bluuebunny/crossref_metadata_2025 huggingface dataset:
939-P: Real-World Performance of the Guardian Connect System with Sugar.IQ
Authors: ARUNACHALAM SIDDHARTH , ZHONG YUXIANG , ABRAHAM SINU BESSY , AGRAWAL PRATIK , VIGERSKY ROBERT , CORDERO TONI L. , KAUFMAN FRANCINE R.
Published: June 2019

Background: The Guardian Connect continuous glucose monitoring (CGM) system displays current and trending sensor glucose (SG) via smartphone; records insulin, carbohydrate and exercise; and sends predictive high and low SG alerts up to one hour in advance. When used with the Sugar.IQ diabetes assistant application, personalized insights based on behavior patterns (e.g., food log or insulin dose entry) and glycemic outcomes can be tracked with the Glycemic Assist feature.

Methods: System data uploaded between June-November of 2018, by 1765 individuals with diabetes were analyzed. Time in target glucose range (TIR, 70-180 mg/dL) and the Glucose Management Indicator (GMI) were compared between those who used (N=530) or did not use Sugar.IQ. Both groups had ≥5 days of SG data and similar demographic and initial glucose profiles.

Results: System users had a mean GMI of 7.1%, mean±SD SG of 157.0±49.1mg/dL (8.7±2.7mmol/L), and a mean TIR of 64.5%, over the data upload period. When predictive alerts were enabled, excursions were avoided after 31% of high SG alerts and 62% of low SG alerts. Those who accessed Sugar.IQ experienced a TIR increase of 2.7% (p=0.006) and a mean SG decrease of -3.0% (p<0.001), with reductions in SD of SG (47.9mg/dL to 41.5mg/dL, p<0.001) and coefficient of variation of SG (0.32 to 0.29, p<0.001), versus those who did not. Their GMI was also 6.8% versus 6.9% (p=0.007). Those who tracked food at least once/day increased TIR by 5% (p<0.001). Users considered 88% of insights helpful.

Discussion: The Guardian Connect CGM system with Sugar.IQ may advance patient understanding of glucose trends, aid in behavioral change that improves therapy adherence, and lead to better glycemic outcomes.

Disclosure

S. Arunachalam: Employee; Self; Medtronic. Y. Zhong: None. S. Abraham: Employee; Self; Medtronic MiniMed, Inc. P. Agrawal: Employee; Self; Medtronic MiniMed, Inc. Stock/Shareholder; Self; Medtronic. R. Vigersky: Employee; Self; Medtronic MiniMed, Inc. T.L. Cordero: Employee; Self; Medtronic. F.R. Kaufman: Employee; Self; Medtronic.
94-OR: Lipid Nanoparticle-Mediated Delivery of Enhanced Costimulation Blockade to Prevent Type 1 Diabetes
Authors: ZHANG YICHUAN , WANG JIALU , CALDERON-COLON XIOMARA , TIBURZI OLIVIA , LOZANO MARCOS IGLESIAS , PATRONE JULIA , RAIMONDI GIORGIO
Published: June 2019

Type 1 diabetes (T1D) remains an untreatable autoimmune disease caused by the destruction of pancreatic beta cells by autoreactive T cells. Because of its complex etiology, many immunotherapy strategies have been investigated, but with disappointing results. Costimulation blockade, blocking the CD28 pathway via administration of CTLA4-Ig, is a promising approach, but recent observations suggest its efficacy is antagonized by inflammatory factors. As antigen presenting cells malfunctions and aberrant accumulation of type 1 interferons are associated with T1D, we pose that inhibiting the signaling of inflammatory cytokines via Tofacitinib (Tofa), a JAK inhibitor, would enhance the efficacy of CTLA4-Ig to prevent T1D development. The objective of this study was to design the controlled and localized delivery of Tofa via implementation of biocompatible lipid nanoparticles, Nanostructured Lipid Carrier (NLC), and assess the immunomodulatory impact of this strategy.

We identified a specific composition of NLC that had negligible toxicity, could be readily taken up by multiple immune cells, and had a favorable Tofa encapsulation efficiency. Live animal imaging using fluorescently-labeled NLC confirmed that these particles have the unique property of accumulating in lymphoid tissues. Moreover, when administrated via oral gavage, they bypassed first-pass metabolism and accumulated in spleen, pancreatic and mesenteric lymph nodes. Ex-vivo, Tofa- NLC rapidly delivered Tofa to mouse antigen presenting cells preventing their maturation and the release of inflammatory cytokines. Ongoing experiments show that short-term administration of Tofa-NLC via oral gavage at early (3-week-old) or late (10-week-old) stage in NOD promotes a significant reduction of T1D onset.

Overall, Tofa-NLC represent a promising strategy to complement CTLA4-Ig (currently investigated) and we envision this combination strategy could enhance the efficacy of antigen specific immunotherapy.

Disclosure

Y. Zhang: None. J. Wang: None. X. Calderon-Colon: None. O. Tiburzi: None. M. Iglesias Lozano: None. J. Patrone: None. G. Raimondi: None.
941-P: Frequency of Blood Glucose Monitoring in Relation to Medical Cost and Glycemic Control in Hospitalized Patients with Type 2 Diabetes
Authors: ZHANG LEI , GU YAN , YANG YUXIU , WANG NA , GAO WEIGUO , WANG JUN , YIN XIAOYAN , DONG YANHU
Published: June 2019

The study aimed to investigate the effect of 7-point or 5-point glucose monitoring on medical costs, glycemic control and the incidence of hypoglycemia in hospitalized patients with type 2 diabetes (T2DM). A total of 4002 patients with T2DM (1490 male and 2512 female cases) with complete medical records were included between 2012 and 2017. The average age was 61.5 years and the mean disease duration 8.68 years. According to the frequency of daily monitoring of blood glucose during hospitalization, patients were divided into 2 subgroups of 5-point group and 7-point group. Patients in 5-point group received fasting blood glucose (FBG), 2h blood glucose (2hBG) after breakfast, 2hBG after lunch, 2hBG after dinner and bedtime blood glucose tests. Patients in 7-point group received additional tests of pre-lunch glucose and pre-dinner blood glucose. Blood glucose monitoring was performed using Johnson & Johnson SureStep blood glucose meter. Comparison of two groups includes duration of in-hospital stay, medical costs, glycemic control and the incidence of hypoglycemia. Patients in 7-point glucose monitoring group had significantly shorter hospital stay (14.4 vs. 16.6 days, P<0.05) and less total medical costs (10324.4 vs. 12087.5 CNY, P<0.05) compared with 5-point group. Laboratory examination cost did not differ significantly between groups (p>0.05). At discharge, both fasting and 2-h glucose decreased significantly compared with baseline levels in either 5-point or 7-point group. In 7-point group, FPG decreased by 2.41mmol/L and 2hPG by 3.9mmol/L. In the 5-point group, the corresponding figures were 2.07mmol/L and 3.6mmol/L, respectively. The incidence of hypoglycemia were 24.2% in 7-point group and 33.1% in 5-point group (P<0.05). In-hospital 7-point daily glucose monitoring improves patients’ adherence to treatment, shortens hospital stay, reduces medical cost, improves blood glucose control, and reduces the incidence of hypoglycemia.

Disclosure

L. Zhang: None. Y. Gu: None. Y. Yang: None. N. Wang: None. W. Gao: None. J. Wang: None. X. Yin: None. Y. Dong: None.
953-P: Sustainable Improvement in Quality of Blood Glucose Control in Users of mySugr’s Integrated Diabetes Management Solution
Authors: MAYER HARALD , BANKOSEGGER RAFAEL P. , KOBER JOHANNA
Published: June 2019

Objective: The mySugr App is the most widespread mobile health application in the diabetes industry, reaching 1.5M patients in 62 countries. mySugr’s Integrated Diabetes Management solution, the mySugr bundle, introduces unlimited test strip delivery and Certified Diabetes Educator-led coaching. In a previous retrospective study we looked at real world changes in blood glucose (BG) in a U.S. population of mySugr Bundle users. In this follow-up study we extended the observation period of intervention to further analyse the course of effect seen before.

Method: We analyzed changes in BG control (mean±SD, tests in range (TIR), estimated A1c (eA1c)) and frequency of testing. Participants monitored BG ≥3 times/day during the observation period. Data from the first 2 weeks of use (t0), 8 weeks before (t1), 8 weeks after (t2) and 8 to 16 weeks after (t3) initiation of Bundle usage were aggregated and statistically compared using two-sided t-tests.

Results: Study participants were 61 users; 59% with type 1 diabetes, 32.8% with type 2 diabetes, 6.6% with LADA and 1.6% with unreported diabetes type. Baseline BG was 152.0±56.0 mg/dl, eA1c 6.9% and TIR 65%. Significant (p<0.05) improvements were observed in mean BG (-11,8 mg/dl), standard deviation (-5,48 mg/dl), TIR (+6.8%), readings above target (-7.2%) and eA1c (-0.41%) between t0 and t3. A significant improvement was also observed in monitoring frequency (+21.4%) between t1 and t3.

Conclusion: Our previous study suggested use of the mySugr Bundle triggered positive changes of glucose control at 8 weeks post intervention. We were now able to show a sustainable improvement in BG control over an extended time period of 16 weeks, indicating the potential benefits of mobile interventions that combine complementary treatment strategies for therapy adherence over longer time periods. Given that improvements were observed in well-controlled patients, findings support further studies in a wider study population range.

Disclosure

H. Mayer: Employee; Self; mySugr. R.P. Bankosegger: Employee; Self; mySugr. J. Kober: Employee; Self; mySugr.
961-P: Glycemic Control and Glycemic Variability Before and After Hypoglycemia in Patients with T1D Treated with MDI or CSII
Authors: MELMER ANDREAS , ZÜGER THOMAS , PÖTTLER TINA , KOJZAR HARALD , CIGLER MONIKA , ABERER FELIX , LAIMER MARKUS , MADER JULIA K.
Published: June 2019

Studies on CGM assume equal glycemic control between MDI and CSII. However, observation periods are often short and the impact of hypoglycemia on glycemic control and variability is unclear. In this study, we analyzed 12846 days (35 years; CSII 2232 days [6 years]; MDI 10614 days [29 years]) of CGM readings obtained from 99 patients with T1D. In the overall analysis mean glucose was 169.6 ± 18.9mg/dl for CSII and 175.0 ± 29.5 mg/dl for MDI. Estimated A1c was 7.54 ± 0.66% (CSII) and 7.7 ± 1.0% (MDI). Percentage of readings in target range (70-180mg/dL) was 54.0 ± 15.5% for CSII and 57.4 ± 11.4% for MDI. In total, 3.1/2.2% of readings were < 54 mg/dL and 14.9/12.4% were > 250mg/dL for CSII and MDI, respectively. In total, 464 hypoglycemic events (< 54mg/dL) occurred in CSII (day: 305 [64%]; night: 170 [36%]), corresponding to 0.21 hypoglycemic events daily. In MDI, 2297 hypoglycemic events occurred (day: 1507/66%; night: 783/34%), corresponding to 0.22 hypoglycemic events daily. Mean duration of hypoglycemia was 146.5 ± 65.9 minutes (CSII) and 132.8 ± 42.8 minutes (MDI); 233 (CSII) vs. 982 (MDI) events were prolonged (>120 minutes). CV was 41.1 ± 6.7% for CSII and 40.8 ± 3.8% for MDI. In the 24 hours prior to hypoglycemia, mean glucose was higher (182.9 ± 30.5 vs. 166.9 ± 26.6mg/dl; p<0.001 for CSII and 167.2 ± 14.7 vs. 152.7 ± 19.1mg/dl; p=0.013 for MDI) and CV was lower (p<0.001 for both treatments) compared to the subsequent 24 hours. Age correlated to CV (r=-.254; p=0.028 for MDI), HbA1c to eA1c (r=.611; p=0.009 for CSII; r=.482; p=0.028 for MDI), and C-peptide to CGM-readings in target range (r=.246; p=0.042 for MDI), which negatively correlated to HbA1c (r=-.484; p<0.001 for MDI). Glycemic control was comparable between MDI and CSII in T1D. Glycemic variability was lower prior to a hypoglycemic event and in older patients, while remaining insulin secretion was associated with longer time in target range.

Disclosure

A. Melmer: None. T. Züger: None. T. Pöttler: None. H. Kojzar: None. M. Cigler: None. F. Aberer: None. M. Laimer: None. J.K. Mader: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Prediktor Medical, Roche Diabetes Care, Sanofi. Speaker's Bureau; Self; Abbott, AstraZeneca, Dexcom, Inc., Novo Nordisk Inc. Stock/Shareholder; Self; decide Clinical Software GmbH.
969-P: Use of Professional CGM in T2DM Patients with Low Socioeconomic Status
Authors: MEHROTRA NEHA , SISTLA DIVYA , KORYTKOWSKI MARY T. , MON SANN
Published: June 2019

Background: Continuous glucose monitoring (CGM) is now considered as a standard of care for glycemic status assessment and therapy adjustment in all patients with T1DM and T2DM patients treated with intensive insulin therapy. CGM has been available to people with diabetes for more than a decade, however, it is used by only about 15% in T1DM and fewer in T2DM. There is even more disparity in the access of its availability in the community with low socio-economic status (SES). The purpose of this study was to examine potential benefits of CGM in patients with limited access to technology.

Method: CGM (Freestyle Libre Pro) was placed for 10-14 days in 36 patients, age (mean age 63.4 years +/- 15.4), 61.1% female, BMI (mean 34.2 +/- 8.33 kg/m2 with T2DM (83.4% on Insulin therapy). The patients were asked to keep food and activity logs during the testing period. CGM data was downloaded after the testing period and glucose results were retrospectively reviewed with patients. Individuals also received self-management education. Shared decision making was encouraged to improve knowledge of how their choices affected their diabetes control using CGM data.

Results: Thirty-three (91.7%) patients were able to use CGM for ≥72 hours and had a follow-up visit with the endocrinologist for interpretation of the data and discussion of medication adjustments as well as behaviors that may have led to BG excursions based on food and activity logs. A1C at baseline (8.23+/-1.88%) slightly improved to mean A1C (7.86+/-1.41%) at follow-up. (p value 0.28).

Conclusion: CGM may be a useful supplement to assess glycemic control, to make therapeutic adjustment and to provide educational feedback on patients’ behaviors among T2DM with low SES who have limited access to technology otherwise. Our study favors a slight improvement in overall glycemic control through patient education and recognition of glucose patterns informed by the professional CGM especially in those with low SES.

Disclosure

N. Mehrotra: None. D. Sistla: None. M.T. Korytkowski: None. S. Mon: None.
97-LB: Point-of-Care HbA1c Testing in Redesign of Diabetes Management Program Lowered Costs and Improved Outcomes
Authors: GALLO JOE P. , RICHARDSON MATT ,   DIABETIC EDUCATION AND CASE MANAGEMENT TEAM
Published: June 2019

Introduction: Empowering a low-income population of diabetic patients with onsite HbA1c testing results, coaching, and culturally appropriate diabetes self-management education materials improve outcomes and lower costs in a public health setting.

Objectives: This study examines the positive outcomes of a redesign in the Diabetes Education and Care Management (DECM) program at Denton County Public Health, (DCPH) a participant in Delivery System Reform Incentive Payment (DSRIP) plan.

Methods: Funding for ongoing management of diabetic patients across the U.S.A. remains an ongoing challenge. The DECM program elected to participate in the DSRIP program to secure funding to reach more diabetic patients with the goal of reducing their HbA1c and improve quality of life. Diabetic patients with an HbA1c of more than 9% met the DSRIP criteria for eligibility to DSRIP. Participants in the education program who followed the quarterly HbA1c appointment schedule were provided with diabetic medications and testing supplies to monitor glucose at no cost. Glycemic control was monitored by onsite testing of HbA1c during a quarterly visit at DCPH with the objective to lower the patients baseline HbA1c by 2.5%. Results presented reflect patient outcomes from Oct 2014 to Sept 2017.

Results: Approximately 251 of the 400 patients met the DSRIP criteria of HbA1c over 9% during the selected dates. The average baseline HbA1c was 10.7% in year 3, which was lowered to 8.2% by year end. Health economic models have shown that, for a population of 500 patients, the improvement of 1.0% in the HbA1c results can lead to multiple complications episodes avoidance (e.g.,: amputation, cataract extraction, etc.) which would result in over U$ 500,000.00 in savings for the healthcare system.

Conclusions: Our study suggests that empowering diabetic patients with education, state of art diabetes management, and onsite testing can lower overall HbA1c results leading to the reduction of complications and heath care costs.

Disclosure

J.P. Gallo: None. M. Richardson: None.
978-P: Ambulatory Glucose Monitoring and Pre-Ramadan Counseling in Patients with Type 2 Diabetes: Results from a Single Center Real-World Study
Authors: SHAIKH SALOMI SAJID , SHEHLA SAJID SHAIKH
Published: June 2019

Background: Change in meal timing and content during Ramadan fasting predisposes patients with type 2 diabetes to adverse glycaemic changes like hypoglycemia. Ambulatory blood glucose monitoring (ABGM) may be a valuable tool for monitoring and prevention of complications.

Methods: A single center observational surveillance, conducted during Ramadan, May 2018. ABGM was recorded 7 days before Ramadan and during first 7 days of fasting using the FreeStyle® Libre™. All patients received Ramadan related education and appropriate adjustments to the dosage and timing of medication as per IDF-Ramadan guidelines. Average glucose level and glycaemic variability were compared before and during the fasting period.

Results: 59 patients gave consent to ABGM during Ramadan fasting. Their mean age was 51.4 years, duration of diabetes 6.5 years, BMI 28.2 kg/m2, systolic blood pressure 124.2 mm Hg and diastolic blood pressure 79.6 mm Hg. Antidiabetic medication included metformin (100%), sulfonylureas (72.9%), dipeptidyl peptidase inhibitors (83%) and alpha-glucosidase inhibitor (6.8%). Co-morbidities included hypertension (52%), dyslipidemia (44%), neuropathy (33.9%) and hypothyroidism (12%). Mean HbA1c was 7.7%. Average glucose levels noted 7 days before Ramadan was 143.4 mg/dL, which reduced to 126.7mg/dL (p <0.0001) during Ramadan (first 7 days of fast). Mean glycaemic pattern demonstrated that time in target was 55.71% and 59.9% (p>0.05), while the time below target (predicting the probable risk of hypoglycaemia) was 10.2% and 16.6% (p = 0.007) before and during Ramadan respectively.

Conclusion: Results from this real world study showed that ABGM could be a guiding tool to adapt the overall diabetes management especially during Ramadan, including patient counselling and education on modification of lifestyle and medications, which has a favorable impact on glycaemic control as well as variability (including probability of hypoglycaemia), during Ramadan.

Disclosure

S.S. Shaikh: None. S.S. Shaikh: None.
99-OR: Leptin Mediates Postprandial Thermogenesis through a Hypothalamic-Adrenomedullary-BAT Axis
Authors: PERRY RACHEL J. , RABIN-COURT AVIVA , DONG JIANYING , LYU KUN , LI XIRUO , SHULMAN GERALD I.
Published: June 2019

The mechanism by which meal ingestion causes thermogenesis remains unknown. Here we show that refeeding leads to a 10x increase in plasma leptin concentrations associated with a 2.5x increase in plasma catecholamine concentrations in 48h-fasted lean rats. This leptin/catecholamine surge was associated with a 1°C increase in body temperature (BT) (fed 35.9±0.1°C, fasted 35.4±0.0°C, P<0.001; refed 36.4±0.1°C, P<0.001 vs. fasted and P<0.05 vs. fed). Leptin infusion in fasted rats replicated these increases in epinephrine and BT. However, the effect of leptin to increase BT was abrogated in adrenalectomized (ADX) rats following refeeding and leptin infusion. Treatment with a β1-adrenergic antagonist (atenolol) or surgical removal of brown adipose tissue (BAT) also prevented leptin- and refeeding-induced thermogenesis. The effect of refeeding to increase leptin and cause thermogenesis depended on the meal composition: a dextrose meal increased leptin, epinephrine, and BT whereas an isocaloric fat meal did not (AUC P<0.01, 0.05, and 0.01, respectively). Meal thermogenesis was not observed in obese rats, in which fasting plasma leptin failed to fall below the threshold (∼1.8 ng/mL) at which reductions in leptin lowered catecholamine concentrations. In order to examine the potential role for meal thermogenesis to regulate energy balance, we compared rats fed for 10 days with a carbohydrate-rich meal replacement by either two boluses daily or a continuous intragastric infusion. Bolus feeding increased BT and reduced BW gain (bolus feeding 0.1±0.3% weight loss vs. continuous feeding 1.7±0.3% weight gain, P<0.001), an effect abrogated by atenolol.

Conclusion: Leptin induces postprandial thermogenesis through stimulation of the hypothalamic-adrenomedullary axis resulting in increased plasma catecholamines, which stimulate BAT through increased β1-adrenergic activity. These results provide a potential mechanism by which time-restricted feeding may improve metabolic health.

Disclosure

R.J. Perry: Research Support; Self; AstraZeneca. A. Rabin-Court: None. J. Dong: None. K. Lyu: None. X. Li: None. G.I. Shulman: Advisory Panel; Self; AstraZeneca, Janssen Research & Development, Merck & Co., Inc. Advisory Panel; Spouse/Partner; Merck & Co., Inc. Board Member; Self; Novo Nordisk A/S. Consultant; Self; Aegerion Pharmaceuticals, IMetabolic BioPharma Corporation, Longitude Capital, Nimbus Discovery, Inc., Staten Biotechnology B.V.

Funding

National Institutes of Health (R01DK113984, P30DK059635, T32DK101019, K99/R00CA215315, R01NS087568, UL1TR000142, T32DK007058, R01DK075632, R01DK089044, R01DK096010, R01DK111401)
997-P: Effect on DPP-4 Inhibitors on Fat Metabolism in Patients with Diabetes and Obesity
Authors: AMETOV ALEXANDER , GUSENBEKOVA DINARA
Published: June 2019

Objective: To evaluate the influence of combined therapy of sitagliptin and metformin on fat metabolism in patients with type 2 diabetes mellitus.

Methods: The study included 82 patients (age, 55.3±9.1 years) with obesity and lipid metabolism disorders. None of the patients had reached their target glycated haemoglobin levels after metformin and diet therapy. Patients in gr1 (n=42) received 1.5-2-g metformin daily before the study and were switched to a formulation of 100-mg sitagliptin and 2-g metformin once a day. Patients in gr 2 (n=40) were on a diet therapy before inclusion and were started on 2-g metformin/day. The following were evaluated at baseline and after 6 months of therapy: fasting glucose levels, postprandial glucose levels, HbA1c, weight, waist circumference and lipid profile; insulin, proinsulin, leptin and adiponectin levels; HOMA IR and HOMA-β. In addition, magnetic resonance imaging was performed to assess the amount of visceral fat for the total cohort.

Results: After 6 months, HbA1c decreased by 18.52% (p <0.001) in gr 1 and by 8.17% (p <0.001) in gr 2. FPGl and PPG levels in gr 1 were reduced by 21% (p <0.001) and 26.35% (p <0.001), respectively; the corresponding reductions in gr 2 were 1.45% (p >0.05) and 5.31% (p <0.05), respectively. HOMA-β increased by 33% in gr1 (p <0.001) and by 11% in gr 2 (p >0.05). Adiponectin levels increased by 27.06% (p <0.001) in gr 1 and by 7.16% in gr 2 (p <0.001). Leptin levels were reduced by 30.47% (p <0.001) in gr 1 and by 5.41% in gr 2 (p <0.001). MRI showed a 7.52% reduction in visceral fat for gr 1 (p <0.001) and a 1.76% reduction for gr2 (p <0.01). The comparison of subcutaneous fat dynamics did not show statistically significant differences between the groups.

Conclusion: Compared with metformin monotherapy, sitagliptin and metformin combination therapy had a prominent effect on nonglycaemic parameters, with more marked decreases in visceral fat and leptin and increases in adiponectin levels.

Disclosure

A. Ametov: None. D. Gusenbekova: None.
Fatty Liver Among Adolescent Offspring of Women With Type 1 Diabetes (the EPICOM Study)
Authors: Knorr Sine , Bytoft Birgitte , Lohse Zuzana , Boisen Anne B. , Clausen Tine D. , Jensen Rikke B. , Damm Peter , Beck-Nielsen Henning , Holst Jens J. , Hartmann Bolette , Møller Holger J. , Højlund Kurt , Gravholt Claus H. , Jensen Dorte M.
Published: June 2019

OBJECTIVE

Intrauterine exposure to maternal type 1 diabetes is associated with a less favorable metabolic profile later in life. Nonalcoholic fatty liver disease is the hepatic manifestation of a cluster of metabolic abnormalities linked to insulin resistance. This study aimed to evaluate the effect of maternal pregestational type 1 diabetes on the presence of fatty liver in offspring and the association between maternal BMI, glycemic control during pregnancy, offspring metabolic risk factors, and offspring level of soluble CD163 (sCD163) (a marker of macrophage activation) and risk of fatty liver.

RESEARCH DESIGN AND METHODS

This study was a prospective nationwide follow-up study of offspring (n = 278) of mothers with pregestational type 1 diabetes between 1993 and 1999 and matched control subjects (n = 303). Mean age at the time of follow-up was 16.7 years (range 13.0–20.4 years). We used the fatty liver index (FLI) and waist-to-height ratio (WHtR) to evaluate the presence of fatty liver among the offspring. An FLI ≥60 or WHtR >0.469 were used as cutoff points for fatty liver.

RESULTS

More type 1 diabetes–exposed offspring had high FLI and WHtR indices compared with unexposed control subjects. We found significant associations between increasing maternal prepregnancy BMI, being born large for gestational age, offspring level of sCD163, as well as offspring metabolic risk factors (decreasing adiponectin and HDL cholesterol and increasing leptin, HOMA of insulin resistance, and HOMA of insulin secretion) and degree of fatty liver.

CONCLUSIONS

Intrauterine exposure to maternal type 1 diabetes and higher maternal prepregnancy BMI may predispose to fatty liver in the offspring. Offspring metabolic risk factors, including sCD163 levels, are associated with indices of fatty liver.
EKSISTENSI PENGERAJIN HIASAN JANUR DENGAN STRATEGI COST REDUCTION
Authors: Pradnyanitasari Putu Dian , Priliandani Ni Made Intan , Juniariani Ni Made Rai , Endra I Nyoman
Published: June 2019

Penjor merupakan symbol dari perayaan keagamaan pada masyarakat Hindu di Bali yaitu perayaan Hari Raya Galungan, dimana penjor akan ditancapkan dilebuh (didepan pintu rumah) umat Hindu di Bali. Penelitian ini bertujuan untuk membantu pengerajin hiasan janur di Bali khususnya di kabupaten Badung dalam memperhitungkan biaya yang dianggap dapat menimbulkan pemborosan melalui cost reduction. Cost reduction merupakan metode termudah dan paling pasti untuk meningkatkan keuntungan dalam jangka pendek (Bragg, 2010). Penelitian ini merupakan penelitian deskriptif kualitatif dengan proses pengumpulan data melalui observasi, wawancara dengan pengerajin, dan dokumentasi. Analisis data menggunakan analisis data model interaktif dengan tiga alur analisis, yaitu kondensasi data (data condensation), penyajian data (display data), serta pengambilan kesimpulan atau verifikasi (conclusion drawing/verification). Hasil dari penelitian ini adalah (1) harga jual hiasan janur oleh para pengerajin bisa berbeda-beda tergantung dari hasil atau model masing-masing hiasan janur, dimana harga jual hiasan janur bisa bervariasi dari Rp250.000,- hingga Rp350.000,-, (2) pengerajin hiasan janur dapat melakukan strategi cost reduction dengan cara meminimalisasi harga biaya bahan baku, yang dalam hal ini dengan membuat sendiri hiasan bunga ratna dari benang wol, (3) untuk mempertahankan eksistensinya para pengerajin hiasan janur diharapkan mampu melakukan inovasi baik dari sisi hasil kerajinan maupun mampu mengembangkan bidang usahanya.
ANALISIS RASIO KINERJA KEUANGAN PROFITABILITAS PT WIJAYA KARYA (PERSERO) TBK. PERIODE 2014 - 2018
Authors: Vidada Irwin Ananta , Ratiyah Ratiyah , Erica Denny , Hartanti Hartanti
Published: June 2019

In estimating the risk in the face of uncertainty , companies can use analysis as a financial report estimated future formulation of the plans . Use report analysis a finance company capable of know estimation the work of these efforts division in his company. To know the financial performance of corporations in this is done through the profitability analysis ( rentabilitas ). Through the ratio of the company capable of measuring the extent to which the company ability to obtain profit. Objectives in this research is to investigate and to identify the financial performance of pt wijaya karya ( persero ) tbk a period of 2014 until 2018. In this research data collection used through via a observation and the literature study with reference to the company financial performance data. Research methodology in the writing of this is done through which is done based on the ratio of the with of a quantitative approach . Observation data to the financial pt wijaya karya ( persero ) tbk the period 2014 until 2018 . Based on the results of the analysis can summarized in general during the past year observation data ratio in the ratio of the gpm, npm, oim roe and had fluctuations caused earnings up and down and ratio in roa was decreasing.keywords : Ratio Analysis, Financial Performance, Profitabiliy
PENGARUH PARTISIPASI MASYARAKAT, PENGGUNAAN SISTEM KEUANGAN DESA, KOMPETENSI PENDAMPING DESA SERTA KOMITMEN PEMERINTAH DAERAH TERHADAP KEBERHASILAN PENGELOLAAN DANA DESA
Authors: Julianto I Putu , Dewi Gusti Ayu Ketut Rencana Sari
Published: June 2019

Research aims to understand The Influence Of Public Participation, The Use Of The Villages Financial System, A Companion Competence Of The Villages And Local Government Commitment To Successful Of Village Funds Management. The research is quantitative research using types of data on obtained from the questionnaire and primary is measured using likert scales. The population in this study using the whole chief of village officer, treasurer, the villages officials, as well as the operator siskeudes in Buleleng Regency. The sample collection Technique use probability sampling that is simple random sampling. The criteria of the sample in this study is the whole chief of village officer, treasurer, the villages officials, as well as the operator siskeudes in Buleleng Regency as many as 224 people. Data analysis techniques in this study using multiple linear regression analysis with SPSS version 23. The results of the research indicated that the variable public participation (x1) influence positively and significant to successful of village funds management, the use of the village financial system (x2) influence positively and significant to successful of village funds management, variable a companion competence of the villages (x3) influence positively and significant to successful of village funds management, and the variable of local government commitment (x4) influence positively and significant to successful of village funds management.
SENI ISLAM TERAPI MURATTAL ALQURAN SEBAGAI PENDEKATAN KONSELING UNTUK MENGATASI KECEMASAN
Authors: Tambunan Syafrianto
Published: June 2019

Every individual has experienced fear and anxiety in life. This is usually caused by excessive emotions, fear of the future, inner contradictions, or something that happens unexpectedly. Islamic counseling is considered to be able to overcome the spiritual emptiness that is often the cause of mental disorientation of modern humans. One method that can be implemented in the context of counseling therapy is murattal (chanting) the Qur’an. With descriptive and analytical approaches, namely narrating the characteristics of an object holistically and systematically, this article explains the steps of counseling therapy through Islamic art, which in this case is the murattal art of the Qur’an. This paper concludes that murattal of the Qur’an can be an alternative approach in the practice of Islamic counseling.
Japanese infrastructure investment in Southeast Asia
Authors: Kikuchi1 Tomoo , Unzaki2 Sayaka
Published: June 2019

Japan’s investment in the domestic construction industry has fallen to less than half its peak in 1992. Given the country’s declining population, Japanese construction companies must go global to remain profitable. To what extent the Japanese government and Japanese companies can contribute to meeting the growing infrastructure needs in the region is unclear as Japanese companies have long been operating primarily in Japan. The Japanese government has in recent years passed a series of new laws that encourage private sector participation in financing, building and operating public infrastructure. Through involvement in such public projects, Japanese companies have developed the skills and technologies to build a variety of infrastructures that are resilient to natural disasters and adaptable to various geographical conditions and social and economic development. But the major challenge for Japanese companies is to transform their business model drastically from one that relies on the domestic market to one that contributes to the social and economic development of third countries.
TREATMENT OF COMPLICATIONS OF PERCUTANEOUS TRANSHEPATIC PROCEDURES IN EMERGENCY HOSPITALS
Authors: Khadjibaev F. A. , Tilemisov S. O. , Anvarov H. E. , Tilemisov R. O.
Published: June 2019

Introduced results of treatment of 430 patients with obstructive jaundice admitted to Republic research center of emergency medicine. Performed retrospective analyses of possible complications after percutaneous transhepatic interventions in such category of patients and how to treat and prevent from these complications in emergency hospitals.
ACUTE CORONARY SYNDROME: A SEA CHANGE IN OUR UNDERSTANDING OF PATHOGENESIS AND WAY OF TREATMENT? (PART I)
Authors: Shalnev V. I.
Published: June 2019

The article highlights the hypothesis of the inflammatory pathways in pathogenesis of atherothrombosis and the conception of residual inflammatory risk in coronary heart disease patients. Modern approach to the correction of inflammatory risk by immune-modulating therapy in acute coronary syndrome setting is discussed. The results of most significant randomized clinical trials dedicated to this problem are also highlighted.
Empathy and Burnout – A Cross-Sectional Study Among Mental Healthcare Providers in France
Authors: Sturzu Livia ,   Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, “Centre Psychothérapique de Nancy”, Laxou, France,   Centre Hospitalier Spécialisé de Sarreguemines, Sarreguemines, France,   Dr. Livia Sturzu, Centre Hospitalier Spécialisé, 2ème Service de Psychiatrie Adulte, 1 Rue Calmette, 57200 Sarreguemines, France. E-mail: livia.sturzu@chs-sarreguemines.fr, Lala Adrian ,   Centre Hospitalier de Sarreguemines, Hôpital “Robert Pax”, Service des Urgences, Sarreguemines, France, Bisch Michael ,   “Centre Psychothérapique de Nancy”, Laxou, France, Guitter Marie ,   Centre Hospitalier Spécialisé de Sarreguemines, Sarreguemines, France, Dobre Daniela ,   “Centre Psychothérapique de Nancy”, Laxou, France, Schwan Raymund ,   Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, “Centre Psychothérapique de Nancy”, Laxou, France,   “Centre Psychothérapique de Nancy”, Laxou, France,   INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Pôle de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France,   Maison des Addictions, CHRU Nancy, France,   University Lorraine, Faculty of Medicine, Department of Psychiatry, Vandoeuvre-Les-Nancy, France
Published: June 2019

Previous studies have established a correlation between empathy and burnout among healthcare providers. The aim of this study is to explore whether empathy – the ability to understand what another person is experiencing, was related to mental healthcare staffs’ burnout.

We performed a descriptive, cross-sectional, observational study among medical and nursing mental healthcare staff working in the district of Moselle, France. Participants completed a survey including The French versions of the Jefferson Scale of Empathy (JSPE) and The Maslach Burnout Inventory-Human Services Survey (MBI-HSS).

The sample included 241 (n=241) participants (N=420, response rate=51.7%). 187 (77.6%) respondents had low burnout, 43 (17.8%) had intermediate burnout and 11 (4.6%) had high burnout. 41 (17%) had low empathy, 156 (64.7) had moderate empathy and 44 (18.3%) scored high.

Empathy scores were positively correlated with scores of personal accomplishment of the MBI-HSS (r=0.2; p<0.001), but negatively correlated with scores of depersonalization (r=-0.2; p<0.003). Highest means of depersonalization (DP) (M=8.7; SD=6.8; p<0.009) and lowest means of compassionate care (M=40.05; SD=7.9; p=0.0001) were found among forensic psychiatric security units staff.

Participation in the Omega educational program was associated with lower scores of EE on the MBI-HSS survey (mean score 14.7 versus a mean score of 19.7 for nonparticipants).

Empathic mental healthcare providers have lower levels of burnout. Forensic psychiatric staff showed low means of compassionate care and high depersonalization.

Interventions designed to foster attributes and skills such as empathy, resilience, and perception of security may be an essential step in reducing and preventing burnout.
Is syncope a predictor of mortality in acute pulmonary embolism?
Authors: Ploesteanu Rodica Lucia ,   Sf. Pantelimon Emergency Hospital, Bucharest, Romania,   Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania,   Rodica Lucia Ploesteanu Department of Cardiology, “Sf. Pantelimon” Clinical Emergency Hospital, Bucharest, 340-342 Pantelimon Road, Code 21659, Bucharest, Romania, Tel.: 40740280282, E-mail: ploesteanu_rodica@yahoo.com,   Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania, Nechita Alexandru Cristian ,   Sf. Pantelimon Emergency Hospital, Bucharest, Romania,   Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania, Andrucovici Silvia ,   Sf. Pantelimon Emergency Hospital, Bucharest, Romania, Delcea Caterina , Mihu Elena Mihaela ,   Sf. Pantelimon Emergency Hospital, Bucharest, Romania,   Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania, Gae Diana ,   Sf. Pantelimon Emergency Hospital, Bucharest, Romania, Stamate Sorin Costel ,   Sf. Pantelimon Emergency Hospital, Bucharest, Romania,   Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania
Published: June 2019

Whether syncope as a presenting symptom independently classifies acute pulmonary embolism (APE) into a high mortality risk group remains a matter of controversy.

We retrospectively included all consecutive patients admitted to our clinic with APE from January 2014 to December 2016.

Our sample consisted of 76 patients with a mean age of 69 ±13.6 years, 64.5% female. 14.3% presented with syncope at admission. In-hospital mortality was 20.8%. Patients with syncope were more likely to require inotropic support (OR = 5.2, 95 % 1.17-23.70, p=0.03) due to the association of cardiogenic shock (OR= 15.95% CI 3.02-74.32, p < 0.001) and systolic blood pressure below 90 mmHg (OR=5.52, 95% CI 1.24-24.47, p=0.03). Patients with syncope had a higher PESI score (150.9 ± 51.1 vs 99.9 ± 30.1, p < 0.001) and a greater in-hospital mortality (OR= 4.5, 95% CI 1.14-17.62, p=0.03). However, multivariate logistic regression equations did not identify syncope as an independent predictor of mortality.

In our sample, syncope did not independently reclassify the patient in a higher mortality group, but due to the association with hemodynamic instability, which remains the primary tool in therapeutic decision-making.
The Role of Polyether Ether Ketone (Peek) in Dentistry – A Review
Authors: Bathala Lakshmana ,   Department of Prosthodontics, Lenora Institute of Dental Sciences, Rajahmundry, India,   Lakshmana Bathala Professor & HOD, Department of Prosthodontics, Lenora Institute of Dental Sciences, Rajahmundry, A.P., India Postal Code: 533294. Tel.: +919618652723 E-mail: kushulubathala@gmail.com, Majeti Vaishnavi ,   Department of Oral & Maxillofacial Surgery, Lenora Institute of Dental Sciences, Rajahmundry, India, Rachuri Narendra ,   Department of Prosthodontics, Lenora Institute of Dental Sciences, Rajahmundry, India, Singh Nibha ,   Department of Prosthodontics, Lenora Institute of Dental Sciences, Rajahmundry, India, Gedela Sirisha ,   Department of Prosthodontics, Lenora Institute of Dental Sciences, Rajahmundry, India
Published: June 2019

This study is aimed to review the applications of Polyether Ether Ketone (PEEK) in dentistry. The increased demand for aesthetics, legislation in some developed countries, few drawbacks with existing materials and clinicians shifting their paradigms towards metal free restorations led space for the metal-free restorations in today’s dental practice. An electronic literature search was conducted through Medline via PubMed, Wiley Online library, EBSCOhost, Science Direct, as well as the Google Scholar between January 2010 and March 2018 using the keywords: PEEK, modified PEEK, PEEK and Dental, advantages of PEEK, applications of PEEK in dentistry and PEEK Implants. A total of 103 articles were found in the literature search and out of these, 18 were not related to our study and hence were excluded. Finally, 85 articles were found to be relevant. PEEK has been explained for a number of applications in dental practice. The literature showed that the PEEK material has superior mechanical properties with different uses in various specialties of dentistry.
A ESTRUTURA DAS POLÍTICAS PÚBLICAS E OS PARADOXOS DA INTERVENÇÃO JUDICIAL POR MEIO DA AÇÃO CIVIL PÚBLICA Uma análise a partir dos cinco estágios do ciclo Político-Administrativo de Michael Howlett, Ramesh e Perl
Authors: Ciarlini Léa Martins Sales , Ciarlini Alvaro Luis De Araujo Sales
Published: June 2019

A devida análise estrutural das políticas públicas e dos paradoxos da intervenção judicial pode ser apreciada a partir da ideia dos cinco estágios do ciclo político-administrativo de Michael Howlett, Ramesh e Perl e da proposta de accountability horizontal de Guilhermo O´Donnell. Esse exame pode ser procedido por meio da observação e reflexão a respeito das complexas escolhas e decisões que são tomadas desde a montagem de uma agenda até a avaliação final de uma política pública (policy-making). Diante desse contexto, será possível ainda a devida reflexão a respeito dos cinco ciclos acima apontados, à análise dos aparatos institucionais de controle a partir da ideia de accountability horizontal, bem como à verificação das possibilidades e dos limites necessários à intervenção judicial no âmbito dos aparatos institucionais de controle das políticas públicas.
PENSAR AS POLÍTICAS PÚBLICAS A PARTIR DO ENFOQUE DAS CAPACIDADES: JUSTIÇA SOCIAL E RESPEITO AOS DIREITOS HUMANOS
Authors: Bagetti Zeifert Anna Paula
Published: June 2019

A concepção de justiça social pensada por Amartya Sen e Martha Nussbaum, tem por objetivo um ideal de sociedade que visa a promoção das necessidades humanas fundamentais. Nesse contexto, o presente artigo analisa como a abordagem das capacidades, desenvolvida de maneira particular por ambos os autores, serve de suporte para a construção de uma sociedade mais igualitária. Especificamente, como as políticas públicas, que emergem para a realização das demandas sociais e a promoção da dignidade, poderiam ser pensadas a partir do enfoque das capacidades com intuito de colaborar para o desenvolvimento de uma sociedade mais inclusiva. O estudo será desenvolvido segundo o método de abordagem hipotético-dedutivo, utilizando uma base teórica presente na filosofia política contemporânea. Conclui-se que o enfoque das capacidades serve como uma referência as políticas públicas a serem construídas e implementadas, objetivando um processo inclusivo e assistencial. A lista de capacidades apresentadas por Nussbaum avança no processo de efetivação da justiça social, para além de Sen. A partir de sua teoria, a autora orienta formas de cuidado para com todos os seres humanos de maneira a promover a justiça social e o respeito aos direitos humanos.
Low Dimensional Representations along Intrinsic Reaction Coordinates and Molecular Dynamics Trajectories Using Interatomic Distance Matrices
Authors: Hare Stephanie , Bratholm Lars , Glowacki David , Carpenter Barry
Published: June 2019

Low dimensional representations along reaction pathways were produced using newly created Python software that utilises Principal Component Analysis (PCA) to do dimensionality reduction. Plots of these pathways in reduced dimensional space, as well as the physical meaning of the reduced dimensional axes, are discussed.
Strong Hydrogen Bonds Are Not Shielded in Ionic Liquids
Authors: Naranjo Teresa , Álvarez-Asencio Rubén , Pedraz Patricia , Nieto-Ortega Belén , Burzurí Enrique , Rutland Mark W. , Pérez Emilio
Published: June 2019

Hydrogen bonds are arguably the most important of noncovalent interactions. The physical properties of water and the information storage in DNA depend on H-bonding, for instance. To this day, the balance between the Coulombic and covalent contributions to H-bonds is still under debate. Here, we show that H-bonded host-guest systems associate in ionic liquids, pure salts with melting point below room temperature, in which dipole-dipole electrostatic interactions should be negligible in comparison with dipole-charge interactions. Binding constants (Ka) obtained from titrations of four H-bonded host-guest systems in two organic solvents and two ionic liquids yield smaller yet comparable Kavalues in ionic liquids than in organic solvents. We also detect the association event using force spectroscopy. Our results indicate that strong H-bonds are only moderately affected by surroundings composed entirely of charges, suggesting that the balance of Coulombic to covalent forces is not tipped towards the former.
Multiplexed Chemical Control of Signaling Pathways by Orthogonal, Plasma Membrane-Specific SLIPT Systems
Authors: Nakamura Akinobu , Oki Choji , Kato Kenya , Fujinuma Satoko , Maryu Gembu , Kuwata Keiko , Yoshii Tatsuyuki , Matsuda Michiyuki , Aoki Kazuhiro , Tsukiji Shinya
Published: June 2019

Most cell behaviors are the outcome of processing information from multiple signals generated upon cell stimulation. A systematic understanding of cellular systems requires methods that activate multiple signaling molecules or pathways in single cells. However, the construction of tools for such multiplexed signal control is challenging. Here we present orthogonal chemogenetic systems that allow control of multiple signaling pathways in living mammalian cells based on self-localizing ligand-induced protein translocation (SLIPT). Two orthogonal SLIPT systems were constructed to enable chemically inducible, individual translocation of two proteins from the cytoplasm to the inner-leaflet of the plasma membrane in the same cell. The SLIPT systems combined with fluorescent reporters achieved simultaneous multiplexed activation and monitoring of endogenous Ras/ERK and PI3K/Akt pathways in single cells. Thus, orthogonal SLIPT systems provide a powerful platform for multiplexed chemical signal control in single cells, offering new opportunities for dissecting cell signaling networks and synthetic cell manipulation.