OBJECTIVE -The most promising ␤-cell replacement therapy for children with type 1 diabetes is a closed-loop artificial pancreas incorporating continuous glucose sensors and insulin pumps. The Medtronic MiniMed external physiological insulin delivery (ePID) system combines an external pump and sensor with a variable insulin infusion rate algorithm designed to emulate the physiological characteristics of the ␤-cell. However, delays in insulin absorption associated with the subcutaneous route of delivery inevitably lead to large postprandial glucose excursions.RESEARCH DESIGN AND METHODS -We studied the feasibility of the Medtronic ePID system in youth with type 1 diabetes and hypothesized that small manual premeal "priming" boluses would reduce postprandial excursions during closed-loop control. Seventeen adolescents (aged 15.9 Ϯ 1.6 years; A1C 7.1 Ϯ 0.8%) underwent 34 h of closed-loop control; 8 with full closed-loop (FCL) control and 9 with hybrid closed-loop (HCL) control (premeal priming bolus).RESULTS -Mean glucose levels were 135 Ϯ 45 mg/dl in the HCL group versus 141 Ϯ 55 mg/dl in the FCL group (P ϭ 0.09); daytime glucose levels averaged 149 Ϯ 47 mg/dl in the HCL group versus 159 Ϯ 59 mg/dl in the FCL group (P ϭ 0.03). Peak postprandial glucose levels averaged 194 Ϯ 47 mg/dl in the HCL group versus 226 Ϯ 51 mg/dl in the FCL group (P ϭ 0.04). Nighttime control was similar in both groups (111 Ϯ 27 vs. 112 Ϯ 28 mg/dl).CONCLUSIONS -Closed-loop glucose control using an external sensor and insulin pump provides a means to achieve near-normal glucose concentrations in youth with type 1 diabetes during the overnight period. The addition of small manual priming bolus doses of insulin, given 15 min before meals, improves postprandial glycemic excursions. Diabetes Care 31:934-939, 2008

Pedometers provide a useful indicator of daily step counts but variability in activity patterns make it difficult to establish step count guidelines that correspond with other public health guidelines.

Background: The Beta-Carotene and Retinol Efficacy Trial (CARET) was terminated 21 months ahead of schedule due to an excess of lung cancers. Deaths from cardiovascular disease also increased (relative risk ¼ 1.26 (95% confidence interval (CI) 0.99-1.61)) in the group assigned to a combination of 30 mg beta-carotene and 25 000 IU retinyl palmitate (vitamin A) daily. The basis for increased cardiovascular mortality is unexplained. Design: We analyzed data on serum lipids, available for 1474 CARET Vanguard participants who were enrolled in the two CARET pilot studies and transitioned to the Vanguard study. Total cholesterol and triglycerides were measured 2 months prior to, 4 and 12 months following randomization, and annually thereafter for up to 7 y. Intervention: In the asbestos-exposed pilot (N ¼ 816), participants were assigned to beta-carotene and retinol or to placebo; in the smokers pilot (N ¼ 1029), participants were assigned to beta-carotene, retinol, a combination, or placebo. Results: Serum cholesterol showed a decline over time in both arms; serum triglycerides had a continuous decline over time in the placebo arm, but an initial increase that persisted in the active arm. Both serum cholesterol concentrations (Po0.0003) and serum triglycerides (Po0.0001) were significantly higher in the participants receiving vitamin A and/or a combination of vitamin A and beta-carotene (n ¼ 863) as compared to the placebo group (n ¼ 611). Those in this active intervention group had an average cholesterol concentration 5.3 mg/dl (0.137 mmol/l) higher than those in the placebo arm. Conclusion: The differences in cholesterol and triglyceride concentrations between the groups following randomization may account in part for the unexpected excess in cardiovascular deaths seen in the active intervention arm of CARET.

Methods: This was a retrospective cohort analysis of consecutive patients diagnosed with toxicity related to cannabis use. Patients were seen at seven emergency departments (EDs) over a 24-month study period (November 2018-October 2020). Spanning 13 counties in Michigan, affiliated institutions included three rural medical centers, three university-affiliated hospitals, and a children's tertiary care facility. Data collected included demographics, clinical features, and treatment outcomes in patients presenting to the ED with neuropsychiatric symptoms (NPS) versus those experiencing other forms of cannabis toxicity. Chisquared and t-tests were used to compare these two groups across key demographic and outcome variables. One investigator performed a blinded critical review of a random sample of 10% of the charts to determine inter-rater reliability using kappa statistics.Results: During the study period, 1214 patients were evaluated for cannabis toxicity. A total of 584 patients (48.1%) had a neuropsychiatric chief complaint (NPS group) and 630 (51.9%) experienced other forms of cannabis toxicity, predominantly symptoms of intoxication (51.0%) or cannabis hyperemesis syndrome (37.5%). The NPS group presented with acute anxiety (37.5%), suicidal ideation (18.4%), depression (16.1%), hallucinations (9.5%), mania (5.9%), seizures (5.5%), psychosis (4.6%), and paranoia (4.5%). NPS patients were more likely to younger (25.3 vs 29.2 years, P<0.001), have comorbidities (15.3 vs 9.2%, P¼0.001) and a history of polysubstance abuse (13.2 vs 8.6%, P¼0.004). These patients also had a longer ED length-of-stay (7.3 vs 4.0 hours, P<0.001) and significantly more hospital admissions (41.9% vs 6.4%, P<0.001). Reliability of data collection (k ¼ 0.91) showed excellent agreement.Conclusions: Neuropsychiatric toxicity is common after acute or chronic cannabis exposures, occurring in nearly half of ED patients in this community-based study. These troublesome findings highlight the risks associated with the use of cannabis for recreational or therapeutic purposes.