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Zenz S, Regittnig W, Boulgaropoulos B, Augustin T, Brunner M, Korsatko S, Münzker J, Narath SH, Raml R, Magnes C, Pieber TR. Effect of Liraglutide Treatment on Whole-body Glucose Fluxes in C-peptide-Positive Type 1 Diabetes During Hypoglycemia. J Clin Endocrinol Metab 2022; 107:e3583-e3593. [PMID: 35833597 DOI: 10.1210/clinem/dgac369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/09/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The effect of liraglutide in C-peptide-positive (C-pos) type 1 diabetes (T1D) patients during hypoglycemia remains unclear. OBJECTIVE To investigate the effect of a 12-week liraglutide treatment on the body glucose fluxes during a hypoglycemic clamp in C-pos T1D patients and its impact on the alpha- and beta-cell responses during hypoglycemia. DESIGN This was a randomized, double-blind, crossover study. Each C-pos T1D patient was allocated to the treatment sequence liraglutide/placebo or placebo/liraglutide with daily injections for 12 weeks adjunct to insulin treatment, separated by a 4-week washout period. SETTING AND PARTICIPANTS Fourteen T1D patients with fasting C-peptide ≥ 0.1 nmol/L. INTERVENTION(S) All patients underwent a hyperinsulinemic-stepwise-hypoglycemic clamp with isotope tracer [plasma glucose (PG) plateaus: 5.5, 3.5, 2.5, and 3.9 mmol/L] after a 3-month liraglutide (1.2 mg) or placebo treatment. MAIN OUTCOME MEASURE(S) The responses of endogenous glucose production (EGP) and rate of peripheral glucose disposal (Rd) were similar for liraglutide and placebo treatment during the clamp. RESULTS The numbers of hypoglycemic events were similar in both groups. At the clamp, mean glucagon levels were significantly lower at PG plateau 5.5 mmol/L in the liraglutide than in the placebo group but showed similar responses to hypoglycemia in both groups. Mean C-peptide levels were significantly higher at PG-plateaus 5.5 and 3.5 mmol/L after liraglutide treatment, but this effect was not reflected in EGP and Rd. Hemoglobin A1c and body weight were lower, and a trend for reduced insulin was seen after liraglutide treatment. CONCLUSIONS The results indicate that 3 months of liraglutide treatment does not promote or prolong hypoglycemia in C-pos T1D patients.
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Affiliation(s)
- Sabine Zenz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Werner Regittnig
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Beate Boulgaropoulos
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Joanneum Research Forschungsgesellschaft mbH HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Thomas Augustin
- Joanneum Research Forschungsgesellschaft mbH HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Martina Brunner
- Center for Medical Research, Clinical Trial Unit, Medical University of Graz, Graz, Austria
| | - Stefan Korsatko
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia Münzker
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sophie H Narath
- Joanneum Research Forschungsgesellschaft mbH HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Reingard Raml
- Joanneum Research Forschungsgesellschaft mbH HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Christoph Magnes
- Joanneum Research Forschungsgesellschaft mbH HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Joanneum Research Forschungsgesellschaft mbH HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
- Center for Medical Research, Clinical Trial Unit, Medical University of Graz, Graz, Austria
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Tiffner KI, Kanfer I, Augustin T, Raml R, Raney SG, Sinner F. Comparative in vitro release testing (IVRT) of acyclovir products. Int J Pharm 2021; 609:121186. [PMID: 34655706 DOI: 10.1016/j.ijpharm.2021.121186] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
The aim was to evaluate whether an in vitro release test (IVRT) could differentiate the release rates from five pharmaceutically equivalent acyclovir cream products and one ointment compared to that from a reference product, Zovirax cream (USA), to identify a test product with an inequivalent drug release rate that could serve as negative control for bioequivalence (BE) in a separate in vivo study. The reference product showed equivalent drug release rates compared to itself. The six test products failed to show equivalent drug release rates compared to the reference product. Aciclovir 1A pharma cream was selected to serve as a negative control for subsequent BE studies, since it exhibited the greatest difference in release rate among all creams, compared to the reference product. The results of this study indicate that IVRT results can be highly sensitive and may discriminate clinically relevant differences between products. Results from an appropriately validated IVRT method can support a demonstration of BE by showing that the drug release rates from test and reference products are statistically equivalent, mitigating the risk that differences may exist between the products which may influence in vivo performance of the drug product.
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Affiliation(s)
- Katrin I Tiffner
- HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010 Graz, Austria
| | - Isadore Kanfer
- Rhodes University, Faculty of Pharmacy, Artillery Road, Grahamstown 6140, South Africa.
| | - Thomas Augustin
- HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010 Graz, Austria
| | - Reingard Raml
- HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010 Graz, Austria
| | - Sam G Raney
- Division of Therapeutic Performance, Office of Research and Standards, Office of Generic Drugs, United States (U.S.) Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Frank Sinner
- HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010 Graz, Austria; Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
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Simic A, Schøndorff PK, Stumpe T, Heschel M, Regittnig W, Pöttler T, Ninaus D, Augustin T, Groselj‐Strele A, Pieber TR, Mader JK. Survival assessment of the extended-wear insulin infusion set featuring lantern technology in adults with type 1 diabetes by the glucose clamp technique. Diabetes Obes Metab 2021; 23:1402-1408. [PMID: 33528887 PMCID: PMC8251565 DOI: 10.1111/dom.14337] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Abstract
Maintaining good glycaemic control with the same infusion set for longer than 3 days may improve the quality of life of insulin pump users. The aim of the current study was to assess the efficacy and safety of the novel, extended-wear infusion set over 7 days of wear in adults with type 1 diabetes. Sixteen participants completed three identical 8-hour euglycaemic clamp experiments on Days 1, 4 and 7 of infusion set wear. Between the experiments, the participants were discharged home for routine diabetes management while wearing the same extended-wear infusion set throughout the study. Time to reach the maximum glucose infusion rate (TGIRmax ) on Day 7 was reduced by 67% compared with Day 1 (p < .001). The corresponding area under the glucose infusion rate curve (AUCGIR ) was comparable for the first 2 h of the clamp (p = .891) but decreased by 28% over time (p < .008). While the extent of insulin absorption decreased with prolonged wear, it was accompanied by an increase in insulin absorption rate. The infusion set survival rate was 100% without leakages, occlusion alarms, severe hypoglycaemia or ketoacidosis. The extended-wear infusion set proved safe and effective during prolonged wear in real-life conditions.
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Affiliation(s)
- Amra Simic
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | | | | | | | - Werner Regittnig
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Tina Pöttler
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Daniela Ninaus
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Thomas Augustin
- HEALTH ‐ Institute for Biomedicine and Health SciencesJoanneum Research GmbHGrazAustria
| | - Andrea Groselj‐Strele
- Core Facility Computational BioanalyticsCenter for Medical Research, Medical University of GrazGrazAustria
| | - Thomas R. Pieber
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
- HEALTH ‐ Institute for Biomedicine and Health SciencesJoanneum Research GmbHGrazAustria
| | - Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
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Hummer J, Schwingenschuh S, Raml R, Boulgaropoulos B, Schwagerle G, Augustin T, Sinner F, Birngruber T. OFM-recirculation and OFM-suction: advanced in-vivo open flow microperfusion (OFM) methods for direct and absolute quantification of albumin in interstitial fluid. Biomed Phys Eng Express 2021; 6:065031. [PMID: 33843658 DOI: 10.1088/2057-1976/abc3a7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To implement OFM-recirculation and OFM-suction capable of direct and absolute in-vivo quantification of albumin in the ISF of pigs. APPROACH OFM-recirculation and OFM-suction were used to collect ISF in-vivo in pigs and lymph was collected from the same pigs after OFM sampling. Blood was collected before and after OFM sampling, plasma was isolated and mean albumin plasma concentrations per pig were used to yield albumin ISF-to-plasma ratios. We characterized the quality of the collected undiluted ISF via (1) stable albumin ISF-to-plasma ratio in OFM-recirculation and in OFM-suction samples, (2) comparison of albumin ISF-to-plasma ratios from OFM-recirculation and OFM-suction and (3) comparison of normalized albumin concentrations in the ISF and lymph. MAIN RESULTS Both advanced OFM methods were successfully implemented and albumin was quantified from the collected ISF samples. OFM-recirculation reached stable albumin ISF-to-plasma ratios after 20 recirculation cycles. Absolute ISF albumin concentrations were 11.2 mg ml-1 (OFM-recirculation) and 14.2 mg ml-1 (OFM-suction). Albumin ISF-to-plasma ratios were 0.39 ± 0.04 (OFM -recirculation) and 0.47 ± 0.1 (OFM-suction). SIGNIFICANCE Knowledge of the ISF protein content is of major importance when assessing PK/PD effects, especially of highly protein bound drugs. Up to now, only blood albumin values have been available to determine the degree of protein binding in several tissues. OFM-recirculation and OFM-suction allow direct, absolute quantification of albumin in ISF for the first time and enable investigation of the degree of protein binding of a drug directly in its target tissue.
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Affiliation(s)
- Joanna Hummer
- HEALTH-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010 Graz, Austria
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Affiliation(s)
- Thomas Augustin
- Thomas Augustin is Professor of Statistics and Head of the Foundations of Statistics and their Applications Group, Department of Statistics, Ludwig-Maximilians Universität München (LMU Munich), Ludwigstr. 33, D-80539 Munich, Germany
| | - Georg Schollmeyer
- Georg Schollmeyer is a post-doctorial staff member of the Foundations of Statistics and their Applications Group, Department of Statistics, Ludwig-Maximilians Universität München (LMU Munich), Ludwigstr. 33, D-80539 Munich, Germany
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Svehlikova E, Mursic I, Augustin T, Magnes C, Gerring D, Jezek J, Schwarzenbacher D, Ratzer M, Wolf M, Howell S, Zakrzewski L, Urschitz M, Tschapeller B, Gatschelhofer C, Feichtner F, Lawrence F, Pieber TR. Pharmacokinetics and Pharmacodynamics of Three Different Formulations of Insulin Aspart: A Randomized, Double-Blind, Crossover Study in Men With Type 1 Diabetes. Diabetes Care 2021; 44:448-455. [PMID: 33328285 PMCID: PMC7818330 DOI: 10.2337/dc20-1017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/12/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the pharmacokinetic and pharmacodynamic properties and safety of a novel formulation of insulin aspart (AT247) versus two currently marketed insulin aspart formulations (NovoRapid [IAsp] and Fiasp [faster IAsp]). RESEARCH DESIGN AND METHODS This single-center, randomized, double-blind, three-period, crossover study was conducted in 19 men with type 1 diabetes, receiving single dosing of trial products (0.3 units/kg) in a random order on three visits. Pharmacokinetics and pharmacodynamics were assessed during a euglycemic clamp lasting up to 8 h. RESULTS Onset of insulin appearance was earlier for AT247 compared with IAsp (-12 min [95% CI -14; -8], P = 0.0004) and faster IAsp (-2 min [-5; -2], P = 0.0003). Onset of action was accelerated compared with IAsp (-23 min [-37; -15], P = 0.0004) and faster IAsp (-9 min [-11; -3], P = 0.0006). Within the first 60 min, a higher exposure was observed for AT247 compared with IAsp by the area under the curve (AUC) glucose infusion rate (GIR) from 0 to 60 min (AUCAsp0-60min: treatment ratio vs. IAsp 2.3 [1.9; 2.9] vs. faster IAsp 1.5 [1.3; 1.8]), which was underpinned by a greater early glucose-lowering effect (AUCGIR,0-60min: treatment ratio vs. IAsp 2.8 [2.0; 5.5] vs. faster IAsp 1.7 [1.3; 2.3]). Furthermore, an earlier offset of exposure was observed for AT247 compared with IAsp (-32 min [-58; -15], P = 0.0015) and faster IAsp (-27 min [-85; -15], P = 0.0017), while duration of the glucose-lowering effect, measured by time to late half-maximum effect, did not differ significantly. CONCLUSIONS AT247 exhibited an earlier insulin appearance, exposure, and offset, with corresponding enhanced early glucose-lowering effect compared with IAsp and faster IAsp. It therefore represents a promising candidate in the pursuit for second-generation prandial insulin analogs to improve postprandial glycemic control.
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Affiliation(s)
- Eva Svehlikova
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ines Mursic
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Augustin
- Joanneum Research Forschungsgesellschaft mbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Christoph Magnes
- Joanneum Research Forschungsgesellschaft mbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | | | - Jan Jezek
- Arecor Limited, Little Chesterford, U.K
| | - Daniela Schwarzenbacher
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Maria Ratzer
- Joanneum Research Forschungsgesellschaft mbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Michael Wolf
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Martina Urschitz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Bernd Tschapeller
- Joanneum Research Forschungsgesellschaft mbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Christina Gatschelhofer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Franz Feichtner
- Joanneum Research Forschungsgesellschaft mbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | | | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria .,Joanneum Research Forschungsgesellschaft mbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
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Abstract
AbstractThe analysis of single-cell RNA sequencing data is of great importance in health research. It challenges data scientists, but has enormous potential in the context of personalized medicine. The clustering of single cells aims to detect different subgroups of cell populations within a patient in a data-driven manner. Some comparison studies denote single-cell consensus clustering (SC3), proposed by Kiselev et al. (Nat Methods 14(5):483–486, 2017), as the best method for classifying single-cell RNA sequencing data. SC3 includes Laplacian eigenmaps and a principal component analysis (PCA). Our proposal of unsupervised adapted single-cell consensus clustering (adaSC3) suggests to replace the linear PCA by diffusion maps, a non-linear method that takes the transition of single cells into account. We investigate the performance of adaSC3 in terms of accuracy on the data sets of the original source of SC3 as well as in a simulation study. A comparison of adaSC3 with SC3 as well as with related algorithms based on further alternative dimension reduction techniques shows a quite convincing behavior of adaSC3.
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Eckelmann D, Augustin T, Leake C. Isomeric stability of indaziflam and major degradation products in the environment. Sci Total Environ 2020; 737:140223. [PMID: 32569903 DOI: 10.1016/j.scitotenv.2020.140223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
Understanding the isomeric behavior of active ingredients in the soil and water environment is the first and a major part of deriving an exposure assessment. Whilst a variety of approaches have been taken previously, with the new regulatory framework for the risk assessment of isomeric plant protection compounds recently published by EFSA, (European Food Safety Authority) there will in future be a more consistent approach which has been taken here. For indaziflam (IAF), the alkylazine, cross spectrum residual herbicide which has a cellulose biosynthesis inhibition mode of action, there was no published data on the isomeric degradation behavior in soil and water. The results of measuring the isomeric stability of [14C]-radiolabeled 437-IAF, the major stereoisomer of indaziflam (AE 1170437, [1R,2S,6R] configuration) during its degradation in an aerobic soil metabolism study with four EU soils, an aerobic aquatic metabolism study with two natural water/sediment test systems, as well as an aqueous photolysis study are reported. To sum up, it was shown that in the different environmental conditions under abiotic as well as biotic degradation processes, indaziflam was not subject to isomeric interconversion to diastereoisomers 435-IAF (RRR), 438-IAF (RSS), or 439-IAF (SSR). Thus, all three chiral centers of indaziflam can be considered isomerically stable. In addition, no isomeric interconversion was observed at the 1-fluoroethyl position for the major degradation products IAF-indanone and IAF-carboxylic acid to the RSS-configuration as well as IAF-diaminotriazine from the R- to the S-configuration.
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Affiliation(s)
- Dennis Eckelmann
- Bayer AG, Crop Science Division, R&D, Environmental Exposure, 40789 Monheim, Germany.
| | - Thomas Augustin
- Bayer AG, Crop Science Division, R&D, Environmental Exposure, 40789 Monheim, Germany
| | - Christopher Leake
- Bayer AG, Crop Science Division, R&D, Environmental Exposure, 40789 Monheim, Germany
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Bodenlenz M, Augustin T, Birngruber T, Tiffner KI, Boulgaropoulos B, Schwingenschuh S, Raney SG, Rantou E, Sinner F. Variability of Skin Pharmacokinetic Data: Insights from a Topical Bioequivalence Study Using Dermal Open Flow Microperfusion. Pharm Res 2020; 37:204. [PMID: 32989514 PMCID: PMC7522073 DOI: 10.1007/s11095-020-02920-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022]
Abstract
Purpose Dermal open flow microperfusion (dOFM) has previously demonstrated its utility to assess the bioequivalence (BE) of topical drug products in a clinical study. We aimed to characterize the sources of variability in the dermal pharmacokinetic data from that study. Methods Exploratory statistical analyses were performed with multivariate data from a clinical dOFM-study in 20 healthy adults evaluating the BE, or lack thereof, of Austrian test (T) and U.S. reference (R) acyclovir cream, 5% products. Results The overall variability of logAUC values (CV: 39% for R and 45% for T) was dominated by inter-subject variability (R: 82%, T: 91%) which correlated best with the subject’s skin conductance. Intra-subject variability was 18% (R) and 9% (T) of the overall variability; skin treatment sites or methodological factors did not significantly contribute to that variability. Conclusions Inter-subject variability was the major component of overall variability for acyclovir, and treatment site location did not significantly influence intra-subject variability. These results support a dOFM BE study design with T and R products assessed simultaneously on the same subject, where T and R treatment sites do not necessarily need to be next to each other. Localized variation in skin microstructure may be primarily responsible for intra-subject variability.
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Affiliation(s)
- Manfred Bodenlenz
- HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010, Graz, Austria
| | - Thomas Augustin
- HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010, Graz, Austria
| | - Thomas Birngruber
- HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010, Graz, Austria
| | - Katrin I Tiffner
- HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010, Graz, Austria
| | - Beate Boulgaropoulos
- HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010, Graz, Austria.,Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Simon Schwingenschuh
- HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010, Graz, Austria
| | - Sam G Raney
- Division of Therapeutic Performance Office of Research and Standards Office of Generic Drugs, United States (U.S.) Food and Drug Administration, 10903 New Hampshire Avenue, MD, 20993, Silver Spring, USA
| | - Elena Rantou
- Division of Biostatistics VIII, Office of Biostatistics, Office of Translational Sciences, United States (U.S.) Food and Drug Administration, 10903 New Hampshire Avenue, MD, 20993, Silver Spring, USA
| | - Frank Sinner
- HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft m.b.H, Neue Stiftingtalstrasse 2, 8010, Graz, Austria. .,Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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Pichler G, Fink N, Weidinger L, Schmidt L, Augustin T, Schippinger W. ["Memory acute"-treatment concept for inpatient remobilization of acutely ill patients with dementia]. Z Gerontol Geriatr 2019; 53:310-317. [PMID: 31701238 DOI: 10.1007/s00391-019-01642-z] [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] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acute hospitals are generally not designed for people with dementia. Behavioral issues pose the greatest challenge. This article reports on the results of a prospective controlled study designed to assess whether dementia patients benefit from a remobilization strategy in a memory clinic (IG-MA) following hospital discharge. METHODS Between January and September 2018 patients with moderate to severe dementia discharged from hospital following acute episodes were admitted to an IG-MA for remobilization. The IG-MA unit provides specially qualified personnel and an adapted environment. Control groups were formed from the standard remobilization unit (KG1-AGR) and four care homes (KG2-PWH). RESULTS Patients in the IG-MA (n = 22) had a worse functional status at admission according to the Barthel index (BI), the timed "up and go" test (TUG) and the Esslinger transfer scale (ETS) than patients in the KG1-AGR (n = 59). Outcomes significantly improved in both groups (IG-MA and KG1-AGR) without a clear difference between groups: IG-MA (BI from 35 to 57.8 points, TUG from 30.8 s to 23 s, ETS from 2.1 to 1.1 points) vs. KG1-AGR (BI from 44.7 to 62.4 points, TUG from 28.6 s to 20.2 s, ETS from 1.7 to 0.9 points). There were differences in cognitive ability at admission (mini mental state examination, MMSE: IG-MA 13.6 points vs. KG1-AGR 20 points). The length of stay in the IG-MA was on average 5 days longer. Early discharge was mostly the result of complications and transfer to acute hospitals in the IG-MA group (22.7%) and in the KG1-AGR group this was mostly due to care issues (27.1%). The KG2-PWH group did not show any significant functional improvements in the first 4 weeks as measured by the BI. CONCLUSION Moderate to severely affected dementia patients with behavioral problems benefited from treatment in a specially designed remobilization unit following hospital discharge after an acute event.
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Affiliation(s)
- Gerald Pichler
- Albert Schweitzer Klinik Graz, Albert Schweitzer Gasse 36, 8020, Graz, Österreich.
| | - Nicole Fink
- Albert Schweitzer Klinik Graz, Albert Schweitzer Gasse 36, 8020, Graz, Österreich
| | - Lisa Weidinger
- Albert Schweitzer Klinik Graz, Albert Schweitzer Gasse 36, 8020, Graz, Österreich
| | - Louise Schmidt
- Joanneum Research Forschungsgesellschaft mbH - Health, Graz, Österreich
| | - Thomas Augustin
- Joanneum Research Forschungsgesellschaft mbH - Health, Graz, Österreich
| | - Walter Schippinger
- Albert Schweitzer Klinik Graz, Albert Schweitzer Gasse 36, 8020, Graz, Österreich
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Mader JK, Motschnig M, Theiler-Schwetz V, Eibel-Reisz K, Reisinger AC, Lackner B, Augustin T, Eller P, Mirth C. Feasibility of Blood Glucose Management Using Intra-Arterial Glucose Monitoring in Combination with an Automated Insulin Titration Algorithm in Critically Ill Patients. Diabetes Technol Ther 2019; 21:581-588. [PMID: 31335205 DOI: 10.1089/dia.2019.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022]
Abstract
Background: This two-center pilot study combined for the first time an intra-arterial glucose sensor with a decision support system for insulin dosing (SGCplus system) in critically ill patients with hyperglycemia. Methods: Twenty-two patients who were equipped with an arterial line and required iv insulin therapy were managed by the SGCplus system during their medical treatment at the intensive care unit. Results: Time to target was 111 ± 195 min (80-150 mg/dL) and 135 ± 267 min (100-160 mg/dL) in the lower and higher glucose target group. Mean blood glucose (BG) was 142 ± 32 mg/dL with seven BG values <70 mg/dL. Mean daily insulin dose was 62 ± 38 U and mean daily carbohydrate intake 148 ± 50 g/day (enteral nutrition) and 102 ± 58 g/day (parenteral nutrition). Acceptance of SGCplus suggestions was high (93%). Conclusions: The SGCplus system can be safely applied in critically ill patients with hyperglycemia and enables good glycemic control.
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Affiliation(s)
- Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Motschnig
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Verena Theiler-Schwetz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Karin Eibel-Reisz
- Department of Anesthesiology and Intensive Care Medicine, Karl Landsteiner Privatuniversität (KPU), Universitätsklinikum St. Pölten, St Pölten, Austria
| | - Alexander C Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Bettina Lackner
- Joanneum Research GmbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Thomas Augustin
- Joanneum Research GmbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Claudia Mirth
- Department of Anesthesiology and Intensive Care Medicine, Karl Landsteiner Privatuniversität (KPU), Universitätsklinikum St. Pölten, St Pölten, Austria
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12
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Plass J, Cattaneo ME, Augustin T, Schollmeyer G, Heumann C. Reliable Inference in Categorical Regression Analysis for Non‐randomly Coarsened Observations. Int Stat Rev 2019. [DOI: 10.1111/insr.12329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Julia Plass
- Department of StatisticsLMU Munich Ludwigstr. 33 Munich 80539 Germany
| | - Marco E.G.V. Cattaneo
- Department of StatisticsLMU Munich Ludwigstr. 33 Munich 80539 Germany
- Department of Clinical ResearchUniversity of Basel Spitalstr. 12 Basel 4031 Switzerland
| | - Thomas Augustin
- Department of StatisticsLMU Munich Ludwigstr. 33 Munich 80539 Germany
| | - Georg Schollmeyer
- Department of StatisticsLMU Munich Ludwigstr. 33 Munich 80539 Germany
| | - Christian Heumann
- Department of StatisticsLMU Munich Ludwigstr. 33 Munich 80539 Germany
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13
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Moser O, Pandis M, Aberer F, Kojzar H, Hochfellner D, Elsayed H, Motschnig M, Augustin T, Kreuzer P, Pieber TR, Sourij H, Mader JK. A head-to-head comparison of personal and professional continuous glucose monitoring systems in people with type 1 diabetes: Hypoglycaemia remains the weak spot. Diabetes Obes Metab 2019; 21:1043-1048. [PMID: 30484947 PMCID: PMC6590188 DOI: 10.1111/dom.13598] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/23/2018] [Accepted: 11/23/2018] [Indexed: 01/08/2023]
Abstract
To compare the performance of a professional continuous glucose monitoring (proCGM) and a personal continuous glucose monitoring (persCGM) system worn in parallel under standardized conditions in individuals with type 1 diabetes (T1D), two CGM systems (iPro2 - proCGM; Minimed 640G - persCGM) worn in parallel using the same sensor (Enlite 2) were compared. Ten people with T1D were included in this single-centre, open-label study in which CGM performance was evaluated. The study consisted of a 24-hours inpatient phase (meals, exercise, glycaemic challenges) and a 4-day home phase. Analyses included fulfilment of ISO 15197:2013 criteria, mean absolute relative difference (MARD), Parkes Error Grid and Bland-Altman plots. During the inpatient stay, ISO 15197:2013 criteria fulfilment was 58.4% (proCGM) and 57.8% (persCGM). At home, the systems met ISO 15197:2013 criteria by 66.5% (proCGM) and 65.3% (persCGM). No difference of MARD in inpatient phase (19.1 ± 16.7% vs. 19.0 ± 19.6; P = 0.83) and home phase (18.6 ± 26.8% vs. 17.4 ± 21.3%, P = 0.87) was observed. All sensors performed less accurately during hypoglycaemia. ProCGM and persCGM showed similar performance during daytime and night-time for the inpatient and the home phase. However, sensor performance was reduced during hypoglycaemia for both systems.
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Affiliation(s)
- Othmar Moser
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
- Diabetes Research Group, Medical SchoolSwansea UniversitySwanseaUK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A‐STEM), College of EngineeringSwansea UniversitySwanseaUK
| | - Marlene Pandis
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Harald Kojzar
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Daniel Hochfellner
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Hesham Elsayed
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Melanie Motschnig
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Thomas Augustin
- Joanneum Research GmbH, HEALTH – Institute for Biomedicine and Health SciencesGrazAustria
| | - Philipp Kreuzer
- Division of Emergency Medicine Department of Internal MedicineMedical University of GrazGrazAustria
| | - Thomas R. Pieber
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
- Joanneum Research GmbH, HEALTH – Institute for Biomedicine and Health SciencesGrazAustria
- Center for Biomarker Research in Medicine, CBmedGrazAustria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
- Center for Biomarker Research in Medicine, CBmedGrazAustria
| | - Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
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14
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Zenz S, Mader JK, Regittnig W, Brunner M, Korsatko S, Boulgaropoulos B, Magnes C, Raml R, Narath SH, Eller P, Augustin T, Pieber TR. Impact of C-Peptide Status on the Response of Glucagon and Endogenous Glucose Production to Induced Hypoglycemia in T1DM. J Clin Endocrinol Metab 2018; 103:1408-1417. [PMID: 29408994 DOI: 10.1210/jc.2017-01836] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 08/17/2017] [Accepted: 01/29/2018] [Indexed: 01/12/2023]
Abstract
CONTEXT Complete loss of β-cell function in patients with type 1 diabetes mellitus (T1DM) may lead to an increased risk of severe hypoglycemia. OBJECTIVE We aimed to determine the impact of C-peptide status on glucagon response and endogenous glucose production (EGP) during hypoglycemia in patients with T1DM. DESIGN AND SETTING We conducted an open, comparative trial. PATIENTS Ten C-peptide positive (C-pos) and 11 matched C-peptide negative (C-neg) patients with T1DM were enrolled. INTERVENTION Plasma glucose was normalized over the night fast, and after a steady-state (baseline) plateau all patients underwent a hyperinsulinemic, stepwise hypoglycemic clamp with glucose plateaus of 5.5, 3.5, and 2.5 mmol/L and a recovery phase of 4.0 mmol/L. Blood glucagon was measured with a specific and highly sensitive glucagon assay. EGP was determined with a stable isotope tracer technique. MAIN OUTCOME MEASURE Impact of C-peptide status on glucagon response and EGP during hypoglycemia. RESULTS Glucagon concentrations were significantly lower in C-pos and C-neg patients than previously reported. At baseline, C-pos patients had higher glucagon concentrations than C-neg patients (8.39 ± 4.6 vs 4.19 ± 2.4 pmol/L, P = 0.016, mean ± standard deviation) but comparable EGP rates (2.13 ± 0.2 vs 2.04 ± 0.3 mg/kg/min, P < 0.391). In both groups, insulin suppressed glucagon levels, but hypoglycemia revealed significantly higher glucagon concentrations in C-pos than in C-neg patients. EGP was significantly higher in C-pos patients at hypoglycemia (2.5 mmol/L) compared with C-neg patients. CONCLUSIONS Glucagon concentrations and EGP during hypoglycemia were more pronounced in C-pos than in C-neg patients, which indicates that preserved β-cell function may contribute to counterregulation during hypoglycemia in patients with T1DM.
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Affiliation(s)
- Sabine Zenz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Werner Regittnig
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martina Brunner
- Center for Medical Research, Clinical Research Center, Medical University of Graz, Graz, Austria
| | - Stefan Korsatko
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Beate Boulgaropoulos
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Joanneum Research Forschungsgesellschaft mbH HEALTH-Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Christoph Magnes
- Joanneum Research Forschungsgesellschaft mbH HEALTH-Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Reingard Raml
- Joanneum Research Forschungsgesellschaft mbH HEALTH-Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Sophie H Narath
- Joanneum Research Forschungsgesellschaft mbH HEALTH-Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Augustin
- Joanneum Research Forschungsgesellschaft mbH HEALTH-Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Joanneum Research Forschungsgesellschaft mbH HEALTH-Institute for Biomedicine and Health Sciences, Graz, Austria
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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15
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Schwingenschuh S, Scharfetter H, Martinsen ØG, Boulgaropoulos B, Augustin T, Tiffner KI, Dragatin C, Raml R, Hoefferer C, Prandl EC, Sinner F, Hajnsek M. Assessment of skin permeability to topically applied drugs by skin impedance and admittance. Physiol Meas 2017; 38:N138-N150. [PMID: 28967873 DOI: 10.1088/1361-6579/aa904e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pharmacokinetic and pharmacodynamic studies of topically applied drugs are commonly performed by sampling of interstitial fluid with dermal open flow microperfusion and subsequent analysis of the samples. However, the reliability of results from the measured concentration-time profile of the penetrating drug suffers from highly variable skin permeability to topically applied drugs that is mainly caused by inter- and intra-subject variations of the stratum corneum. Thus, statistically significant results can only be achieved by performing high numbers of experiments. To reduce the expenditures needed for such high experiment numbers we aimed to assess the correlation between skin permeability and skin impedance/skin admittance. APPROACH We performed an ex vivo drug penetration study with human skin, based on the hypothesis that inter-subject variations of the respective concentration-time profiles can be correlated with variations of the passive electrical properties of the skin. Therefore, skin impedance and skin admittance were related to the skin permeability to the model drug Clobetasol-17-proprionate. MAIN RESULTS The measured low frequency skin impedance and the skin admittance correlated linearly with the drug concentration-time profiles from dermal sampling. SIGNIFICANCE Skin permeability can be assessed by measuring the passive electrical properties of the skin, which enables correction of skin permeability variations. This allows reduction of experiment numbers in future pharmacokinetic and pharmacodynamic studies with human skin ex vivo and in vivo and leads to diminished study costs.
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Affiliation(s)
- Simon Schwingenschuh
- Joanneum Research, HEALTH-Institute for Biomedicine and Health Sciences, Graz, Austria
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16
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Plass J, Cattaneo M, Schollmeyer G, Augustin T. On the testability of coarsening assumptions: A hypothesis test for subgroup independence. Int J Approx Reason 2017. [DOI: 10.1016/j.ijar.2017.07.014] [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: 11/29/2022]
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17
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Tiffner KI, Kanfer I, Augustin T, Raml R, Raney SG, Sinner F. A comprehensive approach to qualify and validate the essential parameters of an in vitro release test (IVRT) method for acyclovir cream, 5. Int J Pharm 2017; 535:217-227. [PMID: 28935255 DOI: 10.1016/j.ijpharm.2017.09.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/23/2017] [Accepted: 09/16/2017] [Indexed: 11/18/2022]
Abstract
The rate of release of an active pharmaceutical ingredient (API) from a topical semisolid dosage form can be influenced by its physical and structural properties. An In Vitro Release Test (IVRT) is an established method to characterize this rate of API release and compare the underlying sameness in product quality characteristics. The purpose of this work was to validate an IVRT method to compare acyclovir cream, 5% products. However, despite widespread use of the IVRT since 1997, there has been no established approach to validate an IVRT method. Our approach included: 1) qualification of the diffusion cell apparatus, 2) qualification of the laboratory, 3) validation of the HPLC analytical method, and 4) validation of numerous critical parameters of the IVRT method, itself, and resulted in a comprehensive and successful IVRT method validation. Subsequent to the IVRT validation work described here, the U.S. Food and Drug Administration (FDA) drafted a guidance on the development and validation of an IVRT method for acyclovir cream, 5%. Although there are notable differences between our approach and the approach in that guidance, this report illustrates how many of the same essential qualification parameters and validation concepts were considered and systematically addressed in our approach to IVRT validation.
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Affiliation(s)
- Katrin I Tiffner
- Joanneum Research Forschungsgesellschaft mbH, Health - Institute for Biomedicine and Health Sciences, Neue Stiftingtalstr. 2, 8010 Graz, Austria
| | - Isadore Kanfer
- Rhodes University, Faculty of Pharmacy, Artillery Road, Grahamstown 6140, South Africa; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
| | - Thomas Augustin
- Joanneum Research Forschungsgesellschaft mbH, Health - Institute for Biomedicine and Health Sciences, Neue Stiftingtalstr. 2, 8010 Graz, Austria
| | - Reingard Raml
- Joanneum Research Forschungsgesellschaft mbH, Health - Institute for Biomedicine and Health Sciences, Neue Stiftingtalstr. 2, 8010 Graz, Austria
| | - Sam G Raney
- Division of Therapeutic Performance, Office of Research and Standards, Office of Generic Drugs, U.S. FDA, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Frank Sinner
- Joanneum Research Forschungsgesellschaft mbH, Health - Institute for Biomedicine and Health Sciences, Neue Stiftingtalstr. 2, 8010 Graz, Austria
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18
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Augustin T, Doria S, Marinacci M. Imprecise probability: Theories and applications. Int J Approx Reason 2017. [DOI: 10.1016/j.ijar.2017.03.001] [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]
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19
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Augustin T, Doria S, Marinacci M. Special Issue: Ninth International Symposium on Imprecise Probability: Theory and Applications (ISIPTA'15). Int J Approx Reason 2017. [DOI: 10.1016/j.ijar.2016.01.004] [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: 10/22/2022]
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20
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Spat S, Donsa K, Beck P, Höll B, Mader JK, Schaupp L, Augustin T, Chiarugi F, Lichtenegger KM, Plank J, Pieber TR. A Mobile Computerized Decision Support System to Prevent Hypoglycemia in Hospitalized Patients With Type 2 Diabetes Mellitus. J Diabetes Sci Technol 2017; 11:20-28. [PMID: 27810995 PMCID: PMC5375083 DOI: 10.1177/1932296816676501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/23/2022]
Abstract
BACKGROUND Diabetes management requires complex and interdisciplinary cooperation of health care professionals (HCPs). To support this complex process, IT-support is recommended by clinical guidelines. The aim of this article is to report on results from a clinical feasibility study testing the prototype of a mobile, tablet-based client-server system for computerized decision and workflow support (GlucoTab®) and to discuss its impact on hypoglycemia prevention. METHODS The system was tested in a monocentric, open, noncontrolled intervention study in 30 patients with type 2 diabetes mellitus (T2DM). The system supports HCPs in performing a basal-bolus insulin therapy. Diabetes therapy, adverse events, software errors and user feedback were documented. Safety, efficacy and user acceptance of the system were investigated. RESULTS Only 1.3% of blood glucose (BG) measurements were <70 mg/dl and only 2.6% were >300 mg/dl. The availability of the system (97.3%) and the rate of treatment activities documented with the system (>93.5%) were high. Only few suggestions from the system were overruled by the users (>95.7% adherence). Evaluation of the 3 anonymous questionnaires showed that confidence in the system increased over time. The majority of users believed that treatment errors could be prevented by using this system. CONCLUSIONS Data from our feasibility study show a significant reduction of hypoglycemia by implementing a computerized system for workflow and decision support for diabetes management, compared to a paper-based process. The system was well accepted by HCPs, which is shown in the user acceptance analysis and that users adhered to the insulin dose suggestions made by the system.
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Affiliation(s)
- Stephan Spat
- Health–Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbh, Graz, Austria
| | - Klaus Donsa
- Health–Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbh, Graz, Austria
| | - Peter Beck
- Health–Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbh, Graz, Austria
- decide Clinical Software GmbH, Graz, Austria
| | - Bernhard Höll
- Health–Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbh, Graz, Austria
| | - Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Lukas Schaupp
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Augustin
- Health–Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbh, Graz, Austria
| | - Franco Chiarugi
- Computational Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology–Hellas, Crete, Greece
| | - Katharina M. Lichtenegger
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Johannes Plank
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas R. Pieber
- Health–Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbh, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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21
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Baurecht H, Hotze M, Rodríguez E, Manz J, Weidinger S, Cordell HJ, Augustin T, Strauch K. Compare and Contrast Meta Analysis (CCMA): A Method for Identification of Pleiotropic Loci in Genome-Wide Association Studies. PLoS One 2016; 11:e0154872. [PMID: 27149374 PMCID: PMC4858294 DOI: 10.1371/journal.pone.0154872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/20/2016] [Indexed: 11/23/2022] Open
Abstract
In recent years, genome-wide association studies (GWAS) have identified many loci that are shared among common disorders and this has raised interest in pleiotropy. For performing appropriate analysis, several methods have been proposed, e.g. conducting a look-up in external sources or exploiting GWAS results by meta-analysis based methods. We recently proposed the Compare & Contrast Meta-Analysis (CCMA) approach where significance thresholds were obtained by simulation. Here we present analytical formulae for the density and cumulative distribution function of the CCMA test statistic under the null hypothesis of no pleiotropy and no association, which, conveniently for practical reasons, turns out to be exponentially distributed. This allows researchers to apply the CCMA method without having to rely on simulations. Finally, we show that CCMA demonstrates power to detect disease-specific, agonistic and antagonistic loci comparable to the frequently used Subset-Based Meta-Analysis approach, while better controlling the type I error rate.
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Affiliation(s)
- Hansjörg Baurecht
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- * E-mail:
| | - Melanie Hotze
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Elke Rodríguez
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Judith Manz
- Research Unit of Molecular Epidemiology, Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Stephan Weidinger
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Heather J. Cordell
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Thomas Augustin
- Department of Statistics, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
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22
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Neubauer KM, Mader JK, Höll B, Aberer F, Donsa K, Augustin T, Schaupp L, Spat S, Beck P, Fruhwald FM, Schnedl C, Rosenkranz AR, Lumenta DB, Kamolz LP, Plank J, Pieber TR. Standardized Glycemic Management with a Computerized Workflow and Decision Support System for Hospitalized Patients with Type 2 Diabetes on Different Wards. Diabetes Technol Ther 2015; 17:685-92. [PMID: 26355756 PMCID: PMC4575539 DOI: 10.1089/dia.2015.0027] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study investigated the efficacy, safety, and usability of standardized glycemic management by a computerized decision support system for non-critically ill hospitalized patients with type 2 diabetes on four different wards. MATERIALS AND METHODS In this open, noncontrolled intervention study, glycemic management of 99 patients with type 2 diabetes (62% acute admissions; 41 females; age, 67±11 years; hemoglobin A1c, 65±21 mmol/mol; body mass index, 30.4±6.5 kg/m(2)) on clinical wards (Cardiology, Endocrinology, Nephrology, Plastic Surgery) of a tertiary-care hospital was guided by GlucoTab(®) (Joanneum Research GmbH [Graz, Austria] and Medical University of Graz [Graz, Austria]), a mobile decision support system providing automated workflow support and suggestions for insulin dosing to nurses and physicians. RESULTS Adherence to insulin dosing suggestions was high (96.5% bolus, 96.7% basal). The primary outcome measure, percentage of blood glucose (BG) measurements in the range of 70-140 mg/dL, occurred in 50.2±22.2% of all measurements. The overall mean BG level was 154±35 mg/dL. BG measurements in the ranges of 60-70 mg/dL, 40-60 mg/dL, and <40 mg/dL occurred in 1.4%, 0.5%, and 0.0% of all measurements, respectively. A regression analysis showed that acute admission to the Cardiology Ward (+30 mg/dL) and preexisting home insulin therapy (+26 mg/dL) had the strongest impact on mean BG. Acute admission to other wards had minor effects (+4 mg/dL). Ninety-one percent of the healthcare professionals felt confident with GlucoTab, and 89% believed in its practicality and 80% in its ability to prevent medication errors. CONCLUSIONS An efficacious, safe, and user-accepted implementation of GlucoTab was demonstrated. However, for optimized personalized patient care, further algorithm modifications are required.
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Affiliation(s)
- Katharina M. Neubauer
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia K. Mader
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Höll
- Joanneum Research GmbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Felix Aberer
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Klaus Donsa
- Joanneum Research GmbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Thomas Augustin
- Joanneum Research GmbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Lukas Schaupp
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Stephan Spat
- Joanneum Research GmbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Peter Beck
- Joanneum Research GmbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Friedrich M. Fruhwald
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christian Schnedl
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander R. Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - David B. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Johannes Plank
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas R. Pieber
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Joanneum Research GmbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
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Schaupp L, Donsa K, Neubauer KM, Mader JK, Aberer F, Höll B, Spat S, Augustin T, Beck P, Pieber TR, Plank J. Taking a Closer Look--Continuous Glucose Monitoring in Non-Critically Ill Hospitalized Patients with Type 2 Diabetes Mellitus Under Basal-Bolus Insulin Therapy. Diabetes Technol Ther 2015; 17:611-8. [PMID: 25927357 DOI: 10.1089/dia.2014.0343] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inpatient glucose management is based on four daily capillary blood glucose (BG) measurements. The aim was to test the capability of continuous glucose monitoring (CGM) for assessing the clinical impact and safety of basal-bolus insulin therapy in non-critically ill hospitalized patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS Eighty-four patients with T2DM (age, 68±10 years; glycosylated hemoglobin, 72±28 mmol/mol; body mass index, 31±7 kg/m(2)) were treated with basal-bolus insulin. CGM was performed with the iPro(®)2 system (Medtronic MiniMed, Northridge, CA) and calibrated retrospectively. RESULTS A remarkable consistency between CGM and BG measurements and therapy improvement was shown over the study period of 501 patient-days. The number of CGM and BG measurements (CGM/BG) in the range from 3.9-10 mmol/L increased from 67.7%/67.2% (on Day 1) to 77.5%/78.6% (on the last day) (P<0.04). The number of low glycemic episodes (3.3 to <3.9 mmol/L) during nighttime detected by CGM was 15-fold higher, and the number of episodes >13.9 mmol/L detected by CGM during night was 12.5-fold higher than the values from the BG measurements. Ninety-nine percent of data points were in the clinically accurate or acceptable Clarke Error Grid Zones A+B, and the relative numbers of correctly identified episodes of <3.9 and >13.9 mmol/L detected by CGM (sensitivity) were 47.3% and 81.5%, respectively. CONCLUSIONS Our data exhibit a good agreement between overall CGM and BG measurements, but there were a high number of missed hypo- and hyperglycemic episodes with BG measurements, particularly during nighttime. Overall assessment of glycemic control using CGM is feasible, whereas the use of CGM for individualized therapy decisions needs further improvement.
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Affiliation(s)
- Lukas Schaupp
- 1 Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz , Graz, Austria
| | - Klaus Donsa
- 2 Joanneum Research GmbH, HEALTH-Institute for Biomedicine and Health Sciences , Graz, Austria
| | - Katharina M Neubauer
- 1 Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz , Graz, Austria
| | - Julia K Mader
- 1 Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz , Graz, Austria
| | - Felix Aberer
- 1 Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz , Graz, Austria
| | - Bernhard Höll
- 2 Joanneum Research GmbH, HEALTH-Institute for Biomedicine and Health Sciences , Graz, Austria
| | - Stephan Spat
- 2 Joanneum Research GmbH, HEALTH-Institute for Biomedicine and Health Sciences , Graz, Austria
| | - Thomas Augustin
- 2 Joanneum Research GmbH, HEALTH-Institute for Biomedicine and Health Sciences , Graz, Austria
| | - Peter Beck
- 2 Joanneum Research GmbH, HEALTH-Institute for Biomedicine and Health Sciences , Graz, Austria
| | - Thomas R Pieber
- 1 Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz , Graz, Austria
- 2 Joanneum Research GmbH, HEALTH-Institute for Biomedicine and Health Sciences , Graz, Austria
| | - Johannes Plank
- 1 Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz , Graz, Austria
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Augustin T, Cehlar O, Skrabana R, Majerova P, Hanes J. Unravelling viral camouflage: approaches to the study and characterization of conformational epitopes. Acta Virol 2015; 59:103-16. [PMID: 26104327 DOI: 10.4149/av_2015_02_103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antibodies are broadly used in clinical and basic research. Many of monoclonal antibodies are successfully adopted for therapeutic and diagnostic targeting of viral pathogens. Efficacy of antiviral neutralizing or protective antibodies depends on their ability to recognize epitopes interfering with viral infection. However, viruses are able to incessantly change their antigenic determinants to escape surveillance of humoral immune system and therefore the successful antiviral therapies require continuous development. Characterization of interactions of antibodies with prevalently conformational viral epitopes is important for understanding antibody mode of action and can help to identify conserved regions that may be exploited in designing new vaccines and virus neutralizing antibodies. In this article, we are reviewing techniques in use for characterization of conformational epitopes of monoclonal antibodies with focus on viruses.
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G. S, Krause R, Kober B, K. V, Zierler R, Brunner G, Augustin T, Stelzl L, Kamolz LP. Hand hygiene behavior in a tertiary university hospital: differences between surgical and nonsurgical departments. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/s40886-015-0002-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Schollmeyer G, Augustin T. Statistical modeling under partial identification: Distinguishing three types of identification regions in regression analysis with interval data. Int J Approx Reason 2015. [DOI: 10.1016/j.ijar.2014.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schmidt LJ, Habacher W, Augustin T, Krahulec E, Semlitsch T. A systematic review and meta-analysis of the efficacy of lixisenatide in the treatment of patients with type 2 diabetes. Diabetes Obes Metab 2014; 16:769-79. [PMID: 24476092 DOI: 10.1111/dom.12269] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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] [Received: 09/03/2013] [Revised: 10/20/2013] [Accepted: 01/19/2014] [Indexed: 02/04/2023]
Abstract
The aim of this study is to assess the efficacy and safety of lixisenatide for treating type 2 diabetes. A systematic search in electronic databases (up to October 2012) was conducted and the manufacturer was contacted regarding unpublished data. Randomized controlled trials (RCTs) were included if they provided information on at least one of the following outcomes: mortality, health-related quality of life, hypoglycaemic events, adverse events, change in HbA1c, body weight, blood pressure, gastric emptying, fasting plasma glucose or 2 h postprandial glucose (PPG). Twenty-six publications and 10 unpublished study reports, relating to 14 RCTs (6156 patients) were included. Eleven studies related to placebo comparisons; active comparators were in three studies. Compared to placebo, lixisenatide significantly reduced HbA1c (-0.52%; 95% CI: -0.64 to -0.39), bodyweight (-0.65 kg; 95% CI: -0.94 to -0.37) and 2-h PPG level (-4.58 mmol/l; 95% CI: -5.88 to -3.28). There were significantly more symptomatic hypoglycaemic events among lixisenatide compared to placebo-treated patients (log OR: 0.54; 95% CI: 0.32-0.75), but significantly fewer compared to other incretin mimetics. In comparison to exenatide and liraglutide, lixisenatide was more effective in reducing 2 h-PPG with a better adverse events profile, but it showed a lower reduction in HbA1c and body weight. Lixisenatide improves HbA1c levels and moderately reduces body weight compared to placebo and showed less frequent symptomatic hypoglycaemic and gastrointestinal events and an improvement in PPG control compared to other GLP-1 agonists. Firm conclusions regarding the performance of lixisenatide compared to other incretin mimetics, however, can not yet be drawn, due to limited data.
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Affiliation(s)
- L J Schmidt
- HEALTH - Institute for Biomedicine and Health Sciences, Joanneum Research, Graz, Austria
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Mader JK, Neubauer KM, Schaupp L, Aberer F, Donsa K, Augustin T, Höll B, Spat S, Beck P, Plank J, Pieber TR. Vergleich von zwei Algorithmen zur Basis-Bolus-Insulintherapie bei Patienten mit Diabetes mellitus Typ 2 im Krankenhaus. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374881] [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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Mader JK, Neubauer KM, Schaupp L, Augustin T, Beck P, Spat S, Höll B, Treiber GM, Fruhwald FM, Pieber TR, Plank J. Efficacy, usability and sequence of operations of a workflow-integrated algorithm for basal-bolus insulin therapy in hospitalized type 2 diabetes patients. Diabetes Obes Metab 2014; 16:137-46. [PMID: 23910952 DOI: 10.1111/dom.12186] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 03/04/2013] [Revised: 05/14/2013] [Accepted: 07/29/2013] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate glycaemic control and usability of a workflow-integrated algorithm for basal-bolus insulin therapy in a proof-of-concept study to develop a decision support system in hospitalized patients with type 2 diabetes. METHODS In this ward-controlled study, 74 type 2 diabetes patients (24 female, age 68 ± 11 years, HbA1c 8.7 ± 2.4% and body mass index 30 ± 7) were assigned to either algorithm-based treatment with a basal-bolus insulin therapy or to standard glycaemic management. Algorithm performance was assessed by continuous glucose monitoring and staff's adherence to algorithm-calculated insulin dose. RESULTS Average blood glucose levels (mmol/l) in the algorithm group were significantly reduced from 11.3 ± 3.6 (baseline) to 8.2 ± 1.8 (last 24 h) over a period of 7.5 ± 4.6 days (p < 0.001). The algorithm group had a significantly higher percentage of glucose levels in the ranges from 5.6 to 7.8 mmol/l (target range) and 3.9 to 10.0 mmol/l compared with the standard group (33 vs. 23% and 73 vs. 53%, both p < 0.001). Physicians' adherence to the algorithm-calculated total daily insulin dose was 95% and nurses' adherence to inject the algorithm-calculated basal and bolus insulin doses was high (98 and 93%, respectively). In the algorithm group, significantly more glucose values <3.9 mmol/l were detected in the afternoon relative to other times (p < 0.05), a finding mainly related to pronounced morning glucose excursions and requirements for corrective bolus insulin at lunch. CONCLUSIONS The workflow-integrated algorithm for basal-bolus therapy was effective in establishing glycaemic control and was well accepted by medical staff. Our findings support the implementation of the algorithm in an electronic decision support system.
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Affiliation(s)
- J K Mader
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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König C, Plank J, Augustin T, Habacher W, Beck P, Frühwald T, Pils K, Sommeregger U, Dovjak P, Pinter G, Mrak P. Effects of audit and feedback on professional practice in Geriatric Acute Care Units. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.05.005] [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: 10/26/2022]
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Bernau C, Augustin T, Boulesteix AL. Correcting the optimal resampling-based error rate by estimating the error rate of wrapper algorithms. Biometrics 2013; 69:693-702. [PMID: 23845182 DOI: 10.1111/biom.12041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 04/01/2011] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 11/27/2022]
Abstract
High-dimensional binary classification tasks, for example, the classification of microarray samples into normal and cancer tissues, usually involve a tuning parameter. By reporting the performance of the best tuning parameter value only, over-optimistic prediction errors are obtained. For correcting this tuning bias, we develop a new method which is based on a decomposition of the unconditional error rate involving the tuning procedure, that is, we estimate the error rate of wrapper algorithms as introduced in the context of internal cross-validation (ICV) by Varma and Simon (2006, BMC Bioinformatics 7, 91). Our subsampling-based estimator can be written as a weighted mean of the errors obtained using the different tuning parameter values, and thus can be interpreted as a smooth version of ICV, which is the standard approach for avoiding tuning bias. In contrast to ICV, our method guarantees intuitive bounds for the corrected error. Additionally, we suggest to use bias correction methods also to address the conceptually similar method selection bias that results from the optimal choice of the classification method itself when evaluating several methods successively. We demonstrate the performance of our method on microarray and simulated data and compare it to ICV. This study suggests that our approach yields competitive estimates at a much lower computational price.
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Affiliation(s)
- Christoph Bernau
- Department for Medical Informatics, Biometry and Epidemiology, Marchioninistr. 15, D-81377, Munich, Germany
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Mader JK, Neubauer KM, Schaupp L, Augustin T, Spat S, Höll B, Beck P, Pieber TR, Plank J. Anwenderakzeptanz von Insulindosierungsvorschlägen eines auf Basis-Bolustherapie basierenden Algorithmus bei hospitalisierten Patienten mit Diabetes mellitus Typ 2. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341900] [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: 10/26/2022]
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Mader JK, Birngruber T, Korsatko S, Deller S, Köhler G, Boysen S, Augustin T, Mautner SI, Sinner F, Pieber TR. Enhanced absorption of insulin aspart as the result of a dispersed injection strategy tested in a randomized trial in type 1 diabetic patients. Diabetes Care 2013. [PMID: 23193211 PMCID: PMC3609526 DOI: 10.2337/dc12-1319] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We investigated the impact of two different injection strategies on the pharmacokinetics and pharmacodynamics of insulin aspart in vivo in an open-label, two-period crossover study and verified changes in the surface-to-volume ratio ex vivo. RESEARCH DESIGN AND METHODS Before the clinical trial, insulin aspart was injected ex vivo into explanted human abdominal skin flaps. The surface-to-volume ratio of the subcutaneous insulin depot was assessed by microfocus computed tomography that compared 1 bolus of 18 IU with 9 dispersed boluses of 2 IU. These two injection strategies were then tested in vivo, in 12 C-peptide-negative type 1 diabetic patients in a euglycemic glucose clamp (glucose target 5.5 ± 1.1 mmol/L) for 8 h after the first insulin administration. RESULTS The ex vivo experiment showed a 1.8-fold higher mean surface-to-volume ratio for the dispersed injection strategy. The maximum glucose infusion rates (GIR) were similar for the two strategies (10 ± 4 vs. 9 ± 4; P = 0.5); however, times to reach maximum GIR and 50% and 10% of the maximum GIR were significantly reduced by using the 9 × 2 IU strategy (68 ± 33 vs. 127 ± 93 min; P = 0.01; 38 ± 9 vs. 49 ± 16 min; P < 0.01; 23 ± 6 vs. 30 ± 10 min; P < 0.05). For 9 × 2 IU, the area under the GIR curve was greater during the first 60 min (219 ± 89 vs. 137 ± 75; P < 0.01) and halved until maximum GIR (242 ± 183 vs. 501 ± 396; P < 0.01); however, it was similar across the whole study period (1,361 ± 469 vs. 1,565 ± 527; P = 0.08). CONCLUSIONS A dispersed insulin injection strategy enhanced the effect of a fast-acting insulin analog. The increased surface-to-volume ratio of the subcutaneous insulin depot can facilitate insulin absorption into the vascular system.
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Affiliation(s)
- Julia K Mader
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Neubauer KM, Schaupp L, Plank J, Augustin T, Mautner SI, Tschapeller B, Pieber TR. Failure to control hyperglycemia in noncritically ill diabetes patients despite standard glycemic management in a hospital setting. J Diabetes Sci Technol 2013; 7:402-9. [PMID: 23566999 PMCID: PMC3737642 DOI: 10.1177/193229681300700217] [Citation(s) in RCA: 14] [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: 01/04/2023]
Abstract
BACKGROUND Successful control of hyperglycemia has been shown to improve outcomes for diabetes patients in a clinical setting. We assessed the quality of physician-based glycemic management in two general wards, considering the most recent recommendations for glycemic control for noncritically ill patients (<140 mg/dl for premeal glucose). METHODS Quality of glycemic management of 50 patients in two wards (endocrinology, cardiology) was assessed retrospectively by analyzing blood glucose (BG) levels, the glycemic management effort, and the online questionnaire. RESULTS Glycemic control was clearly above the recommended target (mean BG levels: endocrinology: 175 ± 62 mg/dl; cardiology: 186 ± 68 mg/dl). When comparing the first half with the second half of the hospital stay, we found no difference in glycemic control (endocrinology: 168 ± 32 vs 164 ± 42 mg/dl, P = .67; cardiology: 174 ± 36 mg/dl vs 170 ± 42 mg/dl, P =.51) and in insulin dose (endocrinology: 15 ± 14 IU vs 15 ± 13 IU per day, P = .87; cardiology: 27 ± 17 IU vs 27 ± 18 IU per day, P = .92), despite frequent BG measurements (endocrinology: 2.7 per day; cardiology: 3.2 per day). A lack of clearly defined BG targets was indicated in the questionnaire. CONCLUSION The recommended BG target range was not achieved in both wards. Analysis of routine glycemic management demonstrated considerable glycemic management effort, but also a lack of translation into adequate insulin therapy. Implementation of corrective measures, such as structured treatment protocols, is essential.
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Affiliation(s)
- Katharina Maria Neubauer
- Medical University of Graz, Department of Internal Medicine, Division Endocrinology and Metabolism, Graz, Austria
| | - Lukas Schaupp
- Medical University of Graz, Department of Internal Medicine, Division Endocrinology and Metabolism, Graz, Austria
| | - Johannes Plank
- Medical University of Graz, Department of Internal Medicine, Division Endocrinology and Metabolism, Graz, Austria
| | - Thomas Augustin
- Joanneum Research, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Selma Isabella Mautner
- Medical University of Graz, Department of Internal Medicine, Division Endocrinology and Metabolism, Graz, Austria
- Joanneum Research, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Bernd Tschapeller
- Joanneum Research, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Thomas Rudolf Pieber
- Medical University of Graz, Department of Internal Medicine, Division Endocrinology and Metabolism, Graz, Austria
- Joanneum Research, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
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Grozavu C, Iliaş M, Marin D, Pantile D, Dabelea C, Augustin T. Minimally invasive repair for pectus excavatum -- aesthetic and/or functional? Chirurgia (Bucur) 2013; 108:70-78. [PMID: 23464773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2013] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Pectus excavatum is the most frequent anterior thoracic wall congenital malformation. This malformation is increasing its effects with the aging process and has its peak during teenage, when the clinical symptoms become more acute and psychological effects are really important. Across the course of time many treatment techniques have been proposed, among which conservative or surgical correction techniques. The minimally invasive repair of pectus excavatum, "Nuss technique", developed after 1987, is the most frequently performed technique world wide. MATERIAL AND METHOD This article analyzes 52 patients, admitted to the University Emergency Military Hospital "Carol Davila" - Thoracic Surgery Department, diagnosed, investigated and surgically treated according to Nuss procedure. Therapeutic and diagnostic protocols will be presented and analyzed: clinical and paraclinical evaluation, indications and contraindications of Nuss procedure, as well as possible intraoperative and postoperative complications. RESULTS AND CONCLUSIONS Nuss procedure's benefits will be presented, as well as improvements of functional and aesthetic parameters. Nuss procedure has a series of advantages: minimally invasive surgical procedure reduced operative time, minimal blood loss and fast socio-professional reinstatement.
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Affiliation(s)
- C Grozavu
- Thoracic Surgery Department, University Emergency Military Hospital "Carol Davila", Bucharest, Romania.
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Abstract
We introduce a correction for covariate measurement error in nonparametric regression applied to longitudinal binary data arising from a study on human sleep. The data have been surveyed to investigate the association of some hormonal levels and the probability of being asleep. The hormonal effect is modeled flexibly while we account for the error-prone measurement of its concentration in the blood and the longitudinal character of the data. We present a fully Bayesian treatment utilizing Markov chain Monte Carlo inference techniques, and also introduce block updating to improve sampling and computational performance in the binary case. Our model is partly inspired by the relevance vector machine with radial basis functions, where usually very few basis functions are automatically selected for fitting the data. In the proposed approach, we implement such data-driven complexity regulation by adopting the idea of Bayesian model averaging. Besides the general theory and the detailed sampling scheme, we also provide a simulation study for the Gaussian and the binary cases by comparing our method to the naive analysis ignoring measurement error. The results demonstrate a clear gain when using the proposed correction method, particularly for the Gaussian case with medium and large measurement error variances, even if the covariate model is misspecified.
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Affiliation(s)
- D Rummel
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
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Abstract
Stevens postulated that the responses of a participant in a ratio scaling experiment can be used directly to construct a psychophysical function. Today, it is generally accepted that the axioms of commutativity and multiplicativity are crucial for the interpretation of the subjects' ratio scaling behaviour. Empirical findings provide evidence that commutativity holds, whereas multiplicativity fails to hold across different sensory modalities. This shows that, in principle, Stevens' direct scaling methods yield measurements on a ratio scale level, but that the numerals occurring in a ratio scaling experiment cannot be taken at face value. Thus, Narens and others introduced a transformation function f, which converts the numerals used in an experiment into the latent mathematical numbers. The aim of the present paper is to specify the (unknown) shape of the transformation function f, by analysing different extensions of the multiplicative property. The results provide evidence that f is either a power function or a logarithmic function.
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Augustin T, Gajanana D, VanderMeer T, Cagir B, Trostle D. Itraoperative Blood Transfusion and Outcomes in General Surgery Patients with Significant Intraoperative Blood Loss; A Five Year Analyses. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.205] [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: 11/25/2022]
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Augustin T, Cagir B, VanderMeer T. Characteristics of Perforated Appendicitis in a Rural Population: True Time to Perforation. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.587] [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: 10/19/2022]
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Kalaiah M, Augustin T, Thomas M, Cagir B, Lawrence S, Bhatti A. Massive Rectus Sheath Hematoma with Spontaneous Bladder Perforation - A Cases Series. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.696] [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: 10/19/2022]
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Campbell L, Augustin T, Cagir B. Nonconventional Strictureplasties for Crohn's Disease: A Systematic Review of Outcomes. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.183] [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: 10/19/2022]
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Strobl C, Augustin T. Adaptive Selection of Extra Cutpoints—Towards Reconciling Robustness and Interpretability in Classification Trees. Journal of Statistical Theory and Practice 2009. [DOI: 10.1080/15598608.2009.10411915] [Citation(s) in RCA: 3] [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: 10/28/2022]
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Coolen F, Augustin T. A nonparametric predictive alternative to the Imprecise Dirichlet Model: The case of a known number of categories. Int J Approx Reason 2009. [DOI: 10.1016/j.ijar.2008.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Einbeck J, Augustin T. On design-weighted local fitting and its relation to the Horvitz-Thompson estimator. Stat Sin 2009. [DOI: 10.5705/ss.2009.1103] [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: 11/06/2022]
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Augustin T, Maier K. Empirical evaluation of the axioms of multiplicativity, commutativity, and monotonicity in ratio production of area. Acta Psychol (Amst) 2008; 129:208-16. [PMID: 18657794 DOI: 10.1016/j.actpsy.2008.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 05/30/2008] [Accepted: 06/02/2008] [Indexed: 10/21/2022] Open
Abstract
Although direct scaling methods have been widely used in the behavioral sciences since the 1950s, theoretical approaches which could clarify the implicit assumptions inherent in Stevens' ratio scaling approach were developed only recently. Today, it is generally accepted that the axioms of commutativity and multiplicativity are fundamental to the subjects' ratio scaling behavior. Therefore, both axioms were evaluated in ratio production of area. Participants were required to adjust the area of a variable circle to prescribed ratio production factors. The results are in accordance with previous empirical findings: commutativity was satisfied, whereas multiplicativity failed to hold. Additionally, the validity of the monotonicity property was analyzed, which postulates that the subjects' adjustments in a ratio production experiment preserve the mathematical order of the ratio production factors. Monotonicity was satisfied empirically, which is consistent with all the current theories of ratio scaling.
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Abstract
BACKGROUND Random forests are becoming increasingly popular in many scientific fields because they can cope with "small n large p" problems, complex interactions and even highly correlated predictor variables. Their variable importance measures have recently been suggested as screening tools for, e.g., gene expression studies. However, these variable importance measures show a bias towards correlated predictor variables. RESULTS We identify two mechanisms responsible for this finding: (i) A preference for the selection of correlated predictors in the tree building process and (ii) an additional advantage for correlated predictor variables induced by the unconditional permutation scheme that is employed in the computation of the variable importance measure. Based on these considerations we develop a new, conditional permutation scheme for the computation of the variable importance measure. CONCLUSION The resulting conditional variable importance reflects the true impact of each predictor variable more reliably than the original marginal approach.
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Affiliation(s)
- Carolin Strobl
- Department of Statistics, Ludwig-Maximilians-Universität Munchen, Ludwigstrasse 33, D-80539 München, Germany.
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