Personalization of a compartmental physiological model for an artificial pancreas through integration of patient's state estimation.

Artificial Pancreas (AP) are developed for patients with Type 1 diabetes. This medical device system consists in the association of a subcutaneous continuous glucose monitor (CGM) providing a proxy of the patient's glycaemia and a control algorithm offering the real-time modification of the insulin delivery with an automatic command of the subcutaneous insulin pump. The most complex algorithms are based on a compartmental model of the glucoregulatory system of the patient coupled to an approach of MPC (Model-Predictive-Control) for the command. The automatic and unsupervised control of insulin regulation constitutes a major challenge in AP projects. A given model with its parameterization on the shelf will not directly represent the patient's data behavior and the personalization of the model is a prerequisite before using it in a MPC. The present paper focuses on the personalization of a compartmental showing a method where taking into account the estimation of the patient's state in addition to the parameter estimation improves the results in terms of mean quadratic error.

Changing face of care for patients with moderate to severe inflammatory bowel disease: the role of specialist nurses in the governance of anti-TNF prescribing.

BACKGROUND: Anti-tumour necrosis factor (TNF) therapy is highly effective for inflammatory bowel disease (IBD), but expensive and potentially toxic. Meticulous supervision prior to and during anti-TNF treatment is required to screen and monitor patients for adverse clinical events. In addition, a systematic administrative process is necessary to comply with Australian Medicare requirements and ensure ongoing therapy is uninterrupted. IBD nurses are essential components of multidisciplinary IBD services, but their role in facilitating the safe and timely delivery of anti-TNF drugs is unacknowledged. AIM: The aim of the study was to calculate time spent by IBD nurses on anti-TNF drug governance and its indirect cost. METHODS: Time spent on activities related to anti-TNF governance was retrospectively assessed by questionnaire among IBD nurses employed at Melbourne hospitals. The capacity of IBD clinics at these hospitals was separately evaluated by surveying medical heads of clinics. RESULTS: On average, each Melbourne IBD service handled 150 existing and 40 new anti-TNF referrals in 2013. The average annual time spent by nurses supervising an existing and newly referred anti-TNF patient was 3.5 and 5.25 h respectively, or a minimum of two full working days per week. If clinicians undertook this activity during normal clinic time, the organisational opportunity cost was at least 58%. CONCLUSIONS: Anti-TNF therapy governance is an essential quality component of IBD care that is associated with a definite, indirect cost for every patient treated. IBD nurses are best positioned to undertake this role, but an activity-based funding model is urgently required to resource this element of their work.