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Introduction: Integrating mobile health (mHealth) apps into daily diabetes management allows users to monitor and track their health data, creating a comprehensive system for managing daily diabetes activities and generating valuable real-world data. This analysis investigates the impact of transitioning from traditional self-monitoring of blood glucose (SMBG) to real-time continuous glucose monitoring (rtCGM), alongside the use of a mHealth app, on users' glycemic control. Methods: Data were collected from 1271 diabetes type 1 and type 2 users of the mySugr ® app who made a minimum of 50 SMBG logs 1 month before transitioning to rtCGM and then used rtCGM for at least 6 months. The mean and coefficient of variation of glucose, along with the proportions of glycemic measurements in and out of range, were compared between baseline and 1, 2, 3, and 6 months of rtCGM use. A mixed-effects linear regression model was built to quantify the specific effects of transitioning to a rtCGM sensor in different subsamples. A novel validation analysis ensured that the aggregated metrics from SMBG and rtCGM were comparable. Results: Transitioning to a rtCGM sensor significantly improved glycemic control in the entire cohort, particularly among new users of the mySugr app. Additionally, the sustainability of the change in glucose in the entire cohort was confirmed throughout the observation period. People with type 1 and type 2 diabetes exhibited distinct variations, with type 1 experiencing a greater reduction in glycemic variance, while type 2 displayed a relatively larger decrease in monthly averages.

The mammalian heart contains cardiac stem cells throughout life, but it has not been possible to harness or stimulate these cells to repair damaged myocardium in vivo. Assuming physiological relevance of these cells, which have evolved and have been maintained throughout mammalian evolution, we hypothesize that cardiac stem cells may contribute to cardiomyogenesis in an unorthodox manner. Since the intermediate filament protein desmin and the matricellular Secreted Protein Acidic and Rich in Cysteine (SPARC) promote cardiomyogenic differentiation during embryogenesis in a cell-autonomous and paracrine manner, respectively, we focus on their genes and employ mouse embryonic and cardiac stem cell lines as in vitro models to ask whether desmin and SPARC cooperatively influence cardiomyogenesis in cardiac stem and progenitor cells. We show that desmin also promotes cardiomyogenesis in a non-cell autonomous manner by increasing the expression and secretion of SPARC in differentiating embryonic stem cells. SPARC is also secreted by cardiac stem cells where it promotes cardiomyogenesis in an autocrine and concentration-dependent manner by upregulating the expression of myocardial transcription factors and its elicitor desmin. Desmin and SPARC interact genetically, forming a positive feedback loop and secreted autocrine and paracrine SPARC negatively affects sparc mRNA expression. Paracrine SPARC rescues cardiomyogenic desmin-haploinsufficiency in cardiac stem cells in a glycosylation-dependent manner, increases desmin expression, the phosphorylation of Smad2 and induces the expression of gata4, nkx2.5 and mef2C. Demonstration that desmin-induced autocrine secretion of SPARC in cardiac stem cells promotes cardiomyogenesis raises the possibility that a physiological function of cardiac stem cells in the adult and aging heart may be the gland-like secretion of factors such as SPARC that modulate age-related and adverse environmental influences and thereby contribute to cardiac homeostasis throughout life., Competing Interests: Declaration of competing interest The authors declare no competing or financial interests., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: Since handheld ultrasound devices are becoming increasingly ubiquitous, objective criteria to determine image quality are needed. We therefore conducted a comparison of objective quality measures and clinical performance., Material and Methods: A comparison of handheld devices (Butterfly IQ+, Clarius HD, Clarius HD3, Philips Lumify, GE VScan Air) and workstations (GE Logiq E10, Toshiba Aplio 500) was performed using a phantom. As a comparison, clinical investigations were performed by two experienced ultrasonographers by measuring the resolution of anatomical structures in the liver, pancreas, and intestine in ten subjects., Results: Axial full width at half maximum resolution (FWHM) of 100µm phantom pins at depths between one and twelve cm ranged from 0.6-1.9mm without correlation to pin depth. Lateral FWHM resolution ranged from 1.3-8.7mm and was positively correlated with depth (r=0.6). Axial and lateral resolution differed between devices (p<0.001) with the lowest median lateral resolution observed in the E10 (5.4mm) and the lowest axial resolution (1.6mm) for the IQ+ device. Although devices showed no significant differences in most clinical applications, ultrasonographers were able to differentiate a median of two additional layers in the wall of the sigmoid colon and one additional structure in segmental portal fields (p<0.05) using cartwheel devices., Conclusion: While handheld devices showed superior or similar performance in the phantom and routine measurements, workstations still provided superior clinical imaging and resolution of anatomical substructures, indicating a lack of objective measurements to evaluate clinical ultrasound devices., Competing Interests: The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: In a randomized controlled trial, the efficacy of a digital diabetes diary regarding a reduction of diabetes distress was evaluated., Methods: A randomized controlled trial with a 12-week follow-up was conducted in 41 study sites across Germany. Key eligibility criteria were a diagnosis of type 1, type 2, or gestational diabetes and regular self-monitoring of blood glucose. Participants were randomly assigned (2:1 ratio) to either use the digital diabetes logbook (mySugr PRO), or to the control group without app use. The primary outcome was the reduction in diabetes distress at the 12-week follow-up. All analyses were based on the intention-to-treat population with all randomized participants. The trial was registered at the German Register for Clinical Studies (DRKS00022923)., Results: Between February 11, 2021, and June 24, 2022, 424 participants (50% female, 50% male) were included, with 282 being randomized to the intervention group (66.5%) and 142 to the control group (33.5%). A total of 397 participants completed the trial (drop-out rate: 6.4%). The median reduction in diabetes distress was 2.41 (interquartile range [IQR]: -2.50 to 8.11) in the intervention group and 1.25 (IQR: -5.00 to 7.50) in the control group. The model-based adjusted between-group difference was significant (-2.20, IQR: -4.02 to -0.38, P = .0182) favoring the intervention group. There were 27 adverse events, 17 (6.0%) in the intervention group, and 10 (7.0%) in the control group., Conclusions: The efficacy of the digital diabetes logbook was demonstrated regarding improvements in mental health in people with type 1, type 2, and gestational diabetes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DE reports Advisory Board member fees from mySugr, Dexcom Germany, and Roche Diabetes Care as well as honoraria for lectures from Berlin-Chemie AG, Sanofi-Aventis, Dexcom Germany, and Roche Diabetes Care. NH reports Advisory Board member fees from Abbott Diabetes Care and Insulet as well as honoraria for lectures from Berlin-Chemie AG, Becton Dickenson, Sanofi Germany, Roche Diabetes Care, and Dexcom Germany. TR reports honoraria for lectures from Berlin-Chemie AG. JK is an employee of mySugr. VS is an employee of Roche Diabetes Care Deutschland. TH reports consulting fees from Eli Lilly, NovoNordisk, Sanofi, Boehringer Ingelheim, and Abbott Diabetes Care as well as honoraria for lectures from Abbott Diabetes Care, Sanofi, and Eli Lilly. RZ reports consulting fees from Roche Diabetes Care and mySugr as well as honoraria for lectures from Roche Diabetes Care, Dexcom, VitalAire, NovoNordisk, and Abbott Diabetes Care. He participated in data safety monitoring boards or advisory boards of Roche Diabetes Care, mySugr, Dexcom, NovoNordisk, and Eli Lilly. LH reports consulting fees from Roche Diabetes Care, Lifecare, Medtronic, Spiden, Embecta, Dexcom, Onetwenty, Perfood, Boydsense, Pharmasense, Unomedical and Sinocare. CR is an employee of Roche Diabetes Care. EB is an employee of mySugr. BK reports Advisory Board member fees from Abbott Diabetes Care, Embecta, Roche Diabetes Care, Novo Nordisk, Berlin-Chemie AG and Dexcom Germany as well as honoraria for lectures from Sanofi Germany, Novo Nordisk, Abbott Diabetes Care, Roche Diabetes Care, Berlin-Chemie AG, Embecta, Dexcom, and Feen. In addition, he reports support for travel and fees for scientific meetings from Sanofi, Roche Diabetes Care and Berlin-Chemie AG as well as unpaid obligations as workshop leader and member of working groups of the German Diabetes Association. SS is an employee of Roche Diabetes Care. The remaining authors have nothing to disclose.

Being one of the oldest en most frequently performed invasive procedures; the lack of scientific progress of tooth removal procedures is impressive. This has most likely to do with technical limitations in measuring different aspects of these keyhole procedures. The goal of this study is to accurately capture the full range of motions during tooth removal as well as angular velocities in clinically relevant directions. An ex vivo measuring setup was designed consisting of, amongst others, a compliant robot arm. To match clinical conditions as closely as possible, fresh-frozen cadavers were used as well as regular dental forceps mounted on the robot's end-effector. Data on 110 successful tooth removal experiments are presented in a descriptive manner. Rotation around the longitudinal axis of the tooth seems to be most dominant both in range of motion as in angular velocity. Buccopalatal and buccolingual movements are more pronounced in the dorsal region of both upper and lower jaw. This study quantifies an order of magnitude regarding ranges of motion and angular velocities in tooth removal procedures. Improved understanding of these complex procedures could aid in the development of evidence-based educational material., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Riet et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In order to deploy robots that could be adapted by non-expert users, interactive imitation learning (IIL) methods must be flexible regarding the interaction preferences of the teacher and avoid assumptions of perfect teachers (oracles), while considering they make mistakes influenced by diverse human factors. In this work, we propose an IIL method that improves the human-robot interaction for non-expert and imperfect teachers in two directions. First, uncertainty estimation is included to endow the agents with a lack of knowledge awareness (epistemic uncertainty) and demonstration ambiguity awareness (aleatoric uncertainty), such that the robot can request human input when it is deemed more necessary. Second, the proposed method enables the teachers to train with the flexibility of using corrective demonstrations, evaluative reinforcements, and implicit positive feedback. The experimental results show an improvement in learning convergence with respect to other learning methods when the agent learns from highly ambiguous teachers. Additionally, in a user study, it was found that the components of the proposed method improve the teaching experience and the data efficiency of the learning process., Competing Interests: Conflict of interestThe authors declare that they have no conflicts of interest in this work., (© The Author(s) 2023.)

The need for a training modality for tooth extraction procedures is increasing, as dental students do not feel properly trained. In this study, a prototype of a training setup is designed, in which extraction procedures can be performed on jaw models and cadaveric jaws. The prototype was designed in a way that it can give real-time feedback on the applied forces in all three dimensions (buccal/lingual, mesial/distal, and apical/coronal), torques, and angular velocity. To evaluate the prototype, a series of experimental extractions on epoxy models, conserved jaws, and fresh frozen jaws were performed. Extraction duration (s), angular velocity (degrees/s), average force (N), average torque (Nm), linear impulse (Ns), and angular impulse (N ms) were shown in real-time to the user and used to evaluate the prototype. In total, 342 (92.9 % ) successful extractions were performed using the prototype (n= 113 epoxy factory-made, n=187 epoxy re-used, n=17 conserved, n=25 fresh frozen). No significant differences were found between the conserved and the fresh frozen jaws. The fresh frozen extraction duration, linear impulse, and angular impulse differed significantly from the corresponding values obtained for the epoxy models. Extractions were successfully performed, and the applied forces, torques, and angular velocity were recorded and shown as real-time feedback using the prototype of the dental extraction trainer. The feedback of the prototype is considered reliable.