bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of liquid fraction pig manure on productivity element formation in the agrophytocenosis of winter rapeseed
Authors:   Kaliningrad State Technical University, Tereshchenko Svetlana А. , Mudrova Lilia D. ,   Kaliningrad State Technical University
Published: June 2024

The purpose of the research is to study the effect of introduction the liquid fraction of pig manure on the productivity of winter rapeseed in the conditions of the Kaliningrad region. The article discusses the results of research conducted in 2018–2022 in the conditions of Pravdinsky municipal district, Kaliningrad region, on the effect of applying pig manure of liquid fraction on the quality of overwintering of winter rapeseed plants, productivity elements (number of productive stems, weight of seeds per plant) and seed yield. Mercedes and Visby hybrids, zoned for North-West region of Russia, were taken as research objects. During the research period, we observed the overwintering of winter rapeseed plants and counted the number of plants per 1 m2 before the onset of the winter period and in early spring, after the plants began to grow, and calculated the percentage of overwintered plants. In variants with the application of organic fertilizers, in most cases, the percentage of overwintered plants was on average 1–5% higher compared to the control. An evaluation of the research results also showed an increase in the number of productive stems of winter rapeseed plants by 1–3 pcs. in variants with the introduction of the liquid fraction of pig manure compared to the control on both hybrids. The mass of seeds collected from one plant was significantly greater in the variants with the introduction of the liquid fraction of pig manure throughout the entire study period. The analysis of yield showed that in the control options the values were lower compared to the options where the liquid fraction of pig manure was used as fertilizer. The increase in yield for Mercedes hybrid ranged from 36 to 79% over the years of research, for Visby hybrid – from 43 to 84%. Accordingly, the introduction of the liquid fraction of pig manure will increase the yield by 1.5–2.0 times.
Apropiación de los resultados de aprendizaje para estudiantes del curso vigilancia tecnológica e innovación sustentable del programa administración de organizaciónes de la UNAD
Authors: Martinez Santos Didier Luisinho
Published: June 2024

Este Dworkin paper busca la apropiación de los conocimientos adquiridos en el curso de vigilancia tecnológica e innovación sustentable , distribuidos en 4 resultados de aprendizaje como lo son ;Resultado de aprendizaje 1: Teoría de sustentabilidad organizacional para explicar su importancia en la aplicación como responsabilidad social de las organizaciones .Resultado de aprendizaje 2: características que debe poseer una organización para considerarse sustentable .Resultado de aprendizaje 3: cómo se puede aplicar la tecnociencia en negocios innovadores y sustentables .Resultado de aprendizaje 4: las ventajas de la vigilancia tecnológica en la creación de Empresas innovadoras y sustentables. Donde cada resultado de aprendizaje o capítulo tiene su propia temática o tema de interés.
La inteligencia artificial como herramienta para potenciar los pequeños y medianos negocios
Authors: Castañeda Hurtado Lady Natalia , Rodríguez Torres Adriana María
Published: June 2024

¿Se puede considerar la inteligencia artificial como una herramienta para potenciar los negocios? ¿Cómo hacer provecho de la inteligencia artificial para mantener el negocio en el mercado? Actualmente nos encontramos en un mundo globalizado que se enfrenta a constantes cambios económicos, sociales, democráticos, educativos y sumado a ello transformaciones tecnológicas que están modelando el futuro de las organizaciones y de los negocios. Con este documento, se pretende responder a estos interrogantes y abordar desafíos relacionados con la inteligencia artificial a los que se exponen los comerciantes de pequeños y medianos negocios para continuar y posicionarse en el mercado.
Capitalismo cognitivo en Colombia
Authors: Garces Pulido Yesid Alexander , Quintero Castaño Iván Alveiro , Pulido Orozco Andrés Mauricio , Catano Gutierrez Dairo Alberto
Published: June 2024

En el escenario del capitalismo cognitivo, propuesto por Fumagalli (2010), el conocimiento y la cognición se erigen no solo como fundamentos, sino también como motores de la transformación productiva y la creación de valor. Este paradigma, que revoluciona las bases de las estructuras laborales históricas, genera una serie de desafíos intrincados para regiones con marcadas idiosincrasias, como América Latina y, en particular, Colombia. Estos desafíos se ven intensificados por las complejidades socioeconómicas y culturales que caracterizan a estas regiones. En medio de este entramado, la Inteligencia Emocional (IE), tal como fue enunciada por Salovey y Mayer (1990), se destaca no solo por su pertinencia, sino también por su potencial transformador en el ámbito laboral. Sin embargo, existe una preocupación latente: bajo el influjo del capitalismo cognitivo, la IE podría ser susceptiblemente objeto de mercantilización, desviándose de su genuina esencia. Esta investigación, a través de un meticuloso enfoque cualitativo, contrapone paradigmas laborales arraigados, como el Taylorismo-Fordismo, con la visión contemporánea del capitalismo cognitivo. En esta comparativa, el trabajo enfatiza la imperiosa necesidad de revitalizar y recontextualizar la IE, garantizando su aplicabilidad genuina, y subrayando su cardinal importancia en el tejido laboral de la América Latina contemporánea y, particularmente, en el contexto colombiano.
Enhanced target detection using fractional Fourier transform features with threshold-modified normalization
Authors: Jiang XingYu , Liu Ningbo , Ding Hao , Dong Yunlong , Guan Jian , Liu Tong
Published: June 2024

Feature extraction from the normalized transformation domain is a key
technique in target detection. Traditional normalization approaches
assume that matrix elements follow a normal distribution, but any
deviations from this assumption can lead to significant systematic
errors. This article presents a novel method that modifies the
normalization process in the fractional Fourier transform (FRFT) domain
by incorporating a threshold mechanism to counteract the effects of
non-normal distributions. Three modified FRFT features are then
extracted from this modified FRFT domain. Furthermore, we propose a
target detection method that utilizes these three adjusted features.
Experimental results based on measured data indicate that the modified
FRFT features exhibit superior classification capabilities for sea
clutter and targets compared to the original ones. Additionally, the
experiments also demonstrate that under the same conditions, the
proposed detection method outperforms traditional FRFT feature detector
and the tri-feature based detector.
Effect of War on Health Institutions of Eastern Tigray, Ethiopia
Authors: Tekulu Fikre Belay , Gebre Haftom Teshale
Published: June 2024

Background The war in Tigray has caused significant damage to the
region’s healthcare facilities. This study aimed to assess the extent of
the war’s impact on healthcare facilities in the Eastern Tigray Zone.
Methods A mixed research strategy was used, with both quantitative
and qualitative approaches. Primary data were collected through
questionnaires, interviews, focus group discussions, and observations,
while secondary data were obtained from published and unpublished
documents. Participants were selected using a simple random sampling
method. The collected data were analyzed using a linear regression model
to determine the statistical significance of the findings. Results
The study found that the impact of the war on healthcare
facilities was high to very high, with 97.9 percent of the damage
attributed to the war. Of the 177 healthcare facilities in the Eastern
Tigray Zone, 29 (16.4 percent) were severely affected, and 118 (66.66
percent) were totally damaged. This indicates that 83 percent of the
health system in the region was damaged. The linear regression model
showed that the war explained 55.8 percent of the observed health
facility damage. Conclusions The damage to health facilities in
the Eastern Tigray Zone has led to the complete collapse of the health
system at the zone level. The urgent need for reconstruction and
restoration of health facilities is highlighted to provide essential
health services to the affected population. The government and concerned
individuals must take immediate action to address this critical
situation and help mitigate the negative impact of the war on the health
of the people in Tigray.
The Effect of Skin-to-Skin Contact and Delayed Cord Clamping on Placental Separation Time, Separation Method, Amount of Postpartum Bleeding and Postpartum Comfort:A Randomized Controlled Trial
Authors: GOBEL Bahar , APAY Serap EJDER
Published: June 2024

Objective: In this study, it was aimed to determine the effect
of late cord clamping with skin-to-skin contact immediately after
delivery on placental abruption time, type of separation, amount of
postpartum hemorrhage and postpartum comfort in primiparous pregnant
women who gave vaginal delivery. Design: The research is an
experimental-type randomized controlled trial. Population: The
study was completed with 126 primiparous pregnant women, 63 control and
63 experiments, who were randomized in the clinic. Methods:
Placental abruption time, type of abruption, participant’s entry and
postpartum 6th hour hemoglobin and hemotocrit levels were recorded by
the researcher via Personal Information Form. Main Outcome
Measures: Skin-to-skin contact and late cord clamping shorten the
placental abruption time, reduce the amount of postpartum hemorrhage,
increase the level of postpartum comfort and have no effect on the type
of placental abruption. Results: When the placental abruption
types were compared in the experimental and control groups, 47.6% of
the experimental group had Duncan type, 52.4% had Schultz type, 36.5%
of the control group had Duncan type and 63.5% had Schultz type, and no
statistically significant difference was found. Skin-to-skin contact was
reduce the amount of postpartum hemorrhage and the postpartum comfort
levels of the experimental group were found to be higher than the
control group. Conclusions: Skin-to-skin contact and late cord
clamping reduce placental abruption time, reduce the amount of
postpartum hemorrhage, and increase postpartum comfort of the mother. It
has no effect on the way the placenta detaches. Link to the trial
registry: [www.clinicaltrials.gov](http://www.clinicaltrials.gov)
Clinical trial number is NCT06011096.
Depression at two months postpartum: results from the 2021 French National Perinatal Survey
Authors: Doncarli Alexandra , Demiguel Virginie , Ray Camille Le , Deneux-Tharaux Catherine , Lebreton Elodie , Apter Gisèle , Boudet-Berquier Julie , Chantry anne , Crenn-Hébert Catherine , Vacheron Marie-Noëlle , Regnault Nolwenn , Tebeka Sarah , Lelong Nathalie , Cinelli Hélène , Blondel Beatrice , Salanave Benoit , Fresson Jeanne , Vilain Annick , Deroyon Thomas , Raynaud Philippe , Rey Sylvie , Chemlal Khadoudja , Rabier-Thoreau Nathalie , Collombet-Migeon Frédérique
Published: June 2024

Objectives. To estimate postpartum depression at two months
(PPD) prevalence and its related risk factors. Design.
Multicentre prospective cohort study. Setting. France.
Population or sample. Representative sample of 7,133 women
participating to the French National Perinatal Survey (ENP) over one
week in March 2021. Methods. Data on maternal characteristics,
course of pregnancy/delivery, and child’s health were collected from
face-to-face interviews in maternity wards and/or medical records, and a
self-questionnaire (including the Edinburgh Postnatal Depression Scale
(EPDS)) at two months postpartum. Women with an EPDS score
>=13 were considered to have PPD. Poisson regression models
with robust variance were used to estimate adjusted prevalence ratios
(aPR) for PPD. Main Outcome Measures. PPD Results. PPD
prevalence at two months was 16.7% (95%CI[15.7-17.7]). Factors
significantly associated with PPD were: i/ age<=29 or
>=40 years (maximum aPR=1.41 95%CI[1.12-1.77] obtained
for 15-24 year-olds vs 35-39 year-olds), ii/ being born in North Africa
(1.29[1.02-1.64] vs France), iii/ having a lower level of health
literacy (1.23[1.14-1.35]), iv/ having a history of psychological
(1.45[1.24-1.69]) or psychiatric (1.52[1.23-1.88]) care since
adolescence (vs none), v/ receiving little/no support or good support
during pregnancy (1.80[1.52-2.14] and 1.31[1.15-1.48] vs.
receiving very good support), vi/ reporting feelings of sadness
(1.92[1.65-2.25]), anhedonia (1.69[1.36-2.11]) or both
(2.61[2.26-3.01]) during pregnancy (vs none of these feelings), vii/
having had an instrumental vaginal delivery (1.18[1.01-1.38] vs
spontaneous vaginal delivery). Conclusions. Our findings on PPD
(prevalence and risk factors) could guide policies on early
identification and preventive support for women in the perinatal period.
Fire drives major Holocene vegetation shifts between subtropical and Mediterranean-type ecosystems: a case study from a biodiversity hotspot in South Africa
Authors: Quick Lynne , Chase Brian , Chevalier Manuel , Grobler Barend , Manzano Saúl
Published: June 2024

Fire plays a pivotal role in driving ecological shifts between
Mediterranean-type vegetation and subtropical ecosystems in South
Africa. This study investigates long-term environmental dynamics and
ecological regime changes at the Mediterranean-type vegetation
/subtropical boundary using a 6000-year palaeoecological sequence from
the Baviaanskloof – a region of South Africa characterized by high
levels of biodiversity and climate dynamism. Combining fossil pollen and
microcharcoal data from a rock hyrax (Procavia capensis) midden, we
analyse vegetation responses to environmental changes. Our findings
reveal that Mediterranean-type vegetation resilience prevailed until ca.
2800 cal yr BP when a major fire event triggered a transition to a
subtropical thicket-dominated environment. This abrupt ecological
turnover underscores the significance of fire as a major driver of
vegetation change at the Mediterranean-type vegetation /subtropical
boundary. Our study emphasizes the vulnerability of Mediterranean-type
vegetation ecosystems to global environmental change, suggesting
potential implications for similar biome boundaries worldwide. By
integrating multi-proxy palaeoecological evidence, we gain insights into
the resilience and vulnerability of these ecosystems, aiding in
understanding future responses to climate change scenarios.
Ultra-low Noise Figure Ka-Band MMIC LNA with Graded-Channel GaN HEMTs
Authors: Tai Joe , Wong Joel , Moon Jeong
Published: June 2024

We report broadband (20GHz - 40GHz) low noise amplifiers in a cascode
topology using graded-channel GaN HEMTs resulting in excellent NF figure
down to 1 dB with 15 dB gain per stage.
Memristor Crossbar Scaling Limits and the Implementation of a Large Neural Network Using 3D Stacked Crossbars
Authors: Hasan Raqibul
Published: June 2024

Memristor crossbar-based neural networks perform parallel operations in
the analog domain. Ex-situ training approach needs to program the
predetermined resistance values to the memristor crossbar. Because of
the stochasticity of the memristor devices, programming a memristor
needs to read the device resistance value iteratively. Reading a single
memristor in a crossbar (without an isolation transistor) is challenging
due to the sneak path current. Programming a memristor in a crossbar to
either the R or R
state is relatively straight-forward. A neural network implemented using
higher precision weights provides higher classification accuracy
compared to a Ternary Neural Network (TNN). This paper demonstrates an
implementation of memristor-based neural networks using only the two
resistance values ( R, R).
We have examined the impact of the device R/
R ratio, driver size on the scaling of the
memristor-based neural network circuit. We have implemented a large
neural network using multiple smaller 3D stacked crossbar arrays. We
also have proposed novel neuron circuits to achieve higher weight
precision. Our experimental result shows that the proposed higher
precision synapses are easy to program and provide better classification
accuracy compared to a TNN.
Vaccine candidates, immuno-dominant antigens, and potent vaccine adjuvants for preventing cutaneous leishmaniasis: a sys
Authors: Angelo Abiy Ayele , Adane Gashaw , Belyhun Yeshambel , Teketelew Bisrat Birke , Berta Dereje Mengesha , Chane Elias , Cherie Negesse , Nigus Mesele , Girmay Getu , Tamir Mebratu , Assefa Muluneh , Adem Mohammed
Published: June 2024

Background: Cutaneous leishmaniasis (CL) is the most common
clinical form of leishmaniasis that causes skin disease. Currently,
there is no licensed prophylactic vaccine for CL, as the mechanisms of
healing and memory T-cell responses that develop after infection with CL
are far from fully understood. A review of the published articles
identifying CL vaccine candidates, immuno-dominant antigens, and potent
vaccine adjuvants is needed to provide comprehensive information.
Therefore, we aimed to review vaccine candidates, immuno-dominant
antigens, and potent vaccine adjuvants for preventing cutaneous
leishmaniasis. Methods: A systematic search of published
studies before December 2023 was identified using electronic databases;
PubMed/MEDLINE, Hinari Research4Life, Google Scholar, and direct Google
search. The Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines were followed. Data were extracted
using a Microsoft Excel 2010 spreadsheet and data obtained were then
reported using tables and figures and synthesized qualitatively. The
quality of the included studies was assessed using the Joanna Briggs
Institute’s (JBI) quality appraisal tool for experimental studies.
Results: The electronic databases search yielded 661 articles
of which 32 articles met the inclusion criteria. The included articles
were conducted in various animal and human models and included vaccine
candidates, immuno-dominant antigens, and potent vaccine adjuvants. Some
of the first-generation vaccine candidates showed complete protection of
the specified animal model. They induced strong T-cell mediated and
antibody-mediated humoral immune responses (e.g. Curdlan dectin-1, total
Leishmania antigen (TLA), and L. infantum heat shock
proteins ( LiΔHSP70-II)). Almost all second and third-generation
vaccine candidates, and the immuno-dominant antigens of the parasite and
the host enhance T cell-mediated and antibody-mediated immune responses.
We also reviewed potent vaccine adjuvants such as myrrh silver
nanoparticles (MSNPs), and Imiquimod, which play an important role in
enhancing immune responses against Leishmania antigens.
Conclusion and recommendations: The T-cell mediated immune
response was significantly induced in various experimental models (e.g.
IFN-γ and TNF-α response) and also the humoral arm in some instances
(e.g. IgG2). This review thus provides comprehensive information on the
efficacy and induction of protective immunity of vaccine candidates,
antigenic molecules, and vaccine adjuvants against CL. However, there is
still a need for a comprehensive understanding of the
immuno-pathogenesis of the disease upon vaccination.
On translation surfaces of framed curves
Authors: Önder Mehmet
Published: June 2024

In this study, we study translation surfaces of framed curves in the
3-dimensional Euclidean space . First, we compute some important
equations and geometric invariants such as first and second fundamental
forms, Gauss equations, Christoffel symbols, Mainardi-Codazzi equations
and Egregium Theorema. Using these equations, we introduce some
characterizations of translation surfaces of framed curves. Also, we
study some special cases such as framed generating curves of the surface
are framed Bertrand-partner curves or Mannheim-partner curves.
MSC: 53A04, 53A05, 53A55.
1000-P: Continuous Glucose Monitoring among Nurse Practitioners in Primary Care—Characteristics Associated with Prescribing, and Resources Needed to Support Use
Authors: HALL TRISTEN , MIRIAM DICKINSON L. , WARMAN MEREDITH K. , OSER TAMARA , OSER SEAN
Published: June 2024

Introduction & Objective: CGM is associated with better clinical and psychosocial outcomes. While expanding, CGM is limited in primary care (PC), where most diabetes care occurs and where NPs are often crucial. We identified NP and practice factors associated with CGM-related behaviors, attitudes, and needs to understand how to support CGM use by NPs in PC.

Methods: Cross-sectional survey; multivariable linear and logistic regression. N=200 NPs in PC, recruited through the American Association of Nurse Practitioners. Outcome: CGM use. Independent variables: NP characteristics (eg, years since training, full- or part-time status) and practice setting (eg, organization type, payer mix).

Results: Most participants practiced family (67%) or internal medicine (28%). Practices included private (34%), hospital-owned (29%), and FQHC (20%). 44% had prescribed CGM. Primary outcome: Compared to private practice, hospital-owned practice NPs were more likely to have prescribed CGM (OR 2.32, 95% CI: 1.09-4.90, p<.01); academic medical center NPs were less likely to have prescribed (OR .098, 95% CI: .012-.799, p<.01). Secondary outcomes: Predictors of favorability toward future CGM prescribing were past CGM prescribing (coef = .73, p<.0001) and time since training (1-5 years: coef = -.48, 6-15 years: coef = -.41; p<.01). Predictors of confidence using CGM in diabetes care were prior CGM prescribing (T1D coef = 3.57, T2D coef = 3.49; p<.0001) and having >50% Medicare patients (T1D coef = 1.77; T2D coef = 2.04, p<.01). NPs identified a one-time endocrine consult (62%), CGM education website (61%), and asynchronous endocrine e-consult (59%) as resources that would make them moderately/very likely to prescribe CGM.

Conclusion: Targeting academic medical centers, private practice, and NPs who serve mostly non-Medicare patients, as well as consults and education resources, could help PC NPs bring CGM to more people with diabetes.

Disclosure

T. Hall: None. L. Dickinson: None. M.K. Warman: None. T. Oser: Research Support; Abbott. Advisory Panel; Medscape. Consultant; Dexcom, Inc. Research Support; Insulet Corporation. S. Oser: Other Relationship; American Diabetes Association, Association of Diabetes Care & Education Specialists. Research Support; Abbott. Advisory Panel; Dexcom, Inc., Jaeb Center for Health Research.
1005-P: CGM for Inpatient Glycemic Management of Type 1 Diabetes—A Remote-Monitoring Program in the Non-ICU Setting
Authors: SPIERLING BAGSIC SAMANTHA R. , LOHNES SUZANNE , FORTMANN ADDIE L. , BELASCO REBEKAH , SANDOVAL HALEY , BASTIAN ALESSANDRA , TALAVERA LAURA , WINKLER DAVID J. , PHILIS-TSIMIKAS ATHENA
Published: June 2024

Introduction & Objective: There is a paucity of data on the use of continuous glucose monitoring (CGM) in real-world inpatient settings for type 1 diabetes (T1D). Using remote monitoring, a large Southern California health system implemented CGM as standard of care (CGM as SOC) amid the COVID-19 pandemic. This analysis describes the characteristics and course of individuals with T1D who participated in CGM as SOC.

Methods: Patient characteristics were captured from the electronic health record. CGM data was extracted using Dexcom Clarity and processed using R.

Results: From 2020-2023, there were N=74 enrollments into CGM as SOC for 54 unique adults with T1D (Fig 1A). Comorbidity burden of enrolled patients was high, and mean admission HbA1c was 9.6%± 2.7. Participants were on CGM for an average of 4.6 ± 5.8 days. Average glucose levels, as assessed by CGM, were 224.9 ± 49.6 mg/dL. Average time in hyperglycemia > 250 mg/dL was 36%, in extreme hyperglycemia > 400 mg/dL was 5%, and in hypoglycemia < 70 mg/dL was 1.3%. Hypoglycemic events (15+ min <70 mg/dL) occurred in 34% of enrollments (Fig 1B). In Fig 1C, glucose readings demonstrate a reduction of extreme deviations after enrollment. CGM was acceptable by patients and RN staff.

Conclusion: This CGM as SOC protocol was feasible for inpatient T1D monitoring and management in a real-world hospital setting. Hypoglycemia and extreme hyperglycemia were infrequent.

Disclosure

S.R. Spierling Bagsic: None. S. Lohnes: Consultant; Dexcom, Inc. A.L. Fortmann: None. R. Belasco: None. H. Sandoval: None. A. Bastian: None. L. Talavera: None. D.J. Winkler: None. A. Philis-Tsimikas: Advisory Panel; Dexcom, Inc., Lilly Diabetes, Novo Nordisk, Sanofi, Medtronic, Bayer Inc.

Funding

Scripps Health and the David Winkler Endowment
1008-P: Real-World Experience with Bigfoot Unity—A Twelve-Month Retrospective Analysis
Authors: TILLMAN JOHN , OLSON BYRON P. , MALONE JAMES K.
Published: June 2024

Background: The Bigfoot Unity® Diabetes Management System (System) is a smart pen cap system incorporating data from the Abbott FreeStyle Libre 2 Sensor, real-time alerts, and clinician-directed dose recommendations. The objective was to analyze real world 12-month data for a large MDI cohort using the System.

Methods: A retrospective analysis was performed using a prespecified analysis plan and de-identified data for those using the System ≥50% of time in the 90 days prior to the 12 month period with ≥45 CGM or BGM glucose readings and a baseline A1C, obtained from clinic medical records, was required (N=303). Using these same criteria, a safety cohort also included those using the System in the 90 days prior to 3 or 6 months (N=402).

Results: The mean age was 63.7 years and 86.5% had T2D. Mean baseline A1C was 8.8±1.8%. Mean GMI at the 12-month endpoint was 7.5±0.9%. Using post-market surveillance data of medical device reports to FDA, 5 severe hypoglycemia events, 1 serious hypoglycemia, 1 DKA and 1 other severe hyperglycemic event occurred and were not related to System malfunction; 4 malfunctions occurred without a reported adverse event.

Conclusions: For this 12-month cohort, primarily adults with insulin-requiring T2D using MDI with suboptimal glycemic control, System use for 12 months results in glycemic improvement. Considering the older age, results demonstrate close progression near established glycemic targets.

Disclosure

J. Tillman: Employee; Abbott. B.P. Olson: Employee; Abbott, Bigfoot Biomedical, Inc. J.K. Malone: Employee; Bigfoot Biomedical, Inc., Abbott.

Funding

Abbott
1012-P: Deep Sleep Interaction with Blood Glucose Levels in People Using an Integrated Digital Health Platform for Diabetes Management
Authors: HERSHCOVITZ YIFAT , BREUER ASHER INBAR , MANEJWALA OMAR
Published: June 2024

Sleep durations are positively associated with impaired outcomes in obesity and type 2 diabetes. Although precise mechanisms are unknown, sleep restriction could affect endogenous processes in glucose metabolism and appetite. Digital health platforms for chronic condition management are aiming to generate behavioral changes that improve patients’ clinical outcomes. Evidence regarding the feasibility of using digital health platforms to measure sleep duration and assess its relationship to ideal diabetes management is lacking. The purpose of this study is to investigate the association between weekly aggregated blood glucose (BG) measurements and deep sleep measured on a single digital health platform. A retrospective data analysis included people with T2D and prediabetes who used iPhone and integrated data into Dario digital health platform during Dec 2022-Dec 2023. Weekly aggregations of average BG and time of deep sleep were calculated. A mixed model analysis was used to determine whether the weekly avg BG can be predicted by weekly avg duration of deep sleep over time.

A cohort of 417 users with type 2 and prediabetes was evaluated (Age 60.4±12.3; female 50.3%). A significant difference between weekly avg BG levels in different durations of weekly avg deep sleep was demonstrated by the model (B=-.00, CI 95% -0.00- -0.00, p=.029). Moreover, simple slope analysis showed that users with increased weekly avg deep sleep duration have significantly stronger reductions in avg BG (B=-.26, CI 95% -0.50- -0.03, p=.03) compared to users with low weekly avg deep sleep duration (B=-.13, CI 95% -0.37- 0.12, p=.31).

A digital health platform that aims to help users adjust deep sleep and manage blood glucose levels can be a powerful tool in promoting overall health and well-being. Sleep quality assessment connected with blood glucose monitoring on one single platform may provide actionable insights and help users understand the impact of sleep on their metabolic health.

Disclosure

Y. Hershcovitz: Employee; DarioHealth Corp. I. Breuer Asher: None. O. Manejwala: Employee; DarioHealth Corp. Stock/Shareholder; DarioHealth Corp.
1013-P: Evaluation of a Continuous Glucose Monitor in Patients with Diabetes on Hemodialysis
Authors: MODI MIHIR , BAGGA MONICA
Published: June 2024

Diabetes management is critical for patients with end-stage renal disease (ESRD). Patients with ESRD experience impaired glucose metabolism, necessitating continuous monitoring. Continuous Glucose Monitors (CGMs) are an effective instrument to monitor glucose levels. The Flash Glucose Monitor (FGM), a CGM variation, displays live, on-demand glucose data; however, the accuracy of FGMs on patients with diabetes on hemodialysis in Canada is not well supported. This study investigates the accuracy of the Freestyle Libre 2, an FGM, in patients with diabetes on hemodialysis at the Windsor Regional Hospital in Windsor, Ontario. A prospective cohort study was performed. Participants ≥ 18 years of age with type 1 or 2 diabetes undergoing hemodialysis were invited to participate. Over 14 days, blood glucose was collected using a capillary blood glucose monitor (CBGM) and FGM four times daily. Accuracy of FGM was assessed via Mean Absolute Relative Difference (MARD), while a Clarke Error Grid correlated paired results between FGM and CBGM. Among 398 paired readings from 8 participants, mean age was 56.8 +/- 4.9 years, 62.5% were male, mean A1C was 7.7 +/- 2.2%, and 25% and 75% had type 1 and type 2 diabetes, respectively. The MARD between the FGM and CBGM was 10.5 ± 8.9%, with 83% of FGM values within ± 1.5 mmol/L of CBGM values. Clarke Error Grid analysis showed 94.5%, 5.5%, 0%, and 0% of correlated pairs in zone A, zone B, zone C, zone D, and zone E respectively, indicating 100% of values within the clinically safe range. Results support the clinical use of Freestyle Libre 2 in patients with diabetes on hemodialysis. With accurate monitoring using FGMs, physicians can better manage hypoglycemia and hyperglycemia associated with hemodialysis, thereby improving patient outcomes. Future work should aim to increase sample size, compare sensor accuracy in patients with diabetes without hemodialysis, and those on peritoneal dialysis.

Disclosure

M. Modi: None. M. Bagga: None.

Funding

WE-Spark Igniting Discovery Grants Program (Tayfour-Emara Research & Education Fund); Schulich-UWindsor Opportunities for Research Excellence Program (SWORP); No reference number indicated.
1022-P: Model for Predicting the Need for Islet Transplantation in Patients with Type 1 Diabetes
Authors: ORR CHRIS , HACKER-STRATTON JEANNETTE , TRUONG JENNIFER L. , MIMILA-OROZCO NAOMI A. , FERRO NANCY , TRUEBLOOD JOSEPHINE , OMORI KEIKO , QI MEIRIGENG , FOROUHAR ELENA , EL-SHAHAWY MOHAMED A. , KANDEEL FOUAD R.
Published: June 2024

Introduction: Hirsch, et al1 used continuous glucose monitoring (CGM) parameters to accurately calculate the personal glycemic state (PGS) of patients with diabetes. We modified this model to see if it can predict the need for islet transplantation (IT) for patients with type 1 diabetes (T1D).

Method: Weighting the glycemic control components used in Hirsch, et al model1, as well as confining the percent time in range to 70-140 mg/dl, result in a PGS score of 15 (IT suitability score; PGSITSS) below which glycemic control is consistent with nondiabetics, and above which it identified T1D patients with frequent episodes of hypoglycemia and hypoglycemia unawareness (current indication for IT need).

Results: Applying this model to data of 31 subjects with T1D transplanted based on the traditional criteria, successfully predicted need for first IT in 16/17 (94%) and subsequent IT in 12/15 (80%), as well as insufficient glycemic control post final IT in 8 subjects consistent with other metabolic assessments. In contrast, the original model with the same cutoff identified only 12 (71%), 3 (20%) and 3 subjects, respectively (Fig 1). Overall results showed concordance between the two models where PGS improved significantly from pre to post IT.

Conclusion: PGSITSS can accurately estimate need for IT and could replace the traditional criteria for patient eligibility.

1. Hirsch IB, et al. Diabetes Technol Ther. 2017;19(S3): S38-S48.

Disclosure

C. Orr: None. J. Hacker-Stratton: None. J.L. Truong: None. N.A. Mimila-Orozco: None. N. Ferro: None. J. Trueblood: None. K. Omori: None. M. Qi: None. E. Forouhar: None. M.A. El-Shahawy: None. F.R. Kandeel: Advisory Panel; Vertex Pharmaceuticals Incorporated.

Funding

National Institutes of Health (U24DK098085)
1027-P: Assessment of Glycemic Control by CGM during Hospitalization and Post-discharge in Insulin-Treated Older Adults
Authors: IDREES THAER , KANTIPUDI SRIYA , ZABALA ZOHYRA , MOAZZAMI BOBAK , URRUTIA MARIA A. , ZHOU SIYU , VELLANKI PRIYATHAMA , PENG LIMIN , UMPIERREZ GUILLERMO
Published: June 2024

Background: Few studies have reported glycemic control in the hospital and post-discharge period in older adults using CGM. Thus, we combined data from 2 RCTs using CGM in 141 insulin-treated participants in the hospital and after discharge. We compared CGM glycemic metrics in 33 participants ≥65 years (mean 70±4) to 108 adults <65 years (mean 52±9 years) with CGM data during hospitalization and for 10 days after discharge.

Results: Participants had similar BMI and total insulin use during hospitalization. Older adults had lower admission HbA1c and blood glucose (BG) compared to younger adults. When assessing CGM glycemic metrics, older adults spent a greater percentage of time in range (TIR, 70-180 mg/dL) during hospitalization (p=0.009) and post-discharge (p=0.02) compared to participants <65. Comparing CGM versus POCT in older adults, CGM exhibited higher detection of hypoglycemic events (<70 and <54 mg/dl, p <0.0001). In addition, older adults had lower glycemic variability (GV) during admission, but similar GV during the post-discharge period.

Conclusion: Compared to younger adults, older adults have better glucose control during hospitalization and post-discharge periods. CGM usage was associated with higher detection of hypoglycemia during hospitalization and post-discharge when compared to POCT in older adults which might improve diabetes care in this population.

Disclosure

T. Idrees: None. S. Kantipudi: None. Z. Zabala: None. B. Moazzami: None. M.A. Urrutia: None. S. Zhou: None. P. Vellanki: Consultant; Eli Lilly and Company. L. Peng: None. G. Umpierrez: Research Support; Abbott, Bayer Inc., Dexcom, Inc., AstraZeneca. Advisory Panel; Dexcom, Inc.
1059-P: Excess Body Weight Contributes to an 8.3 Year Premature Health Economic Aging Equivalent to an Additional Annual Healthcare Expenditure of $306B—Results of a U.S. Population Study
Authors: EVANS MARC , PADGETT THOMAS , MCEWAN PHILIP
Published: June 2024

Introduction: Premature ageing is a recognized feature of chronic disease. As healthcare expenditure increases with age, the concept of health economic (HE) aging can be used to quantify the economic burden of disease. There is limited evidence regarding the effect of excess body weight on HE aging and the impact this may have on healthcare expenditure. This study sought to evaluate the effect of body weight on a measure of HE age and associated healthcare resource use.

Methods: Using US population-level data, we applied published age and body mass index (BMI) direct healthcare cost data to estimate the impact of excess BMI on measures of HE age. Using NHANES (2017-2020) we extracted the adult population who were overweight/obese and related their costs to the optimal age-adjusted BMI in order to derive a measure of HE age and healthcare resource implications.

Results: Compared to an ideal body weight (24 BMI kg/m2), living with excess body weight resulted in a premature ageing of 1.5 billion years across the adult overweight/obese population, representing an average increase in HE age of 8.3 years per person per year (4.2 years in males and 10.4 years for females). The greatest HE aging occurred in the 40-60-year age group with average increase in HE age of 11.2 years. Total BMI attributable premature ageing accounted for $306 billion in direct healthcare expenditure per year. The cost saving associated with achieving ideal body weight, while maintaining current levels of US health care expenditure, would enable the treatment of an additional 45 million 60-years old adults with ideal body weight.

Conclusion: Compared to an ideal body weight, excess weight in the US population contributes to significant premature health economic ageing and excess resource use. Efforts to achieve an ideal body weight may result in cost saving translating into significant additional healthcare capacity at current expenditure levels.

Disclosure

M. Evans: Consultant; Novo Nordisk A/S, AstraZeneca, Eli Lilly and Company, Boehringer-Ingelheim, Sanofi. T. Padgett: Stock/Shareholder; GlaxoSmithKline plc, Novo Nordisk A/S. P. McEwan: Consultant; AstraZeneca, Novo Nordisk A/S, Boehringer-Ingelheim, GlaxoSmithKline plc, Bristol-Myers Squibb Company, Rocket Pharmaceuticals Inc.
1079-P: Assessing Clinical Inertia on Implementing Guideline Recommendations in Patients with Type 2 Diabetes—The ACTION Study
Authors: WILLEY VINCENT , STEPHENSON JUDITH J. , SEMAN LEO J. , WITKOWSKI NANCY , WONG ANNY C.Y. , SMITH JOSEPH L. , BENGTSON LINDSAY
Published: June 2024

Current ADA standards of care (SOC) include recommendations for T2D patients with cardiorenal conditions. Research shows clinical inertia towards implementation of evidence-based guidelines. The study aimed to gain insight into clinician attitudes, knowledge and behavior related to the ADA SOC. Eligible clinicians (PCPs, Endos and PA/NPs) caring for T2D patients were identified from the Healthcare Integrated Research Database based on claims submitted for >5 T2D patients during the study period, 11/30/2019 - 11/30/2021. A survey assessed clinician attitudes and knowledge. ADA SOC behavior was determined by 6 claims-based therapeutic management (TM) measures including A1c and eGFR/UACR testing; statin, GLP-1 and SGLT2 prescribing. High knowledge was defined as answering ≥80% of knowledge questions correctly; high TM metric attainment was defined as ≥75th percentile attainment for each measure. Survey responses and claims-based TM metrics were linked for each respondent. Of 402 respondents, 260 (65%) were PCPs, 44 (11%) Endos and 98 (24%) PA/NPs. Clinician attitudes regarding cardiorenal aspects of the ADA SOC were positive and did not vary by clinician type. High knowledge scores were reported by 58% of PCPs, 77% of Endos and 60% of PA/NPs. Correlation coefficients between attitudes and TM metric attainment ranged from -0.04 - 0.15 and between knowledge and TM metric attainment ranged from -0.03 - 0.14. The most common pattern observed between knowledge and TM metric attainment was high knowledge/low TM measure attainment, followed closely by a low/low pattern. Clinician attitudes were positive and showed adequate knowledge of the cardiorenal ADA SOC. Correlation between ADA SOC attitudes and knowledge and claims-based TM metric attainment were low. Opportunities exist to provide guideline-focused medical education for PCPs and PA/NPs coupled with interventions at the point of care to translate guideline knowledge into improved evidence-based care.

Disclosure

V. Willey: Other Relationship; Carelon Research. J.J. Stephenson: None. L.J. Seman: None. N. Witkowski: Employee; Boehringer-Ingelheim. A.C.Y. Wong: Employee; Boehringer-Ingelheim. J.L. Smith: Employee; Elevance Health. Stock/Shareholder; Elevance Health. L. Bengtson: Employee; Boehringer-Ingelheim, Optum.
108-OR: Insulin Resistance Is Associated with Alterations in the Dynamics of Incretin Secretion
Authors: DI GIUSEPPE GIANFRANCO , SOLDOVIERI LAURA , CICCARELLI GEA , BRUNETTI MICHELA , CINTI FRANCESCA , MOFFA SIMONA , HOLST JENS J. , GIACCARI ANDREA , MEZZA TERESA
Published: June 2024

GIP and GLP-1 exert a fundamental role in glucose homeostasis, but it is still debated if modifications in GIP and GLP-1 secretion can affect the metabolic state, as well as their contribution to the dynamics of incretin-induced insulin secretion. In this study we aimed to explore the relative effect of GIP and GLP-1 secretion on glucose metabolism and beta-cell function. 41 subjects with no previous diagnosis of T2DM were divided into 3 groups according to OGTT-derived glucose tolerance: NGT (12) IGT (12) DM (17). All subjects underwent a mixed meal test (MMT) with glucose, insulin, c-peptide, GIP and GLP-1 levels assessment. Further, we calculated the GIP/GLP-1 Secretion Ratio (GIP/GLP-1 SR) for each timepoint normalized for basal levels and the AUC of the ratio of GIP and GLP-1 secretion. Further, all subjects underwent a euglycemic hyperinsulinemic clamp (EHC) to assess insulin sensitivity. During MMT we observed higher glucose levels in DM subjects compared to NGT and IGT (p<0.01), while insulin and c-peptide secretion showed a non-significant decreasing trend in DM subjects compared to NGT and IGT (p=0.10 and p=0.21). Further, we observed a non-significant decreasing trend in GIP secretion in IGT and DM subjects (p=0.08). No differences in GLP-1 secretion were detected among the 3 groups (p=0.65). Interestingly, IGT and DM groups showed a reduced GIP/GLP-1 SR compared to NGT (p=0.02 for interaction). Further, we found that the AUC of GIP/GLP-1 SR was positively correlated with the EHC-derived M-value (R=0.45, p=0.01). Our data show that, rather than an altered secretion of the incretin hormones per se, insulin resistance leads to an imbalance in the dynamics of incretin secretion overall: the GIP/GLP-1 SR appears to be an early marker of impaired glucose homeostasis. Further studies are needed to investigate whether the altered GIP/GLP-1 secretion is the cause or the effect of altered beta-cell incretin sensitivity and the potential metabolic effects of unbalanced incretin secretion.

Disclosure

G. Di Giuseppe: None. L. Soldovieri: None. G. Ciccarelli: None. M. Brunetti: None. F. Cinti: None. S. Moffa: None. J.J. Holst: Advisory Panel; Novo Nordisk A/S, Merck Sharp & Dohme Corp., Kallyope. Board Member; Antag Therapeutics. A. Giaccari: None. T. Mezza: None.

Funding

This study was supported by grants from the Universita Cattolica del Sacro Cuore (Fondi Ateneo Linea D.3.2, Fondi Ateneo Linea D.1, anno 2019, and Fondi Ateneo Linea D.1, anno 2020); the Italian Ministry of Education, University, and Research (MIUR; GR-2018-12365577 and RF-2019û12369293); the European Foundation for the Study of Diabetes award supported by Astra Zeneca and MIUR and MUIR (PRIN 2020SH2ZZA)
1080-P: Continuous Glucose Monitor Integration into Primary Care Clinics
Authors: ZADEL ALYSSA , CHIAMPAS KATIA , MAKTAZ KATRINA , EIMER MICAH J. , KELLER JOHN G. , SZMUILOWICZ EMILY , O'GARA KATHY W.
Published: June 2024

Introduction & Objective: Continuous glucose monitoring (CGM) has been historically used by endocrinologists to assess glycemic trends and guide therapeutic changes for people with diabetes. We increased access to this tool by equipping primary care physicians (PCPs) to integrate CGM into their practice via a multidisciplinary team approach.

Methods: 18 PCPs were offered a one-hour video training by endocrinology on CGM interpretation. Referred patients were >18yo with A1c > 8% without past CGM use or an endocrinology visit in the past year. Patients saw a Diabetes Care and Education Specialist (DCES) and/or a pharmacist (PharmD) for diagnostic CGM placement and education on nutrition, medication administration, and physical activity goals. DCES or PharmD reviewed the data with patients and sent recommendations to the PCP. Individuals with data post-intervention for A1c and time in range (TIR) were included.

Results: CGM users (n=41) were [mean (SD)] 62.05 (14.54) years of age and 26.83% female. TIR increased by 29.13% from 42.31% (33.25) at baseline to 71.44% (25.79) at 3 months (p <0.001), due to reduced hyperglycemia (Table 1). The proportion of CGM users meeting the consensus target of TIR ≥70% increased from 21.95% to 58.54% (p<0.001). Post-intervention, A1c decreased 2.45% from 9.62 (1.65) to 7.17 (1.08) (p<0.001).

Conclusion: Integration of CGM into primary care clinics is feasible and effective using a multidisciplinary approach.

Disclosure

A. Zadel: None. K. Chiampas: None. K. Maktaz: None. M.J. Eimer: Stock/Shareholder; Agitated Solutions. J.G. Keller: None. E. Szmuilowicz: None. K.W. O'Gara: None.

Funding

Northwestern Medicine North Region Quality and Innovation Funds Award
1081-P: Success of Curriculum-Based Online Education at Improving Knowledge, Competence, and Confidence Related to Staging and Managing Type 1 Diabetes
Authors: LARKIN AMY , LE ANNE
Published: June 2024

Introduction: The goal of continuing medical education (CME) is professional growth and improved patient care. We sought to determine if a curriculum of CME activities could improve the clinical knowledge, competence, and confidence of diabetologists/endocrinologists (D/Es), pediatricians and primary care physicians (PCPs) related to T1D.

Methods: The educational curriculum consisted of 3 online activities, all of which used repeated pairs pre-/post-assessment study design and McNemar’s test (P <.05 is considered significant) to assess educational effect. The activities launched from March to May, 2023, and data were collected for up to 12 weeks for each activity.

Results: The education reached over 24,000 clinicians, including >1,600 D/Es, >1,700 pediatricians, and >2,900 PCPs. Overall, improvements were seen across all target audiences and in all topics, including overall relative improvements of 45% among D/Es, 60% among pediatricians, and 78% among PCPs. Additionally, the proportion of learners who demonstrated improvements/reinforcement of knowledge/competence, the education positively impacted 96% of D/Es, 89% of pediatricians, and 83% of PCPs. This resulted in significant improvements in confidence. Knowledge/competence improvement related to staging T1D: 118% D/Es, 152% pediatricians, and 179% PCPs (relative changes, all P<.001).

Knowledge/competence improvement related to treating T1D: 17% D/Es, 38% pediatricians, and 45% PCPs (relative changes, all P<.001). Knowledge/competence improvement related to educating patients about T1D: 88% D/Es, 65% pediatricians, and 88% PCPs (relative changes, all P<.001).

Conclusion: This curriculum demonstrated success in educating on this topic, with significant increases in knowledge, competence, and confidence of clinicians related to staging, treating and educating patients about T1D.

Disclosure

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

Funding

Developed through an independent educational grant from Provention Bio, a Sanofi Company.