bluuebunny/crossref_metadata_2025 huggingface dataset:
MOST DOMINANT SOURCE OF STUDENT'S SELF-EFFICACY IN ENGLISH PUBLIC SPEAKING
Authors: Tri Setyaningsih  , Supraptiningsih Nurhandayani , Utiarahman Farah Andina
Published: September 2022

The objectives of this research are to investigate the most dominant source of self-efficacy that affects students' English public speaking skills and to discover the students' strategies in developing their self-efficacy. Moreover, this research is conducted among fourth semester of public speaking students consisting of 32 participants. In this case, the researchers use the descriptive qualitative method to calculate the data gathered. The finding reveals that the main source of self-efficacy that affects students' public speaking skills is the Psychological and Affective States. Another finding also shows that varied strategies are elaborated in order to develop self-efficacy, such as getting the assistance from teacher's feedback, finding friends as role model, being noticed by peers, and being able to control physical and emotion stress reactions.
Penerapan Teori Moody Dalam Pembelajaran Apresiasi Lagu Tujuh Belas Karya Tulus
Authors: Atikah Ikah , Hikmat Ade
Published: September 2022

Abstrak

Penelitian ini bertujuan untuk memberikan gambaran penerapan pembelajaran apresiasi sastra dengan metode Moody yang menggunakan lirik lagu Tujuh Belas karya Tulus. Metode Moody dipakai sebagai cara untuk membuat pembelajaran apresiasi sastra menjadi tidak membosankan dimana siswa akan lebih banyak aktif menggali makna suatu karya di dalam kelas. Penelitian ini menggunakan metode deskriptif kualitatif. Data yang diperoleh menggunakan analisis yang menghasilkan penggambaran penerapan pembelajaran apresiasi sastra menggunakan lirik lagu. Hasil dari penelitian ini, guru dapat menggunakan metode Moody untuk menyampaikan pembelajaran apresiasi sastra yang lebih menarik karena menggunakan enam tahapan yaitu pelacakan awal, penentuan sikap praktis, introduksi, penyajian, diskusi dan pengukuhan. Keenam tahapan ini mencakup dua prinsip sastra yaitu pertama, sastra sebagai pengalaman dengan memberikan pengetahuan baru kepada siswa melalui kegiatan apresiasi dan yang kedua adalah sastra sebagai Bahasa dimana siswa dapat menelaah unsur kebahasaan yang terkandung dalam lirik lagu tersebut.

Kata kunci: Apresiasi Sastra; Moody; Lirik Lagu
Representasi Bendera pada Naskah Drama Penjual Bendera Karya Wisran Hadi
Authors: Suciawaty Wulan Nur , Hikmawaty Hikmawaty
Published: September 2022

Dalam mengenali suatu negara perlu memiliki identitas yang sebagai ciri khas suatu negara itu sendiri. Bendera negara merupakan salah satu yang menjadi identitas negara tersebut. Pada identitas bendera di suatu negara memiliki makna simbolik yang menggambarkan atau melukiskan suatu maksud dari bendera itu sendiri. Penelitian ini mengangkat suatu permasalahan tentang identitas serta makna pada bendera bertujuan untuk (1) mendeskripsikan struktur pembangun naskah drama Penjual Bendera, (2) mendeskripsikan identitas bendera berdasarkan ideologi yang direpresentasikan pada naskah drama Penjual Bendera, (3) mendeskripsikan representasi makna yang terkandung dalam bendera pada naskah drama Penjual Bendera. Peneliti menggunakan metode deskriptif kualitatif sebagai metode penelitian yang digunakan. Sumber data pada penelitian ini bersumber dari data naskah drama karya Wisran Hadi yaitu Penjual Bendera. Dalam pengumpulan data penelitian ini menggunakan teknik pustaka, simak, dan catat. Hasil penelitian mengindikasikan adanya tiga tokoh yang memiliki ideologi berbeda, hal tersebut berpengaruh pada identitas bendera dan makna yang dimiliki oleh setiap tokoh.
Performance of the ‘Anna’ apple (Malus domestica Borkh.) in Tropical Highlands: A review
Authors: Gutiérrez-Villamil Diego Alejandro , Alvarez-Herrera Javier Giovanni , Fischer Gerhard
Published: September 2022

The 'Anna' apple is a variety of low requirements of winter chill (250 to 300 chilling hours ≤7.2°C). This apple has essential health benefits and remarkable adaptive potential in tropical and subtropical areas affected by climate change. Thus, this review presents the significance of the 'Anna' apple cultivation, the phenological and eco-physiological modifications, and the current state of agronomic management when continuous crops are managed in tropical highlands. The production of this apple in tropical highlands has outstanding potential to obtain cyclical or continuous harvests (two harvests per year) in certain areas with specific environmental conditions, implementing a particular management system. In plantations, it is crucial to carry out some agronomic practices during the reproductive phenology so that the apple tree does not enter into an endodormancy. These are water stress - defoliation – tie-down branches, and the application of dormancy-breaking agents (flower-inducing compounds). In Colombia, ‘Anna’ variety was introduced in 1985 and is grown in areas with temperatures between 14 and 20°C, altitudes between 1700 and 2800 meters above sea level (m a.s.l.), with bimodal and monomodal rain regimes, and solar brightness between 800 and 2000 hours a year. The harvest is between 100 to 120 days after anthesis, with firmness values of 38.38N, a soluble solids content of 8.58°Brix, and total titratable acidity of 0.7% of the fruit. This documentation indicates a good production with great potential in terms of growth and development, earliness, and quality of the 'Anna' apple tree in Colombian highlands.
The impact of the COVID-19 pandemic on the cultural and leisure industries: evidence from Riga, Latvia
Authors:   University of Latvia, Feizaka Margarita
Published: September 2022

The aim of this study is to evaluate the impact of the Covid-19 pandemic on the creative-cultural and leisure-entertainment industries in Riga, Latvia. Socialising of individuals is one of the main factors in the success of these industries, and therefore, epidemiological restrictions posed a threat to their further operation. The study was conducted using a qualitative research methodology, namely, semi-structured, in-depth interviews with representatives of creative quarters in Riga. The findings suggest that restrictions imposing social distancing affected the whole industry, yet individual experiences were neither completely different nor identical: the preconditions and characteristics of certain venues were key factors in their successful operation during the pandemic, e.g., establishments with vast outdoor premises were able to adapt to ever-changing requirements easier than venues with limited outdoor space or which were mainly indoors. Likewise, it was found that introducing new services amongst the usual cultural consumption during the pandemic paved the way for developing new, multifunctional quarters in Riga.
Is travelling currently a risk? The impact of COVID-19 and war in Ukraine
Authors:   University of Latvia, Apsite-Berina Elina , Klepers Andris ,   Vidzeme University of Applied Sciences, Jegermane Ieva ,   University of Latvia, Lapa Linards ,   University of Latvia
Published: September 2022

The aim of the study is to examine how regular travellers’ behaviour and views regarding international travel have changed as a result of the Covid-19 pandemics and the war in Ukraine. The study includes three research questions 1) how much is travel missed and how do pandemics affect international travel behaviour? 2) how do regular travellers view the danger associated with pandemics and the war in Ukraine? 3) to what extent are future travels perceived as risky? The research is based on statistical data on outgoing tourism and domestic visitor monitoring data analysis, and interviews with 33 regular Latvian travellers. The interviews were conducted during the first quarter of 2022. According to the findings, regular travellers currently feel a lack of excitement about planning trips or international travel experiences. Those who frequently travel for business report a lower level of longing for this experience. The habit of travelling locally has increased due to the lack of international alternatives during the pandemic with restrictions on global mobility. Regular travellers accept the inconveniences caused by the Covid-19 restrictions, but they were afraid and applied self-protection strategies, or even refused to travel entirely, during the first month of the war in Ukraine. Finally, regular travellers are not going to refrain from taking multiple journeys overseas or to Western European countries in the next six months but will avoid travels to zones of military conflict.
Demogaphic changes and migration in LAU 2 regions of Lithuania in 2001-2018
Authors:   Department of Regional and Urban Studies, Lithuanian Centre for Social Science, Baranauskiene Viktorija , Burneika Donatas ,   Department of Regional and Urban Studies, Lithuanian Centre for Social Science
Published: September 2022

Depopulation processes started to intensify in Lithuanian peripheral areas in 2004, when Lithuania joined the EU, and increasing emigration was the main factor behind these processes. This paper analyses the main differences between migration processes at LAU 2 level in 2001 and 2018 in relation to the changing demographic structure of the population inside the country. Analysis of data revealed that migration processes played little role in the redistribution of the population at the beginning of the century; however, the intensification of migration at the end of the 2010s resulted in redistribution of Lithuanian residents towards major metropolitan regions. A rapid increase in the share of residents in three metropolitan regions was followed by a decrease in the population in distant peripheries. A decrease in the size of the population was also followed by ageing processes in those areas.
Residential satisfaction and the factors affecting it in a second-tier city
Authors:   Latvia University of Life Sciences and Technologies, Feldmane Liga
Published: September 2022

Studies of residential satisfaction can help to investigate and improve the emotional state of society and overall satisfaction with life, which is especially important in the wake of the Covid-19 pandemic. This research is based on the population survey in one of the second-tier cities of Latvia, Jelgava, with the aim of investigating the main factors that impact residential satisfaction in a second-tier city. Based on the characteristics of the residential satisfaction assessment of the urban environment in the study, the factors of the urban environment that affect the residential satisfaction assessment by the city’s population are identified, of which the most important factor is the quality of the environment and personal safety. The study reveals that residential satisfaction is impacted by various demographic, socio-economic, housing and migration characteristics of the population.
Results of soil carbonate enrichment research in irrigated areas using remote sensing data
Authors: Filippov D.V. , Chursin I.N. , Boyarenkova A.D. , Rulev D.D.
Published: September 2022

The authors discuss a soil carbonate enrichment problem in the Volgograd region. These processes cause a decrease in yield and require timely identification and assessment of manifestation extent. Observing of large irrigated areas is very difficult. Therefore, the possibilities of monitoring soil carbonate enrichment processes using the analysis of Earth remote sensing data are becoming relevant. The aim of this work is to research the relationship of soil carbonate enrichment with the spectral characteristics of the surface obtained from the data of the “Resurs-P” ultra-high resolution satellite. Using the image from “Resurs-P”, the standard spectral indices were calculated. Most effective ones were selected, having the highest correlation with the degree of soil carbonization, determined from the compared field samples. Through geographic information systems, space images were marked with areas at the sampling points. Information from those sites was then analyzed using graphical visualization and regression analysis. As a result, a relationship was established between the values of the areas’ spectral brightness in the image from the “Resurs-P” and the level of carbonate enrichment. Based on the identified relationships, the Random Forest classifier was trained, using which a map of carbonated soils distribution in the irrigated territory of the Svetloyarsk irrigation system’s test site was created.
A mi salud y a la tuya...
Authors: Núñez Picado Dagoberto
Published: September 2022

Este escrito forma parte de una serie de documentos elaborados por investigadoras e investigadores del Centro de Investigación en Cultura y Desarrollo de la UNED, donde a manera de ensayo se presentan análisis y reflexiones sobre el cómo diversos aspectos de nuestra realidad cotidiana se han visto afectados a partir de la aparición del COVID-19.
A system for urban water cycle health assessment: a case study of Yinchuan City, Northwest China
Authors: Zixi Liu , Tanglian * , Weijiang Zhang , Weibing Zhang
Published: September 2022

The healthy development of the urban water cycle requires the integrated
consideration of natural and socioeconomic factors and is vital for
sustainable regional socioeconomics. This study adopted Yinchuan City as
a typical arid city in Northwest China and constructed a urban water
cycle evaluation indicator system, considering the ecological status,
environmental quality, abundance, and utilization of water. The analytic
hierarchy process combined with the entropy method were used to
determine the weights of the 15 indicators identified. The overall
evaluation of the health of the water cycle in Yinchuan City from 2009
to 2017 was then conducted. The results indicated that the water cycle
of Yinchuan City was in a sub-healthy state in 2009–2014, with a health
score of 3.65~3.95. The water cycle was in a healthy
state in 2015–2017, with a health score of 4.07~1.13,
and the health score in 2015–2017 increased yearly. In addition, water
utilization and water abundance were the main dimensions affecting the
development of the health of the water cycle of Yinchuan City, and the
indicators of their effects were per-capita water resource and
drainage pipe density, respectively. Improving the health status of the
water cycle of Yinchuan City will require increased rationality of the
development and utilization of water resources and a reduction in water
deficits. In turn, the health of the water cycle of Yinchuan City is
expected to further improve.
MetaPlex: An Ion Torrent COI metabarcoding workflow and toolkit to increase experimental efficacy and efficiency
Authors: Gabry Nick , Kinne Jeff , Gonser Rusty
Published: September 2022

DNA barcoding has become a dependable way to assign taxonomic
identifications to otherwise unknown DNA samples. Metabarcoding using
next-generation sequencing (NGS) maintains this same caliber of
taxonomic identification and can occur on a mass scale in pooled, or
multiplexed, samples from a wide variety of sources when properly
multiplexed. However, this methodology has several pitfalls, including
inaccurate source sample assignment, multi-step workflows that leave
room for human error, and high costs. To combat these issues, library
preparation protocols have been established for the popular Illumina
sequencing platform which reduce sequence assignment errors to levels
equivalent to background noise, while also greatly reducing cost. An
equivalent protocol has yet to be established for the Ion Torrent
sequencing ecosystem. Here, we present MetaPlex, a library preparation
workflow and post-processing toolkit for efficient and accurate COI
metabarcoding on Ion Torrent sequencers. These methods significantly
decrease the costs of multiplexed sample sequencing by nearly 9x when
compared to commercially available kits through the reduction of
reagents needed for library preparation. In addition, our workflow
provides increased reliability through elimination of laboratory
processes which are known to negatively bias NGS outputs and
source-sample tracing, limiting the common pitfall known as index jumps
to 0.17%. Finally, our accompanying bioinformatic toolkit increases
user accessibility by providing an easy-to-use command line tool for
processing and correcting for errors in our, and others’, dual-indexed
reads.
A unified creep life prediction method and fracture mechanism of high-temperature alloys under multiaxial stress state
Authors: Zhang Dongxu , Lv Menghui , Li Xiaowen , Liang Jianwei , Wang Jiapo , Wen Zhixun
Published: September 2022

This paper proposes a unified creep rupture life prediction method based
on continuous damage mechanics under multiaxial stress state. Instead of
the traditional method, this method can calculate the skeletal point
location for different size of notches in a uniform way. We also
conducted creep tests on Ni-based superalloy round bar specimens with
different notch parameters, which verified the accuracy of the method.
Meanwhile, we carried out creep rupture mechanism analysis for different
notch sizes by combining finite element simulation with experiment,
which analyzed the stress, damage, and explained the void growth based
on triaxial stress.
3D organization of chicken genome demonstrates evolutionary conservation to extreme environments
Authors: Shao Dan , Yang Yu , Shi Shourong , Tong Haibing
Published: September 2022

High-through chromosome conformation capture (Hi-C) technique is widely
used to study the functional roles of the three-dimensional (3D) genome
architecture of genomes. However, knowledge of 3D genome structure and
its dynamic during extreme environments adaption remain poor. Here we
characterized 3D genome architectures with Hi-C technique for chicken
liver cells. By comparing Lindian chicken (LDC) liver cells with
Wenchang chicken (WCC) liver cells, we discovered that environmental
adaption contributed to the switching of A/B compartments, the
reorganization of topologically associated domains (TADs) and TAD
boundaries in both liver cells. Besides, analysis of the switching of
A/B compartments combined with liver transcriptome revealed the
corresponding changes of gene expression were strongly associated with
extreme environment adaption-related pathways, including Tight junction,
Notch signaling pathway, Vascular smooth muscle contraction, RIG-I-like
receptor signaling pathway and Glycosphingolipid biosynthesis pathways.
This study advanced our understanding of evolutionary role of chicken 3D
genome architecture and their significance in genome activity and
transcriptional regulation.
Successful treatment with ivabradine in a β-blocker refractory patient with acute decompensated HFrEF
Authors: Inoue Tomoko , Matsunaga Keiji , Kobayashi Waki , Minamino Tetsuo
Published: September 2022

Ivabradine is an established treatment for chronic heart failure with
reduced ejection fraction (HFrEF) but not for acute heart failure.
β-blocker up-titration is often not possible because of its negative
inotropic effect (NIE). Ivabradine has no NIE; therefore, it may be
preferred over β-blockers in patients with acute decompensated HFrEF.
Direct adsorption of LDL cholesterol - one center experience
Authors: Tomic-Naglic Dragana , Manojlovic Mia , Mitrovic Milena , Prodanovic Jovana , Bajkin Ivana , Pejakovic Sladjana
Published: September 2022

nema
Case 3: An Unusual Clinical Presentation of Diabetes Eventually Diagnosed as a Monogenic Form
Authors: Montes Vince , Chait Alan , Taplin Craig
Published: September 2022

A 31-year-old man of Eastern European decent was evaluated in the endocrinology clinic for suspected type 2 diabetes. He initially presented to an outside clinic 2 years previously with dizziness and was found to have a blood glucose concentration of nearly 400 mg/dL. He apparently did not appear very ill at the time and was sent home with a prescription for pioglitazone with plans for outpatient follow-up. He took the pioglitazone for approximately 6 months and had little success with attaining satisfactory glycemic control. His primary care physician subsequently discontinued the pioglitazone and placed the patient on metformin 1,000 mg twice daily and glipizide 2.5 mg daily. Glycemic control improved with normalized fasting blood glucose levels and HbA1c levels in the 6.2–6.5% range. During the course of his improvement, the patient presented with changes in his vision and was diagnosed with proliferative diabetic retinopathy and vitreous hemorrhage. The patient also had neurologic symptoms that were consistent with peripheral neuropathy, which subsequently improved with the addition of gabapentin.
Case 4: A Case of Monogenic Diabetes
Authors: Slover Robert
Published: September 2022

This patient presented as a 13-year 10-month-old boy with episodes of hyperglycemia. Several weeks before the visit, he developed symptoms of fatigue, light-headedness, and headaches. His primary care provider (PCP) noted that he had had mononucleosis a year previously and suspected that he might have a recurrence of this disorder. Because his father has a history of diabetes, the PCP checked urine for glucose and found it to be markedly elevated (>1,000 mg/dL). He asked the parents to perform self-monitoring of blood glucose using the father’s meter. The family reported fasting glucose levels as high as 170 mg/dL (9.4 mmol/L) with an average of about 137 mg/dL (7.6 mmol/L). The patient had an initial hemoglobin A1C of 8.4%.
Case 6: Ketoacidosis in a Patient with Type 1 Diabetes on a Low-Calorie Meal Replacement Die
Authors: Brown Katy , Bessesen Daniel
Published: September 2022

A 30-year-old woman with type 1 diabetes (T1D) and a BMI of 31 kg/m2 was told by her obstetrician that she was having trouble becoming pregnant because of her weight. To improve fertility, she enrolled in a medically supervised low-calorie diet (LCD) weight loss program. She managed her diabetes with an insulin pump and her HbA1c was 6.7%.
Case 16: Type 1 Diabetes Can Present at Any Age
Authors: Bell David
Published: September 2022

A 49-year-old white man was diagnosed as having diabetes at age 34 years when he presented with polyuria, polydypsia, weight loss, and a blood glucose level of 367 mg/dL (20.4 mmol/L). He was placed on a diabetic diet for 2 years, and when his glucose levels were not controlled by diet alone, he was started on metformin and a sulfonylurea for 9 years until basal insulin was added at the age of 43 years. Even after three hospital admissions for diabetic ketoacidosis, short-acting insulin had not been added to his regimen.
Case 17: Is This Type 2 Diabetes, Type 1 Diabetes, or Late Autoimmune Diabetes in Adults?
Authors: Tripathy Devjit , Pinkson Sheila , Koops Maureen , DeFronzo Ralph
Published: September 2022

A 55-year-old African American woman was referred for management of uncontrolled diabetes. She was diagnosed with type 2 diabetes (T2D) when she was 44 years old during a routine physical exam and initially was started on metformin. After 2 years, glyburide was added, and 4 years later, glargine insulin was initiated following hospitalization for hyperglycemia with ketosis. She was discharged home on insulin, metformin, and glyburide. She reported that her glycemic control was still poor and she experienced wide swings in her glucose values, ranging from 60 to 400 mg/dL (3.3–22.2 mmol/L). At presentation, she was on glipizide, metformin, glargine, and premeal aspart insulin. On further questioning, she revealed that she had a history of hypothyroidism and pernicious anemia. Her vitamin B12 deficiency was so severe that it led to myelopathy and permanent weakness in her lower extremities. She has been on B-12 and levothyroxine. She denied skin pigmentation or history of adrenal insufficiency. Her other medications included simvastatin and lisinopril. She had a family history of T2D in both parents, but she denied any family history of other autoimmune diseases.
Case 21: A Patient with Newly Diagnosed, Asymptomatic Hyperglycemia
Authors: McElduff Aidan
Published: September 2022

A 31-year-old man was found to have a fasting plasma glucose of 8.3 mmol/L (150 mg/dL) at a routine medical examination. He was asymptomatic. His past medical history was unremarkable. There was no family history of diabetes. He worked as an air traffic controller, which was the reason for his routine medical examination.
Case 26: What to Do with Discrepant HbA1c and SMBG Results? The Utility of Fructosamine and Glycated Albuminv
Authors: Gandrabura Tatiana , Rubin Daniel
Published: September 2022

A 59-year-old white man with a history of orthotopic liver transplant for cryptogenic cirrhosis developed diabetes 1 year post-transplant. His post-transplant immunosuppression regimen consisted of tacrolimus, mycophenolate, and prednisone. The patient presented to the clinic for diabetes management, at which time he was taking glipizide extended release 5 mg daily. The patient checked his blood glucose two times daily (premeal average 170 mg/dL, postmeal average 184 mg/dL; Table 26.1). At this time, the hemoglobin A1c (HbA1c) was 5.8% and the hematocrit was 39.9%. Sitagliptin 100 mg daily was added to the glipizide.
Case 37: Diabetes in Hereditary Hemochromatosis
Authors: McClain Donald
Published: September 2022

A 58-year-old Caucasian man was referred to the University Diabetes Center after unsuccessful attempts to achieve adequate glycemic control with a sulfonylurea and metformin. His diabetes had been diagnosed 8 months earlier by fasting glucose and confirmed by HbA1c at a routine visit to his primary care provider. There was a family history of diabetes in an older brother and his father. The patient was moderately overweight (BMI 28 kg/m2), but the physical exam was otherwise completely normal. Prior laboratory testing had revealed an HbA1c of 8.2% on therapy, with normal electrolytes, renal function, and liver function tests.
Case 40: Diagnosis of Addison’s Disease and Type 1 Diabetes in Twin Boys
Authors: Dunn Urban Andrea , Tamborlane William
Published: September 2022

A 3-year-old Caucasian twin boy (A) presented to the emergency department (ED) because of lethargy, nausea, and vomiting for 3 days. He had a 2-week history of polyuria, polydipsia, and 11 lb weight loss. His past medical history was significant for prematurity (27 weeks estimated gestational age), apnea of prematurity, gastro-esophageal reflux, constipation, and excessive salt craving. Family history was positive for type 1 diabetes (T1D) in a maternal cousin. On arrival to the ED, the patient was lethargic and moderately dehydrated; his pulse was 134, blood pressure was 80/48 mmHg, RR 30. The skin was slightly tan in color. Physical exam was normal.
Case 49: Glycemic Control in a Child with Type 1 Diabetes and Autoimmune Hepatitis
Authors: Muntoni Sandro , Congia Mauro
Published: September 2022

A 5-year-old girl was brought to our clinic in July 2009 for increased values of liver transaminases. She was naturally born at the 40th week of gestation and breast-fed for 6 months. At the 10th month of age after the last mandatory vaccine dose, she developed type 1 diabetes (T1D).
Case 60: Management of Diabetic Ketoacidosis in a Patient on Hemodialysis
Authors: Prabhushankar Roopashree , Syed Sofia , Sowers James
Published: September 2022

A 47-year-old woman with type 1 diabetes (T1D) on hemodialysis (HD) presented with altered mental status, vomiting, and abdominal pain. She had frequent admissions for similar episodes in the past because of nonadherence to insulin. Past medical history is significant for uncontrolled T1D (A1C 10.7%), diabetic retinopathy with blindness, and end-stage renal disease (ESRD); she was producing urine of ~100 mL/day. On admission, pulse rate was 110/min and blood pressure 110/60 mmHg. Her dry weight was documented at 68 kg, and her admission weight was 67 kg. She appeared dehydrated with dry mouth and eyes. Otherwise the physical examination was unremarkable.
Case 74: Glycemic Control in Older Adults with Diabetes and Use of New SGLT2 Inhibitors
Authors: Horney Carolyn , Wallace Jeffrey
Published: September 2022

An 81-year-old man is seen in a seniors clinic for care of his type 2 diabetes (T2D), stage III chronic kidney disease (CrCl 55 mL/min), hypertension, and benign prostatic hypertrophy. His current medications are liraglutide 1.2 mg subcutaneous daily, metformin 1,000 mg every evening, aspirin, atorvastatin, and tamsulosin.
Case 86: Recurrent Hypoglycemia in a Patient with Type 2 Diabetes
Authors: Srimatkandada Pavani , McDonnell Marie , Ananthakrishnan Sonia
Published: September 2022

A 72-year-old Somali woman was brought into the hospital for recurrent hypoglycemia, nausea, vomiting, and poor oral intake. The patient had a history of type 2 diabetes, had been on insulin therapy in the past, and more recently had been on metformin alone. A recent HbA1c was 6.4%. She had multiple admissions over the past year for severe hypoglycemia. The patient’s family reported that she often had asymptomatic hypoglycemia at home, both fasting and postprandial.
Facilitators and Barriers to Smart Insulin Pen Use: A Mixed-Method Study of Multidisciplinary Stakeholders From Diabetes Teams in the United States
Authors: Ospelt Emma , Noor Nudrat , Sanchez Janine , Nelson Grace , Rioles Nicole , Malik Faisal S. , Basina Marina , Indyk Justin , Vendrame Francesco , Schmitt Jessica , Scott Mary L. , Ebekozien Osagie ,   T1D Exchange Quality Improvement Collaborative
Published: September 2022

This study sought to identify barriers and facilitators to successful smart insulin pen (SIP) use and gauge prescribing practices and integration into clinical practice by assessing provider and care team perspectives at participating endocrinology clinics within the T1D Exchange Quality Improvement Collaborative. The identified provider-related, patient-related, and clinic- and operational-level barriers and facilitators varied based on clinic knowledge, capacity, and resources. High-impact barriers included insurance coverage and prescribing processes; high-impact facilitators included improved diabetes clinic visit quality and use of SIPs as an alternative to insulin pump therapy. Findings indicated the need for provider and care team education and training on proper SIP features, use, and prescribing.
Retinal Oxygen Metabolism in Patients With Type 2 Diabetes and Different Stages of Diabetic Retinopathy
Authors: Hommer Nikolaus , Kallab Martin , Schlatter Andreas , Howorka Kinga , Werkmeister René M. , Schmidl Doreen , Schmetterer Leopold , Garhöfer Gerhard
Published: September 2022

The aim of this cross-sectional study was to assess retinal oxygen metabolism in patients with type 2 diabetes and different stages of nonproliferative diabetic retinopathy (DR) (n = 67) compared with healthy control subjects (n = 20). Thirty-four patients had no DR, 15 had mild DR, and 18 had moderate to severe DR. Retinal oxygen saturation in arteries and veins was measured using the oxygen module of a retinal vessel analyzer. Total retinal blood flow (TRBF) was measured using a custom-built Doppler optical coherence tomography system. Retinal oxygen extraction was calculated from retinal oxygen saturation and TRBF. Arteriovenous difference in oxygen saturation was highest in healthy subjects (34.9 ± 7.5%), followed by patients with no DR (32.5 ± 6.3%) and moderate to severe DR (30.3 ± 6.5%). The lowest values were found in patients with mild DR (27.3 ± 8.0%, P = 0.010 vs. healthy subjects). TRBF tended to be higher in patients with no DR (40.1 ± 9.2 μL/min) and mild DR (41.8 ± 15.0 μL/min) than in healthy subjects (37.2 ± 5.7 μL/min) and patients with moderate to severe DR (34.6 ± 10.4 μL/min). Retinal oxygen extraction was the highest in healthy subjects (2.24 ± 0.57 μL O2/min), followed by patients with no DR (2.14 ± 0.6 μL O2/min), mild DR (1.90 ± 0.77 μL O2/min), and moderate to severe DR (1.78 ± 0.57 μL O2/min, P = 0.040 vs. healthy subjects). These results indicate that retinal oxygen metabolism is altered in patients with type 2 diabetes. Furthermore, retinal oxygen extraction decreases with increasing severity of DR.
Impacts of COVID-19 on Glycemia and Risk of Diabetic Ketoacidosis
Authors: Sharma Anukriti , Misra-Hebert Anita D. , Mariam Arshiya , Milinovich Alex , Onuzuruike Anthony , Koomson Wilhemina , Kattan Michael W. , Pantalone Kevin M. , Rotroff Daniel M.
Published: September 2022

Reports indicate that coronavirus disease 2019 (COVID-19) may impact pancreatic function and increase type 2 diabetes (T2D) risk, although real-world COVID-19 impacts on HbA1c and T2D are unknown. We tested whether COVID-19 increased HbA1c, risk of T2D, or diabetic ketoacidosis (DKA). We compared pre– and post–COVID-19 HbA1c and T2D risk in a large real-world clinical cohort of 8,755 COVID-19(+) patients and 11,998 COVID-19(−) matched control subjects. We investigated whether DKA risk was modified in COVID-19(+) patients with type 1 diabetes (T1D) (N = 701) or T2D (N = 21,830), or by race and sex. We observed a statistically significant, albeit clinically insignificant, HbA1c increase post–COVID-19 (all patients ΔHbA1c = 0.06%; with T2D ΔHbA1c = 0.1%) and no increase among COVID-19(−) patients. COVID-19(+) patients were 40% more likely to be diagnosed with T2D compared with COVID-19(−) patients and 28% more likely for the same HbA1c change as COVID-19(−) patients, indicating that COVID-19–attributed T2D risk may be due to increased recognition during COVID-19 management. DKA in COVID-19(+) patients with T1D was not increased. COVID-19(+) Black patients with T2D displayed disproportionately increased DKA risk (hazard ratio 2.46 [95% CI 1.48–6.09], P = 0.004) compared with White patients, suggesting a need for further clinical awareness and investigation.
Derivation and External Validation of a Clinical Model to Predict Heart Failure Onset in Patients With Incident Diabetes
Authors: Sun Louise Y. , Zghebi Salwa S. , Eddeen Anan Bader , Liu Peter P. , Lee Douglas S. , Tu Karen , Tobe Sheldon W. , Kontopantelis Evangelos , Mamas Mamas A.
Published: September 2022

OBJECTIVE

Heart failure (HF) often develops in patients with diabetes and is recognized for its role in increased cardiovascular morbidity and mortality in this population. Most existing models predict risk in patients with prevalent rather than incident diabetes and fail to account for sex differences in HF risk factors. We derived sex-specific models in Ontario, Canada to predict HF at diabetes onset and externally validated these models in the U.K.

RESEARCH DESIGN AND METHODS

Retrospective cohort study using international population-based data. Our derivation cohort comprised all Ontario residents aged ≥18 years who were diagnosed with diabetes between 2009 and 2018. Our validation cohort comprised U.K. patients aged ≥35 years who were diagnosed with diabetes between 2007 and 2017. Primary outcome was incident HF. Sex-stratified multivariable Fine and Gray subdistribution hazard models were constructed, with death as a competing event.

RESULTS

A total of 348,027 Ontarians (45% women) and 54,483 U.K. residents (45% women) were included. At 1, 5, and 9 years, respectively, in the external validation cohort, the C-statistics were 0.81 (95% CI 0.79–0.84), 0.79 (0.77–0.80), and 0.78 (0.76–0.79) for the female-specific model; and 0.78 (0.75–0.80), 0.77 (0.76–0.79), and 0.77 (0.75–0.79) for the male-specific model. The models were well-calibrated. Age, rurality, hypertension duration, hemoglobin, HbA1c, and cardiovascular diseases were common predictors in both sexes. Additionally, mood disorder and alcoholism (heavy drinker) were female-specific predictors, while income and liver disease were male-specific predictors.

CONCLUSIONS

Our findings highlight the importance of developing sex-specific models and represent an important step toward personalized lifestyle and pharmacologic prevention of future HF development.
Obtaining Low-Fat Foods and Improved Nutritional Value
Authors: Ovidiu Tita
Published: September 2022

One of the biggest challenges facing food research is the achievement of sustainable food production and, at the same time, the supply of quality food with added functionality for the prevention of diseases regarding the lifestyle. Currently consumers are more aware of food problems and monitor and attempt to harmonize their diet, they have become more preoccupied with improving their general health through daily nutrition
Pharmacognostic Review on Datura
Authors: Chavhan Sarin
Published: September 2022

Datura, a wildly growing plant from Solanaceae family, is attributed with both poisonous and medicinal values. Datura spp. in Ayurveda, different parts of Datura is used for various human ailments when applied both locally and through oral administration. Several functional groups have been reported to be present in different parts of the plant. The plant shows various types of activities such as analgesic, anti-inflammatory, anti-viral, and anti-diarrheal that may be due to the presence of the active chemical constituents. especially in Ayurvedic medicine, D. stramonium has been used for curing various human ailments, including ulcers, wounds, inflammation, rheumatism and gout, sciatica, bruises and swellings, fever, asthma and bronchitis, and toothache. This comprehensive review of D. stramonium includes information on botany, phytochemistry, pharmacology, toxicology and ethnomedicinal uses.
Effect of Non Antibiotic Antimicrobial Curcuma Longa on Helicobacter Pylori Infection
Authors: TR Patil
Published: September 2022

Helicobacter pylori [H. pylori] induced gastric infection and inflammation, which is potentially carcinogenic, is common in India. Despite the availability of triple drug therapy, its failure is quite common due to the high cost factor, adverse drug reactions and emerging resistance to antibiotics. This necessitates the need for discovering new drugs for treating H. pylori infection. Curcumin [diferuloylmethane], an active ingredient of turmeric [curcumin longa], has been extensively studied and proved to be effective in eradicating H. pylori infection, correcting gastric mucosal damage and to prevent or regress gastric carcinogenesis. Curcumin has strong free radical scavenging and anti oxidant property. It bears anti inflammatory and antimicrobial potential against H. pylori. Mechanisms of its antimicrobial actions are l) The inhibition of shikimate pathway by inhibiting enzyme shikimate dehydrogenase [SDH] resulting in to the failure of synthesizing aromatic amino acids [AAA]. folates and ubiquinone. 2) By inhibiting the assembly dynamics of bacterial profilament FtsZ. Curcumin has anti tumerogenesis potential through it’s anti inflammatory, antioxidant and free radical scavenging actions. Thus curcumin provides potential alternative or an adjunct therapy to treat H. pylori infection and prevent it’s complications.
Irrational and Excessive Use of Antibiotics in Children: A Survey on Parent's Knowledge, Practice and Attitudes in Bangladesh
Authors: Amin : Mohammad Nurul
Published: September 2022

Background and Aim: Antibiotic resistance is a term of global concern worldwide. Irrational and misuse of antibiotic is one of the key factors for this resistance. We aimed to analyze the attitude, knowledge and practices of antibiotics use among parents of children presenting to a tertiary care hospital in Bangladesh. Also, correlate it with the gender, education level and previous use of antibiotics by the parents. Methodology: A cross sectional study was performed at a Shishu Hospital in Dhaka, Bangladesh from November 2017 to March 2018 and a total of 1200 parents were interviewed using a questionnaire developed by the authors. Statistics were used for the analysis of data. Results and Discussion: A total of 1160 parents were included in the present study. Around 15.51% parents correctly identified that antibiotics are used against bacterial infections and only 17.25% parents of total participants knew the meaning of the term antibiotic resistance. Majority of the parents (70.68%) appreciated that misuse of antibiotics could harm the child. Around 67.79% parents mentioned that they don’t use leftover antibiotics from the previous prescription for the next time without doctor’s consult. Our observation was that misconceptions exist about the use and indications of antibiotics. Lack of knowledge about antibiotic resistance was prevalent. But participants were aware of the risks associated with misuse of antibiotics. Conclusion: Pediatricians and involvement of mass media may help to improve the antibiotics knowledge and practices among parents and consequently, control the problem of antibiotic resistance.
Phytochemical Screening of Justicia Gendrussa
Authors: Joghee Suresh
Published: September 2022

Justicia gendarussa belongs to family Acanthaceae is commonly known as Nili-Nirgundi. It is traditionally used to treat various diseases such as the wound healing, antioxidant, anti-proliferative etc. The aim of the present study was to investigate the qualitative and quantitative estimation of phytoconstituents of aerial parts of alcoholic extract of Justicia gendarussa. Physiochemical constant, preliminary phytochemical analysis for carbohydrates, glycosides, alkaloids, flavonoid, phenols, tannins and saponin and quantitative analysis for total flavonoid and total alkaloid content were carried out by standard procedures. The physiochemical constituents like total ash and acid insoluble ash, water soluble ash were found to be 14.25%w/w, 05%w/w, 7.30%w/w respectively. The results confirmed the presence of carbohydrates, glycosides, alkaloids, flavonoid, phenols, tannins and saponin and the plant extracts shows higher yield of total phenolic content and also flavonoid content.
A Brief Review of Naga (Lead) through Rasaratna Samucchaya
Authors: Taviad Krushnkumar
Published: September 2022

Background: Naga Bhasma is widely-used in various herbo-metal formulation of Ayurveda, indicated specially for urogenital and gastro-intestinal disorders such as Prameha (Diabetes), Pradara (leucorrhoea), Atisara (Diarrhoea), Grahani (Malabsorption syndrome), Arsha (Haemorrhoids). Aim: The present work aims to collect and summarize all the information regarding the Naga Bhasma from Rasaratna samuchchaya. Materials and Methods: Critical review of Grahyaagrahyatva, pharmacodynamics properties, Shodhana, Marana procedures, dose, Anupana and formulations of Naga bhasma is compiled from Rasaratna Samucchaya. Therapeutic efficacy of Naga bhasma is discussed on the basis of available data. Results: After critical review, total 45 formulations were observed in Rasaratna samuchchaya. In which maximum number of formulations as an ingredient of Naga bhasma are mentioned in the management of Prameha (13) internally and in the management of Netraroga (12) as an Anjana form externally. Percentage of Naga Bhasma was observed minimum 0.47% to maximum 66.66% in formulations. Conclusion: This review is expected to refurnish the existing knowledge and give an insight to the researchers in this area of education and research.
Pharmacognostic, Phytochemical and In Vivo Hepatoprotective Activity on Pongamia Pinnata Linn Bark
Authors: Devarakonda Ramadevi
Published: September 2022

Pongamia pinnata Linnn (Fabaceae) is a tree/shrub with a broad distribution from India, south-eastern Asia, Indonesia and Australia. Different parts of the plant have been used in traditional medicine for bronchitis, whooping cough, rheumatic and diabetes. Transverse section and powder microscopy study of the bark showed phelloderms, cork cells, cortex cells, medullary rays, stone cells, calcium oxalate crystals and starch grains. The total ash 10.64% w/w. The acid insoluble ash 50.4% w/w, water soluble ash 49.1% w/w, The loss on dried 8% w/w, swelling index 5.4% w/w and foaming index was <100. The extractive values of bark powder of P. pinnata Linn was found to be more for ethanol solvent followed by distilled water, chloroform, ethyl acetate, petroleum ether. Preliminary phytochemical screening of hydro-alcoholic bark extract of P. pinnata Linn revealed the presence of flavonoids, phenolic compounds, tannins, alkaloids, carbohydrates, glycosides, and sterols gave positive reaction. The total phenolic, alkaloid and flavonoid contents of the hydro-alcoholic bark extract of P.pinnata Linn was found to be 68.96 ± 0.376 (mg GA/g). 52.06 ± 0.31 (mg AE/g) and 71.06 ± 0.11 (mg QE/g). From the column chromatography3-methoxy-(3´´,4´´-dihydro-3´´-hydroxy-4´´- acetoxy)-2´´,2´´-dimethylpyrano-(7,8:5´´,6´´)-flavone and Caryophyllene oxide compounds were isolated. The hydroalcoholic bark extract of P. pinnata Linn significantly decreases all the elevated levels of SGOT, SGPT, ALKP, TBL, CHL and increases TPTN and ALB levels at 400 and 800 mg/kg in rats when compared to standard drug silymarin.
Standardization & Safety Measures: Quality-Based Validation of Herbal Medicine
Authors: Jain Sachin Kumar
Published: September 2022

Herbal medicines magnetize the curiosity of both patients and scientists, in all aspects of drug development from natural products and also for rationale of traditional medicine (TM). Numerous developing countries rely on TM because of their convenience and affordability, and scientists all over the world believe medicinal plants as a resource of new chemical entities and use them to isolate compounds such as Sennoside, quinine, strychnine, digoxin, morphine, taxol, atropine, and vinblastine
Taxonomic Study on the Wild Species of Genus Solanum L in the Southern Western Ghats of Tamil Nadu
Authors: K Siva Kumar
Published: September 2022

An excursion flora of Solanum (Solanaceae), distributed in Southern Western Ghats ecoregions of Tamil Nadu. The work illustrated to study of complete morphological features of each species, distribution, nomenclature, synonyms, vernacular name, common name, flowering season, Geographical locations, Ecological status, GPS co-ordinate, elevation, habitat, enthnomedicinal uses, formulations and the taxonomic relationships between the studied species is represented by the cluster analysis. The Morphological characters indicated highly significant role in the identification of the species. Based on the detailed survey, two species was native species and remaining three species were invasive plants. The morphological variations measured by Eluidean distance process and phonogram were constructed. The phenogram showed that the studied species of genus Solanum can simply be divided into two groups that are Melongena and Solanum. The phylogram was represented by using parsimony analysis of the morphological data. The phylogram showed that most of the species are distributed all over the study area. Therefore the goal of the present study was to identify distinctive morphological feature on both of Phylogram, and Phenogram. The results was represented showed great similarity between S.virgianianum and S. incanum suggesting that the two species can be considered as one species with two subspecies or varieties.
Preliminary Phytochemical and Pharmacognostic Studies on a Well-known Medicinal Plant Glycyrrhiza glabra
Authors: Danapur Vijay
Published: September 2022

Glycyrrhiza glabra is a perennial herb in the subtropical and warm temperate regions. The principal constituent of licorice is glycyrrhizin. Licorice is used for the treatment of asthma, acute and chronic bronchitis and chronic cough. It modulates the immune system and has remarkable immuno-stimulant properties. The phyto-constituents like glycyrrhizin and glycyrrhizinic acid, triterpenoid glycosides (saponins), flavonoids (including liquiritigetol) are potent components for health benefits. It is a mild anti-inflammatory for arthritis and rheumatism and is used to treat gastric, duodenal and esophageal ulceration of inflammation, heartburn and mouth ulcers. Since it has got so many pharmacological activities it is important to standardize this drug, hence the present study.