bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive impairment is evident in ‘non-user’ first-degree relatives of persons with cannabis dependence syndrome: An endophenotype study.
Authors: Das Shrayasi , Singh Lokesh , Tikka Sai , Spoorthy Mamidipali , Mandal Sucharita , Soni Puneet , Nandan Neethu
Published: June 2023

Introduction- Cannabis use disorders are global emerging problem
nowadays, with high prevalence and morbidity. Though cognitive
impairments are one of the most replicated findings in individuals with
cannabis dependence, but there are very few studies assessed cognitive
functioning as a risk factor for cannabis use disorder. In this study,
we assessed cognitive functioning as an endophenotype in cannabis use
disorders. Methodology- In this study comparison of cognitive
functioning was done among three groups- patients with cannabis
dependence syndrome, their first degree relative (FDR) and normal
healthy controls (HC). Each group included 30 participants. Individuals
of all three groups were assessed in domains of complex attention,
executive functions, language, learning and memory and perceptual-motor.
Results- Performance of patients with cannabis dependence was impaired
in attention, verbal memory, executive functions compared to both other
groups. Attention, semantic verbal fluency and memory were found to be
an endophenotype as both patient and FDR group performed poorly than HC
group. Verbal memory was impaired in patients’ group compared to group
of first-degree relatives, whose performance in-turn impaired than
normal healthy controls. Performances of verbal and visual memory were
correlated positively with age of onset and negatively with frequency of
cannabis intake. Age of first-degree relatives was inversely correlated
with verbal memory. Conclusion- Performance of individuals with cannabis
dependence was impaired than normal healthy controls in all domains of
cognitive functioning. As per definition, verbal memory could be
considered as an endophenotype marker in cannabis use disorders.
Case report of a benign granular cell tumor mimicking carcinoma of the breast in a young woman: a diagnostic challenge
Authors: Akbari Atieh , Behravan Parisa , Moradi Afshin , Akbari Mohammad Esmaeil
Published: June 2023

Introduction: Granular cell tumors (GCTs) are rare, low-grade Schwann
cell tumors found in the skin, soft tissue, and mucosal surfaces of the
oral, gastrointestinal, and respiratory tracts. 1 in 1000 breast cancer
cases is GCT. Just 1%–2% of GCTs are malignant granular cell tumors
(MGCTs). Case Presentation: Herein we introduce a 34-year-old woman with
a palpable mass that was confirmed to be GCT by pathology. Discussion:
Benign GCTs are described as having an absence of necrosis, vesicular
nuclei with large nucleoli, a high nuclear to cytoplasmic ratio,
pleomorphism, spindling tumor cells, and an accelerated mitotic rate
greater than 2 mitoses per 10 high power fields. GCTs of the breast
typically present as solitary, palpable, painless masses and are
typically located in the upper-inner quadrant along the distribution of
the supraclavicular nerve. Since benign GCTs do not spread to regional
lymph nodes, axillary staging is unnecessary. The probability of local
recurrence is between 2 and 8% with negative surgical margins and above
20% with positive surgical margins; nevertheless, recurrence of benign
GCTs does not predict a bad prognosis. Conclusion: Identifying granular
cell tumors of the breast is essential for avoiding invasive procedures
and radical surgeries.
Response of semicircular canyons and movable cylindrical cavities to SH waves in anisotropic half-space geology
Authors: Yang Zailin , Guo Debao , Bian Jinlai , Song Yunqiu , Yang Yong
Published: June 2023

For engineering the development of tunnels or the laying of underground
pipelines are essential engineering projects in modern society, and in
canyon tunnels and canyon pipeline projects, the surface motion and
cavity edge motion have been topics of concern in ground vibration
problems. In this paper, wave scattering problems in elastic half-space
anisotropic media containing semicircular canyons and underground
movable cylindrical cavities are studied by using theoretical methods,
wave function expansion method, complex function method and mirror image
method to solve the control equations in the form of Helmholtz equations
satisfying zero stress boundary conditions, and the corresponding
displacement functions are solved. The origin singularity problem in the
scattered wave problem in anisotropic half-space medium using the mirror
method is improved. Then the unknown coefficients in the set of
equations to be solved by free boundary conditions combined with the
Fourier expansion method. The displacement field is a superposition of
appropriate wave fields. Finally, the effects of the relevant parameters
on the surface motion| w|(
w), the dynamic stress concentration factor (DSCF) and the
displacement amplitude| w|
are investigated by frequency and time domain analysis. This study not
only provides a theoretical basis for practical unlined tunnels or
pipeline projects, but also can provide a basis for seismic design of
underground structures.
Epidermoid cyst of the testis: a report of six cases
Authors: Usui Kimitsugu , Yamashita Ryo , Sakura Yuma , Nakamura Masafumi , Shinsaka Hideo , Matsuzaki Masato , Niwakawa Masashi
Published: June 2023

Introduction: Testicular epidermoid cysts are rare tumors that occur in
1% of testicular tumors and are often misdiagnosed as malignant lesions
clinically. We report six cases of epidermoid cysts. Case Presentation:
The chief complaints were scrotal induration in five patients and
pruritus scrotum in one patient, and the patients were aged
The effect of misclassification on sample size: one-sample proportion test
Authors: Hársfalvi PharmD Péter , Reiczigel Jenő
Published: June 2023

Potential misclassification of a binary outcome measure is often ignored
in study design, causing considerable loss of power, and threatening the
quality of research. Although there exist studies taking
misclassification into account in data analysis, we argue that it should
be accounted for already in sample size calculation. We illustrate this
by comparing sample sizes needed with and without misclassification in
case of the binomial test. Our sample size procedure, implemented as an
R function, calculates exact power, and accounts for non-monotonicity of
power as a function of sample size, and for potential drop-out or lack
of data in the study. The necessary sample size is computed from the
null proportion p, the assumed true proportion
p, and the probabilities of correct
classification, sensitivity ( Se) and specificity ( Sp).
Our results show that misclassification may drastically affect the
necessary sample size. For p<0.5, the
effect of specificity is stronger than that of sensitivity, whereas for
p>.5 it is the other way round.
Effects are strongest when p is near 0 or 1,
especially for one-sided tests with p located
farther from 0.5 than the null value p. For
example, even with Se = Sp = 99%, p = 0.01, and left-sided alternative, sample size is
more than fourfold of that without misclassification (3-fold if p=0.02; 1.4-fold if p=0.05).
Anti-inflammatory actions of aspirin-triggered resolvin D1 (AT-RvD1) in bronchial epithelial cells stimulated by cigarette smoke extract
Authors: Rogério Alexandre de Paula , Oliveira Jhony Robison de , Pereira Aline Beatriz Mahler , Souza Henrique Ismarsi , Santos Wanessa Maria dos , Assunção Thaís Soares Farnesi de , Silva Paulo Roberto da , Silva Marcos Vinícius , Júnior Virmondes Rodrigues
Published: June 2023

Smoking causes several diseases such as chronic obstructive pulmonary
disease (COPD). Aspirin-triggered-resolvin D1 (AT-RvD1) is a lipid
mediator produced during the resolution of inflammation and demonstrates
anti-inflammatory and pro-resolution effects in several inflammatory
experimental models including in the airways. Here we evaluated the role
of AT-RvD1 (100nM) in bronchial epithelial cells (BEAS-2B) stimulated by
cigarette smoke extract (CSE; 1%; 1 cigarette) for 24h. CSE induced the
productions of IL-1β, TNF-α, IL-10, IL-4 and IFN-γ as well as the
activations of NF-κB and STAT3 and the expression of ALX/FPR2 receptor.
AT-RvD1 reduced the IL-1β and TNF-α production and increased the
production of IFN-γ, while the production of IL-4 and IL-10 were not
altered, in the cells stimulated by CSE when compared to CSE group.
These effects were reversed BOC2, an antagonist of ALX/FPR2 receptor for
AT-RvD1. In addition, AT-RvD1 reduced the phosphorylation of NF-κB and
STAT3 when compared to CSE-stimulated BEAS-2B cells. No alteration of
ALX/FPR2 expression was observed by AT-RvD1 when compared to CSE group.
In the human monocytic leukemia cell line, the relative number of copies
of IL-1β and IL-4 was significantly higher in CSE + AT-RvD1 group
compared CSE group, however, the expression of M1 cytokine is more
pronounced than M2 profile. AT-RvD1 could be an important target for the
reduction of inflammation in the airways associated with smoking.
Global patterns of genetic diversity in marine fishes
Authors: Clark Rene , Pinsky Malin
Published: June 2023

Genetic diversity is a fundamental component of biodiversity and the
medium for speciation events. Examination of global patterns of genetic
diversity can help highlight mechanisms underlying species diversity.
Here, we compiled 6862 observations of genetic diversity from 492
species of marine fish globally, assessed their associations with
macroecological drivers, and tested among three hypotheses for diversity
gradients: the founder effect hypothesis, the kinetic energy hypothesis,
and the productivity-richness hypothesis. We found that mitochondrial
genetic diversity follows latitudinal and longitudinal gradients similar
to those of species diversity, being highest near the equator,
particularly in the Coral Triangle, while nuclear genetic diversity did
not follow clear geographic patterns. Despite these differences, all
genetic diversity metrics were positively correlated with chlorophyll,
while mitochondrial diversity was also positively associated with sea
surface temperature. These findings provide support for the kinetic
energy hypothesis, which predicts that elevated metabolic and mutation
rates at higher temperatures should increase mitochondrial diversity,
and the productivity-richness hypothesis, which posits that
resource-rich regions support larger populations with greater genetic
diversity. Overall, these findings reveal how environmental controls on
mutation and drift in the ocean combine to establish global gradients of
genetic diversity within species, and in turn, community assemblages.
Obstetric and gynaecological features in females carrying variants in the skeletal muscle ryanodine receptor (RYR1) gene: a questionnaire study
Authors: Mistry Arti , Saldanha Georgia , R Luuk van den Bersselaar , Knock Greg A. , F Michael Goldberg , I Maria Vanegas , A Miguel Fernandez-Garcia , Treves Susan , C Nicol Voermans , Tribe Rachel , Jungbluth Heinz
Published: June 2023

Objective: To assess the impact of skeletal muscle ryanodine
receptor ( RYR1) variants, a common cause of neuromuscular
disorders, on smooth muscle function, bleeding, obstetric, and
gynaecological outcomes. Design: Questionnaire study.
Setting: Online via the RYR1-Foundation patient support
group covering countries across the world. Population or
Sample: 154 women consisting of 66 RYR1-variant carrying
participants and 88 controls. Methods: Online questionnaire
designed to investigate symptoms of abnormal smooth muscle function,
obstetric and gynaecological outcomes in women with RYR1
variants. Questions were developed using a modified version of the
MCMDM-1VWD questionnaire, and the NHS-heavy periods self-assessment
tool. Obstetric and gynaecological symptoms explored include
pregnancy-related complications, gestation length, parturition duration,
post-partum haemorrhage and offspring birthweight. Main Outcome
Measures: Bleeding scores were measured using a modified MCMDM-1VWD
scale. Significance between groups were analysed using Fisher exact
tests, Chi Square tests, and Welch’s t-tests. Results: Women
with RYR1 variants exhibited a higher incidence of pathological
bleeding scores (p<0.0001), severe menstrual bleeding,
complications during pregnancy (preeclampsia and placenta praevia),
post-partum haemorrhage, shorter pregnancies, frequent planned Caesarean
sections, and offspring with lower birthweight, compared to controls.
Gastrointestinal symptoms were also more common. Conclusions:RYR1 mutated females exhibit a bleeding disorder and frequent
gynaecological and obstetric complications. Considering their population
frequency in otherwise pauci-symptomatic individuals, RYR1
variants ought to be considered as a cause of otherwise unexplained
menorrhagia and other gynaecological and obstetric manifestations.
Funding: King’s Health Partners Institute of Women and
Children’s Health Keywords: skeletal muscle ryanodine receptor
(RYR1) gene; questionnaire; bleeding; menorrhagia; post-partum
haemorrhage Tweetable abstract: RYR1 mutated females exhibit a
bleeding disorder. RYR1 variants ought to be considered as a cause of
otherwise unexplained menorrhagia, PPH and obstetric complications.
Optimal Allocation of Distributed Generation Units and Fast Electric Vehicle Charging Stations for Sustainable Cities
Authors: Prempeh Isaac , Awopone Albert , Ayambire Patrick , El-Sehiemy Ragab
Published: June 2023

The rise of electric vehicles (EVs) in sustainable cities has fuelled
interest in DG unit allocation. A well-planned and efficient charging
infrastructure is required for effective e-mobility. The paper examined
the single-objective frameworks of optimal simultaneous allocation of DG
units and fast EV charging stations (EVCS). The applications are
employed on the IEEE 69 bus network and a real part of the Ghana network
in the Ashanti region. The optimization tasks are carried out by using
Particle swarm optimization (PSO) and artificial bee colony (ABC)
algorithms. The impact of optimal placement on the networks was
analyzed. The results show that with high penetration levels of DG units
(up to 40%) and fast EVCS, PSO, and ABC can achieve a significant power
loss reduction that reaches 68%. Furthermore, PSO outperforms ABC in
relation to the voltage deviation index on both the test network and the
Ashanti region network, while still satisfying the IEC standards’ 5%
margins. The results indicate that PSO and ABC are viable swarm
algorithms for mitigating active power loss and enhancing the voltage
profile of a system through concurrent allocation
Derivation and Use of the Pump Energy Intensity Equation for Water System Energy Analysis
Authors: Sowby Robert B. , Krieger Kai M
Published: June 2023

Energy intensity-an expression normalizing pump energy use by water
volume, also called specific energy-is becoming a more commonly used key
performance indicator as water utilities seek to analyze and optimize
their energy use. Its theoretical basis, however, has not been well
documented. Beginning with Newton’s second law, we derive the pump power
equation and the pump energy intensity equation, provide specific values
for engineering reference, and discuss applications. In a perfectly
efficient system pumping water, the minimum energy intensity is 0.00272
kWh/m per meter of head or 3.14 kWh/Mgal per foot of
head. Considering typical pump efficiencies, these references may be
scaled and used for analyzing pump performance or estimating future
energy uses. As a key performance indicator, energy intensity is a
convenient input-output quotient where both parts can be observed
directly, enabling tracking over time and comparison among individual
facilities. As a planning tool, energy intensity can estimate expected
energy use without having to know details of the pumping system. Such
are the high-level applications water systems may find as a prelude to
deeper energy analyses in pursuit of sustainable infrastructure.
Credit Expansion and the Social Trust
Authors: Wang Changan
Published: June 2023

We explain the impacts of credit expansion on social trust from the
perspective of Austrian economics, and get the conclusion that credit
expansion will lower social trust whether or not the masses are familiar
with Austrian economics. Even if the public are not familiar with
Austrian economics, the problems such as corporate default and
unemployment, which resulted from economic bust caused by credit
expansion, will lead to the reduction of trust between different
individuals and the creation of self-doubt. If the masses have known
Austrian economics, then they would know that the nature of fractional
reserve system is to infringe on private property rights, that credit
expansion triggers inflation which will cause income and wealthy
redistribution, that credit expansion is a way to consolidate the common
interests between state, banks and industrialists. All those known
knowledge will make the masses reduce their trusts to the state, bankers
and the industrialists, which ultimately reduces social trust. To
eliminate credit expansion from its roots, we have to implement the
system of free banking on the gold standard accompanied with a 100
percent reserve system which not only involves banknotes’ issuing but
also demand deposits
Administrative records and international estimates for international migration analysis
Authors: Siqueira Baltar Cláudia , Baltar Ronaldo
Published: June 2023

This paper addresses the challenges of analyzing contemporary international migration, in the context of South American countries, using databases composed of international migration estimates, from 1990 to 2019, organized by the United Nations, and administrative records produced by the selected countries, between 2000 and 2019. The analysis is developed with reference to the Bengali migration to South America, considered as the expression of one of the trends of South-South migration, in the context of South America, characterized by migratory flows with no historical tradition with the countries of the region. We take into account theories that consider the complexity of contemporary international migrations and their specificities in regional and border contexts. In this study, we organize and discuss United Nations estimates and registration systems for migrants and border movements in South American countries. Our objective is to develop the debate on contemporary international migration, based on the analysis of the data sources available to capture migratory phenomena in the regional context. With this, we seek to contribute to the deepening of studies on south-south international migration in South American countries, considering the complexities of such migratory processes in supranational and border areas.
Migração haitiana na região do Vale do Itajaí
Authors: Torres Portela Bernardo , Machado Gustavo
Published: June 2023

Este trabalho buscou analisar como se dão os modos de reconhecimento de imigrantes haitianos residentes na cidade de Itajaí, Santa Catarina, a partir da teoria do reconhecimento apresentada por Butler. A partir de uma pesquisa etnográfica com uso de análise de narrativa para interpretar as informações, buscou-se responder ao objetivo da pesquisa. Como resultados, a imigração aparece como uma necessidade familiar relacionada à busca de melhores condições de vida. A acolhida, a recepção e a realização da documentação no momento de entrada no país de destino parecem ser essenciais para o sentimento de pertencimento que será desenvolvido durante toda a trajetória dos sujeitos imigrantes. O racismo e a xenofobia são as condições que mais inviabilizam a vida do sujeito migrante na sociedade itajaíense e atuam de modo a reconhecer o sujeito imigrante haitiano na condição de exclusão social.
Migración venezolana
Authors: Vargas León Lady Junek
Published: June 2023

El presente trabajo es un análisis sobre el movimiento migratorio de venezolanos, conocidos como caminantes, personas que realizan su tránsito migratorio interno e internacional a pie, cuyo número ha ido en aumento en los últimos años. Este artículo se sitúa particularmente en San Cristóbal, Estado Táchira, Venezuela y estado fronterizo con Cúcuta, Colombia, ya que es el lugar principal de donde salen los caminantes. Me aproximaré al fenómeno de migración de venezolanos a través de una metodología cualitativa mixta, de observación participante y entrevistas. Para analizar este caso hice una revisión bibliográfica y periodística sobre los migrantes venezolanos que se dirigieron a la frontera colombo-venezolana y hacia países de América del Sur, incluso durante la pandemia por la covid-19. También consiste en un trabajo etnográfico realizado entre los años 2021 y 2022 con jóvenes migrantes venezolanos que hicieron el tránsito hasta Lima, Perú. La investigación se complementa con el seguimiento, por medio de las redes sociales como WhatsApp y Facebook, del recorrido de un joven caraqueño, así como entrevistas a profundidad por medio de videollamadas.
Vidas atravessadas por fronteiras
Authors: Speroni Thales
Published: June 2023

As vidas atravessadas por fronteiras perturbam alguns dos fundamentos clássicos de se pensar o social. Em particular, colocam em xeque o nacionalismo metodológico, marco analítico que pressupõe a primazia do nacional sobre todas as demais escalas da vida social. É com o objetivo de contribuir para uma readequação da interpretação dos fenômenos migratórios que este artigo introduz a perspectiva transnacional. Essa abordagem, que já possui mais de duas décadas, estabelece ângulos e caminhos heurísticos que permitem abranger a diversidade e complexidade das escalas geográficas das migrações contemporâneas. Este artigo está formado por quatro partes. Primeiramente, discute-se a crítica transnacional ao nacionalismo metodológico e à lógica de atração e repulsão que fundamentou grande parte das abordagens clássicas das migrações internacionais. Posteriormente, são apresentados os principais conceitos da perspectiva transnacional, em especial o de espaço transnacional e o de simultaneidade. Na terceira parte, busca-se chamar atenção para os pontos de convergência e divergência que existe no âmbito dos estudos que fizeram uso das lentes transnacionais. Para concluir este artigo, são discutidos quatro desafios teórico-metodológicos que seguem pendentes para a perspectiva transnacional.
1-OR: Burden of Hypoglycemia in Medicare Advantage Beneficiaries with Type 2 Diabetes Not on Insulin Therapy
Authors: HANNAH KATIA , NEMLEKAR POORVA , BUSHMAN JESSE S. , NORMAN GREGORY J.
Published: June 2023

In 2022, the Centers for Medicare & Medicaid Services released proposed changes to Medicare’s continuous glucose monitoring (CGM) coverage policy, making individuals with a history of problematic hypoglycemia eligible for CGM coverage, irrespective of insulin use. This study estimated the burden of hypoglycemia in Medicare Advantage (MA) beneficiaries with type 2 diabetes not on insulin therapy (T2D-NIT). We retrospectively analyzed US healthcare claims data using Optum’s Clinformatics® database. MA beneficiaries with T2D-NIT were identified in the 15 years from 2007 to 2021. Hypoglycemia-related encounters (HREs) were those accompanied by a hypoglycemia-specific ICD9/10 diagnosis code in any position on the claim. HREs following the first claim related to T2D were enumerated and classified by setting (ambulatory or inpatient/emergency department [ED]). MA beneficiaries with T2D-NIT included a study population of 2,708,762 individuals (53% female, 65.2% White) followed for an average of 5 years. HREs were identified in 19.4% (n=525,741) of individuals, of whom 15.8% (n=428,734) had ambulatory encounter(s) and 5.41% (n=146,454) had inpatient/ED encounter(s). Prior to the first HRE, 26.5% (n=142,918) were using a sulfonylurea (SU), 35.9% (n=193,677) had evidence of chronic kidney disease, and 11.5% (n=62,404) had chronic kidney disease and were using a SU. These findings show that HREs are prevalent in the T2D-NIT population and identify a large number of patients who may benefit from CGM. Since >80% of HREs occur in the ambulatory setting and >70% occur in patients not taking SUs, primary care providers should be aware of the latest eligibility criteria for Medicare’s coverage of CGM and not restrict CGM to SU users. The generalizability of these findings is limited to the data source and may not be representative of the overall MA T2D-NIT or Medicare fee-for-service populations.

Disclosure

K.Hannah: Employee; Dexcom, Inc. P.Nemlekar: Employee; Dexcom, Inc. J.S.Bushman: Employee; Dexcom, Inc. G.J.Norman: Employee; Dexcom, Inc.

Funding

Dexcom, Inc.
1001-P: Adherence and Persistence to Basal Insulin Therapy Is Associated with Decreased Health Care Utilization in Adults with Type 2 Diabetes
Authors: NIELSEN NICK F. , ARODA VANITA R. , MANGLA KAMAL K. , DIVINO VICTORIA , NAMVAR TARLAN , RAJPURA JIGAR R.
Published: June 2023

Objectives: Lack of adherence and persistence to prescribed therapy impact achievement of glycemic goals. This study aimed to assess the association between adherence and persistence to basal insulin therapy with healthcare resource utilization (HCRU) among adults with type 2 diabetes (T2D).

Methods: This was an observational, retrospective cohort study of commercially insured US patients using IQVIA PharMetrics® Plus claims data. We identified adults with T2D initiating basal insulin therapy between January 1, 2016 and December 31, 2018. Adherence/non-adherence and persistence/non-persistence were assessed per established definitions. Demographic and clinical characteristics were assessed over the one-year baseline period (prior to initiation). Inverse probability of treatment weighting (IPTW) was used to adjust for confounding by adherence and persistence status. Post-IPTW, all-cause medical HCRU and costs in the one-year follow-up period were compared across cohorts.

Results: The final sample consisted of 64,953 patients: 42% and 58% met criteria for adherence and non-adherence, respectively; 57% and 43% met criteria for persistence and non-persistence, respectively. The proportion of patients with ≥1 hospitalization was lower for the adherence and persistence cohorts compared to their reference groups (adherence: 12.2% vs. 13.8%; persistence: 12.5% vs. 14.2%, both P<0.0001); for these patients, mean hospitalization days were lower among adherence and persistence cohorts (adherence: 10.1 vs. 13.2; persistence: 10.4 vs. 13.8, both P<0.0001). Total mean medical costs were also lower (adherence: $16,118 vs. $17,991; persistence: $16,459 vs. $18,399, both P<0.0001), driven by lower acute care costs (adherence: $6,210 vs. $7,775; persistence: $6,385 vs. $8,171, both P<0.0001).

Conclusions: In this study, adherence and persistence to basal insulin therapy was associated with lower HCRU and costs, particularly for acute care.

Disclosure

N.F.Nielsen: Employee; Novo Nordisk A/S, Coloplast A/S. V.R.Aroda: Consultant; Applied Therapeutics Inc., Fractyl Health, Inc., Novo Nordisk, Pfizer Inc., Sanofi, Other Relationship; Janssen Pharmaceuticals, Inc., Research Support; Applied Therapeutics Inc., Eli Lilly and Company, Fractyl Health, Inc., Novo Nordisk, Sanofi. K.K.Mangla: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. V.Divino: Employee; IQVIA Inc. T.Namvar: None. J.R.Rajpura: Employee; Novo Nordisk.
1007-P: Employment and Work Conditions among U.S. Adults with Diagnosed Diabetes Pre- and Post-COVID-19 Pandemic
Authors: TANG SHICHAO , CHEN YU , ZHANG PING
Published: June 2023

Persons with diabetes mellitus (DM) have been disproportionately impacted by the COVID-19 pandemic compared with those without diabetes. How the pandemic has affected the employment and work conditions of persons with DM is unknown. Using 2018-2021 National Health Interview Survey data, we examined changes in the likelihood of being employed, having paid sick leave, and changes in work hours per week before and after the pandemic among US adults aged 18-64 years with DM using Chi-squared or t-tests. We also examined the likelihood of having social distance measures in place at work and working closer than 6 feet to other people during the pandemic. We compared the changes in the gap of these measures between persons with and without DM before and after the pandemic using multivariable linear regression. Compared with the pre-pandemic period, persons (men and women, and those with and without DM) worked longer hours and were more likely to have paid sick leave after the pandemic. Changes in the gap between persons with and without diabetes in those measures were not statistically significant (see table). Men with DM were more likely to work closer than 6 feet to others than men without DM. The COVID-19 pandemic does not appear to have affected labor market outcomes for persons with DM relative to those without DM. Future research may confirm this finding and explore reasons to explain the identified patterns.

Disclosure

S.Tang: None. Y.Chen: None. P.Zhang: None.
1008-P: The Relationship between Glycemic Control and Total Health Care Costs for Adults with Type 2 Diabetes in the U.S.
Authors: BAE JAY P. , THIEU VIVIAN , LAGE MAUREEN J. , BOYE KRISTINA
Published: June 2023

Introduction: The estimated economic costs of diabetes was $327B in 2017 and is forecasted to increase to $494B by 2030. This study compares total health care costs for adults with T2D with glycemic control (HbA1c < 7%) compared to poor glycemic control (HbA1c ≥ 7%).

Methods: The Optum’s de-identified Clinformatics® Data Mart database from 1/1/2015 - 6/30/2021 was used to identify a cohort of adults with T2D with an index date of first recorded HbA1c test between 1/1/2016 - 7/1/2020 and continuous insurance from 1 year prior through 1 year post index date. Patients with glycemic control were propensity score matched to patients with poor glycemic control. Generalized linear models and two-part models examined all-cause total medical costs in 2021 dollars as well as outpatient, drug, and acute care costs over the 1- year post-period.

Results: Results from the matched cohort (N=59,830) indicate that glycemic control was associated with significantly lower annual total, acute, and drug costs but significantly higher outpatient costs (see Figure 1; all P<0.05). Sensitivity analyses using ≤ 6.5% and < 8% HbA1c thresholds showed that being below threshold was associated with significantly lower total medical costs.

Conclusion: Glycemic control was associated with significantly lower annual all-cause total medical costs. Results suggest economic benefits associated with having HbA1c at or below target.

Disclosure

J.P.Bae: None. V.Thieu: None. M.J.Lage: Consultant; Eli Lilly and Company. K.Boye: Employee; Eli Lilly and Company.
101-OR: Systematic Intraoperative Bone Sampling Increases Healing Chances in Diabetic Foot Osteomyelitis
Authors: IACOPI ELISABETTA , GIANGRECO FRANCESCO , LEONILDI ALESSANDRO , ORTENZI VALERIO , ROBERTO SUARDI LORENZO , PIERUZZI LETIZIA , GORETTI CHIARA , BARNINI SIMONA , FALCONE MARCO , NACCARATO GIUSEPPE , PIAGGESI ALBERTO
Published: June 2023

Aim: We aimed to evaluate if a proactive multidisciplinary diagnostic program could improve outcomes in the management of multidrug resistant (MDR) diabetic foot (DF) osteomyelitis (OM).

Methods: We evaluated all the consecutive patients undergoing surgical procedure for OM July-December 2021 in our department (Group A). Intraoperative bone specimens were collected for microbiological and histological analysis on whose results antibacterial therapy was decided. Controls were patients admitted January-June 2021 with same indications (Group B) but with no systematic intraoperative bone sampling. Clinical and demographic characteristics, procedures, healing rate (HR) and healing time (HT), were compared between the groups.

Results: We derived data from 89 patients: 46 in Group A [51.7%; age 68.8±13.5 yrs; diabetes duration (DD) 19.6±11.6 yrs Hba1c 8.7±4.8%] and 43 in Group B [48.3%; age 70.4±12.9 yrs; DD 18.8±12.1 yrs; Hba1c 8.4±5.1%]. No differences in demographic and clinical features, i.e. chronic kidney disease (39.1% vs 37.2%, p=ns), ischemic cardiac disease (41.3% vs 39.5%, p=ns), peripheral arterial disease (65.2% vs 67.4%, p=ns) and peripheral revascularizations (56.5% vs 53.4%, p=ns). Group A had a higher healing rate (80.4% vs 60.4%, p=0.0021) and a shorter healing time (67±41 days vs 134±92 days, p=0.020) compared to Group B.

Conclusions: Systematic intraoperative bone sampling for culture and histology, and consequent antibiotic adjustment, increases healing rates and reduces healing times in DF patients undergoing surgical debridement for OM.

Disclosure

E.Iacopi: None. G.Naccarato: None. A.Piaggesi: None. F.Giangreco: None. A.Leonildi: None. V.Ortenzi: None. L.Suardi: None. L.Pieruzzi: None. C.Goretti: None. S.Barnini: None. M.Falcone: None.
1010-P: Cost and Utilization of Health Care Services for Persons with Diabetes
Authors: REYNOLDS EVAN L. , MIZOKAMI-STOUT KARA R. , PUTNAM NATHANIEL , BANERJEE MOUSUMI , ALBRIGHT DANA , LEE JOYCE M. , BUSUI RODICA , FELDMAN EVA L. , CALLAGHAN BRIAN C.
Published: June 2023

Objective: To describe and compare healthcare costs and utilization for persons with type 1 diabetes (T1D), type 2 diabetes (T2D), and those without diabetes.

Methods: Using a nationally representative healthcare claims database, we identified matched persons with T1D, T2D, and those without diabetes using a propensity score quasi-randomization technique. In each year between 2009-2018, we summed costs (total and out-of-pocket) and utilization for all healthcare services and those specific to medications, diabetes-related supplies, visits to healthcare providers, hospitalizations, and emergency room (ER) visits. Costs and utilization were scaled using total patient follow-up in each year.

Results: In 2018, we found that out-of-pocket costs and total costs were highest for persons with T1D (out-of-pocket: $950, total: $10,626), followed by persons with T2D (out-of-pocket: $670, total: $7,516), and persons without diabetes (out-of-pocket: $447, total: $4,483). Medication costs made up the largest proportion of out-of-pocket costs regardless of diabetes status (T1D: 78.2%, T2D: 76.2%, control: 70.5%). From 2009-2018, utilization of hospitalizations (T1D: +23.7%, T2D: +17.3%, controls: +22.0%) and ER visits (T1D: +54.9%, T2D: +56.0%, controls: +50.1%) increased regardless of diabetes status, and use of diabetes-related supplies (+22.1%) were increasing for persons with T1D.

Conclusions: Given the substantial out-of-pocket costs for people with diabetes, especially for those with T1D, providers should screen all persons with diabetes for financial toxicity (i.e., wide-ranging problems stemming from these healthcare costs). In addition, policies that aim to lower out-of-pocket costs of cost-effective diabetes related healthcare are needed with a focus on medication related costs.

Disclosure

E.L.Reynolds: None. K.R.Mizokami-stout: None. N.Putnam: None. M.Banerjee: None. D.Albright: None. J.M.Lee: Advisory Panel; GoodRx, Consultant; Tandem Diabetes Care, Inc. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter & Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. E.L.Feldman: None. B.C.Callaghan: None.

Funding

National Institutes of Health (K99DK129785 to E.V.L.), (1K23DK13129601A1 to K.R.M-S.), (D300P30, 12959224, UH3HD087979, UH3HD087979-04S1 to J.M.L.), (R01DK115687 to B.C.C.), (R01DK129320, R01DK107956, R01DK130913 to E.L.F.); National Institute of Diabetes
1013-P: LGBTQ+ Supportive and Inclusive Care Practices in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
Authors: RAYMOND JENNIFER , MUNGMODE ANN , CASES-VILLABLANCA JESSE , FLORES GARCIA JAQUELIN J. , BUTLER ASHLEY , DEMETERCO-BERGGREN CARLA , RIOLES NICOLE , OCHOA-MAYA MARGARITA , MANUKYAN MAKAILA , MAAHS DAVID M. , MCDONOUGH RYAN , MAJIDI SHIDEH , COLLABORATIVE T1DX-QI
Published: June 2023

Background: Individuals with gender-expansive identities and diverse sexual orientations are more likely to experience health disparities and psychosocial stressors when compared to their non-LGBTQ+ peers. It is uncertain if these identities are included in diabetes care discussions. We sought to understand LGBTQ+ supportive and inclusive care practices across the T1DX-QI.

Methods: Thirty-three pediatric (66%) and 17 adult (34%) T1DX-QI centers that serve patients from less than one year old to 99 years old completed a survey about their LGBTQ+ supportive and inclusive care practices in mid-2022. Significance testing was conducted using Fisher’s exact test.

Results: Most pediatric (88%) and adult (76%) centers reported gender-affirming care was legal in their state. Almost 90% of pediatric and adult centers document patients’ self-identified gender identity, but more pediatric (82%) than adult (65%) document pronouns used by patients with diabetes. A majority of pediatric and adult centers (97% and 82%, respectively) document sex assigned at birth (SAAB), but less than half of the institutions (39% pediatric and 24% adult) change SAAB in their electronic health record. Only 44% of pediatric and 47% of adult centers document sexual orientation, but 64% of pediatric and 53% of adult centers have implemented strategies to support asking about gender identity and sexual orientation within their clinics. The results for documented patient self-identified gender identity, and documented pronouns were both significant, with p-values less than 0.05.

Conclusion: Most T1DX-QI centers document gender identity and pronouns. Fewer centers document sexual orientation. Although these are promising first steps, more is needed to support and empower the LGBTQ+ community with diabetes. Additionally, further research is needed to understand how implementing supportive and inclusive care practices impacts outcomes for LGBTQ+ patients with diabetes.

Disclosure

J.Raymond: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. R.Mcdonough: None. S.Majidi: None. T1dx-qi collaborative: n/a. A.Mungmode: None. J.Cases-villablanca: None. J.J.Flores garcia: None. A.Butler: None. C.Demeterco-berggren: Speaker's Bureau; Glooko, Inc. N.Rioles: None. M.Ochoa-maya: None. M.Manukyan: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
1017-P: Association between Early-Pandemic Primary Care Telemedicine Exposure and Ongoing HbA1c Outcomes
Authors: REED MARY , HUANG JIE , MILLMAN ANDREA
Published: June 2023

Objective: Telemedicine helped maintain primary care access for patients with diabetes when in-person health visits were restricted early in the COVID-19 pandemic. There is little known about the longer-term impact of pandemic telemedicine on patient outcomes.

Method: In an integrated health care system that temporarily shifted all patient-initiated primary care visits to telemedicine during the early pandemic, we used EHR data to compare patients with diabetes exposed to a primary care video or telephone telemedicine visit during the first year of the pandemic (4/2020-03/2021), and examined two outcome variables in second year of the pandemic (04/2021-03/2022): any HbA1c measured, and HbA1c <8%. Using multivariate logistic regression to examine the association between telemedicine exposure and outcomes, we adjusted for patient age, sex, race, language, neighborhood SES and internet, video visit and patient portal history, other comorbid chronic conditions, and baseline HbA1c, then calculated multivariate adjusted outcome rates.

Results: Among 242,848 patients with diabetes, 49.8% were age 65+, 59.9% were of non-White race/ethnicity. During the first year of pandemic, 42% were exposed to a primary care video visit, 32% had only telephone visits (25% had no visits). The adjusted rate of HbA1c testing in the outcome period was 91% among those with a video or telephone visit, compared to 87% for those with no visit (p<0.05). Similarly, an adjusted 69% of those with a video visit had HbA1c <8% compared to 67% among patients with no visit (p<0.05), with stronger associations among patients with baseline HbA1c 8+.

Conclusion: In patients with diabetes, primary care telemedicine exposure during the initial pandemic period was associated with downstream higher rates of HbA1c testing and greater rates of HbA1c’s within target range. Telemedicine primary care access likely supported continuity in diabetes management during the pandemic.

Disclosure

M.Reed: None. J.Huang: None. A.Millman: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK085070)
1022-P: Trends in Glucagon Fill Rates among U.S. Adults with Diabetes and End-Stage Kidney Disease on Dialysis
Authors: GALINDO RODOLFO J. , INSELMAN SHEALEIGH , MOAZZAMI BOBAK , ALI MOHAMMED K. , UMPIERREZ GUILLERMO , MCCOY ROZALINA G.
Published: June 2023

Patients with diabetes (DM) and end-stage kidney disease (ESKD) on dialysis have a high risk of severe hypoglycemia and more than 70% are treated with insulin therapy. While not all hypoglycemic events can be prevented, glucagon is recommended for patients at high risk for hypoglycemia to revert and prevent hospitalization with severe hypoglycemic events. Prior studies have shown low rates of glucagon utilization, but excluded patients with ESKD who are at highest risk for these events. We used the USRDS, the most comprehensive nationwide database of patients with ESKD in the US, to examine the quarterly rates of glucagon fills among U.S. adults with DM and ESKD receiving dialysis. Among 254,195 adults (≥18 years) with ESKD and type 1 DM (N=27,538) or type 2 DM (N=226,657), with 76.9% using insulin therapy, between 2013-2017. Fewer than 2% of patients with type 2 DM and fewer than 4% of patients with type 1 DM filled a glucagon prescription, with declining fill rates over time among patients with type 2 DM and stable rates among patients with type 1 DM. Clinical Characteristics and trends in glucagon prescriptions are shown in Table 1. Our findings suggest an urgent and critical need for education of clinicians, patients, and caregivers to improve the prescribing and use of glucagon: a life-saving rescue medication.

Disclosure

R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. S.Inselman: None. B.Moazzami: None. M.K.Ali: Advisory Panel; Bayer Inc., Eli Lilly and Company, Research Support; Merck & Co., Inc. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. R.G.Mccoy: Consultant; Emmi.
1023-P: Current Practices in Racial Equity—Findings from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) in 2022
Authors: SANCHEZ JANINE , CASES-VILLABLANCA JESSE , ADDALA ANANTA , MUNGMODE ANN , WRIGHT TREVON , WOLF RISA M. , AHMANN ANDREW , MATHIOUDAKIS NESTORAS N. , NG JASON , ZUPA MARGARET , EBEKOZIEN OSAGIE , COLLABORATIVE T1DX-QI
Published: June 2023

Background: Medical racism contributes to adverse health outcomes. T1DX-QI is a large population-based cohort engaged in data sharing and quality improvement to drive system changes in type 1 diabetes care. The annual T1DX-QI survey included questions to evaluate racial equity in diabetes care and practices to promote equity.

Methods: The annual T1DX-QI survey was administered to participating clinics fall 2022 and had a 94 % response rate. There were 50 responses consisting of 66% pediatric (P) and 34% adult (A) institutions. Questions concerned clinic resources, LGBTQ+ practices, racial equity, patient transition, and reproductive health. Response data were aggregated, summarized and stratified by P/A institutions.

Results: Only 21% P and 33% A institutions felt all their team members can articulate how medical racism contributes to adverse diabetes outcomes. Pediatric institutions reported more strategies to address medical racism than adult (3.6 vs 3.1). Organizational strategies to decrease racial discrimination included employee trainings, DEI offices/committees, patient resources and hiring practices. Patient resources include interpreter services, transportation, insurance navigation, and housing and food assistance. Hiring practices included changing prior protocols, hiring from the community, and diversifying workforces. Majority of institutions have offered anti-racism training in the last year (P 85%, A 72%) and annually (P 64%, A 56%). Pediatric teams felt that their anti-racism training was effective more often (P 60%, A 45%) and more commonly were provided resources (67% P vs 47% A) to help address inequities.

Conclusion: Despite increased offering in anti-racism training, insufficient institutional support and perceived subeffective training still represent obstacles especially in adult institutions. Sharing effective strategies to address medical racism will help institutions take steps to mitigate inequities.

Disclosure

J.Sanchez: None. M.Zupa: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. T1dx-qi collaborative: n/a. J.Cases-villablanca: None. A.Addala: None. A.Mungmode: None. T.Wright: None. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. A.Ahmann: Advisory Panel; Medtronic. N.N.Mathioudakis: None. J.Ng: Research Support; Sanofi-Aventis U.S.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
1028-P: Rates of GLP1 Prescription in Patients with T2D after MI Are Poor Even among Patients Willing to Inject Insulin
Authors: DWEIK ASEEL A. , DELLA-PENNA PAIGE L. , SUMARSONO NATHAN , MALLADI CHAITANYA L. , GEURINK KYLE , MATHEW CHRIS , MOSS ELIZABETH , PEYKOVA KREMENA , MACK-BOYD LISA , DAS SANDEEP
Published: June 2023

Introduction: SGLT2 inhibitors (SGLT2) and GLP1 agonists (GLP1) both reduce major adverse cardiovascular events (MACE) in patients with T2D after MI. To test whether prescription rates of these medications are associated with willingness to take injectable therapies, we examined prescription rates stratified by co-prescription of insulin in a large urban safety net teaching hospital which provided SGLT2 and GLP1 to low income patients at nominal cost.

Methods: Using data from the hospital EHR for all patients with T2D and eGFR > 30 hospitalized with type 1 MI between 2018-2019, we determined rates of prescription of GLP1 and SGLT2 at one year.

Results: Of the 55 patients prescribed insulin at the time of index MI admission, 9 (16%) were prescribed GLP1RA and 26 (47%) were prescribed SGLT2i at one year follow-up. In contrast, of the 68 patients not prescribed insulin at time of index MI admission, 4 (6%) were prescribed GLP1RA and 39 (57%) were prescribed SGLT2i at one year follow-up.

Conclusion: Even among patients with demonstrated willingness to take injectable medications, rates of GLP1 prescription are poor overall and lower than SGLT2 prescription rates.

Disclosure

A.A.Dweik: None. S.Das: None. P.L.Della-penna: None. N.Sumarsono: None. C.L.Malladi: None. K.Geurink: None. C.Mathew: None. E.Moss: None. K.Peykova: None. L.Mack-boyd: None.