bluuebunny/crossref_metadata_2025 huggingface dataset:
FRI618 Lifetime Risk Of Nontraumatic Lower-extremity Amputation
Authors: Ding Ning , Mok Yejin , Salameh Maya , Tang Weihong , Selvin Elizabeth , Butler Kenneth R , Matsushita Kunihiro
Published: October 2023

Disclosure: N. Ding: None. Y. Mok: None. M. Salameh: None. W. Tang: None. E. Selvin: None. K.R. Butler: None. K. Matsushita: None.

Introduction: Nontraumatic lower-extremity amputation (NLEA) is mainly caused by diabetes and peripheral artery disease. Although the annual incidence of NLEA is generally well-documented, no lifetime risk estimates are currently available. Furthermore, it is unknown whether the estimates vary by sociodemographic characteristics. Methods: In 14,108 ARIC participants aged 45-64 at baseline (1987-89), we estimated the cumulative incidence of NLEA (identified from discharge ICD codes) in the lifespan from age 50 through 80 using Fine and Gray’s proportional subhazards models accounting for the competing risk of death. We also explored the lifetime risk of NLEA by sex, race, annual household income, and in participants with diabetes. Additionally, we estimated the cumulative mortality among participants with and without NLEA using Kaplan-Meier analysis, in the scheme of a 1:2 matched cohort study. Results: There were 226 NLEA cases during a median follow-up time of 30 years. The estimated overall lifetime risk of NLEA from 50 years of age was 1.5% (95% confidence interval [CI], 1.3%-1.7%). The lifetime risk was highest in Black men (4.2% [3.1%-5.5%]), followed by Black women (2.7% [2.1%-3.5%]), White men (1.1% [0.8%-1.5%]), and White women (0.7% [0.5%-0.9%]). When further categorized by income, Black men with low income showed the highest lifetime risk (5.2% [3.7%-7.0%]), while White men with high income had a lifetime risk of 0.9% (0.6%-1.2%). Diabetes drastically increased the risk of NLEA by 5-fold in each race-sex group. Black men with diabetes have a 14% risk of developing NLEA in their lifetime. In the matched cohort study, we included 225 participants with NLEA and 450 without NLEA. The 1-year mortality was 30.9% (25.3%-37.4%) among those with NLEA and 4.1% (2.6%-6.4%) among those without NLEA, while the 10-year mortality was 83.5% (77.7%-88.6%) among those with NLEA and 38.9% (34.2%-44.1%) among those without. Conclusions: In this community-based cohort, 3%-4% of Black individuals experienced NLEA during their lifetime, while 1% of White individuals did. The lifetime risk was enhanced in people with low income and diabetes. Those with NLEA had greater short-term and long-term mortality than those without. Future public health efforts to prevent limb loss should prioritize racial minorities, those with low socioeconomic status, and diabetes.

Presentation: Friday, June 16, 2023
FRI648 GLP-1RA And SGLT2i Treatments May Show Improved Depression Metrics In Diabetes Treatment
Authors: Jain Arad , Esper Layal , Powell Joseph , Meyer Kristin , Sen Sabyasachi
Published: October 2023

Disclosure: A. Jain: None. L. Esper: None. J. Powell: None. K. Meyer: None. S. Sen: None.

Background: Depression is a widespread condition that develops due to a multitude of etiologies. Type 2 Diabetes (T2DM) is associated with several comorbidities, including depression. A class of T2DM medication, Glucagon-Like-peptide-1 receptor agonists (GLP1RA), acts on the hypothalamus, pancreas, and other systems to reduce weight and control blood sugar. GLP1RAs may play a positive role in improving depression by improving satiety and acting on brain centers responsible for anxiety and depression. We hypothesized that patients on GLP1RA would have lower depression scores than those on insulin/metformin standard regimen, or on SGLT2 inhibitors ( which serves as an active comparator) due to localized effects of SGLT2i in the renal cortex. This research will add to ongoing studies in our lab that examine different classes of diabetes medication in treating patients with increased cardiovascular or renal risk, with the goal of increasing the specificity by which endocrinologists prescribe particular classes of glycemic control medications. Methods: We conducted a retrospective observational chart analysis at the Washington DC VA Medical Center and compared the PHQ-9 scores of 50 T2DM patients selected at random over 6 weeks maintaining a consistent diabetes care regimen for 6 months. We observed n=9 GLP1RA, n=7 SGLT2i, and n=31 control subject records. 3 subjects on both medications were excluded from this analysis. We noted the PHQ-9 scores of subjects on active psychotropics, but those were not excluded from the study at this time. Results: Our cohort had a mean age of 61.8±12.5 years and mean A1C of 8.04±2.13%. These factors were evenly distributed between analysis groups. Our analysis showed that T2DM subjects on GLP1RA had PHQ-9 scores of 5.00±1.51. This wasn’t significantly lower than the control cohort (6.21±1.22, p=0.53), or SGLT2i cohort (3.85±1.24, p=0.57). Conclusion: Our preliminary analysis in a real-life clinical setting shows a trend indicating subjects on neither GLP1RA nor SGLT2i have higher depression scores than those on either one. However, we plan to continue reviewing records to see if this trend or differences between classes is significant. With a larger sample size, we also plan to include correlations between depression scores and efficacy of treatment. Continuing this research, particularly in a VAMC cohort at higher risk of depression, may provide insight into clinical decision making in T2DM patients with history or high risk for depression and related disorders.

Presentation: Friday, June 16, 2023
FRI658 Diabetic Ketoacidosis Masked By Cannabis In Type 2 Diabetes Mellitus
Authors: Bosques-Lorenzo Jaymilitte , Velazquez-Acevedo Sharolyn , Baez-Torres Joedali , Colon-Castellano Janet
Published: October 2023

Disclosure: J. Bosques-Lorenzo: None. S. Velazquez-Acevedo: None. J. Baez-Torres: None. J. Colon-Castellano: None.

Background: With the legalization of cannabis in many states, cannabis-related emergency visits have doubled. In recent years, hyperglycemic ketosis and altered glycemic control have been more frequently described in diabetic patients who are also cannabis users. Physicians mostly rely on pH and bicarbonate to diagnose and classify diabetic ketoacidosis (DKA). However, diabetic-cannabis users with typical DKA symptoms may present with alkalosis rather than acidosis. Clinical Case: We present the case of a 71-year-old male patient with a history of insulin-dependent type 2 diabetes mellitus, hypertension, and hyperlipidemia who came to the ED with a chief complaint of increased tiredness, fatigue, polyuria, polydipsia, and a home blood glucose measurement of greater than 500 mg/dl. Labs were remarkable for central blood glucose of 528 mg/dl, b-hydroxybutyrate of 42.1 mg/dl, and anion gap of 18.5mEq/L. Urine was also positive for glucose and ketones. However, arterial blood gasses showed a pH of 7.438 and bicarbonate of 25.5 mmol/l which did not meet the criteria for typical DKA. Upon record review, the patient had prior toxicology tests which were positive for cannabinoids. This admission wasn’t the exception. Studies have suggested that diabetic cannabis users tend to present with metabolic alkalosis despite high anion gap ketosis. Therefore, the patient was managed as per DKA protocol with adequate response and improvement of symptoms. Conclusion: The diagnosis of DKA in cannabis users may be frequently missed due to its differing and conflicting acid-base profile compared with non-cannabis users. Gastric delay and frequent vomiting have been suggested as the likely cause of alkalosis in these patients. Our patient did not present with severe vomiting; therefore, this case suggests that an alternate mechanism for alkalosis is possible and that relying only on pH and bicarbonate can be misleading. This case highlights the importance of screening urine toxicology for cannabis in patients who do not meet the typical criteria for DKA (pH >7.4 and bicarbonate >15 mmol/L) to provide the most effective treatment.

Presentation: Friday, June 16, 2023
SAT050 Liver Androgen Receptor Knockout Delayed The Onset Of High Fructose Diet-induced Dysglycemia In Female Mice
Authors: Falzarano Claire , Oliver Trinitee , Osei-Ntansah Adjoa , Lofton Taylor , Andrisse Stanley
Published: October 2023

Disclosure: C. Falzarano: None. T. Oliver: None. A. Osei-Ntansah: None. T. Lofton: None. S. Andrisse: None.

Introduction: Previous research has indicated that a lipid-independent pathogenic mechanism plays a role in androgen-induced hepatic insulin resistance where liver androgen receptors may play a role in modulating disease. Consequently, this study aims to investigate the pathophysiology of high fructose diet (HFrD) induced dysglycemia in male and female liver androgen receptor knockout (LivARKO) mice. Andrisse et al 2021 showed that deleting the liver androgen receptor prevented female mice from developing hyperandrogenemia (HA)-induced insulin resistance. From this, we asked the question, does LivARKO prevent HFrD induced dysglycemia? Hypothesis: It was hypothesized that HFrD LivARKO female mice would display impaired whole body glucose metabolism in comparison to the Control diet fed LivARKO female mice, suggesting that AR does not play a significant role in regulating HFrD-induced dysglycemia. Methods: We performed insulin tolerance tests (ITT), glucose tolerance tests (GTT), pyruvate tolerance tests (PTT), and glucose stimulated insulin secretion (GSIS) tests on LivARKO female mice fed a high fat diet (HFD) or a control diet (CD) (from Research Diets Inc) during months 1 or 2 after starting the diet. Results: After 1-month, LivARKO female mice fed a Control diet had impaired glucose tolerance compared to LivARKO-HFrD female mice; however, after 2-months, the LivARKO-HFrD female mice displayed impaired glucose tolerance above that of the Control diet LivARKO female mice. LivARKO female mice fed a high fructose diet (HFrD) did not display increased fasting insulin levels compared to LivARKO female mice on a control diet. HFrD LivARKO mice did not display any increase in GSIS at 15-min or 30-min. Conclusion: These findings suggest that LivARKO delayed the onset of HFrD-Induced dysglycemia in female mice. Further research may consist of molecular data to elucidate the mechanistic pathways involved in these whole body phenotypes observed.

Presentation: Saturday, June 17, 2023
SAT078 A Case Of MODY Due To A Rare Activating Variant In The ABCC8 Gene
Authors: Milosavljevic Jovan , Greally John M , Milman Sofiya
Published: October 2023

Disclosure: J. Milosavljevic: None. J.M. Greally: None. S. Milman: None.

Background: ATP-binding cassette transporter subfamily C member 8 (ABCC8) gene encodes the sulfonylurea receptor 1 (SUR1) regulatory subunit of the beta cell ATP-sensitive K+ channel (KATP). Activating mutations in the ABCC8 cause both neonatal and maturity-onset diabetes of the young (MODY). The majority of patients (85%) with diabetes due to ABCC8 gene mutations could be successfully treated with oral sulfonylureas. A substitution c.2473C>T in the ABCC8 gene results in R825W change in the nucleotide-binding domain 1 of SUR1 and in activation of the KATP channel. We report a case of MODY with an activating mutation of ABCC8 gene (R825W). Clinical Case: A 23-year old woman with a history of ventricular septal defect was diagnosed with diabetes mellitus after she presented with a 2-month history of polyuria and polydipsia. At the time of diagnosis, random serum glucose level was 242 mg/dL, Hemoglobin A1c 7.6%, and BMI was 18 kg/m2. There was absence of acanthosis nigricans on exam or a family history of diabetes, although paternal medical history was unknown. A history of low birth weight was reported, but no developmental delays, neonatal diabetes or history of hypoglycemia. A history of seizure during childhood was also noted but was not associated with hypoglycemia. Additional work-up revealed absence of glutamic acid decarboxylase, islet cell, and insulin autoantibodies. C-peptide level was 2.0 ng/mL with blood glucose 113 mg/dL. The patient did not experience microvascular complications of diabetes. Genetic testing was negative for known mutations in HNF1A, HNF1B, HNF4A, GCK, and PPX1 genes. The patient was initially treated with metformin, but never achieved adequate glycemic control and experienced side effects. She was subsequently treated with sitagliptin and ertugliflozin, however, glycemic control remained inadequate (HbA1C 8.1%). At the age of 33 she was referred for clinical exome sequencing. This detected heterozygous ABCC8 variant c.2473 C>T; p.(R825W). Glucose control improved once therapy was switched to glipizide, resulting in the most recent HbA1C of 6.0%. Conclusion: Activating mutations of ABCC8 gene are infrequent genetic causes of diabetes in adults. Sequencing of the ABCC8 gene should be considered in select adult patients, as diagnosis can guide management decisions.

Presentation: Saturday, June 17, 2023
SAT088 Poor Sleep Quality And Insufficient Sleep Duration Are Common In Maturity Onset Diabetes Of The Young
Authors: Arosemena Marilyn A , Wroblewski Kristen , Tasali Esra , Philipson Louis H
Published: October 2023

Disclosure: M.A. Arosemena: None. K. Wroblewski: None. E. Tasali: None. L. Philipson: Research Investigator; Self; Novo Nordisk, Novartis Pharmaceuticals.

Background: Poor sleep quality and insufficient sleep duration are highly common in type 1 and type 2 diabetes. Maturity Onset Diabetes of the Young (MODY) is a unique form of diabetes that is usually characterized by patients being lean, not using insulin, or using diabetes-related technology. This subpopulation has not been studied in regards to their sleep patterns. Objective: To evaluate objective and subjective sleep patterns and their association with glycemic variability in adults with MODY. Methods: Adults with MODY were recruited from the Monogenic Diabetes Registry at the University of Chicago. Subjective sleep quality was measured by a validated survey, the Pittsburgh Sleep Quality Index (PSQI), and sleep patterns were objectively assessed at home by wrist-worn accelerometry (Fitbit Inspire 2) for two consecutive weeks. Glycemic variability was assessed by 2 weeks of continuous glucose monitoring (CGM). Results: To date, a total of 51 patients completed the study. Participants (age:46 ± 12.4 years; BMI:24.6 ± 3.5 kg/m2, diabetes duration: 22.6 ± 13.5, HbA1c: 6.3 ±0.6%) were mostly white (84%), premenopausal (68%), and female (74%). Pathogenic variants included 51% GCK-MODY, 25% HNF1A-MODY, 16% HNF4A-MODY, and 8% HNF1B-MODY. Most participants (71%) reported engaging in regular exercise ( i.e., exercising more than twice and accumulating at least 90 min of moderate or 40 min of vigorous activity in an average week), 45% were only on diet and exercise as their diabetes therapy and 20% were on insulin. Only 27% were on diabetes-related technology (insulin pump and/or CGM) and 88% had no diabetes-related complications. Based on accelerometry (630 nights of analyzed Fitbit data; n=45) 39% of patients had a sleep duration of <7 hours, below the healthy adult recommendations, 90% had a wake after sleep onset (WASO) >40 minutes (normative criteria ≤40 minutes) and, 14% had a sleep efficiency <85% (normative criteria ≥85%)Most patients (69%) reported poor sleep quality with a PSQI mean score of 7.2±3.3 (a score of >5 reflecting poor sleep quality). The data analyses on the association between sleep and glycemic patterns (from CGM) are ongoing. Conclusion: Poor subjective and objective sleep quality and insufficient objective sleep duration are common among MODY patients despite most of them being lean, not on insulin or using diabetes-related technology. Further research should investigate sleep-glycemia relationship in this unique diabetes population.

Presentation: Saturday, June 17, 2023
SAT109 Diabetic Ketoacidosis Due To Non-medical Switching
Authors: Can Ahmet Selçuk , Zhang Zhiwei , Yeakley Forrest
Published: October 2023

Disclosure: A.S. Can: None. Z. Zhang: None. F. Yeakley: None.

Background/Objective: Non-medical switching is a change in treatment regimen for reasons other than efficacy, side effects, or adherence. Non-medical switching aims to decrease health care costs and is initiated by patient’s health insurance company. Case Report: A 20-year-old female with type 1 diabetes mellitus presented with diabetic ketoacidosis (DKA). She was having issues between her health insurance and pharmacy in filling her prescriptions. Both her standing prescription for long-acting (Basaglar, Eli Lilly and Company, Indianapolis, IN, USA) and rapid-acting (Admelog, sanofi-aventis U.S. LLC, Bridgewater, NJ, USA) insulin were no longer covered. The insulin treatment was switched as requested by her health insurance and Semglee (Mylan Pharmaceuticals Inc., a Viatris Company, Morgantown, WV, USA) as long-acting and Humalog (Eli Lilly and Company, Indianapolis, IN, USA) as rapid-acting insulin prescriptions were transmitted to the pharmacy electronically. The patient was confused on what she should be taking. This led to her thinking that her new long-acting insulin (Semglee) was her rapid-acting due to a name that she did not recognize from her past diabetes self-management education. The patient endorsed taking long-acting insulin Semglee three times daily before meals in place of rapid-acting insulin along with previously prescribed long-acting insulin Basaglar twice daily before breakfast and at bedtime. To make things worse, she could not fill her prescription for Semglee due to a Semglee shortage in the preceding three weeks before her admission. Patients with similar health plan were switched to the same insulin at the same time, causing a shortage in our service area. Even if Admelog was prescribed, she was under the impression that she was getting her rapid-acting insulin needs from Semglee. She did not fill her prescription for Admelog. After her discharge, her insurance covered her original regimen (Basaglar and Admelog) that she was on before her non-medical switching. Around the time of admission, wholesale acquisition cost of 5-pack of 3 ml (1500 Units) of Basaglar was $326.36 and unbranded Semglee $147.98 allowing a saving of $0.12 for one unit of insulin. Our patient takes 40 units of long-acting insulin daily, totaling 14600 units per year. Non-medical switching would achieve $1736 savings per year. But inpatient bill for this DKA was $17078. Discussion: In our case, non-medical switching defeated its purpose and increased health care spending. With the switches, patient became confused about her medical regimen. Non-medical switching did not only place additional financial burden but jeopardized patient safety by significantly contributing to an acute complication of diabetes. Further studies that compare health care utilization, not just drug prices are needed to find out if non-medical switching really saves money and is cost-effective.

Presentation: Saturday, June 17, 2023
SAT118 The "Intelligent" Chatbot: Can It Answer Questions About Health And Health Disparities?
Authors: Wu Gloria , Zhao Weichen , Cheng Emily , Wong Adrial , Gim Heidi , Zhang Youcheng , Dorado Perla , Mansubi Nikki
Published: October 2023

Disclosure: G. Wu: None. W. Zhao: None. E. Cheng: None. A. Wong: None. H. Gim: None. Y. Zhang: None. P. Dorado: None. N. Mansubi: None.

Introduction: In 2022, >130 million adults have diabetes or prediabetes and ∼122 million have a form of heart disease. Of those with diabetes; non-Hispanic blacks 12.1%, Hispanics 11.8%, Native Americans 14.5%, Asian Americans 9.5%, and non-Hispanic whites 7.4%. ChatGPT, launched on 11/30/2022, has the newest Artificial Intelligence (AI) software for answering questions in natural language. Purpose: Can ChatGPT answer questions about diabetes, other comorbidities, and health disparities? Methods: ChatGPT was given 5 questions: 1) I am African American, I have diabetes and heart disease. What are my risks of dying? 2) I am South Asian, my cholesterol is 250 mg, my triglycerides are 300 mg, and I am pre-diabetic. What is my risk of dying? 3) I am Native American, I have diabetes and heart disease, drink alcohol, and I smoke. What are my chances of dying versus my blonde American wife? 4) I am Chinese American, and my hemoglobin/A1C is 9. My fasting blood sugar is 200. I cannot read my newspaper anymore. Why? 5) I am Mexican American and my fasting blood glucose is 300, and I was just diagnosed with diabetes but for the past 6 months, I cannot feel my toes. Why? The questions were evaluated with the keywords below: (each keyword was given one point, maximum of 11 pts per question) healthcare team, stroke, heart attack, ADA/Endocrine Society, ACC/AHA, high blood sugar, high blood pressure, complications (eye, kidney, neuropathy, feet), statistics relating to ethnicity, metabolic syndrome.

Keyword Scores: Qn1=4/11; Qn2=5/11; Qn3=1/11; Qn4=3/11; Qn5=3/11 Results: All answers mention “healthcare team,” 4/5 mention heart disease, 4/5 mention high blood sugar, 2/5 mention stroke, 1/5 mention diabetic retinopathy, and 1/5 mention neuropathy. None of the responses list ADA/Endocrine Society, ACC/AHA, statistics, or metabolic syndrome. None of the answers mention eye MD/ophthalmologist, endocrinologist, nephrologist, or podiatrist. None mention health disparities. Qn 1 answers: stroke, heart attack, high blood sugar, and health care team. Qn 2 answers: increased cholesterol as a risk factor and the same answers as Qn1. The answer to Qn 3, involving Native Americans, does not mention “stroke” in the setting of diabetes, heart disease, smoking, and alcohol consumption. Despite the words of "South Asian" and "Chinese American", Qn 2 and 4, respectively, do not mention metabolic syndrome. Qn 4 does not mention the risks of kidney disease and stroke. Only two answers (Qn 1, 2) mention stroke as a risk factor. Conclusions: ChatGPT is not perfect but it provides baseline information for diabetic patients and is a great start to furthering health education for the public.

Presentation: Saturday, June 17, 2023
The autotaxin-LPA axis promotes membrane trafficking and secretion in yolk sac visceral endoderm cells
Authors: Koike Seiichi , Keino-Masu Kazuko , Tanimoto Yoko , Takahashi Satoru , Masu Masayuki
Published: October 2023

Autotaxin, encoded by the Enpp2 gene, is an exoenzyme that produces lysophosphatidic acid, thereby regulating many biologic functions. We previously reported that Enpp2 mRNA was abundantly expressed in yolk sac visceral endoderm (VE) cells and that Enpp2−/− mice were lethal at embryonic day 9.5 owing to angiogenic defects in the yolk sac. Enpp2−/− mice showed lysosome fragmentation in VE cells and embryonic abnormalities including allantois malformation, neural tube defects, no axial turning, and head cavity formation. However, whether the defects in endocytic vesicle formation affect membrane trafficking in VE cells remained to be directly examined. In this study, we found that pinocytosis, transcytosis, and secretion of angiogenic factors such as vascular endothelial growth factor and transforming growth factor β1 were impaired in Enpp2−/− VE cells. Moreover, pharmacologic inhibition of membrane trafficking phenocopied the defects of Enpp2−/− mice. These findings demonstrate that Enpp2 promotes endocytosis and secretion of angiogenic factors in VE cells, thereby regulating angiogenesis/vasculogenesis and embryonic development.
Selective Self-assembly of Gold Nanocrystals Using Complementary Leucine Zipper Peptides
Authors: Nakao Issei , Sumida Kento , Kitamatsu Mizuki , Soejima Tetsuro
Published: October 2023

A heterodimeric leucine zipper (Lz)–based peptide hybrid was utilized as a molecular adhesive to bind two types of gold nanocrystals with different shapes. An acidic leucine zipper (LzE) and a basic leucine zipper (LzK) peptides with terminal cysteine are respectively adsorbed to the surface of spherical gold nanoparticles (LzE–Au NPs) and gold nanocubes (LzK–Au NCs). Transmission electron microscope (TEM) observation and visible (Vis) absorption spectroscopy revealed that LzE–Au NPs and LzK–Au NCs are selectively self-assembled in water. The dynamic self-assembly behavior is also confirmed by in-situ fluorescence resonance energy transfer between fluorescence dyes connected to LzE and LzK peptides and other control experiments.
Κοινωνικοοικονομικές ανισότητες στην υγεία την εποχή του διαδικτύου
Authors: Μαλινάκη Ευανθία
Published: October 2023

Η περιορισμένη εγγραμματοσύνη υγείας έχει θεωρηθεί ένας σημαντικός συμβάλλων παράγοντας στην υγεία και έχει συνδεθεί με φτωχά αποτελέσματα υγείας. Oι ανισότητες στην υγεία έχει βρεθεί ότι καθοδηγούνται από τις κοινωνικοοικονομικές ανισότητες και η εγγραμματοσύνη υγείας έχει βρεθεί ότι συνδέει την κοινωνικοοικονομική κατάσταση με την υγεία. Επιπλέον, οι υποκειμενικές μετρήσεις της κοινωνικοοικονομικής κατάστασης συχνά συνδέονται με αποτελέσματα υγείας ακόμα και μετά τον έλεγχο των σχέσεων με τις αντικειμενικές μετρήσεις της κοινωνικοοικονομικής κατάστασης (μορφωτικό επίπεδο και εισόδημα). Η χαμηλή κοινωνικοοικονομική κατάσταση θεωρείται πιθανός παράγοντας κινδύνου για χαμηλή εγγραμματοσύνη υγείας, παρόλο που η ακριβής σχέση ανάμεσα στην εγγραμματοσύνη υγείας και τις ανισότητες στην υγεία παραμένει ασαφής. Στην παρούσα διδακτορική διατριβή σκοπός είναι η μελέτη της σχέσης ανάμεσα στις υποκειμενικές και αντικειμενικές μετρήσεις της κοινωνικοοικονομικής κατάστασης, τις προσλαμβανόμενες κοινωνικοοικονομικές ανισότητες στην υγεία, την εγγραμματοσύνη και ψηφιακή εγγραμματοσύνη υγείας και τη συμπεριφορά αναζήτησης πληροφοριών υγείας κυρίως στο Διαδίκτυο. Για τους σκοπούς της διατριβής διενεργήθηκαν συνολικά τρεις έρευνες, μία με ποιοτική μεθοδολογία (Έρευνα 1) και δύο με ποσοτική μεθοδολογία (Έρευνες 2 και 3). Στις πρώτες δύο έρευνες (Ε1 και Ε2) συμμετείχαν άνθρωποι χαμηλής κοινωνικοοικονομικής κατάστασης· συνταξιούχοι και νέοι-άνεργοι, ενώ στην τρίτη έρευνα (Ε3) συμμετείχαν άνθρωποι διαφορετικών κοινωνικοοικονομικών επιπέδων. Οι συμμετέχοντες όλων των ερευνών διέμεναν στην Ελλάδα και εντοπίστηκαν μέσω χιονοστιβάδας. Η προσλαμβανόμενη κοινωνικοοικονομική κατάσταση του ατόμου σε συνδυασμό με τις διαθέσιμες πηγές του (οικονομικές, κοινωνικές, τεχνολογικές) συμβάλλει στις κοινωνικοοικονομικές ανισότητες στην υγεία. Οι συμμετέχοντες όσο μεγαλύτερο εισόδημα διέθεταν και όσο υψηλότερα τοποθετούσαν τον εαυτό τους στην κοινωνικοοικονομική ιεραρχία τόσο λιγότερη προσλαμβανόμενη ανισότητα αισθάνονταν ότι βίωναν. Επίσης, οι αντικειμενικοί δείκτες της κοινωνικοοικονομικής κατάστασης και συγκεκριμένα το μορφωτικό επίπεδο βρέθηκε ότι συνδέεται με την εγγραμματοσύνη υγείας και την ψηφιακή εγγραμματοσύνη υγείας. Η ψηφιακή εγγραμματοσύνη υγείας βρέθηκε να εξαρτάται από τη συμπεριφορά αναζήτησης διαδικτυακών πληροφοριών υγείας. Συμπερασματικά, κρίνεται απαραίτητη η βελτίωση των επιπέδων εγγραμματοσύνης υγείας και ψηφιακής εγγραμματοσύνης υγείας, καθώς αυτές οι δεξιότητες εγγραμματοσύνης θεωρούνται κρίσιμες για την ενδυνάμωση του ατόμου κι έχουν αναγνωριστεί ως ζωτικοί παράγοντες για την αντιμετώπιση ασθενειών και τη διατήρηση της καλής υγείας.
Autonomous, bidding, credible, decentralized, ethical, and funded (ABCDEF) publishing
Authors: Oka Taiki , Takashima Kaito , Ueda Kohei , Mori Yuki , Sasaki Kyoshiro , Hamada Hiro Taiyo , Yamagata Masahito , Yamada Yuki
Published: October 2023

Scientists write research articles, process ethics reviews, evaluate proposals and research, and seek funding. Several strategies have been proposed to optimize these operations and to decentralize access to research resources and opportunities. For instance, we previously proposed the trinity review method, combining registered reports with financing and research ethics assessments. However, previously proposed systems have a number of shortcomings, including how to implement them, e.g., who manages them, how incentives for reviewers are paid, etc. Various solutions have been proposed to address these issues, employing methods based on blockchain technologies, called “decentralized science (DeSci)”. Decentralized approaches that exploit these developments offer potentially profound improvements to the troubled scientific ecosystem. Here, we propose a system that integrates ethics reviews, peer reviews, and funding in a decentralized manner, based on Web3 technology. This new method, named ABCDEF publishing, would enhance the speed, fairness, and transparency of scientific research and publishing.
Comparative evaluation of gestosis score vs uterine artery pulsatility index in predicting gestational hypertension: A study protocol
Authors: Dahiphale Swati , Potdar Jyotsna , Acharya Neema , Garapati Jyotsna
Published: October 2023

Background: Gestational hypertension and its consequences such as preeclampsia, eclampsia is a leading cause of maternal mortality in India. Multiple risk factors are already known to cause hypertension in pregnancy and with newer advances in the field of medicine, newer risk factors are also being detected which contribute to gestational hypertension. There is need to detect these risk factors so that women who are susceptible to developing hypertension in their pregnancy can be identified at the earliest and monitored and managed accordingly. This study includes two methods, gestosis score which is a newer method, and uterine artery Doppler pulsatility index which is commonly utilized in usually urban centers where ultrasonography facilities are available to look for these risk factors.

Objective: The study intends to compare the results of both prediction approaches, the Gestosis score and the Uterine Artery Pulsatility Index in identifying women at risk for gestational hypertension so that these women can be monitored vigilantly for the development of hypertension during their pregnancies and contribute to better management and healthy outcomes of pregnancy.

Methods: This study will include 140 pregnant women with gestational ages between 13 to 20 weeks. The gestosis score and mean uterine artery pulsatility index will be calculated. Women with a gestosis score of three or more are deemed at risk for gestational hypertension. Women with mean pulsatility index of 95th percentile or higher are labeled at risk of gestational hypertension. The outcomes of these two methods will be compared to assess which is more effective in predicting developing gestational hypertension.

Expected outcome: The study aims to provide insights into the effectiveness of both the Gestosis Score and the Uterine Artery Pulsatility Index in predicting gestational hypertension. The results will contribute to employing better risk assessment in clinical practice and the management of high-risk pregnancies.
Analytical approach to piezoelectric model synthesis with the use of Cauer’s method for system design
Authors: Harazin Jacek , Wróbel Andrzej
Published: October 2023

Background: Piezoceramic materials have unique property which enables direct and bilateral conversion between mechanical and electrical energy. This ability facilitates significant miniaturisation of technology and opens many opportunities in design of new actuators and energy harvesters. Mathematical modelling of piezoelectric modules is notoriously hard due to complex constitutive equations defining mechanical and electrical energy conversion.

Methods: The article presents research on a new synthesis method based on the Cauer’s method for electrical and mechanical system design. Mechanical damping is introduced with the use of Rayleigh’s approximation. A discrete electromechanical model is formed based on the Mason’s piezoelectric model. As an additional element of the research, a non-standard model analysis method using edge graphs and structural numbers is employed to investigate potential reductions in computational requirements for model analysis.

Results: The electromechanical model analysis has shown an error of 5% in relation to the resonance target. The calculated peak in magnitude of displacement at the resonant frequency was well above the capability of a 3.5mm thick piezoelectric plate. The proposed non-standard method of analysis gave identical results in terms of obtained resonance frequencies. The calculated magnitude of vibrations was varying by 50 – 58%.

Conclusions: The synthesis method presented in this paper allows an approximation of piezoelectric parameters of a real system based on the created mathematical model. Currently this method is subject to a considerable error in the determined vibration amplitudes of the system, but it allows a coarse approximation of the parameters while having a very limited number of input data. The additional method of analysis based on structural numbers offers a promising alternative to matrix calculations but requires a more thorough investigation of the computational power required to determine whether it can compete with existing algorithms.
The pathophysiology of diabetic foot: a narrative review
Authors: Kim Jiyoun
Published: October 2023

An aging population and changes in dietary habits have increased the incidence of diabetes, resulting in complications such as diabetic foot ulcers (DFUs). DFUs can lead to serious disabilities, substantial reductions in patient quality of life, and high financial costs for society. By understanding the etiology and pathophysiology of DFUs, their occurrence can be prevented and managed more effectively. The pathophysiology of DFUs involves metabolic dysfunction, diabetic immunopathy, diabetic neuropathy, and angiopathy. The processes by which hyperglycemia causes peripheral nerve damage are related to adenosine triphosphate deficiency, the polyol pathway, oxidative stress, protein kinase C activity, and proinflammatory processes. In the context of hyperglycemia, the suppression of endothelial nitric oxide production leads to microcirculation atherosclerosis, heightened inflammation, and abnormal intimal growth. Diabetic neuropathy involves sensory, motor, and autonomic neuropathies. The interaction between these neuropathies forms a callus that leads to subcutaneous hemorrhage and skin ulcers. Hyperglycemia causes peripheral vascular changes that result in endothelial cell dysfunction and decreased vasodilator secretion, leading to ischemia. The interplay among these four preceding pathophysiological factors fosters the development and progression of infections in individuals with diabetes. Charcot neuroarthropathy is a chronic and progressive degenerative arthropathy characterized by heightened blood flow, increased calcium dissolution, and repeated minor trauma to insensate joints. Directly and comprehensively addressing the pathogenesis of DFUs could pave the way for the development of innovative treatment approaches with the potential to avoid the most serious complications, including major amputations.
The problem of the incidence of falls in hospitals in Poland in the opinion of physiotherapists
Authors: Mikos Marcin , Ciukszo Agnieszka , Podhorecka Marta , Curyło Mateusz
Published: October 2023

Introduction: An unintentional fall is an event whereby a person inadvertently comes to rest on the ground or floor for reasons other than a violent impact, loss of consciousness, or the sudden onset of paralysis that can occur during a stroke or epileptic seizure. Implementing effective strategies can reduce the risk of falls, reduce fall-related injuries and reduce healthcare costs. Aim: The aim of the study was to get to know the opinion of physiotherapists working in one of the Krakow multi-specialty hospitals on the risk of falls in hospitals in Poland.
Material and methods: Thirty physiotherapists participated in the study. The study was conducted using a proprietary questionnaire consisting of 44 questions. Results: The most common place in the hospital where, according to the respondents, a fall occurs is the toilet, bathroom, corridor and patient room. 80% of respondents indicate that physiotherapists in Poland are sufficiently prepared to conduct professional activities aimed at preventing patients from falling in hospitals.
Conclusions: Falls of patients in hospitals in Poland are a significant systemic problem. The main causes of patient falls in the hospital were indicated by the respondents as staff shortage, poor technical condition of infrastructure and underfunding of health care. According to the surveyed physiotherapists, most falls are recorded in the departments of rehabilitation and internal medicine, which is confirmed by the cited literature.
Models of Fortitudo Feminae in Tacitus Annals: Agrippina the Elder, Epicharis and Boudicca/Modelos de fortitudo feminae en los annales de Tácito: Agripina la mayor, Epícaris y Boudica
Authors: Pavón Pilar
Published: October 2023

This paper analyses three women from the Julio-Claudian period: Agrippina the Great, Epicaris and Boudica, from different social conditions and geographical origins, as paradigms of fortitudo animi et corporis in Tacitus' Annals. Throughout the passages of this work, the author's admiration and sympathy for the lost causes defended by these women against the power of tyranny can be glimpsed. In his narrative, he introduces elements that lead the reader to take a stand in their favour, although he is sometimes critical of the behaviours that are inappropriate for their conditiones feminarum. Despite the extensive bibliography on these women, their figures have not been treated from the perspective discussed here.
How Covid-19 Reshaped the Views of the University Instructors on Technology Integration
Authors: Ozdemir Emsal Ates , Saglam Sercan , Erkir Sarp
Published: October 2023

The aim of this exploratory case study is to investigate the impact of the pandemic as an unexpected situational variable on university instructors’ perceptions and attitudes towards technology integration, as well as their foresight about the future of education in post Covid-19 era. The data for the study came from autobiographies, narratives, and opinionnaires. The findings revealed that the degree of familiarity with educational technology and eagerness to integrate technology into education made a difference in academicians’ adaptation to the new mode of delivery. As for their predictions for the future, an increase in the use of educational technology not only in teaching, but also in testing and assessment is expected. Participants also emphasized a need to enhance the infrastructure to avoid any further technical issues and offer continuous development opportunities for teachers and students to become familiar with new technologies.
Phylogenetic analysis of zoonotic Acinetobacter spp. isolated from Geoffroy's bat (Myotis emarginatus), Northern Iraq
Authors:   Department of Microbiology, College of Veterinary Medicine, University of Al-Qadisiyah, Al-Diwaniyah City, Iraq, Esmaeel Jameela Radi , Saleh Zeena Fouad ,   Unit of Zoonotic Diseases Researchs, College of Veterinary Medicine, University of Al-Qadisiyah, Al-Diwaniyah City, Iraq, Fahad Khilood Hamdan ,   Department of Microbiology, College of Veterinary Medicine, University of Al-Qadisiyah, Al-Diwaniyah City, Iraq, Klaif Saba Falah ,   Unit of Zoonotic Diseases Researchs, College of Veterinary Medicine, University of Al-Qadisiyah, Al-Diwaniyah City, Iraq
Published: October 2023

The current study was conducted to isolate and evaluate the phylogenetic status of the zoonotic Acinetobacter spp. from the Geoffroy's bat (Myotis emarginatus). The sample collection included 35 bats captured in some caves in Northern Iraq. Intestine parts and swabs were taken from each bat. The specimens were subjected to bacterial cultivation processes and 16S rRNA gene and beta lactamase (bla TEM-1) dependent polymerase chain reaction (PCR) methods to detect the genus level and the virulence activity, respectively. The phylogenetic tree was built utilizing the 16S rRNA gene. The findings of the bacterial cultivation revealed the presence of the bacterium in 23 (65.7%) of the collected bats; however, the 16S rRNA-PCR showed that only 10 (28.57%) of the bats demonstrated the incidence of this microorganism in their intestines. The bla TEM-1-PCR reported that 4 (40%) isolates of the 16S rRNA-PCR positive bats carried the β-lactamase gene in their genetic materials. The phylogenetic tree showed that the genetic similarity of the current study isolates was closely related to those from Egypt and China. The present data show that Acinetobacter spp. is present in the intestine of the Geoffroy's bat (Myotis emarginatus) located in some caves from Northern Iraq, and some isolates have virulence potential represented by the composition of the beta lactamase gene.
Visualizing Divergence: Rhetorical Education and Historical Imagination in China and Korea (ca. 1314–1644)
Authors: Yin Shoufu
Published: October 2023

Abstract: This essay explores how basic computer programming and data visualization provides new tools to understand the respective development of rhetorical education and historical imagination in China and Korea during the same period of the fourteenth to seventeenth centuries. Gathering data from large databases that contain thousands of collections printed in China and Korea, I show that a critical divergence emerged during the mid- and late sixteenth century in the field of rhetorical training. Specifically, the historical interests of Chinese elites gravitated toward the most recent episodes in the history of their own dynasty, while Chosŏn elites were increasingly devoted to the earliest phase of the Central Civilization. These observations complement existing studies that have focused on connections between China and Korea, and offer a starting point for understanding parallels and divergences between different regions and realms in East Asia.
Logic operation and all-optical switch characteristics of graphene surface plasmons
Authors: Zhu Jun , Xiong Jiayuan
Published: October 2023

Terahertz logic gates play a crucial role in optical signal processing and THz digitization. In this paper, we propose a design strategy for graphene-based metamaterial THz all-optical logic gate devices based on the induced transparency effect of surface isolated. Theoretically, we realize Boolean operations by coupling of a hexagonal graphene resonant cavity with dual embedded rotatable ellipses. Based on the coupled mode theory, the elliptical rotation angle of the resonator is an important factor affecting the PIT phenomenon. We control the logic input by adjusting the rotation angles of the two embedded ellipses. The analysis results show that: under the incidence of y-polarized light, the ellipse deflection angle of 0° represents the input signal ‘0’, and the ellipse deflection angle of 30° represents the input signal ‘1’. Through numerical simulation, the structure realizes two logical operations of NAND and AND. Under the incidence of x-polarized light, the ellipse deflection angle of 0° represents the input signal ‘0’, and the ellipse deflection angle of 90° represents the input signal ‘1’. Through numerical simulation, the structure realizes three logical operations of NAND, XNOR and OR. Finally, we analyze the performance of the logic gates by extinction ratio. The extinction ratio of the logic gate is up to 10.38 dB when performing OR Boolean operations. Numerically simulated all-optical logic gates can be key components of optical processing and telecommunication equipment.
One dimensional temperature measurements by resonantly ionized photoemission thermometry of molecular nitrogen
Authors: McCord Walker , Clarks Aleksander , Zhang Zhili
Published: October 2023

This paper presents an extensive parameter study of a non-intrusive and non-seeded laser diagnostic method for measuring one dimensional (1D) rotational temperature of molecular nitrogen (N2) at 165 - 450 K. Compared to previous efforts using molecular oxygen, here resonantly ionized and photoelectron induced fluorescence of molecular nitrogen for thermometry (N2 RIPT) was demonstrated. The RIPT signal is generated by directly probing various rotational levels within the rovibrational absorption band of N2, corresponding to the 3-photon transition of N2 (X1Σ
g
+,v=0→b1Π
u
,v′=6) near 285 nm, without involving collisional effects of molecular oxygen and nitrogen. The photoionized N2 produces strong first negative band of N2+ (B2Σ
u
+−X2Σ
g
+) near 390 nm, 420 nm, and 425 nm. Boltzmann analyses of various discrete fluorescence emission lines yield rotational temperatures of molecular nitrogen. By empirically choosing multiple rotational levels within the absorption band, non-scanning thermometry can be accurately achieved for molecular nitrogen. It is demonstrated that the N2 RIPT technique can measure 1D temperature profile up to ∼5 cm in length within a pure N2 environment. Multiple wavelengths are thoroughly analyzed and listed that are accurate for RIPT for various temperature ranges.
A call to implement preclinical study registration in animal ethics review
Authors: Jeffers Matthew S. , MacLellan Aileen , Avey Marc T. , Menon Julia ML , Sunohara-Neilson Janet , Fergusson Dean A. , Lalu Manoj M.
Published: October 2023

Protocol registration is required in clinical trials. Registration of animal studies could improve research transparency and reduce redundancy, yet uptake has been minimal. Integrating study registration into institutional approval of animal use protocols is a promising approach to increase uptake.
Coaching as a growth- or security-oriented process–How regulatory fit increases coaching success
Authors: Mühlberger Christina , Böhm Andreas Maximilian , Hansen Jochim , Behrendt Peter , Wastian Monika , Jonas Eva
Published: October 2023

Regulatory focus theory suggests that promoters are more concerned with growth and preventers are more concerned with security. Since coaching is a growth-oriented process, it seems to be more suitable for clients high on promotion than for clients high on prevention. Applying regulatory fit theory, the present research investigates how preventers can also benefit from coaching. First, a study looking at real coaching processes (N1 = 103) found that a higher promotion than prevention focus was indeed related to more coaching success, i.e., satisfaction and approach motivation. Next, testing the hypothesis that fit effects should also be present in coaching, a study using a vignette approach (N2 = 99) shows that participants experiencing a fit between their focus and a promotion versus a prevention coaching indicate a better coaching evaluation than participants experiencing no fit. In three studies (N3a = 120, N3b = 85, N3c = 189), we used an experimental approach and manipulated the regulatory focus of coaching interventions. We found promotion as well as prevention fit effects showing that participants experiencing a fit indicate more coaching success than participants experiencing no fit. Two studies (N4a = 41, N4b = 87) further tested interpersonal fit, i.e., the fit between the coach’s and client’s regulatory focus. We found promotion as well as prevention fit effects on participants’ satisfaction with and trust in a coach (Study 4a) and promotion fit effects on participants’ goal attainment and coaching progress (4b). The findings suggest that by adapting coaching to the client’s focus, coaching success can be increased not only for promoters but also for preventers. Thus, we found that regulatory fit effects, albeit small to medium, are also present in coaching. Multiple studies assessing multiple variables relevant to coaching showed that the findings differ regarding the interventions used and the variables that we looked at. The practical implications of these findings are discussed.