Jeffrey Joseph | Thomas Jefferson University (original) (raw)

Papers by Jeffrey Joseph

Diabetes Technology & Therapeutics, Nov 7, 2022

Diabetes

Insulin exposure and action are known to differ on each of 3 days of infusion set wear during CSI... more Insulin exposure and action are known to differ on each of 3 days of infusion set wear during CSII. We extend these observations to 1 week in a pilot phase study comparing conventional Teflon angled infusion sets to a prototype extended wear set using Capillary Biomedical SteadiFlow™ technology. Participants with T1DM for >12 months, A1C <8.5%, c-peptide <0.6 nmol/L, and ≥6 months use of Medtronic model 530G or higher were enrolled in a 2-period crossover euglycemic clamp study; clamps were performed after fasting overnight stabilization with IV insulin. Five men and 2 women, mean duration of diabetes 22.5 (16.6 SD) years and mean BMI 27.6 (3.8 SD) kg/m2 were enrolled; 4 completed all 8 clamps, 2 completed 7 clamps and 1 completed 1 clamp. We present the pharmacokinetic profiles of insulin lispro, 0.15 U/kg delivered by bolus infusion on Days 0, 3, 5 and 7 of infusion set wear. The Figure shows aggregate results from Control and Investigational infusion sets for insulin con...

JMIR mHealth and uHealth, 2020

Background New consumer health devices are being developed to easily monitor multiple physiologic... more Background New consumer health devices are being developed to easily monitor multiple physiological parameters on a regular basis. Many of these vital sign measurement devices have yet to be formally studied in a clinical setting but have already spread widely throughout the consumer market. Objective The aim of this study was to investigate the accuracy and precision of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO2) measurements of 2 novel all-in-one monitoring devices, the BodiMetrics Performance Monitor and the Everlast smartwatch. Methods We enrolled 127 patients (>18 years) from the Thomas Jefferson University Hospital Preadmission Testing Center. SBP and HR were measured by both investigational devices. In addition, the Everlast watch was utilized to measure DBP, and the BodiMetrics Performance Monitor was utilized to measure SpO2. After 5 min of quiet sitting, four hospital-grade standard and three investigation...

Diabetes, 2018

Over 1 million people with diabetes use insulin pumps and insert a new continuous subcutaneous in... more Over 1 million people with diabetes use insulin pumps and insert a new continuous subcutaneous insulin infusion (CSII) set every 2-3 days for adequate blood glucose control. Insulin absorption from the subcutaneous tissue is slow and varies over time. This can lead to complications such as hypoglycemia and diabetic ketoacidosis. Furthermore, the repeated trauma of insertion contributes to scar tissue formation and may result in infusion site loss. The development of an extended-wear CSII infusion set that can improve the safety and efficacy of CSII therapy would be a major advantage and facilitate proper glycemic control for diabetic patients. A prototype infusion set was developed using a soft polymer material with multiple ports and tested against commercially available single-port infusion sets in ambulatory large swine. Infusion sets were inserted into the subcutaneous tissue every other day for 8 days. A 70µL bolus of insulin and contrast agent was infused through each cannula ...

Diabetes, 2019

There is great clinical need for an insulin infusion set that produces reliable and consistent in... more There is great clinical need for an insulin infusion set that produces reliable and consistent insulin absorption (PK) from dose to dose and functions reliably for 7 or more days. Capillary Biomedical, Inc. is developing SteadiFlow technology which features a soft yet kink-proof cannula with 1 distal orifice and 3 additional orifices distributed over the final 6 mm of the distal end of the cannula. We compared the performance of the SteadiSet to commercial insulin infusion sets with a Teflon cannula in large ambulatory swine. Investigational infusion sets featuring SteadiFlow technology and commercial Teflon infusion set were inserted into the subcutaneous tissue of swine’s abdomen every other day for 14 days. Insulin lispro (U-5) was infused through the catheters using the same basal/bolus pattern. On day # 14, a 70 ul bolus of insulin/x-ray contrast agent was infused through each CSII catheter. The tissue surrounding each CSII was excised 5 minutes later, frozen, and imaged using ...

Physiological measurement, Jan 27, 2018

A recent study investigated the potential utility of new photoplethysmogram (PPG) indicators to i... more A recent study investigated the potential utility of new photoplethysmogram (PPG) indicators to improve cuffless continuous blood pressure (BP) measurement. In this Comment we provide additional discussion of the physiology underlying PPG- and pulse arrival time (PAT)-based BP measurement. We also discuss validation of these measurements. Changes in PPG features and PAT can occur independently of BP. Any study validating BP measurement based on PPG features or PAT should include a variety of calibration independent physiological challenges affecting BP. PPG/PAT-based BP measurement has been investigated extensively as an alternative to cuff-based BP measurement. We feel the inherent physiological confounding in PPG/PAT-based measurement makes it unlikely that it will be of clinical value.

European Journal of Anaesthesiology, 2008

BMJ Open Diabetes Research & Care, 2019

ObjectiveThis study investigated the effects of the inflammatory tissue response (ITR) to an insu... more ObjectiveThis study investigated the effects of the inflammatory tissue response (ITR) to an insulin infusion set (IIS) on insulin bolus spread over wear time, as well as the effect of cannula insertion angle on the ITR, bolus shape, and pump tubing pressure.Research design and methodsAngled or straight IISs were inserted every other day for 14 days into the subcutaneous tissue of 11 swine and insulin was delivered continuously. Prior to euthanasia, a 70 µL bolus of insulin/X-ray contrast agent was infused while recording a pressure profile (peak tubing pressure, pmax; area under the pressure curve, AUC), followed by the excision of the tissue-catheter specimen. Bolus surface area (SA) and volume (V) were assessed via micro-CT. Tissue was stained to analyze total area of inflammation (TAI) and inflammatory layer thickness (ILT) surrounding the cannula.ResultsA bolus delivered through an angled IIS had a larger mean SA than a bolus delivered through a straight cannula (314.0±84.2 mm2...

Journal of medical Internet research, Jan 22, 2018

Journal of diabetes science and technology, 2015

Current methods of blood glucose (BG) monitoring and insulin delivery are labor intensive and com... more Current methods of blood glucose (BG) monitoring and insulin delivery are labor intensive and commonly fail to achieve the desired level of BG control. There is great clinical need in the hospital for a user-friendly bedside device that can automatically monitor the concentration of BG safely, accurately, frequently, and reliably. A 100-patient observation study was conducted at 6 US hospitals to evaluate the first generation of the Intravenous Blood Glucose (IVBG) System (Edwards Lifesciences LLC & Dexcom Inc). Device safety, accuracy, and reliability were assessed. A research nurse sampled blood from a vascular catheter every 4 hours for ≤ 72 hours and BG concentration was measured using the YSI 2300 STAT Plus Analyzer (YSI Life Sciences). The IVBG measurements were compared to YSI measurements to calculate point accuracy. The IVBG systems logged more than 5500 hours of operation in 100 critical care patients without causing infection or inflammation of a vein. A total of 44135 IV...

The Annals of Applied Statistics, 2014

Journal of Diabetes Science and Technology, 2009

Automation and standardization of the glucose measurement process have the potential to greatly i... more Automation and standardization of the glucose measurement process have the potential to greatly improve glycemic control, clinical outcome, and safety while reducing cost. The resources required to monitor glycemia in hospitalized patients have thus far limited the implementation of intensive glucose management to patients in critical care units. Numerous available and up-and-coming technologies are targeted for the hospital patient population. Advantages and limitations of these devices are discussed herewith in.

Journal of Controlled Release, 2004

Hydrogels of poly(methacrylic acid-g-ethylene glycol) were prepared using different reaction wate... more Hydrogels of poly(methacrylic acid-g-ethylene glycol) were prepared using different reaction water contents in order to vary the network mesh size, swelling behavior and insulin loading/release kinetics. Gels prepared with greater reaction solvent contents swelled to a greater degree and had a larger network mesh size. All of the hydrogels were able to incorporate insulin and protected it from release in acidic media. At higher pH (7.4), the release rates increased with reaction solvent content. Using a closed loop animal model, all of the insulin loaded formulations produced significant insulin absorption in the upper small intestine combined with hypoglycemic effects. In these studies, bioavailabilities ranged from 4.6% to 7.2% and were dependent on reaction solvent content.

American Journal of Physiology-Heart and Circulatory Physiology, 2011

Expression and activity of cardiac Na+/Ca2+ exchanger (NCX1) are altered in many disease states. ... more Expression and activity of cardiac Na+/Ca2+ exchanger (NCX1) are altered in many disease states. We engineered mice in which the phosphomimetic phospholemman S68E mutant (inhibits NCX1 but not Na+-K+-ATPase) was constitutively overexpressed in a cardiac-specific manner (conS68E). At 4–6 wk, conS68E mice exhibited severe bradycardia, ventricular arrhythmias, increased left ventricular (LV) mass, decreased cardiac output (CO), and ∼50% mortality compared with wild-type (WT) littermates. Protein levels of NCX1, calsequestrin, ryanodine receptor, and α1- and α2-subunits of Na+-K+-ATPase were similar, but sarco(endo)plasmic reticulum Ca2+-ATPase was lower, whereas L-type Ca2+ channels were higher in conS68E hearts. Resting membrane potential and action potential amplitude were similar, but action potential duration was dramatically prolonged in conS68E myocytes. Diastolic intracellular Ca2+ ([Ca2+]i) was higher, [Ca2+]i transient and maximal contraction amplitudes were lower, and half-ti...

Critical care (London, England), Jan 13, 2014

Achieving adequate glucose control in critically ill patients is a complex but important part of ... more Achieving adequate glucose control in critically ill patients is a complex but important part of optimal patient management. Until relatively recently, intermittent measurements of blood glucose have been the only means of monitoring blood glucose levels. With growing interest in the possible beneficial effects of continuous over intermittent monitoring and the development of several continuous glucose monitoring (CGM) systems, a round table conference was convened to discuss and, where possible, reach consensus on the various aspects related to glucose monitoring and management using these systems. In this report, we discuss the advantages and limitations of the different types of devices available, the potential advantages of continuous over intermittent testing, the relative importance of trend and point accuracy, the standards necessary for reporting results in clinical trials and for recognition by official bodies, and the changes that may be needed in current glucose managemen...

Diabetes technology & therapeutics, May 1, 2018