bluuebunny/crossref_metadata_2025 huggingface dataset:
SAT077 Association Of Mitochondrial DNA With Type-2-diabetes, Glucose Level, And Insulin Resistance
Authors: Heydarpour Mahyar , Pojoga Luminita , Romero Jose R , Williams Gordon H , Williams Jonathan S
Published: October 2023

Disclosure: M. Heydarpour: None. L. Pojoga: None. J.R. Romero: None. G.H. Williams: None. J.S. Williams: None.

Background: Mitochondrial dysfunction leads to decreased Adenosine-3-phosphate (ATP) production and increased ROS production, leading to insulin resistance, and diabetes (T2D). Mutations in mitochondrial DNA (mtDNA) have been associated with increased ROS production. Current studies have shown a role for mtDNA variants in the pathogenesis of both T2D and insulin resistance. Despite both of these disorders are controlled by many features involving interplay between genetic and environmental factors, however amongst genetic factors, variations in mtDNA have shown a potential role in the risk of T2D. We analyzed the genomic influence of mtDNA on T2D, insulin resistance, and fasting plasma glucose in humans. Methods: Participants (113 cases with T2D and 303 controls) from the HyperPATH Cohort were selected and genotyped using a Multi-Ethnic-Genotyping-Array. Individuals consumed two study diets containing high (>200mEq/day) and low (<10mEq/day) sodium content for 7 days each. The Homeostasis Model Assessment (HOMA-IR) index was used to assess insulin resistance. We performed association analyses between 275 mitochondrial genetic markers (SNVs) and three outcomes (T2D, insulin resistance, and fasting plasma glucose) using PLINK program. Results: We identified 2 significant SNVs within mtDNA that associated with T2D after adjusting the model for sex, age, study site, and BMI. One SNV (rs2248727, OR=3.15, P=0.00035) was within the coding region of Cytochrome C Oxidase III (COX3) and another (rs2857284, OR=3.13, P=0.00037) within the coding region of NADH Dehydrogenase subunit 4 (ND4). Further, we identified 2 SNVs associated with fasting plasma glucose; rs28359176, beta=22.7, P=0.0006 in the coding region of NADH Dehydrogenase subunit 5 (ND5), and rs367951226 beta=22.7, P=0.0006) in the region of ATP Synthase membrane subunit 6 (ATP6). We also identified a significant signal (rs376888742, beta=5.61, P=6.09E-06) associated with insulin-resistance in the coding region of Cytochrome B (CYB). Conclusion: These results show a significant association between mitochondrial ND4 and COX3 gene variants with T2D and CYP with insulin resistance. Gene variants of mitochondrial ND5 and ATP6 were associated with increase plasma glucose.

Presentation: Saturday, June 17, 2023
SAT086 Early-onset HNF1B-MODY With Persistent Insulin Requirement In A 2-year-old Female
Authors: Ighalo Fulfilled , Renee Kelly Sarah , Tosur Mustafa , Elizabeth Craven Meghan
Published: October 2023

Disclosure: F. Ighalo: None. S.R. Kelly: None. M. Tosur: None. M.E. Craven: None.

Introduction: Diabetes related to HNF1B pathogenic variants or deletions (maturity-onset diabetes of the young 5 [MODY 5]) typically presents in adolescence or early adulthood, with a median age of 20 years. Bustamante et al. previously described two patients with 17q12 deletion encompassing HNF1B presenting with diabetes and pre-diabetes before the age of 3, who were managed with dietary intervention alone without insulin requirement. This case describes a 2-year-old diagnosed with HNF1B-MODY after developing hyperglycemia in the setting of an acute illness, who continued to require insulin therapy following recovery. Clinical Case: A 2-year-old female with a history of recurrent viral infections and failure to thrive was admitted to the intensive care unit in hypovolemic shock due to hemolytic uremic syndrome due to Shiga toxin. On hospital day 7, while on supraphysiologic steroid doses, she developed hyperglycemia with glucoses above 600 mg/dL. She required an insulin drip to maintain blood glucoses between 100 and 200 mg/dL. Her four-month hospital stay was complicated by cardiogenic shock requiring extracorporeal mechanical oxygenation, renal failure requiring hemodialysis, respiratory failure resulting in a tracheostomy, and dysphagia resulting in a gastrostomy tube. During this time, she continued to require insulin despite being weaned off steroids and transitioning from total parenteral nutrition to gastrostomy tube feeds. Her hemoglobin A1c one month post-diagnosis was 4.9%, and continued to rise to 6.6% and 7.6% at 3 and 4 months post-diagnosis, respectively. Testing for islet autoantibodies was negative. A chromosomal microarray analysis revealed a micro-deletion in chromosome 17q12 that included the HNF1B gene. MRI showed a near total absent pancreas, and multiple small cysts scattered throughout both kidneys. She also had fecal elastase levels in the insufficient range (135 mcg/g, normal >200 mcg/g). Six weeks after the start of insulin drip, she was transitioned from an insulin drip to subcutaneous insulin injections, and eventually placed on an insulin pump prior to discharge. With continued clinical improvement, her insulin doses decreased, but she was not able to come off insulin completely. She had gradual decline in her insulin requirements from 1.0 units/kg/day down to 0.1 units/kg/day at time of discharge. Her current insulin requirement at 6 months post-diagnosis is 0.2 units/kg/day. Conclusion: This case represents the rare development of diabetes before adolescence in HNF1B-MODY, and one of the most severe presentations seen in a prepubertal child requiring persistent insulin therapy at 6 months post-diagnosis. Potential contribution of complicated hospital course on persistent insulin requirement in the setting of 17q12 micro-deletion cannot be excluded.

Presentation: Saturday, June 17, 2023
SAT099 Should We Use HbA1c Or Continuous Glucose Monitoring (CGM) For Treatment Adjustment In Type 2 Diabetes Non-insulin Treated Patients?
Authors: Totomirova Tzvetelina , Arnaudova Mila
Published: October 2023

Disclosure: T. Totomirova: None. M. Arnaudova: None.

Current recommendations include treatment changes in type 2 non-insulin patients to be based preferably on HbA1c. HbA1c shows insufficiency as glucose control assessment tool omitting glucose fluctuations and hypoglycemic episodes. Continuous glucose monitoring (CGM) was mostly used for insulin dose adjustment in type 1 and type 2 diabetes patients on insulin. In our study we compared the retrospective CGM data with HbA1c to find out their usefulness for treatment decision in patients with type 2 diabetes. We studied 62 patients with type 2 diabetes non-treated with insulin (28 women, 34 men; age 59.35±11.0г years, disease duration 8.06±5.86г years). All of them performed retrospective Continuous Glucose Monitoring by using iProTM for seven days and HbA1c was measured at the end of this period. We found HbA1c level to show good significant correlation with percentage of time in range be similar in three groups (7.13±0.85 vs 55.65±25.99%, r=-0.48), with maximum CGM glucose level (r=0.47, p<0.01) and minimum CGM glucose level (r=0.44, p<0.01) as well as with the mean CGM glucose level (7.15±1.80mmol/l, r=0.74, p<0.01). Patients estimated to be well controlled are the same percentage based on HbA1c as well based on TIR. HbA1c does not show any correlation with the number of excursions, with AUC below the limit and percentage of time below the limit. Our conclusion is that CGM gives more precise data about glycemic control and thus could be much more useful for treatment adjustment in non-insulin treated patients.

Presentation: Saturday, June 17, 2023
SAT100 Management Of Post-exercise Hyperglycemia In A Patient Using Control IQ Artificial Pancreas System - A Case Report
Authors: Sharma Pranjali , Ramirez Berlioz Ana
Published: October 2023

Disclosure: P. Sharma: None. A. Ramirez Berlioz: None.

Introduction: The automated insulin delivery (AID) Tandem Control IQ (CIQ) system has improved glycemic control with increased time in range (∼10%) & decreased hypoglycemic events (∼1%) through automatic basal rate modifications & correction bolus administration. The sleep & exercise activity (EA) decrease hypoglycemia risk. The CIQ EA decreases basal rate for predicted glucose =<140 mg/dl, increases basal rate for predicted glucose >160 mg/dl, and suspends insulin delivery for glucose =<80 mg/dl. It is designed for mild-moderate physical activity and is aggressive for high-intensity aerobic exercise or endurance training. High-intensity activity can cause post-exercise hyperglycemia. There is minimal data regarding management of post-exercise hyperglycemia when using AID systems. Case Report: A 40 year old female with uncomplicated type 1 diabetes mellitus managed by Tandem CIQ system reported post-exercise hyperglycemia after starting a new exercise routine. Previous routine included cardio and weight training on 4 days of the week. She had recently started a stationary cycling routine lasting 15-45 minutes with varying intensity. She would start the CIQ EA 1.5 hours prior to exercise and stop after completion. The pump report revealed hyperglycemia between 200-300 mg/dl occurring within 1 hour after exercise, lasting several hours after. Patient attempted using normal mode during exercise, manual bolusing immediately after exercise, and post-exercise insulin sensitivity factor modification without effect. Stopping EA 10-15 mins before completion led to elimination of post-exercise hyperglycemia. Discussion: The CIQ EA is designed to decrease exercise-induced hypoglycemia. After high-intensity exercise, the CIQ algorithm can exaggerate the hyperglycemia. High-intensity routines such as sprints, weight-lifting, intensive cycling, are associated with varying degrees of hyperglycemia. Our patient's new cycling routine was higher-intensity compared to what she previously did, leading to persistent hyperglycemia. Some recommendations to avoid post-exercise hyperglycemia in patients on AID systems include using CIQ normal mode during exercise, utilization of a temporary basal rate, or administration of a manual correction bolus. However, the use of normal mode or temporary basal rates can lead to glycemic variations during exercise. A manual correction bolus administered after exercise may be too late to avoid the hyperglycemia and leads to subsequent hypoglycemia due to enhanced insulin sensitivity post-activity. We tried stopping EA a few minutes before routine completion and found that 10 minutes was appropriate. We suggest that discontinuation of the EA 10 minutes before completion of exercise routine can alleviate post-exercise hyperglycemia. Additional studies are required to confirm whether this method would work on a larger scale.

Presentation: Saturday, June 17, 2023
SAT104 Evaluation Of Glucose Variability By Continuous Glucose Monitoring In Patients With Diabetes Mellitus And History Of Stroke
Authors: Musurakis Clio , Poudel Bidhya , Chitrakar Solab , Qureshi Faisal , Gilden Janice L
Published: October 2023

Disclosure: C. Musurakis: None. B. Poudel: None. S. Chitrakar: None. F. Qureshi: None. J.L. Gilden: None.

Background: Data has now emerged that use of continuous glucose monitors (CGM) is associated with improvements in HbA1c, and patient reported outcomes. Hypothesis: In this study we assessed whether data obtained from personal CGM is associated with chronic complications of patients with diabetes mellitus (DM) and whether HbA1c was able to predict diabetic chronic complications. Methodology: A retrospective chart review of 69 DM patients [(59% T2: 8% T1: 5% of LADA) (91% with hyperlipidemia; 68% with hypertension; 59% obese )(average age= 61.47) (85% males; 15% female) (73% white: 21% black:<2% Asian; <2% Hispanic: <1% Native American) (Average HbA1c 7.74 ± 1.21) (Duration of DM >10 years =63%)(30% used insulin pumps)], from two community care-based healthcare facilities was performed. Data obtained from CGM were collected for a three-month period of time. IBM SPSS Statistics software was utilized for analysis. Results: Percentages of patients with chronic diabetic complications were as follows: 30% with urine microalbumin/cr ratio between 30-300 mg/day and 8% had >300 mg/day, 8% CKD stage III-IV, 4% ESRD, 1.4% autonomic neuropathy, 2% history of amputations, 5% history of diabetic foot infections, 34% hypoglycemia unawareness, 24% CAD, 5% had history of stroke, 7% PVD, 33% retinopathy, and 40% peripheral neuropathy. Averages ± SD of data obtained from CGM were: % time in range =52.55 ± 21.17; % high= 29.60 ± 10.89; % Very High= 15.64 ± 14.36; % very low =0.51± 1.02 and % low= 0.13 ± 0.38. The Average GMI was 7.70 % ± 0.82, with % CV 52.73 ± 18.82. A positive correlation was observed between a history of stroke and % CV, as well as GMI. AUC for %CV was 0.690 (SD 0.093, 95% CI 0.507-0.873) (p<0.05), AUC for GMI was 0.697 (SD 0.101, CI 0.499-0.895) (p=0.05). AUC for HbA1c was 0.572 (SD 0.078, CI 0.419-0.724) (NS). The % CV of 38.5 had 71% specificity and 20% sensitivity to predict stroke with a cutoff of 55.5 with 80% sensitivity and 35% specificity. The GMI of 7.65 had 80% sensitivity and 53% specificity of stroke history and a cutoff or 9.45 with 100% sensitivity and 96% specificity. HbA1c did not reach statistical significance. There were also no significant associations between HbA1c and GMI, or % CV, and other chronic complications Conclusions: Our study demonstrates that large variations of blood glucose levels, as indicated by higher than goal %CV (n<=36%), and GMI are both predictive for history of stroke. Further studies are needed to explore the pathophysiology of these associations. Furthermore, there were no associations between HbA1c and history of stroke, indicating that GMI and glucose variability, as measured by % CV, are more accurate diagnostic tools.

Presentation: Saturday, June 17, 2023
SAT106 Use Of Data Sharing Feature Of Dexcom G6 Sensor Is Associated With Improved Glycemic Control: A Comparative Analysis
Authors: Sadek Batoul
Published: October 2023

Disclosure: B. Sadek: None.

Introduction: The use of Continuous Glucose Monitoring (CGM) sensors has significantly increased in part due to the seamless integration with smartphones. The Dexcom G6 CGM automatically sends real-time glucose readings to a compatible smart device. Moreover, the Dexcom Clarity app provides analytic tools and allows users to continuously share glucose data with their healthcare professionals, enabling remote monitoring of patients' glycemic control. Although multiple studies have shown better glucose control in patients who use CGM systems, what remains unexplored is if glucose metrics are further improved in those who share CGM data with healthcare providers. In this study, we compared glycemic outcomes among patients who use the sharing feature of the Dexcom G6 sensor to share their data with their healthcare providers to those who do not. Method: We conducted a single-center cross-sectional study in a community hospital with patients who use the Dexcom G6 CGM (n=201). Data was obtained from Dexcom Clarity for Healthcare Professionals, an online platform for clinicians to review patients' glucose patterns and statistics through interactive reports. The following data was collected for each patient: date of the last upload, data sharing status, average glucose, standard deviation, glucose management indicator (GMI) (%), glucose ranges (categorized as very high, high, in range, low, very low), sensor usage, and coefficient of variation (%). Two-tailed unpaired Student's t-tests were used to analyze the CGM metrics based on data sharing status. Significance was defined as a p-value less than 0.05. Results: 123 (61.19%) of the study participants shared data with healthcare providers. Participants with sharing data 'on' were significantly younger (49±15 years, p-value = 0.0007) and had increased sensor usage (90±21%, p-value = 0.0012), compared to those with sharing off. Participants who shared data spent more time in range (57±24 %, p-value = 0.0435), indicating a higher percentage of readings with glucose levels in a healthy range (70-180 mg/dL). Lastly, average glucose was lower in participants who shared data, although not statistically significant (179 ±44 mg/dL, p=0.08). Conclusion: The data-sharing feature on Dexcom G6 was utilized more frequently by younger people and was associated with a higher percentage of sensor usage. In addition, using the data-sharing feature of the Dexcom G6 could lead to a clinically meaningful improvement in glycemic control.

Presentation: Saturday, June 17, 2023
SAT119 Artificial Intelligence Mediated Assistants: Will They Educate The Public About Health Disparities In Diabetes?
Authors: Zhao Weichen , Wu Gloria , Cheng Emily , Lee Jay Yong , Wong Adrial
Published: October 2023

Disclosure: W. Zhao: None. G. Wu: None. E. Cheng: None. J. Lee: None. A. Wong: None.

Background: In 2022, 37 million US adults had diabetes and 96 million had pre-diabetes. Diabetes and prediabetes affect 49.3% population in America. In the diabetic population, 12.1% are non-Hispanic blacks, 11.8% of Hispanics, and 9.5% of Asian Americans. 54% of Americans read at or below the sixth-grade level. ChatGPTTM, launched 11/30/22, has the newest Artificial Intelligence (AI) software versus Google AssistantTM, launched 05/2016. Purpose: Can ChatGPT use its natural language software to educate the lay public about diabetes and health disparities? Methods: Evaluate the readability of responses after five questions were posed to ChatGPTTM and Google AssistantTMQuestions: 1. Do African Americans have a higher risk of complications with Type 2 Diabetes? 2. Do Hispanic Americans have a higher risk of complications with Type 2 diabetes? 3. Do Asian Americans have a higher risk of complications with Type 2 diabetes? 4. Do women get Type 2 diabetes more than men? 5. What is pre-diabetes vs diabetes? Word count and Dale-Chall score assessed the readability level of both ChatGPT and Google Assistant responses. The Dale-Chall readability formula is calculated based on the percentage of difficult words and average sentence length in words. The U.S. Department of Education used the Dale-Chall formula to adjust the text to grade-level readability. Result: Word count: CHAT:Q1=104; Q2=135; Q3=136; Q4=133; Q5=232 vs GOOGLE: Q1=38, Q2=49, Q3=16; Q4=50; Q5=42. CHAT Word Count Avg=148, SD=48.81; GOOGLE Word Count Avg=39, SD=13.7; P-value=0.003908 Dale-Chall: CHAT: Q1=8.4; Q2=8.6; Q3=9.8, Q4=8.6, Q5=8.7 vs. GOOGLE: Q1=6.7, Q2=9, Q3=9.4, Q4=6.3, Q5=9.1. CHAT Dale-Chall Score Avg=8.82, SD=0.56; GOOGLE Dale-Chall Score Avg=8.1, SD=1.47; P-value=0.1306. ChatGPT has nearly the same grade level of comprehension as Google Assistant, including statistics about health disparities. However, ChatGPT was trained using information and transforming it into paragraphs, and google assistant extracts the data from websites and the variability is higher with a higher standard deviation than ChatGPT. Conclusion: ChatGPT with its artificial intelligence software is able to provide answers to our patients. While the answers may require a high school reading level and beyond, this is an excellent beginning for health education.

Presentation: Saturday, June 17, 2023
SAT123 Treatment Satisfaction And Barriers To Diabetes Care In Patients With Uncontrolled Diabetes Mellitus: A Cross-Sectional Study
Authors: Alghrid Sarah , Refadah Omnia , Alharbi Danah , Aljuhani Najla , Albalawi Shouq , Aljuhani Sammar , Alaradi Rahaf , Yzeed Almslmani , Albalawi Shouq , Amirthalingam Palanisamy , Alqifari Saleh F
Published: October 2023

Disclosure: S. Alghrid: None. O. Refadah: None. D. Alharbi: None. N. Aljuhani: None. S. Albalawi: None. S. Aljuhani: None. R. Alaradi: None. A. Yzeed: None. S. Albalawi: None. P. Amirthalingam: None. S.F. Alqifari: None.

Background: Diabetes prevalence is reaching 25% in Saudi Arabia. Although diabetes care is provided free of charge, barriers to care and treatment satisfaction among patients remain unknown. Objectives: This study aims to examine diabetes patients’ treatment satisfaction and barriers to care in Saudi Arabia. Methods: We utilized the validated Diabetes Treatment Satisfaction Questionnaire (DTSQ) survey tool to assess diabetes treatment satisfaction among 782 adult Arabic-speaking patients with type 2 diabetes. An additional survey construct was utilized to assess patients’ perspectives on possible barriers to receiving diabetes care. Multivariate linear regression, r Pearson regression, and U Mann-Whitney tests were analyzed. Results: Of the 782 participants interviewed, 55.3% were females. The mean age of the study sample was 59.4 years. The average DTSQs value was 13.5. A strong correlation was observed between DTSQs score and glycemic control, female gender, and utilization of governmental healthcare. Patients of primary healthcare centers had higher satisfaction than tertiary care. Among the barriers to care reported, living in a rural area, transportation, and availability of appointments were the most frequent. Conclusion: Diabetes treatment satisfaction correlated well with glycemic control. The degree of treatment satisfaction in patients with type 2 diabetes was higher in female patients receiving government healthcare. Logistics constituted the most frequent barriers to care reported including living in rural areas, availability of transportation, and appointments.

Presentation: Saturday, June 17, 2023
SAT125 Promoting Habitual Exercise In People With Diabetes By Using Mission Certification Via App
Authors: Kim Mi-kyung , Park Jeong Hyun
Published: October 2023

Disclosure: M. Kim: None. J. Park: None.

Regular exercise is very important for blood glucose control and overall health in patients with diabetes. Many guidelines recommend that diabetes should engage in 150 min or more of moderate-to-vigorous intensity activity weekly, spread over at least 3 days/week, with no more than 2 consecutive days without activity. However, one big problem is that it is not easy to maintain everyday exercise. We used “mission certification“ through SNS (social network service) for promoting habitual exercise. BAND of NAVER Corp. is the most popular grouping platform in Korea provides “mission certification” program to do same mission among group members. About 20 billion mission certifications in Korea nationwide until now. We made our BAND mission for everyday exercise and thirty patients joined to certificate mission for 12 weeks. We assessed their adherence and maintenance of exercise. We compared their glycemic control, body weight, lipid profile and body composition before and after mission program. We defined 100% mission completion as posting certification everyday without missing. At the first 4-week follow-up, the number of patients of 100% mission completion was 14(47%). The proportion was increased to 87% at 12 weeks. Their HbA1c was significantly decreased in patients with 100% mission completion (P<.05). Their body weight, LDL cholesterol and fat/muscle ratio showed the tendency to decrease, but not statistically significant. Unexpected positive findings were that patients actively posted encourage messages to other’s mission certification and recruited their friends and family to mission certification program. Mission certification via app increased adherence and maintenance of everyday exercise in diabetes. This intervention promoted habitual exercise and improved glycemic control. Future work is needed in more patients with diabetes for longer term.

Presentation: Saturday, June 17, 2023
Διαγράμματα ελέγχου για υποδείγματα διακριτών χρονολογικών σειρών
Authors: Αναστασοπούλου Μαρία
Published: October 2023

Η παρούσα διδακτορική διατριβή πραγματεύεται θέματα που αφορούν στην ανάπτυξη διαγραμμάτων ελέγχου με μνήμη για την παρακολούθηση διεργασιών, οι οποίες μοντελοποιούνται σύμφωνα με ένα μοντέλο χρονοσειρών με ακέραιες τιμές. Συγκεκριμένα, βασικό αντικείμενο της διατριβής αποτελεί η μελέτη και η ανάπτυξη διαγραμμάτων ελέγχου για την παρακολούθηση διεργασιών που προέρχονται από διαδικασίες BAR(1), BBAR(1) και BINARCH(1). Το πρώτο υπόδειγμα χρησιμοποιείται συχνά στην περιγραφή διωνυμικών δεδομένων (π.χ. αριθμός ελαττωματικών αντικειμένων) στα οποία υπάρχει συσχέτιση 1ης τάξης. Επιπλέον, τα μοντέλα BBAR(1) και BINARCH(1), αποτελούν γενίκευση του BAR(1) και είναι κατάλληλα σε περιπτώσεις που παρατηρείται σημαντική απόκλιση της μεταβλητότητας των δεδομένων από την αντίστοιχη του διωνυμικού μοντέλου. Και για τα τρία υποδείγματα δίνονται, εν συντομία, οι βασικές τους ιδιότητες και στη συνέχεια αναπτύσσονται κατάλληλα διαγράμματα ελέγχου για την παρακολούθηση των αντίστοιχων διεργασιών. Για την περίπτωση των διεργασιών τύπου BAR(1) προτείνονται και μελετώνται μονόπλευρα διαγράμματα ελέγχου τύπου EWMA. Παράλληλα, εξετάζεται η απόδοση των διαγραμμάτων ελέγχου τύπου DEWMA (double EWMA), τα οποία αποτελούν σύγχρονα διαγράμματα ελέγχου με μνήμη, με σκοπό να διαπιστωθεί αν και πόσο υπερτερούν έναντι του συνήθους διαγράμματος ελέγχου τύπου EWMA στην παρακολούθηση διεργασιών BAR(1). Στη συνέχεια, προτείνονται και μελετώνται μονόπλευρα διαγράμματα ελέγχου EWMA για την παρακολούθηση των διεργασιών τύπου BBAR(1). Επίσης, για την περίπτωση διεργασιών BINARCH(1), εξετάζονται μονόπλευρα διαγράμματα ελέγχου τύπου Shewhart, EWMA και CUSUM καθώς και δίπλευρα διαγράμματα ελέγχου τύπου Shewhart και EWMA. Εκτός από τον τρόπο λειτουργίας και εφαρμογής των παραπάνω διαγραμμάτων, παρουσιάζεται ο στατιστικός σχεδιασμός τους ενώ δίνονται και πρακτικές οδηγίες για την επιλογή των τιμών των παραμέτρων κάθε διαγράμματος. Για τον υπολογισμό της απόδοσης των προτεινόμενων διαγραμμάτων ελέγχου χρησιμοποιείται η τεχνική των Μαρκοβιανών αλυσίδων αλλά και η προσομοίωση Monte Carlo. Τέλος, πραγματοποιείται αριθμητική σύγκριση της απόδοσης των προτεινόμενων διαγραμμάτων ελέγχου, χωριστά για διεργασίες τύπου BAR(1), BBAR(1) και BINARCH(1) ενώ παρουσιάζονται και πρακτικές εφαρμογές αυτών σε πραγματικά δεδομένα και συγκεκριμένα σε προβλήματα στατιστικής παρακολούθησης από τις επιστημονικές περιοχές της επιδημιολογίας, των οικονομικών και της διαχείρισης δικτύων υπολογιστών.
Ο ήχος ως ερμηνευτικό μέσο στο μουσείο
Authors: Σαλμούκα Φωτεινή
Published: October 2023

Η σχέση του μουσείου με τον ήχο είναι πολυδιάστατη, καθώς ο ήχος είναι παρών στο περιβάλλον του μουσείου είτε ακούσια, μέσω των ανθρώπινων και ατμοσφαιρικών ήχων που συνθέτουν το μουσειακό ηχοτοπίο, είτε εκούσια, μέσω των έργων σύγχρονων καλλιτεχνικών πρακτικών και των ερμηνευτικών μέσων που εντάσσονται στην έκθεση. Οι απαρχές της σχέσης του μουσείου με τον ήχο εντοπίζονται ήδη από τη σύλληψη του μουσείου, σταδιακά, ωστόσο, περιορίστηκε η θεώρηση και η χρήση του ως μέσου εκτίμησης των πολιτισμικών αντικειμένων, όπως άλλωστε συνέβη με το σύνολο των αισθητηριακών ερεθισμάτων πλην των οπτικών. Στο πλαίσιο της βιωματικής προσέγγισης της μουσειακής επίσκεψης που υιοθετείται από τα σύγχρονα μουσεία ο ήχος εντάσσεται πλέον στις μουσειακές λειτουργίες ως έκθεμα, ως εκθεσιακό θέμα και ως ερμηνευτικό μέσο. Στην παρούσα διδακτορική διατριβή ερευνάται η σχέση του μουσείου με τον ήχο με σκοπό την επανεξέταση του ρόλου του ήχου στο περιβάλλον της έκθεσης για την παραγωγή νοήματος, γνώσης και εμπειρίας. Τα τρία πλαίσια μελέτης του ήχου στις μουσειακές εκθέσεις που προτείνονται, μπορούν να αξιοποιηθούν από τους επαγγελματίες των μουσείων για την οργανική ένταξη του ήχου στο εκθεσιακό περιβάλλον. Το πρώτο πλαίσιο βασίζεται στον ρόλο που επιτελεί ο ήχος σε μια έκθεση και εισάγει μια τυπολογία ηχητικών πρακτικών βάσει των τριών ρόλων που αναγνωρίζονται: πληροφοριακός, ερμηνευτικός και εμβυθιστικός. Το δεύτερο πλαίσιο αναγνωρίζει και αναλύει τρεις προσεγγίσεις που εντοπίζονται στη χρήση του ήχου ως ερμηνευτικού μέσου: θεσμική, εννοιολογική και ανεξάρτητη. Το τρίτο πλαίσιο αξιοποιεί το σημειωτικό μοντέλο του Charles Sanders Peirce για την ανάλυση βασικών ήχων που εντάσσονται στις εκθέσεις. Η μελέτη της σχέσης ήχου και ερμηνείας ολοκληρώνεται με την ανάλυση οχτώ αξόνων βάσει των οποίων ο ήχος μπορεί να αναπλαισιώσει τη μουσειακή έκθεση. Οι εν λόγω άξονες προτείνονται ως συμπεράσματα-προτάσεις της παρούσας διατριβής σε σχέση με τη χρήση του ήχου ως ερμηνευτικού μέσου στο μουσείο με σκοπό την καλλιέργεια μιας νέας ηχητικής μουσειακής κουλτούρας.
Development of green nanobiocatalytic systems for the synthesis of phenolipids as new food additives
Authors: Φωτιάδου Παρθένα
Published: October 2023

Η παρούσα διδακτορική διατριβή επικεντρώνεται στην ανάπτυξη πράσινων και επαναχρησιμοποιήσιμων νανοβιοκαταλυτικών συστημάτων (δηλαδή ενζύμων ακινητοποιημένων σε καινοτόμα νανοϋλικά-νανοδομές) και στον δομικό και βιοχημικό τους χαρακτηρισμό. Αυτά τα συστήματα με καταλυτική δραστικότητα λιπάσης θα μπορούσαν να εφαρμοστούν αποτελεσματικά στην ενζυμική εστεροποίηση/μετεστεροποίηση φαινολικών ενώσεων με τη χρήση διαφορετικών άκυλο-δοτών. Το κύριο αντικείμενο είναι η προετοιμασία λιπόφιλων παραγώγων φυσικών αντιοξειδωτικών ως νέα συντηρητικά τροφίμων με έμφαση στην παράταση του χρόνου ζωής των φυτικών ελαίων.
Frequency of nursing student medication errors: A systematic review
Authors: Triantafyllou Christos , Gamvrouli Maria , Myrianthefs Pavlos
Published: October 2023

Background: Health promotion and patient safety are the main targets of the healthcare provision by the National Health Systems. As for the nursing profession, nursing students make medication errors during clinical interventions, which could be a potential danger to patient safety. The investigation of the frequency of nursing student medication errors, as well as the frequency of each type of nursing student medication errors.
Method and Material: A systematic review of the literature was conducted on the electronic database "PubMed" with the keywords: "medication error", "prescribing error", "drug error", "drug use error", "drug mistake", "wrong drug", "wrong dose", "administration error", "dispensing error", "incorrect drug", "incorrect dose", "inappropriate prescribing", "inappropriate medication", "transcription error", "nursing student", "nursing trainee" and on the Greek electronic database IATROTEK-online with the keywords: "medication errors" and "nursing students", without time limit for the publication of scientific papers. On PubMed, the keywords were searched in the title and abstract of the studies. Studies were excluded if they were not published in English and Greek language, were conducted on animals, and were case studies, editorials, and letters to the editor. 
Results: Of the 47 scientific papers retrieved, 6 were included in the systematic review. A total of 1,904 nursing student medication errors were recorded by nursing students. The majority of errors were: 1) wrong dose form (330,17%), 2) omission error (313, 16.4%), and 3) wrong time (259, 13.6%).
Conclusions: The frequency of nursing student medication errors is high. The safe administration of medications is an important skill that nursing students should learn. medication administration.
High-vs medium-frequency neuromuscular electrical stimulation protocols on muscle mass in Intensive Care Unit patients, a pilot study
Authors: Georgopoulos Christos , Katsogianni Aikaterini , Patsaki Eirini , Sidiras Georgios , Vasileiadis Ioannis , Magira Eleni , Nanas Serafim , Karatzanos Lefteris
Published: October 2023

Aim: The aim of the present study was to investigate whether a high-frequency (HF) neuromuscular electrical stimulation (NMES) protocol could result in a smaller loss of muscle mass than a moderate-frequency (MF) protocol in ICU patients.
Methods and materials: In this randomized pilot control trial, patients of the two intervention groups followed daily NMES sessions from the day of ICU admission until the tenth day. All study groups received physiotherapy in terms of usual care. Muscle layer thickness was assessed with ultrasound in the vastusintermedius (VI) and rectus femoris (RF) muscle to evaluate changes in muscle mass.
Results: Totally 58 patients were allocated into three groups and 29 were finally analyzed (control: 10, MF: 12, HF: 7). Significant differences (p=0.05) between control and pooled NMES groups were observed for the right RF and VI. Significant differences in favor of HF vs MF group were observed for the left RF (3.6±15.3 vs 7.2±7.9% respectively, p=0.04). No differences were found regarding the number of sessions and presence of oedema (p>0.05), while strength of contraction during sessions tended to be somewhat higher in the HF (p=0.09).
Conclusion: HF may be more effective than MF to prevent muscle mass loss in ICU patients. More studies are needed to determine the optimal NMES characteristics.
Comprehensive program development for congenital heart disease in the United Arab Emirates and in Singapore
Authors: Kiraly Laszlo , Aye Maung Maung Winn , Subbian Senthil Kumar , Shah Nishant Chandrakant , Hetharsi Balazs , Al Hakami Aref Mohammed , Kofidis Theo
Published: October 2023

Background/Objective. Establishment and development of tertiary-care centres for congenital heart disease (CHD) face multiple challenges as they need to be accessible, affordable/sustainable and provide the best possible outcomes. We report our experience of foundation a new tertiary-care CHD centre in the United Arab Emirates (UAE) and program development in Singapore.

Methods. Prevalence and incidence of CHD in the context of local sociocultural environment was reviewed. Having established program elements of team, premises and workflow, quality assurance system was established. Outcome analysis, continuous audit modified internal therapeutic policies in accordance to international databases.

Results. Consanguinity, segregated pattern of the population, high birth rate and low prenatal screening rate increased the incidence/prevalence and complexity of CHD in the UAE. Higher complexity/redo presentation and presence of associated anomalies were prevalent in Singapore at a lower birth rate. Increasing patient-load, strict professional working environment, strong governmental financial mandate for care nominated our centre into a market-leading position in the UAE. Singapore has a highly-developed, regulated, still competitive healthcare infrastructure that represents challenges for program development. Additional surgical activity from underserviced regions could provide the adequate CHD patient-pool that is critical to achieve team-expertise and ensure the best possible patient and program outcomes.

Conclusion. CHD has significant public health aspects, however, new and/or developing centres face different challenges depending on the sociocultural and economic environment they function in. External demographic factors, case-load, complexity, referral patterns, health-care financing structure are difficult to adjust; internal factors: program structure, quality assurance, professional working framework are subjects for improvement.
A study protocol for clinico-pathological diagnosis of hematological malignancies in a tertiary care hospital in central India
Authors: Chatterjee Priya , Hiwale Kishore , Vagha Sunita , Hingway Snehlata
Published: October 2023

There is a paucity of a relevant national registry or any individual center study on clinico-pathological profiles of acute/chronic leukemias and multiple myeloma from central India. The proposed observational, prospective, longitudinal study in a rural tertiary center hospital in central India therefore intends to combine diagnostic techniques like peripheral blood smears, immunophenotyping via flow cytometry, bone marrow aspiration, and cytogenetic studies along with World Health Organisation and French-American-British classification for sub-typing, to accurately diagnose acute/chronic leukaemia and multiple myeloma. A total of 55 patients with any clinical suspicion of leukaemia and myeloma will be followed-up for a one-year period post diagnosis to ascertain if the patient is in complete or partial remission, or in a relapsed disease state. Furthermore, these diagnostic techniques will be compared in terms of their effectiveness and if these could substitute or complement each other keeping the limitations of Indian health settings in mind.
Case Report: Duodenal perforation complicated by psoas muscle collection and spondylodiscitis successfully managed without surgery - An unusual case of a toothpick ingestion
Authors: Belhadj Anis , Touati Med Dheker , Khefacha Fahd , HAMZA Sahar , OMRY Ahmed , BEN OTHMENE Mohamed Raouf , BELHAJ AMMAR Leila , Saidani Ahmed , KALLEL Lamia , Chebbi Faouzi
Published: October 2023

Perforation of the intestine caused by an ingested foreign object remains a complex challenge in terms of clinical presentation, diagnosis, and treatment. A 55-year-old man presented with complaints of right-sided abdominal pain and functional impairment of the lower limbs. Physical examination revealed an afebrile status and tenderness in the right upper quadrant of the abdomen. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a duodenal perforation caused by a densely linear foreign body. Additionally, a collection in the psoas muscle and contiguous spondylodiscitis were identified. To address this condition, an endoscopic procedure was performed to extract the toothpick successfully, and a CT-guided fine-needle aspiration was conducted to collect the fluid. Spondylodiscitis was managed with antibiotic therapy and immobilization. Remarkably, significant clinical and radiological improvement was observed within a span of three weeks. This case emphasizes the importance of multidisciplinary care involving interventional treatments as a viable and safe alternative to surgical intervention.
Development of a communication book for children with cerebral palsy and communication disorders using the partner assisted scanning method: A pilot study
Authors:   Communication Disorders, Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai Province, Thailand, Pappring Worakanok , Chinchai Supaporn ,   Communication Disorders, Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai Province, Thailand
Published: October 2023

Background: Cerebral Palsy (CP) is a physical disability impacting movement, posture, and communication. For children with CP and severe communication challenges, methods like Partner Assisted Scanning (PAS) are invaluable. Despite its effectiveness, research on PAS in the context of Thailand is scarce. Objectives: This study aimed to develop and validate a communication book and related materials for children with CP, utilizing the PAS method. Additionally, the study aimed to analyze communication partners’ satisfaction levels with the communication book. Materials and methods: The study involved two phases. First, four instruments were developed and assessed for content validity: The communication Abilities Assessment, the Communication Partners’ Satisfaction Survey, the Communication Book Manual, and the Communication Book. In the second phase, these instruments were tested with three families, evaluating partner satisfaction and addressing encountered issues. Results: The study demonstrated high content validity of the communication book (overall validity index=0.97) as assessed by specialists. Feedback highlighted concerns about the book’s format and the time needed for children to grasp its usage. However, communication partners expressed overall high satisfaction (mean=4.67, SD=0.49). Conclusion: This pilot study establishes the robust content validity of the communication book developed using the PAS method. Moreover, it underscores high satisfaction levels among communication partners, affirming the potential of the communication book to enhance communication skills in children with CP.
Identity And Performance Among Filipino Nurses In The United States
Authors: Felizardo Carlo
Published: October 2023

Abstract: How do Filipino American nurses manage and express ethnic and professional identities in the USA? I propose that settings, audiences, and philosophies on Filipino and American identities influence their decisions. Settings and audiences bring different constraints and stakes; philosophies determine whether migrants default to preserving or avoiding Filipino identity. I analyze interviews with eighteen first-generation Filipino nurses regarding such decisions. The prevailing determinant of preservation or eschewal is whether they view Filipino identity to be compatible with a model of American identity as “cultureless” or “postcultural.” These views may also be related to subjective evaluations of Filipino culture as a whole.
Korean Chronicles Under a Macroscope: Towards a Digital Infrastructure in Premodern Korean Studies
Authors: Kang Hyeok Hweon , Suh Michelle
Published: October 2023

Abstract: Starting in the 1990s, digital humanists have endeavored to create the "macroscope," a holistic research environment that allows for a flexible, multiscalar reading of large text corpora. Many macroscopes have since emerged, from fields as diverse as Danish folklore studies, English literary studies, and Chinese biographical studies. But in creating Silloker, we are the first to offer a "historian's macroscope" for premodern Korean chronicles. Silloker is a digital platform that opens creative avenues into studying Korea's Chosŏn dynasty (1392–1910). Its title takes after Chosŏn wangjo sillok ("Veritable Records of the Chosŏn Dynasty" 朝鮮王朝實錄), court annals that cover five centuries and topics as varied as diplomacy, economy, religion, quotidian life, and natural phenomena. For this archive and others—for example, Diaries of the Royal Secretariat 承政院日記 ( Sŭngjŏngwŏn ilgi ), Records of the Border Defense Council 備邊司謄錄 ( Pibyŏnsa tŭngnok )—our platform features new search capacities and tools for exploratory data analysis. First, it allows users to make unified queries across multiple archives and download the search results. Second, it offers a tool for aggregating and graphing the frequency of search hits throughout the five-centuries long dynasty, generating real-time results in table and graph. This essay introduces Silloker, its functionalities, and data architecture. It then provides an example case study of the Little Ice Age in Korea to demonstrate the platform's utility for historical research.
Stability in Variation: Visualizing the Actantial Core of The Journey to the West ,
Authors: Wall Barbara , Lee Dong Myong
Published: October 2023

Abstract: The urge to find the authentic original of a story seems to be a universal longing. Recently, narratologists like Barbara Herrnstein Smith, as well as experts for East Asian literatures like Michael Emmerich or Lena Henningsen, draw our attention away from the original—which is often unknowable—and instead towards the variants of a story. While this suggestion brings a breath of fresh air to the field of narrative studies, it also poses a fundamental problem. If a story does not necessarily exist as a static original, but is comprised of many variants, how should we then imagine the story itself? This paper proposes imagining the story not as a separate static unit, but rather as a story cloud that includes all variants and changes its form when new variants join, or old variants fall into oblivion. Just as it is much easier to take a picture of a static object than of a moving one, it is much easier to imagine a static text than a text in motion. The main aim of this paper is therefore to find ways to make story clouds more graspable through visualizations. Specifically, for this endeavor we will focus on one of the most popular story clouds in East Asia, The Journey to the West . Methodologically, we draw on the actant-relationship model that the computational folklorist Tim Tangherlini has developed in the article "Toward a Generative Model of Legend: Pizzas, Bridges, Vaccines, and Witches." We will apply Tangherlini's model to variants of The Journey to the West and use the data to visualize the story cloud, especially its actantial core.
Intertextual Du Fu: A Study of Citation Network Analysis
Authors: Yoo Jamie Jungmin , Sung Kiho , Lee Changhee
Published: October 2023

Abstract: How does a reader give a text meaning? In what ways do we understand the operations of encounters between a text and a reader? Focusing on the materiality of reading, this study aims to understand how anonymous readers in late Chosŏn Korea read the poetry of Du Fu, a renowned literary canon from China. To identify the meaning of the texts as constituted by the readers, we look at both the texts and the readers' practices by identifying the readers' prior knowledge of the text that has been embedded and coded in their reading notes, and by analyzing the relationship between the notes and the main body of poetry. Through this analysis, this paper shows that the reading of texts was performed through constant interactions with interpretive traditions and cultural legacies. Through their practices of reading, consequently, they reveal which communities of interpretation they distinctively belong to. To identify the invisible patterns of the exegetical traditions in their reading practices, we particularly apply methods in digital humanities, such as citation network analysis, which is an effective tool to recognize the structure of relationships among the notes, poems, and many other factors of the texts.
From Claw Crane to Toy Crane: Catching, Courting, and Gambling in South Korea
Authors: Karhulahti Veli-Matti , Heljakka Katriina , Jo Dongwon
Published: October 2023

Abstract: The claw crane—an arcade game that invites its players to remotely grab a prize with a "claw"—has undergone a long process of development from an eye-catching "steam shovel" to a calculated gambling machine across amusement arcades, train stations, and traveling carnivals. Recently, the claw crane has become a common transmedia object in various consumer outlets around the world, serving today's "kidults" who are willing to play and be playful with toys as grownups. Especially in South Korea, the claw crane now rewards its players with cutified character plushies, which arguably reflects and resonates with the local sociocultural conventions. In this mixed-methods study, we deconstruct the claw crane as a historical artifact that promotes diverse forms of human interaction and engagement in the techno-cultural and social context of South Korea. The claw crane (or in South Korea, rather the "toy crane") is investigated by means of historical design analysis, a review of contemporary South Korean media texts, and field observations in Seoul. We suggest the claw crane to serve as a multipurpose medium for playful interactions beyond the act of play itself—and in South Korea, having become a means for playful courting and emotional support, which at times of anxiety, stress, and uncertainty may contribute to one's confidence and belief in the future.
Ruminations on the Global Reach of the Tahoe Crayfish
Authors: Strekal Edan
Published: October 2023

Abstract: In the spring of 1993 the opening of Pure Pleasure Book Store in Mesquite, Nevada, met with protests from many of the citizens of Virgin Valley in southeast Nevada. The conservative and church-going community rallied around members of the Church of Jesus Christ of Latter-day Saints (the Mormons) who objected to what they saw as an affront to the moral standards of the community and the dangers that pornography presented to children and families. The Mesquite Chamber of Commerce formed an organization with the acronym HOME, Help Our Moral Environment, to fight for the closure of the bookstore. HOME attracted support from the citizens of the valley and neighboring communities in Utah who volunteered to serve on picket lines near the store with signs denouncing pornography. Store owners asserted their right to free speech and kept the doors open while challenging a zoning ordinance in the courts that was passed by the City of Mesquite which prohibited such businesses. As the courts deliberated, picketing continued for twenty-four hours a day, seven days a week, for two and a half years. On March 27, 1996, in Las Vegas Federal District Court, Judge Phillip Pro ruled in favor of the City of Mesquite to close the offending business under the authority of its zoning ordinance.