bluuebunny/crossref_metadata_2025 huggingface dataset:
Penggunaan model RASCH untuk soal perkalian bilangan cacah Siswa Sekolah Dasar
Authors: Apriani Ika Fitri , Islamiati Ginna , Putri Irni Rachmawati , Susilawati Lilis , Wahid Muharram Muhammad Rijal , Nur'aeni Epon
Published: June 2023

Penelitian ini bertujuan untuk memperoleh gambaran kemampuan operasi hitung siswa pada konsep perkalian bilangan cacah dengan menggunakan pemodelan RASCH. Melalui pemodelan RASCH ini dapat memberikan gambaran kepada guru tentang kemampuan siswa dalam menjawab soal. Dengan menggunakan model RASCH dapat mengetahui siswa yang menjawab soal dengan cara teknik menebak jawaban. Jika siswa yang memiliki kemampuan kompetensi rendah tetapi tebakannya benar pada soal pilihan ganda ini dapat menyulitkan guru dalam mengukur kemampuan siswa dalam operasi hitung perkalian bilangan cacah. Dengan menggunakan RASCH model ini guru dapat meninjau kembali jawaban siswa sehingga penggunaan model RASCH ini dapat memberikan gambaran kemampuan siswa dengan tepat.Â  Penelitian ini dikategorikan sebagai penelitian deskriptif dengan tujuan untuk mendeskripsikan kemampuan pemahaman konsep perkalian bilangan cacah pada pembelajaran matematika di sekolah dasar. Subjek pada penelitian ini yakni 24 siswa kelas II SD di salah satu SD swasta di Kecamatan Tawang Kota Tasikmalaya. Teknik analisis data yang digunakan pada penelitian ini yakni melalui instrumen lembar tes berisikan soal yang berkaitan dengan materi konsep perkalian bilangan cacah. Hasil data yang diperoleh ditabulasikan melalui pemodelan RASCH mencakup (a) analisis peta WRIGHT (b) analisis kesesuaian butir soal (c) analisis abilitas siswa (d) analisis scalogram dan (e) analisis reliabilitas. Sistem penilaian menggunakan skala Guttman. Hasil penelitian menunjukan bahwasannya terdapat sebagian siswa masih mengalami miskonsepsi terhadap konsep perkalian bilangan cacah. Indikasi ini terlihat dari tingkat respon siswa terhadap soal kurang ideal. Hal ini menandakan bahwasannya masih banyaknya miskonsepsi siswa terhadap materi konsep perkalian bilangan cacah pada pembelajaran matematika.Kata Kunci: pembelajaran matematika, konsep perkalian, bilangan cacah.
Implementasi senam ceria dalam pembelajaran PJOK untuk meningkatkan kecerdasan kinestetik pada Siswa Sekolah Dasar
Authors: Prasetio Pajar Anugrah , Acesta Arrofa , Damayanti Dian , Nugraha Febby Fajar
Published: June 2023

This research is motivated by the low ability to kinesthetic intelligence in students, because students are not confident, low cognitive skills and active and creative thinking patterns are still low. Considering how important kinesthetic intelligence is in elementary school students. This researcher aims to Â describes the implementation of cheerful gymnastics to improve kinesthetic intelligence in students. This research method used is pre-eksperimental with a design one group pretest posttest design with a class IV of 12 students. Collecting data used in this study was a test instrument work method. Based on the results of the average score of students in the pretest, which was 55,5 and the average score of the posttest, which was 81,75 it showed that the average score of the student was different, including the average score of the pretest before being given treatment and the average score of the posttest after being given treatment. This is proven through the t test stating that the calculation (10,39) > ttabelÂ  (2,074) at a significant level of 5% then HO is rejected and H1 is accepted. And for the N-gain score test (0,6) the percent N-gain (60%) is in the medium category. Thus, it can be concluded that there an cheerful gymnastics is effective in increasing kinesthetic intelligence in grade IV students in SD Negeri 11 Kuningan.
Pengaruh model pembelajaran TGT (team games tournament) terhadap kemampuan berpikir kritis siswa kelas IV pada mata pelajaran PPKn materi keragaman sosial dan budaya di SDN Jatiranggon II
Authors: Anwai Rizqi Muhammad Dwi , Mulyawati Ima
Published: June 2023

Penelitin ini bertujuan untuk mengetahui adanya pengaruh dari penerapan model pembelajaran Team Games Tournament ( TGT ) terhadap kemampuan berpikir kritis siswa kelas IV pada mata pelajaran PPKn materi keragaman sosial dan budaya di SDN Jatiranggon II. Metode penelitian yang digunakan yaitu desain menggunakan Quasi Eksperimen. Pengumpulan data dilakukan melalui pre-test dan post-test melalui pendekatan kuantitatif. Subjek dalam penelitian ini adalah peserta didik kelas IV SDN Jatiranggon II, dengan jumlah siswa sebanyak 60 orang. Instrumen yang digunakan adalah memberikan pretest dan posttest lebar penilaian diri peserta didik. Teknik analisis data yang digunakan yaitu analisis data kuantitatif deskripstif dengan perhitungan uji beda atau uji paired simple t-test. Berdasarkan hasil perhitungan menggunakan analisis variasi dua jalan, dengan taraf signifikan 0,05, diperoleh nilai yang sig (0,036), dimana 0,036 < 0,05. Hal ini menunjukkan bahwa model TGT memberikan hasil belajar yang baik, kemudian diperoleh nilai yang sig (0,001), dimana 0,001 < 0,05; sehingga disimpulkan bahwa self confidence tinggi, sedang dan rendah berpengaruh terhadap hasil belajar, serta diperoleh nilai sig (0,728), dimana 0,728 > 0,05; sehingga tidak terdapat interaksi antara model pembelajaran terhadap hasil belajar. Dapat disimpulkan bahwa, model Times Games Tournaments (TGT) berpengaruh terhadap hasil belajar, sedang maupun rendah dan tidak ada interaksi antara model pembelajaran terhadap hasil belajar dan model TGT lebih baik dalam kemampuan berpikir kritis.Â
Validation of the first risk stratification based penicillin delabeling program outside an allergy clinic in Norway
Authors: Alnæs Marie , Oppegaard Oddvar , Kittang Bård Reiakvam , Lygre Stein Håkon Låstad , Langeland Anine Bernhoft , Skodvin Brita , Bjånes Tormod , Storaas Torgeir
Published: June 2023

Background: Penicillin allergy is self-reported by 3-10% of
patients admitted to hospital. The label is wrong in 90% of the cases
and has severe health implications. Penicillin-delabeling can reverse
the negative effects of the label, and pathways adapted to local
practice are needed. No tools are available in Norway for penicillin
delabeling outside an allergy clinic. Methods: An
interdisciplinary taskforce created a penicillin allergy delabeling
program (PAD) adapted to the Norwegian health care system. This was
validated in a prospective, single-centre study. Very low-risk and
low-risk patients underwent a direct oral penicillin challenge and
high-risk patients were referred for allergologic evaluation.
Results: 149 patients declaring penicillin allergy were
included. Seventy-four (50%) were very-low- and low risk patients
suitable for a direct oral penicillin challenge resulting in only one
mild reaction. 60 high-risk patients were eligible for an oral
penicillin challenge after allergologic evaluation, three patients
reacted non-severely. Conclusion: We have demonstrated
excellent repeatability and feasibility of the first PAD applicable in a
hospital setting outside an allergy clinic in Norway. Our data suggests
this is safe and beneficial, with 49% patients delabeled through a
direct oral penicillin challenge, performed without any serious adverse
events, and an overall 87% delabeling rate.
Deep Learning for Personalized Health Monitoring and Prediction: A Review
Authors: S Rajesh Kandala N V P , Damaševicˇius Robertas , Jagatheesaperumal Senthil Kumar , Hussain Sadiq , Alizadehsani Roohallah , Gorriz Jua
Published: June 2023

Personalized health monitoring and prediction have become essential for
improving health- care delivery, especially with the growing prevalence
of chronic diseases and an aging population. Deep learning (DL) has
emerged as a promising approach for developing personalized health mon-
itoring systems that can predict health outcomes accurately and
efficiently. With the increasing availability of personal health data,
DL-based methods have emerged as a promising approach to improve
healthcare delivery by providing accurate and timely predictions of
health outcomes. This article provides a comprehensive review of the
recent developments in the application of DL for personalized health
monitoring and prediction. It summarizes various DL architectures and
their applications for personalized health monitoring, including
wearable devices, electronic health records, and social media data.
Furthermore, the article also explores the challenges and future
directions for the application of DL in personalized health monitoring.
valuable insights into the potential of DL for personalized health
monitoring and prediction.
Waterbird community responses to anthropogenic land cover at multiple spatial scales along the Nile in Egypt
Authors: Mossad Haitham , Hof Anouschka , Snijders Lysanne , Naguib Marc , Boer Willem de
Published: June 2023

The human population is growing rapidly, increasing pressure on natural
habitats. Suitable habitats for resident and migratory waterbirds are,
therefore, more threatened. This study analyses how the presence of
anthropogenic land cover (urban area and cropland) on multiple spatial
scales affects the community composition of waterbirds along the Nile in
Egypt. We analysed data collected during the international waterbird
census, 2017-2018, combined with data from satellite images on land
cover at a multi-spatial scale. The census covered 970 km, compromising
194 shoreline transects of 5 km along the River Nile, Egypt. The area
includes a broad gradient of human disturbance, making this dataset
ideal for assessing effects of anthropogenic land cover on waterbird
community composition. We tested whether the waterbird community indices
and guild composition were associated with urban area and cropland, and
other land covers (e.g., grassland, wetland) at spatial scales of 100,
500, 1,000 and 5,000 m. We recorded over 96,000 waterbirds and show that
landscape characteristics at larger spatial scales (5,000 m) explained
more of the species and guilds’ presence than smaller scales. Species
richness increased with increasing water surface area of the river
within the transect and decreased with increasing urban area and
cropland. Waders were negatively associated with urban area. Overall,
the guilds’ composition was poorly predicted by anthropogenic land cover
and other landscape compositions, probably because species within a
guild do not react similarly to increasing human disturbance. The
probability of observing red-listed species decreased with increasing
urban area. With this study, we expand on the existing evidence by
showing that species richness negatively correlates with anthropogenic
pressure, and we highlight the importance of studying the responses of
species rather than guilds. Our study shows the relevance of considering
the landscape at larger scales while planning for conservation measures,
especially in such human-dominated landscapes.
De novo design of anti-variant COVID-19 Vaccine
Authors: Goswami Arpita , Kumar S. Madan , Ullah Samee , Gore Milind
Published: June 2023

Recent studies have demonstrated the effectiveness of hybrid SARS-CoV-2
vaccines that combine the wild-type nucleocapsid (N) and Spike (S)
proteins. Based on this strategy, we have further enhanced the idea by
incorporating the spike protein with mutations from delta and post-delta
omicron variants of concern (VOC). Both delta and omicron mark the
transition of vaccine driven viral immunity and resistance, so their
mutations are highly crucial for future viral variants also.
Additionally, we have included certain nucleocapsid peptides, which have
clinically shown superior T-cell immunity being similar to homologous
sequences from other Human Coronaviruses (HuCoV). We have also carefully
selected an envelope peptide that elicits strong T-cell immune response.
These peptides are clustered in the hybrid spike’s cytoplasmic region
with non-immunogenic helical linkers, enabling systematic arrangement.
Through AlphaFold analysis, we have determined that the resulting domain
folds more efficiently when the construct lacks the transmembrane
domain. The AlphaFold designs were validated using the molecular
dynamics (MD) simulations and assessed various parameters of root mean
square deviation (RMSD), root mean square fluctuation (RMSF), radius of
gyration (Rg) and weighed the structural stability and conformational
dynamics. Interestingly, the dynamics revealed more insights into the
conformational changes in the structure overtime, more flexibility in
the C-terminus region, and overall compactness of the structures in a
time-based gradient indicating less fluctuation and transition in terms
of structure mobility and maintained a relatively compact fold
conformation throughout the simulation. Our proposed approach may
provide option for incorporating diverse anti-viral T-cell peptides,
similar to HuCoV, into linker regions, offering a versatile solution to
address outbreaks and challenges posed by various viruses, thereby
enabling effective management through multiepitope strategies in this
era of innovative vaccines.
Comparing biofilm reactors inoculated with Shewanella for decolorization of Reactive Black 5 using different carrier materials
Authors: Zheng Yumin , Song Haihong , Chen Qianfei , Hou Yayi , Zhang Xinxin
Published: June 2023

This study evaluated the performance of biofilm reactors inoculated with
azo dye degrading Shewanella for the decolorization of Reactive
Black 5 (RB5), using three different carrier materials, namely almond
shell biochar, moving bed biofilm reactor (MBBR), and polypropylene
carrier (PPC). The reactors were fed with low-nutrient artificial
wastewater containing RB5 for a long term, and all three carriers showed
good RB5 decolorization performance, with varying efficiencies. LC-MS
analysis revealed significant differences in the degradation pathways of
RB5 among the carriers, indicating the role of carrier materials and
microbial communities. The MBBR carrier exhibited good stability due to
its rough surface and microbial aggregates. Sequencing results revealed
significant differences in the microbial community structure among the
carriers. Shewanella was the dominant functional bacteria in the
MBBR and PPC carriers, while highly efficient degrading microbial
communities were observed on the biochar carrier. Overall, the
physicochemical properties of the carrier materials had a significant
impact on the microbial community in the reactor, which affected the
degradation efficiency of RB5. These findings provide valuable insights
into the optimization of biofilm reactors for dye-containing wastewater
treatment.
Multi-Objective Distributionally Robust Optimal Scheduling of Park-Level Integrated Energy System
Authors: Chenjian Zhang , Botao Jiang , Shilin Lv , Xifei Xie , Bao Z. , Yu Miao
Published: June 2023

In order to reduce operational costs and improve energy utilization
efficiency of the park-level integrated energy system (IES), a
multi-objective distributionally robust scheduling optimization approach
is proposed. The objective functions aim to minimize operating costs and
maximize comprehensive energy efficiency. To address uncertainties
related to wind and photovoltaic power generation, the Wasserstein
metric-based distributionally robust optimization method is employed.
The strong duality theory and reformulation-linearization technique are
utilized to linearize the non-convex model of distributionally robust
optimization. To obtain the Pareto frontier set effectively, the NNC
(normalized normal constraint) method is employed to transform the
multi-objective optimization problem into a single-objective
optimization problem. The compromise solution within the Pareto solution
set is then determined using the fuzzy membership function. The case
study analysis demonstrates that the obtained Pareto frontier set is
well-distributed, and compared with robust optimization and stochastic
optimization approaches, the proposed approach can effectively balance
optimism and conservativeness.
IVMD-based identification for broad-band oscillation subjected to noise
Authors: Ma Yanfeng , Zheng Haoyang , Yang Yongchun , Lin Hui , Zhao Shuqiang , Wang Yijing , Zhang Xinyu
Published: June 2023

The rapid increase in the proportion of new energy sources causes great
changes in the structure and stability characteristics of the system,
and a new type of oscillation appears with multi-mode and broad-band
characteristics. In order to predict, locate and suppress broad-band
oscillation, it is necessary to identify the mode parameters of
broad-band oscillation signals accurately and quickly. First, Both low
noise and high noise signals are simultaneously decomposed by VMD, a
criterion based on permutation entropy (PE) is used to distinguish
between high and low noise signals. Then, improved variational mode
decomposition (IVMD) is used to efficiently denoise high noise signals.
Finally, hilbert transform (HT) is used to identify decomposed modes,
and short-time fourier transform (STFT) provides time-frequency
characteristics to help restore oscillations. The simulation and actual
oscillation data verify that both obvious oscillation signals with low
noise and ambient signals with high noise are effectively identified,
and results reveal that the proposed method outperforms the other
similar methods in accuracy and time of use.
Programas específicos de inserção de estudantes imigrantes na UFFS
Authors: Peron Lucelia , Cella Rosenei , De Avila Farias Bordignon Sandra
Published: June 2023

Este texto é um estudo descritivo e exploratório que aborda a configuração e integração de estudantes imigrantes, mais especificamente os imigrantes haitianos, como política institucional de acesso e permanência ofertada pela Universidade Federal da Fronteira Sul (UFFS). É relatada a experiência da instituição com os Programas Prohaiti e Pró-Imigrante. Os registros se baseiam em documentos institucionais, produções acadêmicas e relatos de experiências desses estudantes. Como resultados, observa-se que eles demonstram uma satisfação muito grande por estarem na universidade; porém, enfrentam muitos desafios provenientes tanto de questões culturais quanto de limitações decorrentes da sua condição econômica e social. Destaca-se que esses estudantes têm superado as inúmeras situações difíceis que vivenciam no dia a dia ao buscarem a educação superior.
museus como figurações sociais e redes de interdependências
Authors: Micali Taiane Vanessa da Silva , Honorato Tony
Published: June 2023

Busca-se, com este artigo, analisar a história dos museus, entre os séculos XVIII e XX, a fim de compreendê-los como figurações sociais e redes de interdependências. O viés teórico-metodológico se pauta em historicizar a trajetória das instituições museológicas e sua relação com as mudanças que ocorreram nos comportamentos dos indivíduos e nas estruturas das sociedades, em um processo de longa duração, com base na teoria de Norbert Elias. Os resultados apontam que os museus possuem um universo simbólico que estimula e, ao mesmo tempo, se forja a partir de tensões e interdependências dos indivíduos. Assim, compreende-se que, até meados do século XX, os museus priorizavam memórias unívocas. Posteriormente, as demandas de diversos grupos sociais contribuíram para com a valorização de múltiplas memórias. Além disso, percebe-se que as missões dos museus transcendem as exposições de acervos e coleções, pois estas instituições são vetores de produções científicas e documentais.
1000-P: The Economic Impact of Reducing Hospitalizations and Amputations in Patients with Diabetic Foot Ulcers
Authors: GAROUFALIS MATTHEW G.
Published: June 2023

The purpose of this real-word evidence (RWE) cohort study was to evaluate whether utilization of Cyclical Pressurized Topical Oxygen (TWO2) therapy had any impact on the incidence of Diabetic Foot Ulcer related hospitalizations and amputations over a 12-month period in patients with hard to heal Diabetic foot Ulcers (DFU). An IRB approved retrospective review of deidentified DFU patient medical records was conducted at 2 US Veterans Affairs Medical Centers in Illinois and Virginia, which included demographic information on wound characteristics, clinical characteristics, neuropathy, cardiovascular disease (CVD), peripheral vascular disease (PVD), pain levels and kidney disease etc. Within the unmatched cohorts of the 202 DFU patients (91 TWO2, 111 NO TWO2)there was an 88% reduction in hospitalizations and a 71% reduction in amputations over a 12-month period for the patients treated with TWO2 therapy compared to those that did not receive TWO2 therapy. Propensity score matching was conducted showing similar outcomes and a regression analysis as preformed along with a budget impact model which demonstrated significant cost saving to the payor system. This large RWE study demonstrates the TWO2 therapy positively impacts patients quality of life and the costs associated with treating their DFU by forcing them into remission, resulting in significantly reduced rates of hospitalizations, amputations and cost outlay.

Disclosure

M.G.Garoufalis: Consultant; Uluru, Employee; AOT Inc., Speaker's Bureau; 3M/KCI, Horizon Therapeutics plc.
1002-P: Health Care Utilization among Telehealth Users and Nonusers with Diabetes during the COVID-19 Pandemic—Results from National Medicare Claims
Authors: SHAO YIXUE , WANG YU , ZHOU XILIN , ROLKA DEBORAH B. , ZHANG PING
Published: June 2023

Little is known on differences in healthcare utilization between telehealth users (USER) and non-users (NON-USER) in persons with diabetes mellitus (DM) during the COVID-19 pandemic. We compared healthcare utilization of USER to that of NON-USER in Medicare beneficiaries with DM who enrolled in fee-for-service plans, using 100% Medicare claims database. The USER included persons who used any telehealth services during 03/2020-06/2020. We used nearest neighbor propensity score matching to construct a NON-USER group, who did not use any telehealth services during the pandemic (03/2020-06/2021), based on demographic, healthcare utilization, and comorbidity variables measured at baseline (03/2019-02/2020). We used linear regression to compare healthcare utilization during the later pandemic period (07/2020-06/2021) between USER and NON-USER groups, controlling for baseline characteristics. Utilization was measured as per person use of each type of healthcare services in 12 months. We also performed a subgroup analysis among patients who used fewer than 15 clinician office visits (low utilizers). The USER group used more services in all service types, ranging from 0.02 to 2.08 visits in 12 months (table). These differences were smaller for the low utilizers. We suggest future studies identify reasons behind these differences.

Disclosure

Y.Shao: Employee; Biogen. Y.Wang: None. X.Zhou: None. D.B.Rolka: None. P.Zhang: None.
1005-P: Developing a Machine-Learning–Based Prediction Model for Diabetes Duration Using Information from Electronic Health Records
Authors: GUAN DAWEI , LI PIAOPIAO , FONSECA VIVIAN , SHI LIZHENG , ALI MOHAMMED K. , SAM VARGHESE JITHIN , CARRILLO-LARCO RODRIGO M. , ROUHIZADEH MASOUD , WINTERSTEIN ALMUT G. , JIAO TIANZE , SHAO HUI
Published: June 2023

Diabetes duration is key information for epidemiologic studies but is not routinely collected in real-world data, such as claims and electronic health records (EHRs). This study aimed to build a predictive model for diabetes duration to nourish future research. Using data from the National Health and Nutrition Examination Survey (2009 to 2018), we identified individuals with self-reported diabetes and extracted information routinely collected in EHR. Predictors included demographics (e.g., age, sex), biomarkers (e.g., HbA1c, systolic blood pressure), diabetes-related comorbidities (e.g., retinopathy, end-stage renal disease), and glucose-lowering therapy (e.g., insulin, metformin). We used diabetes duration (in years) as the outcome. We compared the ordinary least square (OLS) model, least absolute shrinkage and selection operator (LASSO) regression, random forest, and extreme gradient boosting (XGBoost) models, using 10-fold cross-validation for tuning hyperparameters. A total of 3,267 survey participants were included, with a median diabetes duration of 9 years (Q1: 4 years, Q3: 16 years). The LASSO regression achieved the best performance (Root Mean Square Error [RMSE]: 7.62, Mean Absolute Error [MAE]: 5.74, Average Error [AE]: 0.53), followed by random forest (RMSE: 7.63, MAE: 5.74, AE: 0.47), XGBoost (RMSE: 7.63, MAE: 5.76, AE: 0.55), and OLS model (RMSE: 7.64, MAE: 5.76, AE: 0.59). The random forest algorithm identified age, insulin therapy, metformin monotherapy, retinopathy, and HbA1c as the predominating factors associated with diabetes duration. The prediction is more accurate if the diabetes duration is: 1) <10 years (RMSE:4.43, MAE: 3.66, AE: 0.10); 2) 10 to 20 years (RMSE: 5.71, MAE: 4.72, AE: 0.79). Our model could properly predict the diabetes duration using information available in EHR data. Model performance improved when applied to individuals living with diabetes for shorter than 20 years.

Disclosure

D.Guan: None. T.Jiao: None. H.Shao: Consultant; Lilly Diabetes. P.Li: None. V.Fonseca: Consultant; Abbott, Corcept Therapeutics, Eli Lilly and Company, Other Relationship; BRAVO4HEALTH, LLC, Research Support; Fractyl Health, Inc., Stock/Shareholder; Amgen Inc. L.Shi: None. M.K.Ali: Advisory Panel; Bayer Inc., Eli Lilly and Company, Research Support; Merck & Co., Inc. J.Varghese: None. R.M.Carrillo-larco: None. M.Rouhizadeh: None. A.G.Winterstein: Consultant; Bayer Inc., Genentech, Inc., Ipsen Biopharmaceuticals, Inc., Research Support; Merck Sharp & Dohme Corp.
1015-P: Impact of Social Vulnerability on Resources for CGM Initiation across Michigan Primary Care Practices
Authors: KHOSROVANEH KATHERINE L. , AIKENS JAMES E. , OSHMAN LAUREN , RAU JACQUELINE , REISS JACOB , YOUNG LARREA A. , WEISENSEL JULIAN , OKEKE PRECIOUS , MIZOKAMI-STOUT KARA R. , BUSUI RODICA , JAMISON CORNELIUS D. , RICHARDSON CAROLINE R. , DIEZ HEIDI L.
Published: June 2023

Objective: The Michigan Collaborative for Type 2 Diabetes (MCT2D) is a state-wide quality initiative supported by Blue Cross Blue Shield of Michigan. MCT2D aims to improve type 2 diabetes care by encouraging prescribing of continuous glucose monitoring (CGM), SGLT2i/GLP-1RA medications, and low carbohydrate diets. The study’s purpose was to describe clinic-level resources and barriers to CGM initiation in counties with high and low social vulnerabilities.

Methods: We surveyed primary care practice providers about practice-level CGM patient education and barriers, and providers’ understanding of insurance coverage. 169 of 264 practices (64%) completed the survey. We classified practices as high vulnerability (HV; quartile 4), or low vulnerability (LV; quartiles 1-3) using the county-level CDC Social Vulnerability Index.

Results: Among HV practices, the main CGM education was prescriber instruction (61.5%), while for LV it was printed material (69.8%). For both HV and LV practices the second most common educational resource was web links (53.9% and 51.6%, respectively). For both practice types, the most common barrier to CGM was patients’ lack of smartphone (60.5%, 62.4%, respectively), followed by patients’ lack of internet (55.3%) for HV practices and patients’ ability to use CGM (38.5%) for LV practices. Provider understanding of Michigan Medicaid CGM coverage policy was similar across practices with most reporting incorrectly that it was akin to Medicare (≥3 injections daily) (35.3% (HV) and 44.0% (LV)) or reporting lack of awareness of coverage (32.4% (HV) and 24.1% (LV)).

Conclusions: There is a mismatch between practices’ educational approaches and patients’ access to technology. Improved transparency of CGM coverage criteria would enhance provider understanding and promote equitable access for patients. Limitations include that the data is county-level and further analysis evaluating other practice level social determinants of health is needed.

Disclosure

K.L.Khosrovaneh: None. 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. C.D.Jamison: None. C.R.Richardson: Other Relationship; Annals of Family Medicine, JMIR Diabetes, Research Support; Dexcom, Inc., Blue Cross Blue Shield of Michigan, Neilson Foundation. H.L.Diez: None. J.E.Aikens: None. L.Oshman: Stock/Shareholder; Abbott, AbbVie Inc., Merck & Co., Inc., Procter & Gamble, Johnson & Johnson, Eli Lilly and Company. J.Rau: None. J.Reiss: None. L.A.Young: None. J.Weisensel: None. P.Okeke: None. K.R.Mizokami-stout: None.
1016-P: Prescribing SGLT2 and GLP-1 for Patients with Type 2 Diabetes at Time of Discharge after MI Increases Their Likelihood of Having Active Prescriptions at One Year
Authors: SUMARSONO NATHAN , MALLADI CHAITANYA L. , DWEIK ASEEL A. , DELLA-PENNA PAIGE L. , GEURINK KYLE , MATHEW CHRIS , MOSS ELIZABETH , PEYKOVA KREMENA , MACK-BOYD LISA , DAS SANDEEP
Published: June 2023

Intro: SGLT2 inhibitors (SGLT2) and GLP1 agonists (GLP1) both reduce major adverse cardiovascular events (MACE) in patients with T2D and MI. We characterize the pattern of prescriptions for these medications in an urban safety net teaching hospital which provided these medications to low income patients at nominal cost.

Methods: Using the hospital EHR, we reviewed medication lists for patients with T2D who were hospitalized with type 1 MI between 2018-2019.

Results: There were 178 patients with one-year follow-up data, of which 75 (42.1%) were uninsured. We summarized the distribution of diabetes therapies in Table 1. SGLT2 and GLP1 were prescribed in 39% and 8% of patients at 1-year, respectively. Likelihood of having an active SGLT2 prescription at 1-year was higher for patients prescribed it at discharge compared to those who were not (RR 2.6; 95% CI 1.9-3.4). Likelihood of having an active GLP1 prescription at 1-year was higher for patients prescribed it at discharge compared to those who were not (RR 10.9; 95% CI 4.9-24.5).

Conclusions: Rates of prescription of MACE-reducing therapies (SGLT2 and GLP1) after MI are low compared to metformin and insulin, which have no proven MACE benefit. Prescribing SGLT2 and GLP1 at index discharge can significantly increase the likelihood that patients will be prescribed these medications one year later.

Disclosure

N.Sumarsono: None. S.Das: None. C.L.Malladi: None. A.A.Dweik: None. P.L.Della-penna: None. K.Geurink: None. C.Mathew: None. E.Moss: None. K.Peykova: None. L.Mack-boyd: None.
1018-P: Disparities in Diabetes Technology Use in Youth with Diabetes
Authors: SINGH PUJA , GRISHMAN ELLEN , NARANJO DIANA , HYNAN LINDA S. , WHITE PERRIN C. , GUPTA OLGA
Published: June 2023

Background: Diabetes technology can improve glycemic control and diabetes outcomes, but there are disparities in patient use.

Aims: Identify racial, ethnic, and socioeconomic disparities in technology utilization and determine provider, patient, and parent identified barriers to this.

Methods: Technology (continuous glucose monitors [CGM] and pump) usage and demographic data on patients at a large urban pediatric hospital were obtained from a clinical database. Providers (physicians, nurse practitioners, diabetes educators [CDEs]) completed a survey on diabetes technology prescribing habits. English and Spanish speaking patients ages 8 to 17 years with type 1 or type 2 diabetes on insulin and their guardians completed patient and parent specific surveys that assessed attitudes and perceived benefits and burdens of diabetes technology. Responses (16 physicians, 11 CDEs, 109 patients, 117 parents) were analyzed with Kruskal-Wallis tests.

Results: From August 2020-2021, independent of socioeconomic status, non-Hispanic Black (NHB) and Hispanic children were less likely to be prescribed pump (odds ratio 0.40 and 0.35 respectively) or CGM (0.50 and 0.49) compared to non-Hispanic White (NHW) children. For pump eligibility, CDEs placed higher importance on subjective factors such as parental education, health literacy, and psycho-social stability (p value < 0.05) compared to physicians. Hispanic and NHB patients and parents learned about diabetes technology later after diagnosis compared to NHW group. Physicians and CDEs identified patient perceived barriers to CGM use (i.e., embarrassment and/or discomfort in wearing devices) as reasons for not discussing technology, though patients did not identify such factors as barriers.

Conclusions: There are marked disparities in diabetes technology use among youth with diabetes. Families and providers perceive different barriers to utilization. This study adds perspective of patients with T2D as well as targeted recruitment of underrepresented minorities.

Disclosure

P.Singh: None. E.Grishman: None. D.Naranjo: None. L.S.Hynan: None. P.C.White: Consultant; Provention Bio, Inc. O.Gupta: None.
102-LB: Cumulative Probability of Mortality among Non-Hispanic Black Compared with Non-Hispanic White Individuals with Type 2 Diabetes on Empagliflozin (EMPA-AA)—Real-World Data
Authors: MISHRIKY BASEM M. , CUMMINGS DOYLE M. , FU YUANYUAN , HALLADAY JACQUIE , JONES WILLIAM S. , BOAN ANDREA D. , JONES BERKELEY SARA , PATIL SHIVAJIRAO P. , POWELL JAMES R. , ADAMS ALYSSA , IRISH WILLIAM
Published: June 2023

Authors 1, 2 & 11 participated equally. Given the underrepresentation of minorities in the CV outcome trials, guidelines encouraged investigating antihyperglycemic medications in minorities, particularly in non-Hispanic Blacks (Black). Our goal was to evaluate the incidence of all-cause mortality (ACM) among Black vs non-Hispanic White (White) patients with type 2 diabetes (T2D) who were prescribed empagliflozin (EMPA). We performed a multicenter retrospective study using EMR-derived data for adults with T2D cared for at 4 healthcare systems in North and South Carolina between Aug 2014 and Dec 2019. In patients without HF hospitalizations (hHF) prior to an initial EMPA prescription, we compared ACM in Black vs White patients. A propensity-score weighted analysis was performed to balance characteristics by race. The cumulative probability of ACM by race was estimated using the cumulative incidence function. A total of 8789 patients were eligible. Baseline characteristics and results are summarized in Table 1. After propensity-score weighted analysis adjusting for age, gender, and baseline comorbidities, there was no significant difference in the risk of ACM between Black vs White patients. In patients with T2D without hHF prior to an initial EMPA prescription, we found no significant difference in ACM in Black vs White patients.

Disclosure

B. M. Mishriky: Advisory Panel; Bayer Inc., Research Support; Lilly. A. Adams: None. W. Irish: Consultant; Eurofins Transplant Genomics, Other Relationship; CTI Clinical Trial and Consulting. D. M. Cummings: None. Y. Fu: None. J. Halladay: None. W. S. Jones: None. A. D. Boan: None. S. Jones berkeley: None. S. P. Patil: None. J. R. Powell: None.

Funding

Brody Brothers Endowment Fund (20-0922)
102-OR: Barriers to Diabetic Foot Care in Urban Safety-Net Hospital
Authors: BLANCO GERARDO , RASHIED AMMAR A. , CHIRUMAMILLA SIRI , MARIE MORENO EMMELIN , SANTAMARINA GABRIEL , SCHECHTER MARCOS , FAYFMAN MAYA
Published: June 2023

We explored barriers to foot care in a disadvantaged population using surveys of patient perceptions on barriers and self-care. Participants were recruited from an outpatient diabetes clinic at a safety-net hospital in Atlanta, Georgia from 2021-2022 and stratified into two groups: Complications, defined as patient history of foot ulcer or amputation and No Complications, defined as no history of ulcer or amputation. The survey addressed patients' experience in daily foot care and barriers to care. A composite score was created for barriers to foot care comprised of financial and transportation barriers, access to providers, understanding of foot care, and ability to reach feet. Logistic regression was utilized to perform univariate and multivariate assessments adjusting for race, gender, age, employment, and education. Among 80 participants 39% had complications and 61% had no complications. As compared to patients without complications, those with complications were younger (55 yo vs 60, p=0.067) and more often male (63% vs 40%, p=0.04). Both groups were comprised primarily of non-Hispanic Black participants (77% and 94%). Those with complications had longer diabetes duration, > 10 years (64% vs 37%, p=0.015), lower education level, no high school/GED degree or less (54% vs 20%m p=0.003) and lower employment status (p=0.003). Those with complications were more likely to have had discussions about foot care with health care providers (97% vs 74%, p=0.027) and professional examination of their feet (p<0.0001). People with complications were more likely to experience delays in care due to transportation problems (68% vs 39%, p=0.0116). Patients with complications had eight fold greater odds of reporting composite of barriers to care in both unadjusted and adjusted models (unadjusted OR 8.3, 95% CI: 2.5, 27.3; adjusted OR 9.4, 95% CI 1.8, 49.2). Despite having greater focus on foot care in the healthcare setting, patients with foot ulceration or amputation experienced greater barriers to care.

Disclosure

G.Blanco: None. A.A.Rashied: None. S.Chirumamilla: None. E.Moreno: None. G.Santamarina: None. M.Schechter: None. M.Fayfman: None.
1020-P: A New Ambulatory Glucose Profile Report to Evaluate and Support Glucose Control in People after Bariatric Surgery
Authors: COSSU LUCA , CAPPON GIACOMO , HERZIG DAVID , FACCHINETTI ANDREA , BALLY LIA
Published: June 2023

Bariatric surgery increases postprandial glucose excursions with higher peaks and lower nadirs. Etiologically linked is the phenomenon of postbariatric hypoglycaemia (PBH), an increasingly recognized metabolic disorder. Continuous glucose monitoring (CGM) has become an important tool in the diagnosis and management of PBH. The Ambulatory Glucose Profile (AGP) is an internationally recognized and standardized format that provides structured and graphical compilation of CGM data to guide treatment decisions in people with diabetes. However, its applicability to patients suffering from bariatric surgery-induced dysglycaemia, such as PBH, remains limited. Based on the collection of CGM data in healthy individuals and post-bariatric surgery patients with and without PBH, we selected a set of summary statistics that are important to diagnose the condition, decide on and evaluate the efficacy of therapeutic strategies. We propose a novel AGPr which contains the following: %time spent with non-physiological glucose values, the diurnal distribution of hypoglycaemic events (including level and duration) and information on postprandial glucose excursions by colour-coding of rate of glucose change and variability metrics. The new AGPr uses data generated by CGM to provide a rapid visual presentation of glucose dynamics and hypoglycemia burden in post-bariatric surgery individuals.

Disclosure

L.Cossu: None. G.Cappon: Consultant; Dexcom, Inc. D.Herzig: None. A.Facchinetti: None. L.Bally: Research Support; Dexcom, Inc., Ypsomed AG.

Funding

University of Padova, Italy (SID-Networking Project 2021)
1024-P: Management Algorithm of Patients with Concomitant Diabetes Mellitus and Chronic Venous Insufficiency
Authors: GASTALDI GIACOMO , BOZKURT AHMET K. , JOSEE VAN RIJN MARIE , BOUSKELA ELIETE , GLAUSER FREDERIC , RABE EBERHARD , MANSILHA ARMANDO , HALLER HERMANN , ROSAS-SAUCEDO JUAN
Published: June 2023

Introduction: Diabetes mellitus (DM) and Chronic Venous Insufficiency (CVI) are significant burden in patient daily life. While the two diseases share common risk factors and pathophysiology, they are often assessed and managed as separate conditions.

Aim: To develop recommendations for the identification and treatment of patients with concomitant DM and CVI.

Methods: Using a modified Delphi method, a panel of experts developed 38 statements and 2 multiple choice questions. These were used to form an online survey which was disseminated through vascular and diabetes specialists across Europe, Central America, South America, and Middle East. Respondents indicated their level of agreement with each statement. The threshold for consensus was set as ≥75% of agreement.

Results: A total of 238 responses were received. Most of the statements (27/38) reached >90% agreement, 9/38 attained between 75-90% agreement, and 2 failed to meet the threshold. The awareness around the impact of the two diseases was high and a gap was highlighted in the identification of patients suffering from concomitant DM and CVI. Seventy-seven (77%) respondents consider overweight (BMI >30) and leg oedema as signs for assessment of the presence of DM and diabetic microvascular complications (DmVC) in patients with CVI, while 63% agreed that three parameters (skin changes, leg burden and oedema) would be required to trigger investigation for coexistent CVI in patients with DM. Treatment of patients with DmVC and CVI should be accomplished with a combination approach, including lifestyle change, non-medical and pharmacological treatments. Venoactive drugs indicated in both DmVC and CVI were recognized as treatment option in this patient population.

Conclusion: These results raised the need to consider DM and CVI as a combined therapy area. As outcome, an algorithm is proposed to help the identification of at-risk patients and to provide recommendation on the management of patients with concomitant diseases.

Disclosure

G.Gastaldi: Advisory Panel; Ascensia Diabetes Care, Insulet Corporation, Novo Nordisk, Lilly, Other Relationship; Abbott Diabetes, AlfaSigma, Research Support; Ypsomed AG, Speaker's Bureau; Dexcom, Inc., Medtronic, Roche Diabetes Care. A.K.Bozkurt: Advisory Panel; OM PHARMA. M.Van rijn: None. E.Bouskela: None. F.Glauser: Consultant; Servier Laboratories. E.Rabe: Consultant; Sigvaris Int., EUROCOM, Mylan, Speaker's Bureau; OM Pharma. A.Mansilha: None. H.Haller: None. J.Rosas-saucedo: None.

Funding

OM Pharma Ltd.
1025-P: Success of Interactive, Online Education Related to Screening and Staging Type 1 Diabetes
Authors: LARKIN AMY , LE ANNE
Published: June 2023

Objective: Determine if interactive, case-based, online continuing medical education (CME) improves the competence and confidence of diabetologists/endocrinologists (D/Es) and pediatricians on staging T1D. Methods: Educational design included a “test, then teach” approach to elicit cognitive dissonance, with evidence-based feedback provided following each learner response. A repeated pairs pre-/post-assessment study design and a McNemar’s test (P <.05 is considered significant) assessed educational effect, with Cohen’s d being used to assess educational impact (<0.2 modest effect, 0.2-0.49 small effect, 0.5-0.79 moderate effect and >0.8 extensive effect). The activity launched July 29, 2022 and data were collected through October 6, 2022.

Results: 77 D/Es and 160 pediatricians were included in the analysis. Matched learner data indicate that overall, 77% D/Es and 76% of pediatricians improved their competence from pre-to-post (both P<.0001 with extensive overall impacts in both groups 0.9-1.06) On a question-level: 56% of D/Es (P<.001) and 48% of pediatricians (P<.001) improved at appropriate screening of high-risk patients for T1D 27% of D/Es (P<.001) and 31% of pediatricians (P<.001) improved at educating caregivers about screening of siblings at risk of T1D 51% of D/Es (P<.001) and 51% of pediatricians (P<.001) improved at staging of patients with T1D based on test results Overall, 60% of D/Es and 61% of pediatricians reported increased confidence in staging patients with T1D, for an overall confidence shift of +75% in D/Es and +96% in pediatricians with increased confidence.

Conclusion: Interactive, case-based, online CME is successful at improving competence and confidence of D/Es and pediatricians related to staging of at-risk patients for T1D. Case-based education with interactive polling questions and detailed explanations related to best choices should be employed more often to help clinicians apply guidelines into practice to improve patient care.

Disclosure

A.Larkin: None. A.Le: None.

Funding

Provention Bio, Inc.
1036-P: Developing an Explainable AI Model to Identify Members with Diabetes at High Risk for Worsening Glycemic Control in a Large Accountable Care Network (ACN)
Authors: KERMANI ASRA , KOLLIPARA USHA , ACOSTA JUAN , BOWEN MICHAEL E. , ALMANDOZ JAIME P. , GOLDBERG BRENT , ROZICH ALLISON , HE MEILU , ACOSTA SUSANA V.J. , MCCALL CAROL J. , GARTNER JOSEPH A. , DECAPRIO DAVE , MUTZ JACQUELINE M. , FISH JASON S.
Published: June 2023

People with diabetes and poor glycemic control (HbA1c ≥9%) have a greater likelihood of diabetes complications, increased healthcare utilization, and higher total cost of care (TCOC). Novel approaches to identify patients at high risk for worsening glycemic control can improve outcomes and contain costs within ACNs. We used XGBoost Decision Trees to build and validate a model predicting worsening glycemic control (HbA1c increase ≥1.5% over 12 months) using Medicare ACN administrative claims and electronic health record data. Eligible members had ≥18 mos. continuous enrollment, were age ≥18 years with Type 1 or 2 diabetes, had ≥2 HbA1c values between 6.5 and 14%, and no disability. Members were split into HbA1c outcome stratified training (80%) and validation (20%) datasets for 10-fold cross-validation. The model utilized 1,490 features including medical history, labs, demographics, SDOH, utilization, and quality of care. Of the 44,007 unique members (mean age 72 years, 51% Female, 61% Non-Hispanic White, mean HbA1c 7.2%, 9% on insulin, HTN 92%, Obesity 71%, CKD 33%, CAD 32%, Heart Failure 15% and COPD 13%), 5.23% had an HbA1c increase ≥1.5% over 12 months. Key features in the final model included duration of diabetes, last HbA1c value, treatment intensification, prescribed insulin or sulfonylureas, weight change, depression, acute renal failure, area deprivation index, and no car access. Model AUC was 0.672 (95% CI ±0.005) in the validation sample. The model was able to identify 23.5% of members with worsening glycemic control in the highest predicted decile of HbA1c progression (sensitivity 23.5% at 10% alert rate). Mean TCOC at 10% alert rate was $43,850 PMPY which was substantially higher than training population at $18,208 PMPY. Our model can identify ACN members with diabetes at high risk for worsening glycemic control that may benefit from education, medication adherence, food insecurity and transportation interventions.

Disclosure

A.Kermani: None. C.J.Mccall: None. J.A.Gartner: None. D.Decaprio: Employee; ClosedLoop.ai. J.M.Mutz: None. J.S.Fish: None. U.Kollipara: None. J.Acosta: None. M.E.Bowen: Research Support; Boehringer-Ingelheim. J.P.Almandoz: Advisory Panel; Eli Lilly and Company, Novo Nordisk. B.Goldberg: None. A.Rozich: None. M.He: None. S.V.J.Acosta: None.