An artificial pancreas system that closely mimics the body’s blood sugar control mechanism was able to maintain near-normal glucose levels without causing hypoglycemia in a small group of patients.The system, combining a blood glucose monitor and insulin pump technology with software that directs administration of insulin and the blood-sugar-raising hormone glucagon, was developed at Boston University (BU).The first clinical trial of the system was conducted by Harvard researchers at Massachusetts General Hospital (MGH) and confirmed the feasibility of an approach utilizing doses of both hormones. In their report, appearing in Science Translational Medicine, the researchers also found unexpectedly large differences in insulin absorption rates between study participants, differences they were able to account for by adjustments to the system.“This is the first study to test an artificial pancreas using both insulin and glucagon in people with type 1 diabetes. It showed that, by delivering both hormones in response to frequent blood sugar tests, it is possible to control blood sugar levels without hypoglycemia, even after high-carbohydrate meals,” says Steven Russell, a Harvard Medical School (HMS) instructor in medicine in the MGH Diabetes Unit, who co-led the research team with Edward Damiano of the BU Department of Biomedical Engineering.In type 1 diabetes, the insulin-producing beta cells of the pancreas are destroyed by the immune system, requiring insulin treatment to regulate blood sugar levels. Intensive glucose control involving frequent blood sugar testing and insulin administration can delay or prevent long-term complications – such as retinal damage, kidney failure, or cardiovascular disease – but is extremely demanding and difficult to maintain. Continuous glucose monitors and insulin pumps can help, but patients remain at risk for hypoglycemia, a potentially life-threatening drop in blood sugar caused by too much insulin.Because any administration of insulin, even by an artificial pancreas system, has been associated with the risk of hypoglycemia, BU investigators Damiano and lead author Firas El-Khatib developed a system that both accounts for the rate of insulin absorption and also incorporates glucagon, a hormone naturally released by the pancreas to raise blood sugar levels. While the alpha cells of the pancreas that produce glucagon are not destroyed in people with type 1 diabetes, the cells no longer release glucagon in response to low blood sugar.“Large doses of glucagon are used as a rescue drug for people with severely low blood sugar,” explains Damiano. “Our system is designed to counteract moderate drops in blood sugar with minute doses of glucagon spread out throughout the day, just as the body does in people without diabetes.” In 2007 Damiano’s team tested the system in diabetic pigs, which led to FDA approval of the human trial.The current study enrolled 11 adults with type 1 diabetes and was primarily designed to test the software that controls the system. To get the most accurate glucose levels, the system used a monitor that directly reads blood sugar through a sensor placed into a vein instead of a continuous glucose monitor that takes readings under the skin.Participants’ blood sugar was controlled by the system for 27 hours, during which time they ate three standardized, high-carbohydrate meals and slept through the night at the hospital. While the system kept glucose levels close to the target range for six participants, five others experienced hypoglycemia significant enough that they needed a dose of orange juice to raise their blood sugar.Close analysis of participants’ blood-insulin levels revealed a nearly fourfold difference in the rate at which individuals absorbed and cleared the fast-acting insulin used in the study, with some rates of absorption being much slower than anticipated. Since the controlling software determined dosage based on the expected rate of insulin absorption, participants who absorbed at a slower rate received excessive doses, leading to hypoglycemia.A test of participants’ response to a single insulin injection verified that some had consistently slow and some consistently fast rates of insulin absorption. Rates of absorption also varied too much from experiment to experiment, even on an individual basis, to allow participant-specific dosage calculations.After globally adjusting the software parameters to a slower insulin absorption rate, the researchers conducted repeat experiments in the same participants. This time none of the slow-absorption participants experienced hypoglycemia significant enough to require intervention. Blood-sugar levels were only slightly higher in repeat experiments involving participants with fast insulin absorption, showing that the adjusted software parameters were effective for all study participants and may be adequate for everyone with type 1 diabetes.The elimination of episodes of hypoglycemia in repeat experiments involving the same participants affirmed that the initial mismatch between parameter settings and insulin absorption rate had been the cause of the hypoglycemia. All previous reported studies of artificial pancreas systems have included episodes of hypoglycemia, but this is the first study to confirm and address the cause of that hypoglycemia.Later this spring the researchers will begin a follow-up study with a system using the revised settings and driven by an FDA-approved continuous glucose monitor. Those experiments will last more than 48 hours and include children as well as adults. The investigators also plan to compare the insulin/glucagon system with a version that uses only insulin. “The device we ultimately envision will be wearable and incorporate a glucose sensor inserted under the skin that communicates wirelessly with a pump about the size of a cell phone,” says Harvard’s Russel. “The pump would administer insulin and probably glucagon, and would contain a microchip that runs the control software.”Damiano, whose 11-year-old son was diagnosed with type 1 diabetes at the age of 1, adds, “a system like this would replace the need for people to constantly check their blood sugar and to make treatment decisions every few hours. It would need to be maintained but could take over the decision-making process, closely emulating a functioning pancreas. It wouldn’t be a cure, but it has the potential to be the ultimate evolution of insulin therapy for type 1 diabetes.” Damiano is an associate professor of Biomedical Engineering at Boston University.The study was supported by grants from the Juvenile Diabetes Research Foundation, the Wallace H. Coulter Foundation, the Charlton Fund for Innovative Research in Diabetes and the National Center for Research Resources. Co-authors of the paper are David M. Nathan, MD, professor of medicine at HMS and director of the MGH Diabetes Center, and Robert Sutherlin, RN, also of the MGH Diabetes Center.
Referee Andranik Arsenyan and assistant Hovhannes Avagyan, who oversaw a UEFA Europa League match last month, have been given life bans by the UEFA Control and Disciplinary Body.Following the provisional decision rendered by the chairman of the CDB on 7 August 2013, the plenary meeting of the CDB analysed the case today.The CDB took note of the decision of the Executive Committee of the Football Federation of Armenia (FFA) with regard to the referee and assistant referee who officiated at the first qualifying round match between Inter Turku and Víkingur on 11 July 2013.In a hearing at the FFA, referee Arsenyan and assistant referee Avagyan admitted having tried to manipulate the outcome of the second-leg fixture, which ended 1-0 in favour of Víkingur.The UEFA betting fraud detection system (BFDS) – which monitors over 32,000 matches across Europe, including all first and second-division games, cup ties and UEFA competition fixtures – had detected suspicious betting patterns around this encounter, and this prompted the start of an investigation by UEFA, to which the FFA contributed closely.UEFA is pleased with the excellent cooperation of the FFA, the local authorities and the betting operators during the investigation process.
Position eligibility based on Yahoo’s default settings (10 games played or 5 games started)More 2020 Fantasy Baseball: Auction Values | Mock Draft SimulatorRankingPlayerTeamPosition(s)1Ronald Acuna Jr.BravesOF2Christian YelichBrewersOF3Mike TroutAngelsOF4Mookie BettsDodgersOF5Cody BellingerDodgers1B, OF6Alex BregmanAstros3B, SS7Francisco LindorIndiansSS8Trevor StoryRockiesSS9Juan SotoNationalsOF10Nolan ArenadoRockies3B11J.D. MartinezRed SoxOF12Fernando Tatis Jr.PadresSS13Trea TurnerNationalsSS14Max ScherzerNationalsSP15Gerrit ColeYankeesSP16Anthony RendonAngels3B17Jose RamirezIndians3B18Jacob deGromMetsSP19Freddie FreemanBraves1B20Jose AltuveAstros2B21Javier BaezCubsSS22Justin VerlanderAstrosSP23Mike ClevingerIndiansSP24Gleyber TorresYankees2B, SS25George SpringerAstrosOF26Walker BuehlerDodgersSP27Paul GoldschmidtCardinals1B28Pete AlonsoMets1B29Aaron JudgeYankeesOF30Yordan AlvarezAstrosOF31Rafael DeversRed Sox3B32Bryce HarperPhilliesOF33Giancarlo StantonYankeesOF34Starling MarteD-backsOF35Jack FlahertyCardinalsSP36Adalberto MondesiRoyalsSS37Jonathan VillarMarlins2B, SS, OF*38Ketel MarteD-backs2B, SS, OF39Xander BogaertsRed SoxSS40Blake SnellRaysSP41Manny MachadoPadres3B, SS42Eloy JimenezWhite SoxOF43Stephen StrasburgNationalsSP44Charlie BlackmonRockiesOF45Austin MeadowsRaysOF46Kris BryantCubs3B, OF47Eugenio SuarezReds3B48Vladimir Guerrero Jr.Blue Jays3B49Yoan MoncadaWhite Sox3B50Luis CastilloRedsSP51Lucas GiolitoWhite SoxSP52DJ LeMahieuYankees1B, 2B, 3B53Keston HiuraBrewers2B54Ozzie AlbiesBraves2B55Tyler GlasnowRaysSP56Nicholas CastellanosRedsOF57Josh DonaldsonTwins3B58Jorge SolerRoyalsOF59Whit MerrifieldRoyals2B, OF60Shane BieberIndiansSP61Matt OlsonA’s1B62Franmil ReyesIndiansOF63Charlie MortonRaysSP64Jose AbreuWhite Sox1B65Anthony RizzoCubs1B66Chris PaddackPadresSP67Kyle SchwarberCubsOF68Josh BellPirates1B69Aaron NolaPhilliesSP70Bo BichetteBlue JaysSS71Clayton KershawDodgersSP72Joey GalloRangersOF73Nelson CruzTwinsUTIL74Khris DavisA’sUTIL75Kirby YatesPadresRP76Josh HaderBrewersRP77Patrick CorbinNationalsSP78J.T. RealmutoPhilliesC79Gary SanchezYankeesC80Carlos CorreaAstrosSS81Frankie MontasA’sSP82James PaxtonYankeesSP83Roberto OsunaAstrosRP84Max MuncyDodgers1B, 2B, 3B85Mike MoustakasReds2B, 3B86Eduardo EscobarD-backs2B, 3B87Brad HandIndiansRP88Aroldis ChapmanYankeesRP89Matt ChapmanA’s3B90Lance McCullers Jr.AstrosSP91Corey KluberRangersSP92Carlos CarrascoIndiansSP93Oscar MercadoIndiansOF94Victor RoblesNationalsOF95Liam HendriksA’sRP96Jesus LuzardoA’sSP97Jose BerriosTwinsSP98Yuli GurrielAstros1B, 3B99Yasmani GrandalWhite SoxC, 1B100Willson ContrerasCubsC101Andrew BenintendiRed SoxOF102Ramon LaureanoA’sOF103Luis RobertWhite SoxOF104Aristides AquinoRedsOF105Tommy PhamPadresOF106Rhys HoskinsPhillies1B107Carlos SantanaIndians1B108Miguel SanoTwins1B, 3B109Taylor RogersTwinsRP110Ken GilesBlue JaysRP111Kenley JansenDodgersRP112Mike SorokaBravesSP113Marcell OzunaBravesOF114Edwin EncarnacionWhite Sox1B115Hyun-Jin RyuBlue JaysSP116Marcus SemienA’sSS117Tim AndersonWhite SoxSS118Sonny GrayRedsSP119Zack GreinkeAstrosSP120Raisel IglesiasRedsRP121Michael ConfortoMetsOF122Willie CalhounRangersOF123Justin UptonAngelsOF124Gavin LuxDodgers2B125Cavan BiggioBlue Jays2B, OF126Edwin DiazMetsRP127Max FriedBravesSP128Justin TurnerDodgers3B129Craig KimbrelCubsRP130Luke WeaverD-backsSP131Sean ManaeaA’sSP132Brandon WorkmanRed SoxRP133Kyle TuckerAstrosOF134Eddie RosarioTwinsOF135Michael BrantleyAstrosOF136Yu DarvishCubsSP137Byron BuxtonTwinsOF138Mallex SmithMarinersOF139Salvador PerezRoyalsC140Mitch GarverTwinsC141Trevor BauerRedsSP142Hansel RoblesAngelsRP143Nick AndersonRaysRP144Max KeplerTwinsOF145Scott KingeryPhillies2B, 3B, SS, OF146Danny SantanaRangers1B, 2B, 3B, SS, OF147Jake OdorizziTwinsSP148Christian WalkerD-backs1B149Lance LynnRangersSP150Will SmithDodgersC151Miguel AndujarYankeesUTIL152Andrew McCutchenPhilliesOF153David DahlRockiesOF154Jeff McNeilMets2B, 3B, OF155Brandon WoodruffBrewersSP156Zac GallenD-backsSP157Ian HappCubs2B, 3B, OF158Alex ColomeWhite SoxRP159Archie BradleyD-backsRP160Sean DoolittleNationalsRP161Dinelson LametPadresSP162Tommy EdmanCardinals2B, 3B, OF163Wil MyersPadres1B, OF164Elvis AndrusRangersSS165Zack WheelerPhilliesSP166Ryan McMahonRockies1B, 2B, 3B167Brandon LoweRays1B, 2B, OF168Corey SeagerDodgersSS169Jose LeClercRangersRP170Marcus StromanMetsSP171Eduardo RodriguezRed SoxSP172Madison BumgarnerD-backsSP173Hector NerisPhilliesRP174Lourdes Gurriel Jr.Blue Jays2B ,OF175Kenta MaedaTwinsSP176Renato NunezOrioles1B, 3B177Didi GregoriusPhilliesSS178Paul DeJongCardinalsSS179Ian KennedyRoyalsRP180Luke VoitYankees1B181Kyle HendricksCubsSP182Joey LucchesiPadresSP183Rougned OdorRangers2B184Dee GordonMariners2B185Robbie RayD-backsSP186Matt BoydTigersSP187Avisail GarciaBrewersOF188Nick SenzelRedsOF189Bryan ReynoldsPiratesOF190Shohei OhtaniAngelsSP191Mark MelanconBravesRP192Julio UriasDodgersSP193Keone KelaPiratesRP194Eric HosmerPadres1B195Amed RosarioMetsSS196Lorenzo CainBrewersOF197Adam EatonNationalsOF198Jorge PolancoTwinsSS199Jean SeguraPhillies3B*, SS200Adrian HouserBrewersSP201Michael ChavisRed Sox1B, 2B202Joc PedersonDodgers1B, OF203Mark CanhaA’s1B, OF204Brandon KintzlerMarlinsRP205Tyler MahleRedsSP206Brian AndersonMarlins3B, OF207German MarquezRockiesSP208Carlos MartinezCardinalsSP209Randal GrichukBlue JaysOF210Hunter RenfroeRaysOF211Kole CalhounD-backsOF212J.D. DavisMets3B, OF213Nick SolakRangers2B, 3B214Joe JimenezTigersRP215Gio UrshelaYankees3B216Daniel MurphyRockies1B217Ryan BraunBrewers1B*, OF218Jon GrayRockiesSP219Hunter DozierRoyals1B, 3B, OF220Austin RileyBraves3B*, OF221Shohei OhtaniAngelsUTIL222Kyle SeagerMariners3B223Joe MusgrovePiratesSP224Wade DavisRockiesRP225Jorge AlfaroMarlinsC226Mike MinorRangersSP227Andrew HeaneyAngelsSP228Kolten WongCardinals2B229Anthony DeSclafaniRedsSP230Yandy DiazRays1B, 3B231C.J. CronTigers1B232Omar NarvaezBrewersC233Wilson RamosMetsC234Christian VazquezRed SoxC235Caleb SmithMarlinsSP236Brendan McKayRaysSP237Howie KendrickNationals1B, 2B, 3B238Carson KellyD-backsC239Mychal GivensOriolesRP240Jarrod DysonPiratesOF241Alex VerdugoRed SoxOF242Gregory PolancoPiratesOF243Shin-Soo ChooRangersOF244David PeraltaD-backsOF245Matt MagillMarinersRP246Tony WatsonGiantsRP247Kevin NewmanPirates2B, SS248Mauricio DubonGiants2B, SS249Carter KieboomNationals3B*, SS250Brett GardnerYankeesOF251Griffin CanningAngelsSP252Mitch KellerPiratesSP253Trent GrishamPadresOF254Kwang-Hyun KimCardinalsRP255Harrison BaderCardinalsOF256Teoscar HernandezBlue JaysOF257Jesus AguilarMarlins1B258Eric ThamesNationals1B, OF259Francisco MejiaPadresC260Sean MurphyA’sC261Luis UriasBrewers2B, SS262Garrett HampsonRockies2B, SS, OF263Jurickson ProfarPadres2B, OF264Aaron CivaleIndiansSP265A.J. PukA’sSP266Rowdy TellezBlue Jays1B267Dan VogelbachMariners1B268Jackie Bradley Jr.Red SoxOF269A.J. PollockDodgersOF270Jesse WinkerRedsOF271Joey VottoReds1B272Miguel CabreraTigers1B273Albert PujolsAngels1B274Masahiro TanakaYankeesSP275Austin HaysOriolesOF276Jordan MontgomeryYankeesSP277Jose QuintanaCubsSP278Dansby SwansonBravesSS279Isan DiazMarlins2B280Cesar HernandezIndians2B281Spencer TurnbullTigersSP282Cole HamelsBravesSP283Gio GonzalezWhite SoxSP284Dallas KeuchelWhite SoxSP285Willy AdamesRaysSS286Nick AhmedD-backsSS287Roberto PerezIndiansC288Justus SheffieldMarinersSP289Josh LindblomBrewersSP290Jon LesterCubsSP291Kevin KiermaierRaysOF292Domingo SantanaIndiansOF293Nomar MazaraWhite SoxOF294Dominic SmithMets1B, OF295Yoenis CespedesMetsOF296Jo AdellAngelsOF297Tyler O’NeillCardinalsOF298Chris ArcherPiratesSP299Zach PlesacIndiansSP300Jordan YamamotoMarlinsSP It’s officially draft season for 2020 fantasy baseball leagues, and no cheat sheet is complete without a set of overall top 300 rankings. From the top-tier stars to the late-round sleepers — and everything in between — we have you covered. The debates start at the top, where you can make strong cases for several different players to be No. 1. Christian Yelich and Ronald Acuna Jr. both have 40-40 potential, but given Acuna’s age, he seems more likely to continue going all out for SBs. Yelich could top him in every other category, though, so there’s no shame if he’s your preferred option. Mike Trout is Mike Trout, Mookie Betts should continue to be a monster even away from The Monster, and the next dozen or so players all have top-five upside, too. 2020 Fantasy Baseball Rankings:Catcher | First | Second | Third | Short | Outfield | Starter | RelieverThe important thing to remember with a fantasy baseball big board is that after the first 30-40 players, position/category needs can greatly change the value of players relative to your team. We always caution that our top 300 shouldn’t be viewed as a glorified mock draft, but rather a rough guide for the overall value of players in a vacuum. 2020 Fantasy Baseball Tiers, Draft Strategy:Catcher | First | Second | Third | Short | Outfield | Starter | RelieverCompared to other sites, we’re generally a little lower on SPs. Not only is pitcher a volatile position because of frequent serious injuries, but you also have to factor in the unpredictability of wins/saves and the variance of ERA and WHIP. There’s nothing wrong with valuing pitchers more highly, especially if you think you have a good system for evaluating them, but generally speaking, hitters are more reliable. 2020 Fantasy Baseball Sleepers:Catcher | First | Second | Third | Short | Outfielder | Starter | Each teamWe’ll be updating these rankings frequently as needed, so check back for the latest player movement. DOMINATE YOUR DRAFT: Ultimate 2020 Fantasy Baseball Cheat SheetFantasy Baseball Rankings: Top 300 cheat sheetRankings based on 5×5 H2H leagues with ERA, WHIP, Ks, Ws, and Saves as pitching categories and Rs, HRs, RBIs, SBs, and batting average as hitting categories.