ALP at year 5 was –101 U/L for responders and –121 U/L for incomplete responders (P<0.0001; Figure). Median (Q1, Q3) baseline GLOBE 10-year risk of event scores were 16 (11, 23) for responders and 25 (15, 43) for incomplete responders. Change from baseline in median (Q1, Q3) GLOBE 10-year risk of event at year 1, which includes age and thus increases with time, was –2 (–4, 2) for responders and –2 (–6, 4) for incomplete responders; at year 5, these changes were 2 (–2, 7) and 4 (–4, 11), respectively. Median (Q1, Q3) baseline UK-PBC 10-year risk of event scores were 5 (3, 8) for responders and 8 (4, 16) for incomplete responders. Change from baseline in median (Q1, Q3) UK-PBC 10-year risk of event at year 1 was –1 (–3, 0.2) for responders and –1 (–3, 1) for incomplete responders; at year 5, these changes were –0.8 (–2, 0.2) and –0.05 (–2, 2), respectively. The most frequently reported AEs among responders and incomplete responders were pruritus (67%, 86%) and fatigue (35%, 31%).
Conclusions
OCA treatment improved key biochemical markers of PBC, regardless of achieving the POISE primary endpoint after 1 year of OCA treatment. Changes in biochemical parameters over time were often similar between groups.
Funding Agencies
Intercept Pharmaceuticals
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Affiliation(s)
| | - D Jones
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - M Carbone
- Universita degli Studi di Milano-Bicocca, Milano, Lombardia, Italy
| | - C L Bowlus
- University of California Davis School of Medicine, Sacramento, CA
| | - F Nevens
- University Hospitals KU, Leuven, Belgium
| | - A E Kremer
- Friedrich Alexander University of Erlangen–Nürnberg, Erlangen, Germany
| | - A Liberman
- Intercept Pharmaceuticals, San Diego, CA
| | | | - B E Hansen
- University of Toronto, Toronto, ON, Canada
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Esenwa C, Cheng NT, Lipsitz E, Hsu K, Zampolin R, Gersten A, Antoniello D, Soetanto A, Kirchoff K, Liberman A, Mabie P, Nisar T, Rahimian D, Brook A, Lee SK, Haranhalli N, Altschul D, Labovitz D. COVID-19-Associated Carotid Atherothrombosis and Stroke. AJNR Am J Neuroradiol 2020; 41:1993-1995. [PMID: 32819896 DOI: 10.3174/ajnr.a6752] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Abstract
We present a radiology-pathology case series of 3 patients with coronavirus disease 2019 (COVID-19) with acute ischemic stroke due to fulminant carotid thrombosis overlying mild atherosclerotic plaque and propose a novel stroke mechanism: COVID-associated carotid atherothrombosis.
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Affiliation(s)
- C Esenwa
- From the Department of Neurology (C.E.E., N.T.C., D.A., A.S., K.K., A.L., P.M., T.N., D.R., D.L.)
| | - N T Cheng
- From the Department of Neurology (C.E.E., N.T.C., D.A., A.S., K.K., A.L., P.M., T.N., D.R., D.L.)
| | - E Lipsitz
- Cardiothoracic and Vascular Surgery (E.L.), Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - K Hsu
- Radiology (K.H., R.Z., A.B., S.-K.L.)
| | | | | | - D Antoniello
- From the Department of Neurology (C.E.E., N.T.C., D.A., A.S., K.K., A.L., P.M., T.N., D.R., D.L.)
| | - A Soetanto
- From the Department of Neurology (C.E.E., N.T.C., D.A., A.S., K.K., A.L., P.M., T.N., D.R., D.L.)
| | - K Kirchoff
- From the Department of Neurology (C.E.E., N.T.C., D.A., A.S., K.K., A.L., P.M., T.N., D.R., D.L.)
| | - A Liberman
- From the Department of Neurology (C.E.E., N.T.C., D.A., A.S., K.K., A.L., P.M., T.N., D.R., D.L.)
| | - P Mabie
- From the Department of Neurology (C.E.E., N.T.C., D.A., A.S., K.K., A.L., P.M., T.N., D.R., D.L.)
| | - T Nisar
- From the Department of Neurology (C.E.E., N.T.C., D.A., A.S., K.K., A.L., P.M., T.N., D.R., D.L.)
| | - D Rahimian
- From the Department of Neurology (C.E.E., N.T.C., D.A., A.S., K.K., A.L., P.M., T.N., D.R., D.L.)
| | - A Brook
- Radiology (K.H., R.Z., A.B., S.-K.L.)
| | - S-K Lee
- Radiology (K.H., R.Z., A.B., S.-K.L.)
| | - N Haranhalli
- Neurosurgery (N.H., D.A,), Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - D Altschul
- Neurosurgery (N.H., D.A,), Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - D Labovitz
- From the Department of Neurology (C.E.E., N.T.C., D.A., A.S., K.K., A.L., P.M., T.N., D.R., D.L.)
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Farfel A, Liberman A, Yackobovitch-Gavan M, Phillip M, Nimri R. Executive Functions and Adherence to Continuous Glucose Monitoring in Children and Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2020; 22:265-270. [PMID: 31789577 DOI: 10.1089/dia.2019.0341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Continuous glucose monitoring (CGM) has a beneficial impact on diabetes control; however, its utilization within people with diabetes remains low. The success of CGM requires cluster of cognitive skills and executive functions (EF). We speculated that participants with high EF would be more adherent to CGM use. Materials and Methods: The study population included 85 children and adolescents between 5 and 18 years old being followed for type 1 diabetes. Participants and their parents completed three questionnaires-"Behavior Rating Inventory of Executive Function" (BRIEF), CGM satisfaction, and a questionnaire assessing reasons for discontinuing CGM use. Results: Sixty-one participants used CGM on a regular basis and 24 discontinued use. Adherent participants were significantly younger than participants with nonadherence to CGM (P = 0.011). No significant differences were found between gender, diabetes duration, or HbA1c. Females adhering to CGM had a significantly higher "organization of environment" skill than those with nonadherence to CGM (P = 0.023). Also, adherent participants older than 14 years had a higher "organization of environment" skill than participants with nonadherence to CGM (P = 0.032). No difference was found between the groups in other EF domains. Alarm fatigue was found to be the main reason for discontinuing CGM. Conclusions: Given the interplay between CGM adherence and EF, it is recommended that people with diabetes should receive training by a multidisciplinary team, including psychological counseling, before CGM use and thus preparing them to cope with the demands of CGM and to avoid false expectations.
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Affiliation(s)
- Alon Farfel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Department of Pediatrics Assuta, Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Alon Liberman
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Nimri
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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15
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Liberman A, Barnard-Kelly K. Diabetes Technologies and the Human Factor. Diabetes Technol Ther 2020; 22:S130-S140. [PMID: 32069154 DOI: 10.1089/dia.2020.2510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alon Liberman
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Petah Tikva, Israel
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16
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Affiliation(s)
- Alon Liberman
- 1 Jesse Z and Lea Sara Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Katharine Barnard
- 2 Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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17
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Kahles F, Liberman A, Halim C, Mertens RW, Rau M, Moellmann J, Rueckbeil M, Walla B, Diepolder I, Diebold S, Burgmaier M, Lebherz C, Marx N, Lehrke M. 4147The incretin hormone GIP is upregulated in patients with atherosclerosis and stabilizes plaques in ApoE-/- mice by blocking proinflammatory signaling in macrophages. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F Kahles
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - A Liberman
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - C Halim
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - R W Mertens
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - M Rau
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - J Moellmann
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | | | - B Walla
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - I Diepolder
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - S Diebold
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - M Burgmaier
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - C Lebherz
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - N Marx
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - M Lehrke
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
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18
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Affiliation(s)
- Alon Liberman
- 1 Jesse Z and Lea Sara Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes , Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Katharine Barnard
- 2 Faculty of Health and Social Sciences, Bournemouth University , Bournemouth, United Kingdom
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Kahles F, Liberman A, Halim C, Moellmann J, Diebold S, Burgmaier M, Findeisen H, Lebherz C, Marx N, Lehrke M. 3857Activation of the GIP system attenuates pathological vascular remodeling by decreasing infiltration and proinflammatory activation of monocytes in ApoE−/− mice. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Kahles F, Liberman A, Halim C, Julia M, Diebold S, Burgmaier M, Findeisen HM, Lebherz C, Marx N, Lehrke M. The incretin hormone GIP decreases vascular infiltration and proinflammatory activation of monocytes in ApoE-/- mice. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- F Kahles
- Medizinische Klinik I, Aachen, Germany
| | | | - C Halim
- Medizinische Klinik I, Aachen, Germany
| | - M Julia
- Medizinische Klinik I, Aachen, Germany
| | - S Diebold
- Medizinische Klinik I, Aachen, Germany
| | | | - HM Findeisen
- Universitätsklinikum Münster, Department für Kardiologie, Münster, Germany
| | - C Lebherz
- Medizinische Klinik I, Aachen, Germany
| | - N Marx
- Medizinische Klinik I, Aachen, Germany
| | - M Lehrke
- Medizinische Klinik I, Aachen, Germany
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Liberman A, Drobnic Radobuljac M. Diabetes Technology and the Human Factor. Diabetes Technol Ther 2017; 19:S120-S127. [PMID: 28192026 DOI: 10.1089/dia.2017.2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alon Liberman
- 1 Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel , Petah Tikva, Israel
| | - Maja Drobnic Radobuljac
- 2 Faculty of Medicine, University of Ljubljana , Slovenia
- 3 Unit for Adolescent Psychiatry, Center for Mental Health, University Psychiatric Clinic , Ljubljana, Slovenia
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Pencek R, Marmon T, Roth JD, Liberman A, Hooshmand-Rad R, Young MA. Effects of obeticholic acid on lipoprotein metabolism in healthy volunteers. Diabetes Obes Metab 2016; 18:936-40. [PMID: 27109453 DOI: 10.1111/dom.12681] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 12/23/2022]
Abstract
The bile acid analogue obeticholic acid (OCA) is a selective farnesoid X receptor (FXR) agonist in development for treatment of several chronic liver diseases. FXR activation regulates lipoprotein homeostasis. The effects of OCA on cholesterol and lipoprotein metabolism in healthy individuals were assessed. Two phase I studies were conducted to evaluate the effects of repeated oral doses of 5, 10 or 25 mg OCA on lipid variables after 14 or 20 days of consecutive administration in 68 healthy adults. Changes in HDL and LDL cholesterol levels were examined, in addition to nuclear magnetic resonance analysis of particle sizes and sub-fraction concentrations. OCA elicited changes in circulating cholesterol and particle size of LDL and HDL. OCA decreased HDL cholesterol and increased LDL cholesterol, independently of dose. HDL particle concentrations declined as a result of a reduction in medium and small HDL. Total LDL particle concentrations increased because of an increase in large LDL particles. Changes in lipoprotein metabolism attributable to OCA in healthy individuals were found to be consistent with previously reported changes in patients receiving OCA with non-alcoholic fatty liver disease or non-alcoholic steatohepatitis.
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Affiliation(s)
- R Pencek
- Intercept Pharmaceuticals, Inc., San Diego, CA, USA
| | - T Marmon
- Intercept Pharmaceuticals, Inc., San Diego, CA, USA
| | - J D Roth
- Intercept Pharmaceuticals, Inc., San Diego, CA, USA
| | - A Liberman
- Intercept Pharmaceuticals, Inc., San Diego, CA, USA
| | | | - M A Young
- Intercept Pharmaceuticals, Inc., San Diego, CA, USA
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Ziegler C, Liberman A, Nimri R, Muller I, Klemencic S, Bratina N, Bläsig S, Remus K, Phillip M, Battelino T, Kordonouri O, Danne T, Lange K. Weniger Sorgen vor Unterzuckerungen, hohe Zufriedenheit und ein Anstieg in der subjektiv wahrgenommenen Handhabbarkeit nach 4 Nächten unter häuslichen Bedingungen mit einer künstlichen Bauchspeicheldrüse (MD Logic) (DREAM4). DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Heyman SN, Leibowitz D, Mor-Yosef Levi I, Liberman A, Eisenkraft A, Alcalai R, Khamaisi M, Rosenberger C. Adaptive response to hypoxia and remote ischaemia pre-conditioning: a new hypoxia-inducible factors era in clinical medicine. Acta Physiol (Oxf) 2016; 216:395-406. [PMID: 26449466 DOI: 10.1111/apha.12613] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/01/2015] [Accepted: 10/02/2015] [Indexed: 01/30/2023]
Abstract
Transient ischaemia leads to tolerance to subsequent protracted ischaemia. This 'ischaemia pre-conditioning' results from the induction of numerous protective genes, involved in cell metabolism, proliferation and survival, in antioxidant capacity, angiogenesis, vascular tone and erythropoiesis. Hypoxia-inducible factors (HIF) play a pivotal role in this transcriptional adaptive response. HIF prolyl hydroxylases (PHDs), serving as oxygen sensors, control HIFα degradation. HIF-mediated ischaemic pre-conditioning can be achieved with the administration of PHD inhibitors, with the attenuation of organ injury under various hypoxic and toxic insults. Clinical trials are currently under way, evaluating PHD inhibitors as inducers of erythropoietin. Once their safety is established, their potential use might be further tested in clinical trials in various forms of acute ischaemic and toxic organ damage. Repeated transient limb ischaemia was also found to attenuate ischaemic injury in remote organs. This 'remote ischaemic pre-conditioning' phenomenon (RIP) has been extensively studied recently in small clinical trials, preceding, or in parallel with an abrupt insult, such as myocardial infarction, cardiac surgery or radiocontrast administration. Initial results are promising, suggesting organ protection. Large-scale multi-centre studies are currently under way, evaluating the protective potential of RIP in cardiac surgery, in the management of myocardial infarction and in organ transplantation. The mechanisms of organ protection provided by RIP are poorly understood, but HIF seemingly play a role as well. Thus, Inhibition of HIF degradation with PHD inhibitors, as well as RIP (in part through HIF), might develop into novel clinical interventions in organ protection in the near future.
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Affiliation(s)
- S. N. Heyman
- Department of Medicine; Hadassah Hebrew University Hospitals; Jerusalem Israel
| | - D. Leibowitz
- Department of Medicine; Hadassah Hebrew University Hospitals; Jerusalem Israel
- Department of Cardiology; Hadassah Hebrew University Hospitals; Jerusalem Israel
| | - I. Mor-Yosef Levi
- Department of Nephrology; Hadassah Hebrew University Hospitals; Jerusalem Israel
| | - A. Liberman
- Department of Neurology; Hadassah Hebrew University Hospitals; Jerusalem Israel
| | - A. Eisenkraft
- The Research Institute for Military Medicine; The Hebrew University Medical School and the Israeli Defense Force Medical Corps; Jerusalem Israel
| | - R. Alcalai
- Department of Medicine; Hadassah Hebrew University Hospitals; Jerusalem Israel
- Department of Cardiology; Hadassah Hebrew University Hospitals; Jerusalem Israel
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Affiliation(s)
- Alon Liberman
- 1 Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel , Petah Tikva, Israel
| | - Bruce Buckingham
- 2 Stanford Medical Center , Division of Endocrinology and Diabetes, Stanford, CA
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Liberman A, Wang J, Lu N, Viveros R, Allen CA, Mattrey R, Blair S, Trogler W, Kim MJ, Kummel A. Mechanically Tunable Hollow Silica Ultrathin Nanoshells for Ultrasound Contrast Agents. Adv Funct Mater 2015; 25:4049-4057. [PMID: 26955300 PMCID: PMC4778971 DOI: 10.1002/adfm.201500610] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Perfluoropentane (PFP) gas filled biodegradable iron-doped silica nanoshells have been demonstrated as long-lived ultrasound contrast agents. Nanoshells are synthesized by a sol-gel process with tetramethyl orthosilicate (TMOS) and iron ethoxide. Substituting a fraction of the TMOS with R-substituted trialkoxysilanes produces ultrathin nanoshells with varying shell thicknesses and morphologies composed of fused nanoflakes. The ultrathin nanoshells had continuous ultrasound Doppler imaging lifetimes exceeding 3 hours, were twice as bright using contrast specific imaging, and had decreased pressure thresholds compared to control nanoshells synthesized with just TMOS. Transmission electron microscopy (TEM) showed that the R-group substituted trialkoxysilanes could reduce the mechanically critical nanoshell layer to 1.4 nm. These ultrathin nanoshells have the mechanical behavior of weakly linked nanoflakes but the chemical stability of silica. The synthesis can be adapted for general fabrication of three-dimensional nanostructures composed of nanoflakes, which have thicknesses from 1.4-3.8 nm and diameters from 2-23 nm.
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Affiliation(s)
- A. Liberman
- Materials Sciences and Engineering Program, University of California, San Diego
| | - J. Wang
- Department of Nanoengineering, University of California, San Diego
| | - N. Lu
- Department of Materials Science and Engineering, The University of Texas at Dallas, Richardson, TX 75080
| | - R.D. Viveros
- Department of Nanoengineering, University of California, San Diego
| | - C. A. Allen
- Department of Chemistry and Biochemistry, University of California, San Diego
| | - R.F. Mattrey
- Department of Radiology, University of California, San Diego
| | - S.L. Blair
- Moores Cancer Center, University of California, San Diego
| | - W.C. Trogler
- Department of Chemistry and Biochemistry, University of California, San Diego
| | - M. J. Kim
- Department of Materials Science and Engineering, The University of Texas at Dallas, Richardson, TX 75080
| | - A.C. Kummel
- Department of Chemistry and Biochemistry, University of California, San Diego
- Corresponding Author Info: University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, Mailbox 0358,
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Affiliation(s)
- Alon Liberman
- Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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28
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Affiliation(s)
- Alon Liberman
- 1 Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel , Petah Tikva, Israel
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Ziegler C, Liberman A, Nimri R, Muller I, Klemenčič S, Bratina N, Bläsig S, Remus K, Phillip M, Battelino T, Kordonouri O, Danne T, Lange K. Reduced Worries of Hypoglycaemia, High Satisfaction, and Increased Perceived Ease of Use after Experiencing Four Nights of MD-Logic Artificial Pancreas at Home (DREAM4). J Diabetes Res 2015; 2015:590308. [PMID: 26581230 PMCID: PMC4637058 DOI: 10.1155/2015/590308] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/05/2015] [Indexed: 01/08/2023] Open
Abstract
AIMS This study assesses the impact of using an AP-system at home on fear of hypoglycaemia. In addition, satisfaction and acceptance of the new technology are evaluated. METHODS In a multicentre, multinational study of 75 patients using the MD-Logic AP during four consecutive nights in home setting 59 of them (aged 10-54 years, 54% male, HbA1c 7.89 ± 0.69% [62.72 ± 7.51 mmol/mol], diabetes duration 11.6 ± 8.4 yrs) answered standardized questionnaires (HFS, adapted TAM, and AP satisfaction) before and after using the AP. RESULTS After experiencing the AP in home setting worries of hypoglycaemia were significantly reduced (before 1.04 ± 0.53 versus after 0.90 ± 0.63; P = 0.017). Perceived ease of use as a measure of acceptance with the AP significantly increased after personal experience (before 4.64 ± 0.94 versus after 5.06 ± 1.09; P = 0.002). The overall satisfaction mean score after using the AP was 3.02 ± 0.54 (range 0-4), demonstrating a high level of satisfaction with this technology. CONCLUSIONS The four-night home-based experience of using MD Logic AP was associated with reduced worries of hypoglycaemia, high level of satisfaction, and increased perceived ease of use of the new technology in children, adolescents, and adults.
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Affiliation(s)
- Claudia Ziegler
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, 30173 Hannover, Germany
- *Claudia Ziegler:
| | - Alon Liberman
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 49202 Petah Tikva, Israel
| | - Revital Nimri
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 49202 Petah Tikva, Israel
| | - Ido Muller
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 49202 Petah Tikva, Israel
| | - Simona Klemenčič
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, 1000 Ljubljana, Slovenia
| | - Nataša Bratina
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, 1000 Ljubljana, Slovenia
| | - Sarah Bläsig
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, 30173 Hannover, Germany
| | - Kerstin Remus
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, 30173 Hannover, Germany
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 49202 Petah Tikva, Israel
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, 1000 Ljubljana, Slovenia
| | - Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, 30173 Hannover, Germany
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, 30173 Hannover, Germany
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, 30625 Hannover, Germany
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Hascalovici JR, Song W, Liberman A, Vaya J, Khatib S, Holcroft C, Laferla F, Schipper HM. Neural HO-1/sterol interactions in vivo: implications for Alzheimer's disease. Neuroscience 2014; 280:40-9. [PMID: 25218961 DOI: 10.1016/j.neuroscience.2014.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/29/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Up-regulation of heme oxygenase-1 (HO-1) and altered cholesterol (CH) metabolism are characteristic of Alzheimer-diseased (AD) neural tissues. We previously provided evidence of significant HO-1/sterol interactions in vitro (cultured rat astroglia) and in post-mortem human AD brain (Religious Orders Study). METHODS The current experiments were designed to further delineate these interactions in vivo by comparing the behavior of HO-1/sterol interactions in two mouse models; (1) a novel HO-1 transgenic mouse (GFAP.HMOX1) engineered to selectively express human HO-1 in the astrocytic compartment and (2) the previously described triple transgenic AD mouse (3xTg-AD). In samples of frontal cortex, total CH, CH precursors and relevant oxysterols were quantified by gas chromatography-mass spectrometry (GC-MS) and HO-1 protein expression was assessed by ELISA. The relationships of HO-1 expression to total CH, CH precursors and total oxysterols were determined for both mouse models using linear regression analysis. RESULTS HO-1 expression is increased in GFAP.HMOX1 mice relative to wild type and in 11-12-month-old 3xTg-AD mice (with AD-like phenotype) relative to control mice and 5-6-month-old 3xTg-AD mice (no AD-like phenotype). Total oxysterols significantly decreased as HO-1 expression increased in GFAP.HMOX1 mice expressing high levels of HO-1, whereas total oxysterols increased as HO-1 expression increased in aged 3xTg-AD mice. Total CH and total CH precursors increased as HO-1 protein expression increased in 11-12-month-old 3xTg-AD mice relative to 5-6-month old 3xTg-AD mice. CONCLUSIONS Our findings indicate a differential impact of HO-1 on patterns of brain sterol and redox homeostasis that is contingent on the presence or absence of AD-like neuropathology. These data provide fresh insight concerning the regulation of sterol homeostasis within the aging and degenerating CNS which may inform the development of novel therapeutic and preventive strategies for the management of AD and related conditions.
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Affiliation(s)
- J R Hascalovici
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Sainte Catherine Road, Montreal, Quebec H3T 1E2, Canada; Department of Neurology and Neurosurgery, McGill University, Jewish General Hospital, 3755 Cote Sainte Catherine Road, Montreal, Quebec H3T 1E2, Canada
| | - W Song
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Sainte Catherine Road, Montreal, Quebec H3T 1E2, Canada
| | - A Liberman
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Sainte Catherine Road, Montreal, Quebec H3T 1E2, Canada
| | - J Vaya
- Laboratory of Natural Medicinal Compounds, Migal-Galilee Technological Center and Tel Hai College, Kiryat-Shmona 11016, Israel
| | - S Khatib
- Laboratory of Natural Medicinal Compounds, Migal-Galilee Technological Center and Tel Hai College, Kiryat-Shmona 11016, Israel
| | - C Holcroft
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, 3755 Cote Sainte Catherine Road, Montreal, Quebec H3T 1E2, Canada
| | - F Laferla
- Department of Neurobiology and Behavior and Institute for Brain Aging and Dementia, University of California, Irvine, Irvine, CA 92697-4545, USA
| | - H M Schipper
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Sainte Catherine Road, Montreal, Quebec H3T 1E2, Canada; Department of Neurology and Neurosurgery, McGill University, Jewish General Hospital, 3755 Cote Sainte Catherine Road, Montreal, Quebec H3T 1E2, Canada.
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Gomez J, Pestilli F, Golarai G, Witthoft N, Liberman A, Yoon J, Grill-Spector K. Functionally-defined white matter selectively predicts face- and place-processing performance. J Vis 2014. [DOI: 10.1167/14.10.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Witthoft N, Nguyen M, Golarai G, Liberman A, LaRocque KF, Smith ME, Grill-Spector K. Visual Field Coverage of Category-Selective Regions in Human Visual Cortex Estimated Using Population Receptive Field Mapping. J Vis 2014. [DOI: 10.1167/14.10.718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kahles F, Möllmann J, Bäck C, Liberman A, Hess K, Findeisen HM, Krüger S, Lebherz C, Tacke F, Marx N, Lehrke M. The PDE-4 Inhibitor Roflumilast reduces weight gain, enhances insulin sensitivity and prevents hepatic steatosis in mice by increasing mitochondrogenesis. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- Alon Liberman
- 1 Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes , Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Liberman A, Whitney D. Tracking Serial Dependence Behind an Occluder. J Vis 2013. [DOI: 10.1167/13.9.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Affiliation(s)
- Alon Liberman
- Jesse Z and Lea Sara Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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38
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Golarai G, Liberman A, Grill-Spector K. Evidence for an own-age-bias to face stimuli in the distributed responses of fusiform gyrus. J Vis 2012. [DOI: 10.1167/12.9.985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Witthoft N, Golarai G, Nguyen M, LaRocque K, Liberman A, Smith ME, Grill-Spector K. Anatomy, Retinotopy, & Category Selectivity in Human Ventral Visual Cortex. J Vis 2012. [DOI: 10.1167/12.9.1177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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40
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Liberman A, Fischer J, Whitney D. Serial Dependence of Face Identity. J Vis 2012. [DOI: 10.1167/12.9.982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vittone F, Liberman A, Vasic D, Ostertag R, Esser M, Walcher D, Ludwig A, Marx N, Burgmaier M. Sitagliptin reduces plaque macrophage content and stabilises arteriosclerotic lesions in Apoe (-/-) mice. Diabetologia 2012; 55:2267-75. [PMID: 22648661 DOI: 10.1007/s00125-012-2582-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/16/2012] [Indexed: 02/04/2023]
Abstract
AIMS/HYPOTHESIS Inhibitors of dipeptidyl peptidase-IV (DPP-IV), such as sitagliptin, increase glucagon-like peptide-1 (GLP-1) concentrations and are current treatment options for patients with type 2 diabetes mellitus. As patients with diabetes exhibit a high risk of developing severe atherosclerosis, we investigated the effect of sitagliptin on atherogenesis in Apoe (-/-) mice. METHODS Apoe (-/-) mice were fed a high-fat diet and treated with either sitagliptin or placebo for 12 weeks. Plaque size and plaque composition were analysed using Oil Red O staining and immunohistochemistry. Furthermore, in vitro experiments with the modified Boyden chamber and with gelatine zymography were performed to analyse the effects of GLP-1 on isolated human monocyte migration and metalloproteinase-9 (MMP-9) release. RESULTS Treatment of Apoe (-/-) mice with sitagliptin significantly reduced plaque macrophage infiltration (the aortic root and aortic arch both showing a 67% decrease; p < 0.05) and plaque MMP-9 levels (aortic root showing a 69% and aortic arch a 58% reduction; both p < 0.01) compared with controls. Moreover, sitagliptin significantly increased plaque collagen content more than twofold (aortic root showing an increase of 58% and aortic arch an increase of 73%; both p < 0.05) compared with controls but did not change overall lesion size (8.1 ± 3.5% vs 5.1 ± 2.5% for sitagliptin vs controls; p=NS). In vitro, pretreatment of isolated human monocytes with GLP-1 significantly decreased cell migration induced by both monocyte chemotactic protein-1 and by the protein known as regulated on activation, normal T cell expressed and secreted (RANTES) in a concentration-dependent manner. Furthermore, GLP-1 significantly decreased MMP-9 release from isolated human monocyte-derived macrophages. CONCLUSIONS/INTERPRETATION Sitagliptin reduces plaque inflammation and increases plaque stability, potentially by GLP-1-mediated inhibition of chemokine-induced monocyte migration and macrophage MMP-9 release. The effects observed may provide potential mechanisms for how DPP-IV inhibitors could modulate vascular disease in high-risk patients with type 2 diabetes mellitus.
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Affiliation(s)
- F Vittone
- Department of Internal Medicine II - Cardiology, University of Ulm, Ulm, Germany
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Abstract
When developing new technologies for human use the developer should take into consideration not only the efficacy and safety of the technology but also the desire and capabilities of the potential user. Any chronic disease is a challenge for both the patient and his/her caregivers. This statement is especially true in the case of patients with type 1 diabetes mellitus (T1DM) where adherence to therapy is crucial 24 hours a day 365 days a year. No vacation days are possible for the T1DM patient. It is therefore obvious why any new technology which is developed for helping patients cope with the disease should take into consideration the 'human factor' before, during and after the production process starts. There is no doubt that technology has changed the life of patients with T1DM in the last few decades, but despite the availability of new meters, new syringes, new sophisticated insulin pumps and continuous glucose sensors and communication tools, these technologies have not been well utilised by many patients. It is therefore important to understand why the technology is not always utilised and to find new ways to maximise use and benefits from the technology to as many patients as possible. The present chapter will review papers published in the last year where the patient's ability or willingness was an important factor in the success of the technology. We will try to understand why insulin pumps, glucose sensors and self-monitoring of blood glucose (SMBG) are not used enough or appropriately, whether there is a specific group that finds it more difficult than others to adopt new technologies and what can be done to overcome that issue. For this chapter we chose articles from a Public Medicine review of the literature related to human factors affecting the outcome of studies and of user acceptance of continuous glucose monitoring, insulin infusion pump therapy. We also searched the literature in the field of psychology in order to accurately define the problems that the users of technology are facing (such as adherence, quality of life, motivations, executive functioning etc.) Those articles that had the most important contributions to understanding human factors as well as those highlighting the interface between technology and psychology, were chosen for this review, with emphasis on articles that provide insight into future studies and acceptance of emerging technologies for glycemic control.
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Affiliation(s)
- A Liberman
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
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Witthoft N, Poltoratski S, Nguyen M, Golarai G, Liberman A, Grill-Spector K. Psychophysical and Neural Investigations of Congenital Prosopagnosia. J Vis 2011. [DOI: 10.1167/11.11.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Liberman A, Spina S, Chan M, Gordon W, Latham T. 609 Seamless anticoagulation therapy after open heart surgery. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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45
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Golarai G, Liberman A, Yoon J, Spector K. Differential development of the ventral visual cortex extends through adolescence. J Vis 2010. [DOI: 10.1167/10.7.572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Zimerman L, Liberman A, Castro R, Ribeiro J, Nóbrega A. Acute electrophysiologic consequences of pyridostigmine inhibition of cholinesterase in humans. Braz J Med Biol Res 2010; 43:211-6. [DOI: 10.1590/s0100-879x2010005000001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 11/04/2009] [Indexed: 03/25/2023] Open
Affiliation(s)
- L.I. Zimerman
- Hospital de Clínicas de Porto Alegre, Brasil; Universidade Federal do Rio Grande do Sul, Brasil
| | - A. Liberman
- Hospital de Clínicas de Porto Alegre, Brasil
| | | | - J.P. Ribeiro
- Hospital de Clínicas de Porto Alegre, Brasil; Universidade Federal do Rio Grande do Sul, Brasil
| | - A.C.L. Nóbrega
- Universidade Federal Fluminense; Universidade Federal Fluminense, Brasil
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Golarai G, Liberman A, Hong S, Yoon J, Grill-Spector K. Evidence for Development of Face-selective and Place-selective Cortex During Adolescence. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
The media make it seem that greedy health care professionals are perpetrating a widespread conspiracy to defraud the Medicare trust fund of billions of taxpayer dollars. However, the media often underreport another side to the health care fraud and abuse issue-the flawed, inordinately complex, and ill-equipped Medicare payment system itself. It is difficult to quantify the purported loss of billions of dollars to fraud or estimate the costs to the U.S. health care system of the advocated increased controls. However, this discussion serves to divert attention from key health care issues--the many Americans who are uninsured, underinsured, or lack access to care and the system's administrative complexities.
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Affiliation(s)
- T J Falen
- Department of Health Professions, University of Central Florida, Orlando, Florida, USA
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Borten O, Liberman A, Tuchweber B, Chevalier S, Ferland G, Schipper HM. Effects of Dietary Restriction and Metal Supplementation on the Accumulation of Iron-Laden Glial Inclusions in the Aging Rat Hippocampus. Biogerontology 2004; 5:81-8. [PMID: 15105582 DOI: 10.1023/b:bgen.0000025071.78517.3a] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The mechanisms responsible for the pathological deposition of iron and other redox-active metals in the aging and degenerating mammalian CNS remain poorly understood. We previously demonstrated that normal aging and pharmacological (oxidative) stressors promote the transformation of astroglial mitochondria to iron-laden, diaminobenzidine (DAB)-positive cytoplasmic inclusions in sub-cortical regions of the rat brain. In the current study, we demonstrate that (1) numbers of DAB-positive glial granules in the rat dorsal hippocampus, an area implicated in learning and memory, progressively increase between 3, 12 and 22 months of age; (2) dietary restriction (40%), a manipulation that attenuates many mammalian aging processes, has no effect on the age-related accumulation of these gliosomes in the rat hippocampus; and (3) the latter can be accelerated by dietary supplementation of iron and copper. Our data support the view that dietary exposure to iron and/or copper in adult life can impact the sequestration of redox-active metals in aging hippocampal astroglia.
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Affiliation(s)
- O Borten
- Centre for Neurotranslational Research, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Que., Canada H3T 1E2
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Mehran A, Jaffe P, Efron J, Vernava A, Vernavay A, Liberman A. Screening colonoscopy in the asymptomatic 50- to 59-year-old population. Surg Endosc 2003; 17:1974-7. [PMID: 14569451 DOI: 10.1007/s00464-003-8807-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2003] [Accepted: 04/25/2003] [Indexed: 02/06/2023]
Abstract
BACKGROUND In an effort to decrease the death rate from colorectal cancer, a multitude of medical societies and task forces recommend routine screening for colorectal cancer beginning at age 50. Yet, there is no consensus as to the best and most cost-effective screening method. Medicare now pays for screening colonoscopies for its average risk beneficiaries [3]. Many insurance companies, however, will not cover this test in younger patients. We therefore reviewed our institution's colonoscopy experience with asymptomatic 50- to 59-year-olds, with negative fecal occult blood tests and negative family histories. METHODS Between January 1999 and January 2002, 4779 colonoscopies were performed at our institution. The charts for 619 persons 50-59 years of age were retrospectively reviewed, with 91 patients meeting the strict requirements of this study. We defined polyps with high-grade neoplasias as those with villous or tubulovillous components, and cancerous lesions included those with carcinoma in situ. The distal colon was defined as the rectum and sigmoid colon. RESULTS There was a 58% incidence of neoplastic polyps in this younger asymptomatic population. More than 4% of our subjects had high-grade neoplasias or cancerous lesions. In the absence of any distal findings, flexible sigmoidoscopy would have missed up to 38% of these polyps. CONCLUSIONS The findings generally support the recommendations by the American College of Gastroenterology for average-risk patients to preferentially undergo a screening colonoscopy at age 50 in lieu of other methods.
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Affiliation(s)
- A Mehran
- Department of Surgery, Cleveland Clinic Florida, 6101 Pine Ridge Road, Naples, FL 34119, USA
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