Identifying Glycemic Variability in Diabetes Patient Cohorts and Evaluating Disease Outcomes.

Glycemic variability (GV) is an obstacle to effective blood glucose control and an autonomous risk factor for diabetes complications. We, therefore, explored sample data of patients with diabetes mellitus who maintained better amplitude of glycemic fluctuations and compared their disease outcomes with groups having poor control. A retrospective study was conducted using electronic data of patients having hemoglobin A1C (HbA1c) values with five recent time points from Think Whole Person Healthcare (TWPH). The control variability grid analysis (CVGA) plot and coefficient of variability (CV) were used to identify and cluster glycemic fluctuation. We selected important variables using LASSO. Chi-Square, Fisher's exact test, Bonferroni chi-Square adjusted residual analysis, and multivariate Kruskal-Wallis tests were used to evaluate eventual disease outcomes. Patients with very high CV were strongly associated (p < 0.05) with disorders of lipoprotein (p = 0.0014), fluid, electrolyte, and acid-base balance (p = 0.0032), while those with low CV were statistically significant for factors influencing health status such as screening for other disorders (p = 0.0137), long-term (current) drug therapy (p = 0.0019), and screening for malignant neoplasms (p = 0.0072). Reducing glycemic variability may balance alterations in electrolytes and reduce differences in lipid profiles, which may assist in strategies for managing patients with diabetes mellitus.

Toward a Pragmatist Epistemology: Arthur O. Lovejoy's and H. S. Jennings's Biophilosophical Responses to Neovitalism, 1909-1914.

The sustained interdisciplinary debate about neovitalism between two Johns Hopkins University colleagues, philosopher Arthur O. Lovejoy and experimental geneticist H. S. Jennings, in the period 1911-1914, was the basis for their theoretical reconceptualization of scientific knowledge as contingent and necessarily incomplete in its account of nature. Their response to Hans Driesch's neovitalist concept of entelechy, and his challenge to the continuity between biology and the inorganic sciences, resulted in a historically significant articulation of genetics and philosophy. This study traces the debate's shift of problem-focus away from neovitalism's threat to the unity of science - "organic autonomy," as Lovejoy put it - and toward the potential for development of a nonmechanististic, nonrationalist theory of scientific knowledge. The result was a new pragmatist epistemology, based on Lovejoy's and Jennings's critiques of the inadequacy of pragmatism's account of scientific knowledge. The first intellectual move, drawing on naturalism and pragmatism, was based on a reinterpretation of science as organized experience. The second, sparked by Henri Bergson's theory of creative evolution, and drawing together elements of Dewey's and James's pragmatisms, produced a new account of the contingency and necessary incompleteness of scientific knowledge. Prompted by the neovitalists' mix of a priori concepts and, in Driesch's case, and adherence to empiricism, Lovejoy's and Jennings's developing pragmatist epistemologies of science explored the interrelation between rationalism and empiricism.

Gallbladder management during laparoscopic Roux-en-Y gastric bypass surgery: routine preoperative screening for gallstones and postoperative prophylactic medical treatment are not necessary.

In the bariatric surgery literature, the optimum approach to the gallbladder is controversial. Recommendations range from concomitant cholecystectomy to selective screening and postoperative medical prophylaxis. At our institution, we have taken a highly selective approach where patients are not routinely screened for gallstones, nor are they medically treated postoperatively with bile salts. We have reviewed our experience with this approach. From January 2003 to January 2005, 407 laparoscopic Roux en Y gastric bypasses were performed at UCLA and postoperative outcomes were collected into a prospective database. Exclusion criteria included previous cholecystectomy, a follow-up period less than 6 months, or incomplete records. One hundred ninety-nine patients were included in the study. With a mean follow up period of 17.8 months, 12 (6%) patients required cholecystectomy for gallstone-induced pathology. Laparoscopic removal was performed in 11 (92%) patients. Indications for surgery included acute cholecystitis in five (2.5%) patients, gallstone pancreatitis in two (1%) patients, and biliary colic alone in another five (2.5%) patients. The incidence of symptomatic gallstones requiring cholecystectomy after laparoscopic Roux en Y gastric bypass is low. These results are similar to those from institutions where routine preoperative screening and prophylactic postoperative medical therapy is used. Routine preoperative screening or medical prophylaxis may not be necessary.