M. A. Gibney

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OBJECTIVE During subcutaneous insulin therapy, inadvertent intramuscular (IM) injections may increase pain and/or adversely affect glucose control. The most appropriate needle length for patients depends on skin thickness (ST) and the distance to muscle fascia. ST and subcutaneous adipose layer thickness (SCT) were measured in adults with diabetes. (More)
We present an approach to resource allocation in telecommunications networks based on the interaction of self-interested agents which have limited information about their environment. A system architecture is described which allows agents representing various network resources, potentially owned by different real-world enterprises, to coordinate their(More)
We present a market-based approach to call routing in telecommunications networks. A system architecture is described that allows self-interested agents, representing various network resources, potentially owned by different real world enterprises, to co-ordinate their resource allocation decisions without assuming a priori co-operation. It is argued that(More)
OBJECTIVE Pen needles (PN) for subcutaneous insulin therapy have become smaller; 5 mm PNs are now the shortest in use. We evaluated the safety, efficacy and patient ratings of a new 4 mm x 32 gauge (G) PN. RESEARCH DESIGN AND METHODS Subjects with type 1 and type 2 diabetes and HbA1c 5.5% to 9.5% participated in a randomized non-inferiority cross-over(More)
Sixty patients with the diagnosis of reflex sympathetic dystrophy of the knee were evaluated retrospectively at our institution. The average followup was 2 years. Fifty-five (92%) patients treated with outpatient sympathetic blockade had resolution of the symptoms attributed to reflex sympathetic dystrophy. The time from onset of symptoms to initiation of(More)
BACKGROUND Intramuscular (IM) injection can increase insulin absorption, causing hypoglycemia. Available needle lengths today are 4-12.7 mm for pens and 6-12.7 mm for syringes. We describe the distance (D) from skin surface to muscle fascia at injection sites for subcutaneous (SC) insulin therapy and recommend needle lengths to reduce IM injection risk. (More)
OBJECTIVE The shortest pen needle (PN) for subcutaneous insulin therapy is 4 mm. Clinicians may hesitate to use it in obese patients. We report a post hoc analysis of a previously published study of the 4 mm × 32 G PN, evaluating responses in obese (≥30 kg/m(2)) and non-obese (<30 kg/m(2)). METHODS Subjects (BMI 20 to 49 kg/m(2), 52% obese) with diabetes(More)
BACKGROUND Pen needles (PNs) are essential for insulin injections using pen devices. PN characteristics affect patients' injection experience. OBJECTIVE The goal of this study was to evaluate the impact of a new extra-thin wall (XTW) PN versus usual PNs on overall patient preference, ease of injection, perceived time to complete the full dose, thumb(More)
BACKGROUND Insulin pump users experience periods of unexplained hyperglycemia. In some cases these may be due to insulin flow interruptions termed "silent occlusions," which occur without activating the pump alarm and may require set replacement. MATERIALS AND METHODS In-line pressure profiles of a novel infusion set with a 6-mm, 28-gauge polymer,(More)
OBJECTIVE To determine whether insulin delivered via a 4-mm × 32-gauge pen needle (PN) provides equivalent glycemic control as 8-mm × 31-gauge and 12.7-mm × 29-gauge PNs in obese (body mass index ≥30) patients with diabetes. PATIENTS AND METHODS This prospective, multicenter, randomized, open-label, 2-period, crossover, equivalence, home-based study was(More)