***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE We estimate the effect size of hypoglycemia risk reduction on closed-loop control ( CLC ) versus open-loop ( OL ) sensor-augmented insulin pump therapy in supervised outpatient setting . RESEARCH DESIGN AND METHODS Twenty patients with type 1 diabetes initiated the study at the Universities of Virginia , Padova , and Montpellier and Sansum Diabetes Research Institute ; 18 completed the entire protocol . Each patient participated in two 40-h outpatient sessions , CLC versus OL , in r and omized order . Sensor ( Dexcom G4 ) and insulin pump ( T and em t : slim ) were connected to Diabetes Assistant (DiAs)—a smartphone artificial pancreas platform . The patient operated the system through the DiAs user interface during both CLC and OL ; study personnel supervised on site and monitored DiAs remotely . There were no dietary restrictions ; 45-min walks in town and restaurant dinners were included in both CLC and OL ; alcohol was permitted . RESULTS The primary outcome —reduction in risk for hypoglycemia as measured by the low blood glucose ( BG ) index (LGBI)— result ed in an effect size of 0.64 , P = 0.003 , with a twofold reduction of hypoglycemia requiring carbohydrate treatment : 1.2 vs. 2.4 episodes/session on CLC versus OL ( P = 0.02 ) . This was accompanied by a slight decrease in percentage of time in the target range of 3.9–10 mmol/L ( 66.1 vs. 70.7 % ) and increase in mean BG ( 8.9 vs. 8.4 mmol/L ; P = 0.04 ) on CLC versus OL . CONCLUSIONS CLC running on a smartphone ( DiAs ) in outpatient conditions reduced hypoglycemia and hypoglycemia treatments when compared with sensor-augmented pump therapy . This was accompanied by marginal increase in average glycemia result ing from a possible overemphasis on hypoglycemia safety Background Patients with Parkinson 's disease ( PD ) suffer from a high fall risk . Previous approaches for evaluating fall risk are based on self-report or testing at a given time point and may , therefore , be insufficient to optimally capture fall risk . We tested , for the first time , whether metrics derived from 3 day continuous recordings are associated with fall risk in PD . Methods and Material s 107 patients ( Hoehn & Yahr Stage : 2.6±0.7 ) wore a small , body-fixed sensor ( 3D accelerometer ) on lower back for 3 days .  Walking quantity ( e.g. , steps per 3-days ) and quality ( e.g. , frequency-derived measures of gait variability ) were determined . Subjects were classified as fallers or non-fallers based on fall history . Subjects were also followed for one year to evaluate predictors of the transition from non-faller to faller . Results The 3 day acceleration derived measures were significantly different in fallers and non-fallers and were significantly correlated with previously vali date d measures of fall risk . Walking quantity was similar in the two groups . In contrast , the fallers walked with higher step-to-step variability , e.g. , anterior-posterior width of the dominant frequency was larger ( p = 0.012 ) in the fallers ( 0.78±0.17 Hz ) compared to the non-fallers ( 0.71±0.07 Hz ) . Among subjects who reported no falls in the year prior to testing , sensor-derived measures predicted the time to first fall ( p = 0.0034 ) , whereas many traditional measures did not . Cox regression analysis showed that anterior-posterior width was significantly ( p = 0.0039 ) associated with time to fall during the follow-up period , even after adjusting for traditional measures . Conclusions / Significance These findings indicate that a body-fixed sensor worn continuously can evaluate fall risk in PD . This sensor-based approach was able to identify transition from non-faller to faller , whereas many traditional metrics were not successful . This approach may facilitate earlier detection of fall risk and may in the future , help reduce high costs associated with falls Background Maternal obesity is associated with an increased risk of pregnancy complications , including gestational diabetes . Physical activity ( PA ) might improve glucose metabolism and reduce the incidence of gestational diabetes . The purpose of this study was to explore patterns of PA and factors associated with change in PA in obese pregnant women . Methods PA was assessed objective ly by accelerometer at 16 – 18 weeks ’ ( T0 ) , 27 – 28 weeks ’ ( T1 ) and 35 – 36 weeks ’ gestation ( T2 ) in 183 obese pregnant women recruited to a pilot r and omised trial of a combined diet and PA intervention ( the UPBEAT study ) . Results Valid PA data were available for 140 ( 77 % ) , 76 ( 42 % ) and 54 ( 30 % ) women at T0 , T1 and T2 respectively . Moderate and vigorous physical activity as a proportion of accelerometer wear time declined with gestation from a median of 4.8 % at T0 to 3 % at T2 ( p < 0.05 ) . Total activity as a proportion of accelerometer wear time did not change . Being more active in early pregnancy was associated with a higher level of PA later in pregnancy . The intervention had no effect on PA . Conclusions PA in early pregnancy was the factor most strongly associated with PA at later gestations . Women should be encouraged to participate in PA before becoming pregnant and to maintain their activity levels during pregnancy . There is a need for effective interventions , tailored to the needs of individuals and delivered early in pregnancy to support obese women to be sufficiently active during pregnancy . Trial registration Current Controlled Trials IS RCT N89971375 ( Registered 28/11/2008 ) Background Inadequate response to proton pump inhibitor ( PPI ) therapy in patients with gastroesophageal reflux disease ( GERD ) is reported in up to 40 % . Patients with non erosive reflux disease ( NERD ) have lower response rates compared to patients with erosive reflux disease ( ERD ) ; pH metry contributes to GERD diagnosis and is critical for proper diagnosis of NERD . Aim of the study was to assess the need for doubling esomeprazole st and ard dose ( 40 mg ) for 4 weeks in PPI naive patients with typical reflux symptoms and diagnosis of GERD based on endoscopy and 48 hours , wireless pH metry . Methods All patients underwent upper GI endoscopy .  Symptoms were recorded with a structured question naire ( RDQ ) and acid exposure was determined by 48 hours , wireless pH monitoring ( BRAVO ) . In case of abnormal acid exposure , patients received a short term treatment with esomeprazole 40 mg q.d . for 4 weeks . If symptoms persisted , patients underwent a second pH metry on PPI and the dose was increased to 40 mg b.i.d . Results 31 consecutive patients with typical reflux symptoms underwent 48 hours pH monitoring . 22 patients ( 71 % ) had abnormal acid exposure , 9 patients had normal pH metry ( 29 % ) . Of the 9 patients with normal pH metry , 2 were found with erosive esophagitis and 7 without endoscopic abnormalities.24  patients with documented GERD received esomeprazole treatment . 21 patients achieved complete symptom resolution with 40 mg q.d . after 4 weeks ( 88 % ) . Only 2 patients required doubling the dose of esomeprazole for complete symptom resolution , 1 patient remained with symptoms . Conclusions Patients with typical reflux symptoms and abnormal acid exposure have a high response rate to st and ard dose esomeprazole regardless of whether they have ERD or NERD OBJECTIVE : To estimate whether women receiving daily text-message reminders have increased oral contraceptive pill adherence compared with women not receiving reminders . METHODS : This r and omized controlled trial estimated whether there was an effect of daily text-message reminders on oral contraceptive pill adherence of new oral contraceptive pill users . Pill-taking was tracked for 3 months by an electronic monitoring device with wireless data collection . During the study period , participants assigned the intervention received a daily reminder text message .  Eighty-two women were assigned r and omly to detect a 1.6±2.0 pill difference ( 90 % power , 5 % & agr ; , 15 % dropout ) . RESULTS : Participants were 79 % white , non-Hispanic , 99 % high school graduates , and 99 % nulliparous with a mean age of 22 years . Most reported condom use  with past coital activity , and more than half reported prior emergency contraception use . The mean number of missed pills per cycle did not differ significantly between the groups : 4.9±3.0 for the text-message group and 4.6±3.5 for the control group ( P=.60 ) . The number of missed pills per cycle increased over the course of the study , but this pattern did not increase differentially between the groups . Adherence recorded by the electronic monitoring device indicated much poorer adherence than that recorded by patient diaries . Despite poor pill-taking , there were no pregnancies . CONCLUSION : Daily text-message reminders did not improve oral contraceptive pill adherence . Although the lack of benefit may be attributed to the frequent use of alternative reminder systems in the control group , the rate of missed pills when measured objective ly was still very high in both groups . CLINICAL TRIAL REGISTRATION : Clinical trials.gov , www . clinical trials.gov , NCT00733707 . LEVEL OF EVIDENCE : PURPOSE : To determine whether individuals with chronic obstructive pulmonary disease ( COPD ) have decreased arm activity during daily life compared with healthy controls and explore the relationships between arm activity during daily life and arm functional measures in individuals with COPD . METHODS : This was a prospect i ve cross-sectional study that included 30 people with COPD and 14 healthy controls . Subjects attended a single assessment session in which measurements of arm exercise capacity , arm functional performance , self-perception of performance during activities of daily living ( ADL ) , shoulder and elbow flexion force and biceps and triceps thickness  were performed . On completion of this session , participants were issued a wrist actigraph and asked to wear the device on the dominant arm for 24 hours for 7 consecutive days . RESULTS : Compared with healthy controls , patients with COPD presented decreased total activity level in daily life ( P = .001 ) . When corrected for walking , the level of arm activity did not differ between individuals with COPD and healthy controls ( P = .62 ) . No correlations were found between arm activity and arm exercise capacity , arm functional performance , upper limb muscle strength , and self-perception of performance during ADL ( r = −0.20 to 0.14 ; all P ≥ .10 ) . CONCLUSIONS : Arm activity intensity in individuals with COPD did not differ from that of healthy controls when measured by a wrist actigraph . Moreover , arm activity was not associated with other clinical outcomes of arm function . Disability during ADL is multifactorial , and only limited inferences of function can be made from accelerometer data Aims To assess the performance and safety of an integrated bihormonal artificial pancreas system consisting of one wearable device and two wireless glucose sensor transmitters during short‐term daily use at home . Methods Adult patients with type 1 diabetes using an insulin pump were invited to enrol in this r and omized crossover study . Treatment with the artificial pancreas started with a day and night in the clinical research centre , followed by 3 days at home . The control period consisted of 4 days of insulin pump therapy at home with blinded continuous glucose monitoring for data collection . Days 2–4 were predefined as the analysis period , with median glucose as the primary outcome . Results A total of 10 patients completed the study .  The median [ interquartile range ( IQR ) ] glucose level was similar for the two treatments [ 7.3 ( 7.0–7.6 ) mmol/l for the artificial pancreas vs. 7.7 ( 7.0–9.0 ) mmol/l for the control ; p = 0.123 ] . The median ( IQR ) percentage of time spent in euglycaemia ( 3.9–10 mmol/l ) was longer during use of the artificial pancreas [ 84.7 (82.2–87.8)% for the artificial pancreas vs. 68.5 (57.9–83.6)% for the control ; p = 0.007 ] . Time in hypoglycaemia was 1.3 (0.2–3.2)% for the artificial pancreas and 2.4 (0.4–10.3)% for the control treatment ( p = 0.139 ) . Separate analysis of daytime and night‐time showed that the improvements were mainly achieved during the night . Conclusions The results of this pilot study suggest that our integrated artificial pancreas  provides better glucose control  than insulin pump therapy in patients with type 1 diabetes at home and that the treatment is safe Introduction A piezoelectric sensor ( PS ) converts mechanical deformations into electrical signals . We used a contactless under-the-mattress PS to monitor physiological vibrations result ing from breathing , pumping of the heart , and body movements , among individuals at home following hospitalization for heart failure ( HF ) . Our objectives were to assess acceptability of the device in the home , to assess physiological patterns , and to determine if altered patterns correlate with readmission . Methods We conducted a prospect i ve observational study of 30 patients discharged home following HF hospitalization .  PS data included a continuous nightly assessment of heart rate , respiration rate , movement rate , rapid and shallow respiration 
    Output:
    
Other mobile outcomes included assessment s of sleep , mobility , and pill adherence , as well as biomarkers assessed using a mobile device , including cardiac measures , glucose , gastric reflux , respiratory measures , and intensity of head-related injury .