bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Misinformation Across Multiple Digital Ecologies: Qualitative Study of Data From Interviews With International Students
Authors: Bahl Rashika , Chang Shanton , McKay Dana , Buchanan George
Published: May 2022

Background

Transient migrants such as international students have received limited support from host country governments throughout the COVID-19 pandemic. An increase in misinformation, resulting in poor health outcomes for individuals, may impact an already vulnerable group.

Objective

Existing research examines the spread of misinformation. Similarly, there is extensive literature on the health information behavior of international students. However, there is a gap in the literature focusing on international students’ interaction with health misinformation. This exploratory research aims to address this gap by examining international students’ interaction with health misinformation during the COVID-19 pandemic.

Methods

A total of 11 participants took part in semistructured interviews and a health misinformation-identification exercise via Zoom. The data collected were subjected to qualitative thematic analysis. Multiple rounds of coding, checked by other coders, revealed 2 themes and 6 subthemes.

Results

The 2 main themes that emerged were (1) approaches to dealing with health misinformation and (2) how international students navigate across multiple digital ecologies. Results show that international students who draw on multiple digital ecologies for information reliably identify misinformation, suggesting that the use of multiple digital ecologies may have a protective effect against health misinformation.

Conclusions

Findings show that international students encounter health misinformation across multiple digital ecologies, and they also compare information across multiple ecologies. This comparison may support them in identifying health misinformation. Thus, the findings of this study combat narratives of international students’ susceptibility to misinformation.
Rise n' Shine: Understanding Morning Behavior Change Based on Wake-Up Tasks (Preprint)
Authors: Oh Kyuetaek , Ko Jisu , Shin Jaemyung , Ko Minsam
Published: May 2022

BACKGROUND

Early morning behaviors between waking up and beginning daily work can develop into productive habits. However, sleep inertia limits the level of human ability immediately after waking, lowering a person’s motivation and available time for productive morning behavior.

OBJECTIVE

This study aims to explore a design for morning behavior change by utilizing a wake-up task, a simple assignment that the user needs to finish before alarm dismissal. Specifically, we set two research objectives: (1) Explore key factors that relate to morning behavior performance, including the use of wake-up tasks in an alarm app. (2) Understand the general practice of effecting morning behavior change by implementing wake-up tasks.

METHODS

We designed and implemented an apparatus that provides wake-up task alarms and facilities for squat exercise. A between-group study was designed to ask users to try to do squat exercises in the early morning using the wake-up tasks for two weeks. We recruited 36 participants, and they were randomly assigned to three different alarm dismissal methods, two wake-up tasks (taking a picture and solving math problems) and a conventional one (touching a button). The target behavior for this study was performing 15 squats in ten minutes after the target time set for the morning alarm.

We conducted generalized estimating equations (GEE) analysis for the first research objective. We considered eight independent variables: (i) the use of wake-up tasks, (ii) alarm usage (ringing time and dismissal time), (iii) theory of planned behavior (TPB; intention, attitude, subjective norm, and control), and (iv) elapsed days. Dependent variables for morning behavior performance were (i) success rate and (ii) time between the alarm ringing and starting the first squat in a successful trial.

The second objective aimed to understand the practice of morning behavior with wake-up tasks by analyzing the app usage logs and survey responses. We conducted a thematic analysis of the answers to the post-survey to find key themes about morning behavior change with the wake-up tasks.

RESULTS

The GEE analysis revealed key factors for morning behavior change. The use of wake-up tasks was significantly related to both the completion of the target behavior (math task: p=.006, picture task: p<.000) and the elapsed time (picture task: p=064). Also, the behavior completion was significantly related to the time to dismissal (p < .001) and TPB variables (intention: p=.062 and norm: .003). Similarly, we found significant relationships between the elapsed time to complete and the time to dismiss (p < .001) and TPB variables (intention: p=.062 and subjective norm: .003). Furthermore, the qualitative study results show detailed alarm usage and characteristics for wake-up task types.

CONCLUSIONS

The results reveal the wake-up tasks’ effectiveness in accomplishing the target behavior and address design implications for morning behavior change based on the wake-up tasks.
PRACTICES AND PROBLEMS OF SUPERVISION AT ELEMENTARY LEVEL IN DISTRICT BHAKKAR
Authors: Shahzadi Uzma , Haider Ghulam , Jabeen Rehana
Published: May 2022

Supervision is an important aspect of performance management and effectiveness of an organization. This study was conducted to assess the practices and problems of supervision at elementary level in district Bhakkar. To conduct the study, descriptive survey design was employed. Random sampling technique was used to select the sample. The population of the study was all 197 elementary schools and 64 supervisors from district Bhakkar. From population, 16 supervisors and 50 head teachers were selected for the study conveniently. The data collected through questionnaires were analyzed by calculating mean and standard deviation through SPSS v.21. Consequently, the main findings of this study were as follows: The major problems that affect supervisors while implementing supervision. Supervisors were not given adequate facility to manage transportation, while visiting schools for the purpose of supervision. Supervisors are overburden with tasks and lack of access to many schools for visit. Furthermore, the study found that they were not rewarded and encouraged if they perform well. Department takes disciplinary action against them when they cannot achieve targets. Supervisors are facing the problem of lack of means of transportation especially those that have to go to the rural areas. Based on the findings, it was recommended that a supervisor must be trained to perform their duties efficiently. Recommendations can also be made for the provision of required facilities to the supervisory staff that may ultimately impact their work of supervision. Official human resource policies may be developed to recognize the efforts and an incentive system may be introduced to acknowledge and motivate the supervisors.
Musical Value and Praxical Music Education
Authors: Regelski Thomas
Published: May 2022

Since post-war II, music education has advocated its presumed aesthetic benefits. Aesthetic advocacy became instituted through the abundance of publications by Bennett Reimer (e.g., 1970, 1989, 1995, 2003). That aesthetic meme is still influential. The debate about Music Education as Aesthetic Education MEAE may be weakening; still, the philosophically untutored conviction remains that involvement with music automatically promotes an educationally valuable aesthetic experience. Hence, teachers need only to enable music experiences. By definition, however, aesthetic experiences defy explicit evaluation. This lack of noticeably improved ‘aesthetic refinement' creates legitimation crises among school boards and education ministries, doubting music's value in the curriculum. Following a critique of Reimer’s theorizing, I argue for a praxical alternative for music education. Compared to the vagueness of aesthetic experience, praxical music education promotes music as a social praxis that depends on substantial and noticeable musicianship gains capable of continuation in adult life. These demonstrate the evident social values of musicking that make aesthetic rationales unnecessary. I argue for a 'turn' in music education that regards music as a social praxis promoting musical sociality throughout life and society, one that is philosophically and pragmatically warranted, and where long-term practical (praxical) results are gained instead of 'activities' that terminate with graduation. A philosophy that guides music educators to promote musicking responsive to human sociality can instead foster professional teaching praxis that society can respect and value as with the other helping professions.
Genre and “Genring” in Music Education
Authors: Ellefsen Live
Published: May 2022

In this article, I explore the theoretical and analytical potential of the concept of genring, which here refers to productive acts of temporary interpretation and signification, wherein existing classification systems and genre categories in the social are operationalized and (re)negotiated. Foucault and Butler’s theories of discursive subjection serve as a theoretical framework to consider how genring works as a performative mode of action: a discursive, reiterative, and citational practice that establishes ontological effects of truth, reality, and naturalness. This performative mode of action is not a “discursive practice” in itself; rather, it might be understood as one of the ways discourse practices itself. To probe the analytical value of the concept genring, I take as my case the field of music education, where genring seems to be a common strategy for associating music with music, music with people, and people with people for educational purposes.
Integraciones comerciales en la frontera sur. Chiapas frente al Tratado de Libre Comercio México-Centroamérica
Authors:   CESMECA, Villafuerte Solís Daniel
Published: May 2022

Los procesos de integración económica son uno de los rasgos que caracterizan a la economía mundial contemporánea; su análisis constituye una exigencia impostergable. Este libro contribuye a ese debate. Pone de relieve las implicaciones de estos procesos en regiones subdesarrolladas de nuestro continente. Centra su atención en los impactos que tendrá el acuerdo comercial entre México y Centroamérica en el medio rural del estado de Chiapas. Los elementos que se aportan conducen a construir escenarios poco alentadores: reconcentración de la tierra, especialización productiva en condiciones de vulnerabilidad extrema, profundización del subempleo y la emigración. Esta valoración no puede sino convertirse en un desafío que nos propone el autor y que rebasa el ámbito de las preocupaciones intelectuales; finalmente, se trata de debatir sobre el futuro de nuestras regiones en el nuevo contexto de la economía mundial.
Química II
Authors:   Dirección General del Colegio de Ciencias y Humanidades, Herrera Hernández Alfredo César , Benítez Albarrán Claudia ,   Dirección General del Colegio de Ciencias y Humanidades, Guerrero Segura Alicia Guadalupe ,   Dirección General del Colegio de Ciencias y Humanidades, López Rivera Paulina Itzel ,   Dirección General del Colegio de Ciencias y Humanidades, Nicio Cruz Ariana Andrea ,   Dirección General del Colegio de Ciencias y Humanidades
Published: May 2022

La antología fue elaborada para el programa de la asignatura de Química II del Colegio de Ciencias y Humanidades (2016), ya que en ella se encuentra una compilación de diversos materiales que pretenden apoyar algunos de los aprendizajes de dicho programa.
Intrusion Detection System Using Principal Component Analysis with Random Forest Approach
Authors: Rahul J. Sanjay , Keerthana J. Sai , Tejaswini G. , Kalpana R. N. S.
Published: May 2022

Abstract: Through the evolution in radio communication, there are many security threats over the internet. The intrusion detection system helps to find the outbreaks on the system and the intruders are detected. Previously various machine learning techniques are applied on the IDS and tried to progress the results on the detection of trespassers and to increase the precision of the IDS. This paper has expected for an approach to develop IDS by using the principal component analysis (PCA) and the random forest classification algorithm. Where the PCA will help to shape the dataset by reducing the dimensionality of the dataset and the random forest will help in classification. Results obtained states that the proposed approach works more resourcefully in terms of accuracy as compared to other methods like SVM, Naïve Bayes, and Decision Tree. The results obtained by projected method are having the values for performance time (min) is 3.24 minutes, Accuracy rate (%) is 96.78 %, and therefore the Error rate (%) is 0.21%. Keywords: Intrusion detection, Principal component Analysis, and Random Forest.
EV Charging Station with Coin Based Payment System with Solar Power
Authors: Taware Yogesh , Kale Nitesh , Jadhav Neha , Chauhan Uttam , Shau Prof. R. M.
Published: May 2022

Abstract: The transportation sector of the world is in the transformation stage, shifting from conventional fossil fuel-powered vehicles to zero or ultra-low tailpipe emission vehicles. To support this transformation, a proper charging station (CS) infrastructure in combination with information technology, smart distributed energy generating units, and favorable government policies are required. The motive of this Project is to address the key aspects to be taken care of while planning for the charging station infrastructure for electric vehicles. The Project also provides major indignation and developments in planning and technological aspects that are going on for the enhancement of the design and efficient management of charging station infrastructure. The Project addresses the present scenario of India related to electric vehicle charging station developments. The Project specially provides a critical review on the research and developments in the charging station infrastructure, the problems associated with it, and the efforts that are going on for its standardization to help the researchers address the problems Keywords: electric vehicle; charging station; EV charging Station; smart charging; charging infrastructure etc
Smart Door Lock System Using Face Recognition
Authors: Harke Namrata , Patil Aishwarya , Nimbalkar Yash , Khore Sandesh , Rathod Prof. Sunil
Published: May 2022

Abstract: Currently, we're facing security issues in every aspect. So, we've to resolve these issues by using streamlined technology. In this project, we're using the Face recognition module to capture human images and to compare with stored database images. The most important of characteristic of any home security system is to discover the people who enter or leave the house. Instead of monitoring that through passwords or pins, unique faces can be made use of as they're one’s biometric characteristic. We aim to make a smart door, which secures the gateway on the base of who we are. The goal of this project is to help users improve the door security of sensitive places by using face detection and recognition. The proposed system consists of basically the following subsystems: Face Detection, Face Recognition and also automatic door access control. Keywords: Face Detection, Face Recognition, Authentication, Convolutional Neural Networks
Ethnic aspects of toxic elements in the Russian Northeast
Authors: Pokhilyuk Natalia V. , Gorbachev Anatoly L.
Published: May 2022

One of the urgent problems of ecology is the environmental pollution of the northern regions with toxic elements and their negative impact on human health. The analysis of the content of lead, cadmium and mercury in the body of aboriginal and visiting residents of the Northeast of Russia was carried out. The balance of essential (calcium, zinc) and toxic (lead, cadmium) elements was considered. Statistically significant differences in the content of cadmium and lead in aboriginal residents and Caucasians were noted. Among the Evens, the median of cadmium exceeded that of the Koryaks, Chukchis, and Caucasoids; the value of the median of lead among the Chukchis was lower compared to that in other ethnic groups. There were no statistically significant differences in the content of mercury between Koryaks, Evens and Chukchis, as well as between aboriginal residents and Caucasians. There are no critical levels of mercury in the body of aborigines. The median mercury in the hair of the Koryaks, Chukchis and Evens did not exceed the biologically acceptable level - 0.5 µg/g. Among aboriginal residents, the highest percentage of samples with mercury content in the range from 0.5 to 1.0 µg/g (background level) was noted in 33.8% of Evens and 30% of Koryaks; among the Chukchi, this figure was 8.6%. Elevated levels of mercury in some aboriginal people may be due to the high proportion of fish and seafood containing methylmercury in the diet. The proportions of toxic metals (Pb, Cd) in relation to their essential antagonist elements (Ca, Zn) indicate that toxic elements do not disrupt the biochemical processes controlled by the corresponding essential elements. Thus, the study area of the Northeast of Russia, in terms of toxic load on the population, can be attributed to territories with a relatively favorable environmental situation.
Designing a cultural landscape in order to preserve the natural and cultural heritage: on the example of the Neverskinsky District of the Penza Region
Authors: Artemova Serafima N.
Published: May 2022

Approaches to the preservation of natural, cultural and historical heritage are shown on the example of the administrative district. Along with the existing list of objects of natural and cultural heritage, it is proposed at the regional level to identify historical cultural landscapes, including villages with preserved ethnic culture and their natural environment, and to classify them as heritage sites. Landscape planning capabilities of ecological balance zones and tourist and recreational systems are shown on the example of the Neverskinsky District of the Penza Region. Historical cultural landscapes together with fragments of wildlife are attributed to the ecological framework of the countryside, which can be used as a tourist and recreational area.
An uncommon cause of anterior knee pain in a child: Osteoid Osteoma of the patella and a review of the literature
Authors: KAYMAZ Nazan , KAYMAZ Burak
Published: May 2022

Introduction: Osteoid osteoma (OO) is a small, benign bone neoplasm that has a well demarcated nidus surrounded by a reactive zone of sclerosis. It is most common in the long bones and only rarely in the patella.Case Presentation: An eight-year-old girl was admitted to the outpatient clinic with the complaint of anterior knee pain. She had been suffering from pain for approximately one year. The patient had a patellar osteoid osteoma. Surgical curettage of the lesion was performed, and the patient was free of pain the day after the surgery.Conclusions: Although Patellar OO is rare, it should be included in the differential diagnosis of persistent knee pain in children and young adults.Keywords: Osteoid Osteoma, patella, knee pain, curettage, delayed diagnosis, bone neoplasms
Concepciones en la mediación pedagógica y en la evaluación del aprendizaje que repercuten en la exclusión educativa
Authors: Segura-Castillo Mario Alberto , Quirós-Acuña Maybel
Published: May 2022

El propósito del siguiente ensayo es mostrar las concepciones que han imperado en la mediación pedagógica y en la evaluación del aprendizaje que repercuten en la exclusión educativa. En este aspecto, se propone el Diseño Universal para el Aprendizaje como un enfoque de alto impacto y como alternativa para dar respuesta a la diversidad del estudiantado. Se puede colegir que, el personal docente que considera la inclusión educativa en la mediación pedagógica y evaluación de los aprendizajes tiene un rol fundamental en la valoración de semejanzas y diferencias personales. Esto lo logra a partir del ejercicio de la libertad, el desarrollo de la autonomía, el autoconocimiento, el autocontrol de las emociones, la autoestima, los sentimientos y la autorrealización; esto, de manera que se respete la diversidad sociocultural, étnica, religiosa, entre otros aspectos.
Macroeconomic performance and the budget deficit in Jordan: A trigger point for change in the aftermath of COVID-19
Authors: Obeidat Muhanned , Al-Tarawneh Ahmad , Omet Ghassan , Khataybeh Mohammad , Khamees Basheer
Published: May 2022

No one doubts that COVID-19 will widen the budget deficit in most, if not all, developing countries. This development (widening public deficit) is particularly important for countries like Jordan. Indeed, since 1965, all governments have witnessed a deficit in their budgets. Within this context, the primary purpose of this paper is to examine the impact of real gross domestic product (GDP) on the fiscal deficit in the Jordanian economy. To examine the impact of real GDP on the real fiscal deficit of Jordanian government, we use annual data that covers the period 1992–2019 and use some relevant econometric techniques (stationarity test, co-integration, vector error correction model (VECM), and variance analysis) to realize the primary objective of the paper. The documented evidence indicates that the underlying long-run relationship between fiscal deficit and GDP is stable. In addition, the results indicate that real GDP takes on increasing weight in explaining the variability in the fiscal deficit over time. Considering the fact that real GDP affects (positively) the fiscal deficit, the government should use the implications of COVID-19 on the budget, as a “trigger” point for change. The government should re-examine its public spending and where possible, seek savings, and greater spending efficiency levels. The government must also re-examine the current tax law, and make the necessary changes to make the system generate not only more tax revenues but more diversified tax revenues as well.
Combination of Spironolactone and Sitagliptin Improves Clinical Outcomes of Outpatients with COVID-19: A Prospective Cohort Study
Authors: Davarpanah Mohammad Ali , Adatorwovor Reuben , Mansoori Yasaman , Ramsheh Fatemeh Sadat Rajaie , Parsa Amir , Hajiani Mehdi , Faramarzi Hossein , Kavuluru Ramakanth , Asadipooya Kamyar
Published: May 2022

Rationale: Coronavirus disease 2019 (COVID-19) leads to
hospitalization and death, especially in elderly and those with
comorbidities. There are evidences showing that sitagliptin and
spironolactone can potentially improve the clinical outcomes of COVID-19
cases. Objective: In this observational study on acutely
symptomatic outpatient COVID-19 cases, we investigated the effects of
spironolactone and sitagliptin on the outcomes of the disease.
Methods: This prospective cohort study was conducted at Shiraz
University of Medical Sciences Clinics during the fifth wave of the
COVID-19 pandemic between July 2021 and September 2021. We followed mild
to moderate symptomatic COVID-19 patients, who were treated with either
combination (spironolactone 100 mg daily and sitagliptin 100 mg daily)
or standard (steroid, antiviral and/or supportive care) therapy up to 30
days. Our primary outcome was hospitalization rate. The secondary
outcomes included ER visit, duration of disease, and complications, such
as hypoglycemia, low blood pressure or altered mental status.
Results: Of the 206 patients referred to clinics, 103 received
standard therapy and 103 treated with combination therapy. There were no
significant differences in baseline characteristics, except for slightly
higher clinical score in control group (6.92 ± 4.01 control, 4.87 ± 2.92
combination; P <0.0001). Treatment with combination
therapy was associated with lower admission rate (5.8% combination,
22.3% control; P = 0.0011), ER visits (7.8% combination, 23.3%
control; P = 0.0021) and average duration of symptoms (6.67 ±
2.30 days combination, 18.71 ± 6.49 days control; P
=<0.0001). Conclusion: In this prospective cohort
study of acutely ill outpatients with COVID-19, the combination of
sitagliptin and spironolactone reduced duration of COVID infection and
hospital visits better than standard therapeutic approaches. The effects
of combination of sitagliptin and spironolactone in COVID-19 patients
should be further verified in a double blind, randomized,
placebo-controlled trial. Iranian Registry of Clinical Trials:
IRCT registration number: IRCT20201003048904N2, Registration date:
December 10, 2020.
First records of Ipomoea subrevoluta Choisy (Convolvulaceae) for the Flora of Maranhão state, northeastern Brazil
Authors: Guarconi Elidio Armando Exposto , Amorim Daniele Santos , Sosa Jordana Martins , Lopes Rayssa Costa Carvalho
Published: May 2022

Ipomoea subrevoluta belongs to the Convolvulaceae family and is commonly found in environments close to rivers and lakes. The species is considered vulnerable, being little known and poorly represented in the herbarium material. The objective of this work is to register the occurrence of the species in an area of Maranhão state, collected in the municipality of Bacabal, a region of ecological tension between the Amazon Domain and the Cerrado. We provide a concise description, phenology, ecological observations, as well as photographs, as well as up-to-date data on the species conservation status.
Anxiety and depression in individuals with and without cancer during the early COVID-19 pandemic period
Authors: Yıldırım Ayaz , Dincer Berna
Published: May 2022

Introduction/Objective. The COVID-19 disease, which has turned into an important public health problem, has negatively affected individuals not only physically but also psychologically. The aim of this study is to examine the anxiety and depression status of cancer patients, comparing to individuals with non-cancer chronic diseases and healthy individuals during the COVID-19 pandemic period. Methods. This cross-sectional study was conducted during the COVID-19 pandemic period between May 8 and June 25 2020 with 1107 people in Turkey. The mean age of the participants in the study was 36.41 ? 12.80. The sample comprised three groups: cancer group (n = 262), chronic disease control group (n = 250), and healthy control group (n = 595). The data were collected with the Descriptive Characteristics Form and Hospital Anxiety and Depression Scale. Results. The anxiety and depression scores were found to be higher in patients with cancer comparing to the other two groups. Having cancer was predictive of higher anxiety and depression score explaining 13% of the anxiety scores variance and 17% of the depression scores variance. Patients with the non-cancer chronic diseases, and healthy participants had anxiety and depression mean scores in the range of the borderline level. Conclusion. These findings suggest that depression and anxiety rates among patients with cancer are specifically higher comparing to patients with other chronic diseases and healthy individuals. The levels of anxiety and depression in the latter two groups should also be paid attention to during the pandemic. This study may have important practical implications in terms of the need for psychological screening.
1008-P: Trends in Improvement in Clinical Outcomes and Health Care Access in Underrepresented Youth with Type 1 Diabetes (T1D)
Authors: YGLECIAS LOREN , REED ALISON , NOYA CAROLINA E. , MCGRATH MAUREEN T. , STONE ANNEMARIE , LODISH MAYA , SPIRO KIMBERLY B. , GOMEZ INGRID C. , HARRIS MICHAEL A. , WAGNER DAVID V. , WONG JENISE C.
Published: May 2022

Background: There is a dearth of research focused on youth living with T1D from publicly insured and ethnically and racially diverse populations. Additionally, there are very few interventions that target social determinants of health (SDH) , despite their documented impact on diabetes outcomes, uptake of diabetes technology, and healthcare utilization. Novel Interventions in Children’s Healthcare (NICH) was developed as a systems and community-based intervention that targets SDH. We describe demographics and outcomes of youth with T1D enrolled in NICH services and related research.

Methods: Youth with T1D were eligible if they had >=1 SDH and >=1 of the following in the year prior to enrollment: >=1 DKA hospitalizations after diagnosis, hemoglobin A1c (A1c) >=14%, >=2 emergency room visits or >=2 missed clinic visits. Demographics were collected from chart review and baseline surveys. Outcomes included continuous glucose monitoring (CGM) use, A1c values, hospital costs, and number of hospital days.

Results: Participants (n=18) had a mean age of 15.1 (±2.4) years, 67% reported female gender, 89% self-identified as Black and/or Latinx, and 94% were publicly insured. CGM use significantly increased from 33% prior to NICH enrollment to 78% after enrollment (p=0.005) . Noted trends included a 1.0% decrease in mean A1c, 20% reduction in average per member, per month (PMPM) hospital costs, and 33% decrease in mean hospital days per month from the year prior to enrollment to the time since being enrolled in the NICH intervention.

Conclusions: Enrollment of publicly insured and ethnically and racially diverse youth living with T1D in research is feasible despite limited existing interventional studies on these populations. Youth with T1D from underrepresented populations experience increased use of technology from participation in the NICH intervention, and they show encouraging trends in improved glycemic control, hospital cost savings, and healthcare utilization.

Disclosure

L.Yglecias: None. D.V.Wagner: None. J.C.Wong: Consultant; Provention Bio, Inc., Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. A.Reed: None. C.E.Noya: None. M.T.Mcgrath: None. A.Stone: None. M.Lodish: None. K.B.Spiro: None. I.C.Gomez: None. M.A.Harris: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust (G-1911-03543)
1015-P: Disparities in CGM Uptake and Sustained Use among Youth with Type 1 Diabetes
Authors: GRUNDMAN JODY , CASTRO MERYLL GRACE , HOOVER ABIGAYLE E. , MONAGHAN MAUREEN , STREISAND RANDI , PERKINS AMANDA G. , MCKENZIE LEANNA M. , REILLY JENNIFER K. , RICHARDSON ALEXIS M. , GOGGIN BAILEY , MARKS BRYNN E.
Published: May 2022

Introduction: We evaluated potential factors influencing CGM uptake and sustained use to better understand the worsening disparities in CGM use among American youth with type 1 diabetes.

Methods: This is a retrospective chart review of youth with type 1 diabetes less than 21 years old seen at a tertiary care center from 1/1/2021 to 11/5/2021. Most recent clinic note and prescriptions were used to determine CGM use (active, attrition, never) and whether CGM was accessed through pharmacy or durable medical equipment. Binary logistic regression was used to assess effects of age, sex, race/ethnicity, insulin regimen, health insurance, and CGM supplier on CGM uptake and sustained use. χ2 was used to assess the impact of language in Latinx youth.

Results: Chart review identified 13youth (female 48.1%, NHW 43.7%, NHB 32.7%, Latinx 10.5%, publicly insured 52.1%) . Table 1 shows predictor variables associated with CGM use. NHW youth were more likely to have ever used CGM while CGM attrition was more common in NHB youth. Ever and active CGM use were less common in publicly insured youth and more common in pump users. CGM use was more common in Latinx English speakers than Spanish speakers (75.4% vs. 56.6%, p=0.03) .

Conclusions: In an era of rapidly advancing technologies, efforts to support equity in diabetes technology use in publicly insured, minority, non-English speaking youth with type 1 diabetes may help to address disparities in health outcomes.

Disclosure

J. Grundman: Research Support; American Diabetes Association. M. Castro: None. A.E. Hoover: None. M. Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases. Research Support; American Diabetes Association. R. Streisand: None. A.G. Perkins: None. J.K. Reilly: None. A.M. Richardson: None. B. Goggin: None. B.E. Marks: Advisory Panel; JDRF. Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc.

Funding

American Diabetes Association (7-21-PDFHD-09)
1029-P: INNOVATIONS: Improving Care of Patients with Type 1 Diabetes Mellitus through Utilization of Telemedicine and Outreach
Authors: RASBACH LISA E. , PURRINGTON VIRGINIA , ADKINS DEANNA , BENJAMIN ROBERT
Published: May 2022

Frequent diabetes support and glucose review via telehealth may help decrease hospitalization rates and improve glycemic control for high-risk youth. This support may also help with uptake and durability of diabetes technology. Eligible youth had insulin dependent diabetes, Medicaid insurance, ages 8-18, and willing to use a continuous glucose monitor (CGM) . The quality improvement project provided weekly check-ins with a diabetes educator, visit reminders, and monthly video visits with a nurse practitioner. 10-item Likert questionnaire (1=not at all comfortable; 5=very comfortable) given at baseline assessed diabetes related comprehension. A needs assessment evaluated a family’s interest in learning about certain areas of diabetes management. A1c was done at quarterly clinic visits and ED/hospitalization rates tracked. 3 month data presented. Youth (N=29, 62% female, 79% NHB) , aged 8-18 yr, diabetes duration 6.3±4.3 years, had baseline mean A1c 12.3±1.7%; 28% on CSII. Mean baseline score of diabetes comprehension was 4.0±0.6. Baseline A1c correlated negatively with diabetes comprehension (r=-0.40, p<0.05) . There was no difference between A1c at baseline and at 3 months (p=0.14) and no differences in ED/hospitalization rates compared to 2 years prior when controlled for time. There was an increase in CGM use from 3 months prior to the intervention (36% of participants) to 3 months after baseline (64%) , though this was not statistically significant (p=0.09) . There was no difference in clinic visit adherence at 3 months despite reminders. Preliminary data reveal that those patients with the highest HbA1c often have the lowest comprehension regarding optimal diabetes care, and may benefit from education reinforcement. CGM use increased with greater understanding of this technology, and may become clinically significant over time. Further research is needed to assess the long-term impact of telehealth interventions.

Disclosure

L.E.Rasbach: None. V.Purrington: None. D.Adkins: None. R.Benjamin: None.

Funding

Innovation Health (2933476)
1065-P: The Use of OGTT and Phenotypic Characteristics to Identify GDM Subtypes in Mexican Women, an Approach towards Precision Medicine
Authors: GALLARDO-RINCÓN HECTOR , ORTEGA-MONTIEL JANINNE , MARTINEZ-JUAREZ LUIS ALBERTO , LOMELIN-GASCON JULIETA , MONTOYA ALEJANDRA , REYES-MUÑOZ ENRIQUE , GALICIA-HERNANDEZ VICTORIA , AVILA-DOMINGUEZ ROSANGELA , PEREZ-TORRES LUCIA V. , GARCIA-GONZALEZ NATALI , PEREZ-HERNANDEZ AZUCENA H. , PEREZ-ROMERO BRENDA , GRANILLO-RAMIREZ CYNDY G. , TAPIA-CONYER ROBERTO
Published: May 2022

GDM is a heterogeneous disease. Three subtypes of GDM have been identified, insulin sensitivity defect, insulin secretion defect, and both. Insulin sensitivity defect is associated with higher risk for fetal overgrowth and GDM associated adverse outcomes. Based on the 2hr-OGTT-75g values, the phenotype of GDM-sensitivity is associated with elevated fasting glucose and GDM-secretion by elevated one and/or two hours post-load glucose values. We evaluated the 2hr-OGTT-75g values of 1713 in Mexican pregnant women without previous diagnosis of T2D from the cohort study Cuido mi Embarazo between April 20 and December 2021. We identified 251 cases of GDM (14.6%) . Based on the distribution of 2hr-OGTT-75g values related to known GDM subtypes, 132 (52.6%) had elevated fasting glucose but normal post-load glucose values (GDM-sensitivity) , 90 (35.8%) had elevated post-load glucose but normal fasting glucose values (GDM-secretion) , and 29 (11.6%) patients with elevated fasting and post-load glucose values (GDM-mixed) . Women in the GDM-sensitivity group were younger (27.3 ± 6.5 yr) , nulliparous (56.1%) and more often had a family history of T2D (50.0%) compared to the women in the GDM-secretion and GDM-mixed groups. However, there was no statistical difference between the principal groups regarding pregestational BMI (GDM-sensitivity: 27.7 ± 5.5; GDM-secretion: 27.4 ± 4.4; GDM-mixed: 28.4 ± 6.2 kg/m2, p=0.90) ; although this last group showed the higher prevalence of obesity (29.4% - 23.3% - 38.0% respectively for each group) . To our knowledge, this is the first analysis of GDM subtypes in Mexican pregnant women. The high proportion of GDM diagnoses with normal fasting glucose supports the importance of unavoidably offering a complete OGTT. This strategic approach by classifying GDM subtypes according to OGTT values takes clinical importance in the offering of personalized and timely management care to minimize perinatal and newborn adverse outcomes.

Disclosure

H.Gallardo-rincón: None. N.Garcia-gonzalez: None. A.H.Perez-hernandez: None. B.Perez-romero: None. C.G.Granillo-ramirez: None. R.Tapia-conyer: None. J.Ortega-montiel: None. L.Martinez-juarez: None. J.Lomelin-gascon: None. A.Montoya: None. E.Reyes-muñoz: None. V.Galicia-hernandez: None. R.Avila-dominguez: None. L.V.Perez-torres: None.

Funding

Eli Lilly and Company
1105-P: Moderate-to-Advanced Liver Fibrosis Is Common in Patients with Type 1 Diabetes (T1D) and Nonalcoholic Fatty Liver Disease (NAFLD)
Authors: TOMAH SHAHEEN , SALAH TAREQ , AL-BADRI MARWA , DHAVER SHILTON E. , CURRY MICHAEL P. , JIANG ZHENGHUI , LAI MICHELLE , ELENANI OMNIA A. , KIBAA KARIM , GARDNER HANNAH , MCCARRAGHER RYAN , KAUSHIK AARYA A. , ZIEMNIAK NOLAN A. , HAMDY OSAMA
Published: May 2022

ADA guidelines recommend screening for significant fibrosis in patients with type 2 diabetes and steatosis or elevated ALT. In contrast, there are limited or inconsistent data about the prevalence of NAFLD and liver fibrosis in patients with type 1 diabetes (T1D) . We screened patients with T1D unaware of having NAFLD at a tertiary diabetes center and excluded those with secondary causes of fatty liver or heavy alcohol consumption. We utilized liver stiffness measurement (LSM) by transient elastography for fibrosis screening and controlled attenuation parameter (CAP) for steatosis screening. Referral to hepatology unit was done based on a priori criteria suggestive of clinically significant fibrosis (≥F2) .

We screened 285 patients with T1D (age 48±16 yrs; 55% females; 93% non-Hispanic whites; BMI 27±4.9 kg/m2; diabetes duration 28±15 yrs; A1c 7.1±1.1%; total insulin dose 48±27 units/day; AST 23±9 IU/L; ALT 20±12 IU/L) . The prevalence of NAFLD (CAP≥274 dB/m) was 29.3% (95%CI 24-35) and fibrosis (LSM≥7 kPa) 11% (95%CI 7-15) . Among those with NAFLD (n=76) , 13% (95%CI 5-20) had ≥F2 fibrosis (LSM ≥ 8.2 kPa) suggesting nonalcoholic steatohepatitis. Among patients with NAFLD and those with fibrosis respectively, 72% and 59% had ALT≤30 IU/L (men) or ≤IU/L (women) . After multivariate adjustment, larger waist circumference (>102 cm [men]; >88 cm [women]) and BMI >30 kg/m2 were associated with increased risk of steatosis (OR 4.13, 95%CI 1.61-10.6, p=0.014; 2.4, 1.3-4.5, p=0.007, respectively) . Continuous glucose monitoring parameters (e.g., %TIR) were not associated with steatosis or fibrosis.

In conclusion, NAFLD and liver fibrosis are common in patients with T1D. ALT alone is inadequate for screening. Central obesity, consistent with insulin resistance, independently predicts NAFLD. Future guidelines should consider screening for steatosis and significant fibrosis in patients with T1D and high BMI or large waistline even without elevated ALT.

Disclosure

S.Tomah: None. H.Gardner: None. R.Mccarragher: None. A.A.Kaushik: None. N.A.Ziemniak: None. O.Hamdy: Advisory Panel; L-Nutra Inc., Nestlé, Consultant; Abbott, Sanofi, Research Support; Eli Lilly and Company, Gilead Sciences, Inc., National Dairy Council, Novo Nordisk, Stock/Shareholder; Healthimation. T.Salah: None. M.Al-badri: None. S.E.Dhaver: None. M.P.Curry: Consultant; Gilead Sciences, Inc., Mallinckrodt, Sonic Incytes, Research Support; Gilead Sciences, Inc., Mallinckrodt, Sonic Incytes. Z.Jiang: Advisory Panel; Olix Pharmaceutical, Research Support; Gilead Sciences, Inc., Pfizer Inc. M.Lai: None. O.A.Elenani: None. K.Kibaa: None.

Funding

Investigator-initiated grant from Gilead Sciences (IN-US-989-5675)
1145-P: Individual SGLT2 Inhibitors and the Risk of Diabetic Ketoacidosis
Authors: ABRAHAMI DEVIN , D'ANDREA ELVIRA , KIM SEOYOUNG C. , WEXLER DEBORAH J. , PAIK JULIE M. , PATORNO ELISABETTA
Published: May 2022

SGLT2 inhibitors (SGLT2i) are increasingly prescribed to treat type 2 diabetes (T2D) given their cardiovascular benefits. However, SGLT2i are known to increase the risk of diabetic ketoacidosis (DKA) , a rare yet serious outcome. It remains unclear whether individual SGLT2i are associated with a differential risk of DKA. Using 3 US healthcare claims databases (1/2014 - 12/2020) we assembled 2 cohorts of adults with T2D initiating (1) individual SGLT2i, i.e., canagliflozin, dapagliflozin, or empagliflozin, for a within-class comparison between SGLT2i (cohort #1, median age=62 years, 55% male) , and (2) individual SGLT2i or dulaglutide, for comparisons between SGLT2i and an out-of-class comparison (cohort #2, median age=63 years, 54% male) . Cohorts were reweighed using inverse probability of treatment weights, accounting for >130 baseline patient characteristics. Hazard ratios (HRs) and 95% CIs were estimated for hospitalization for DKA in each database and pooled using random-effects models. Over a median follow-up of 6 months, neither empagliflozin [HR (95% CI) = 0.96 (0.78-1.19) ], or dapagliflozin [HR (95% CI) = 0.76 (0.58-1.01) ] had a differential DKA risk vs. canagliflozin. All 3 SGLT2i were associated with a similar increase in DKA risk vs. dulaglutide (Table) . In this large cohort study, we found no difference in the risk of DKA across individual SGLT2i, but all SGLT2i types were associated with an increased risk of DKA vs. dulaglutide.

Disclosure

D.Abrahami: None. E.D'andrea: None. S.C.Kim: Research Support; AbbVie Inc., Bristol-Myers Squibb Company, Pfizer Inc., Roche Pharmaceuticals. D.J.Wexler: Other Relationship; Elsevier, Novo Nordisk, UpToDate. J.M.Paik: None. E.Patorno: Research Support; Boehringer Ingelheim International GmbH, National Institutes of Health, Patient-Centered Outcomes Research Institute.

Funding

Patient-Centered Outcomes Research Institute (DB-2020C2-20326)
1213-P: REVEAL-CKD: Undiagnosed Chronic Kidney Disease in Patients with Type 2 Diabetes in Germany and France
Authors: SCHNEIDER MARKUS P. , VIRGITTI JEAN B. , PEACH EMILY , BARONE SALVATORE , ARNOLD MATTHEW , TANGRI NAVDEEP
Published: May 2022

Background: Early recognition of chronic kidney disease (CKD) is crucial to slow its progression, yet underdiagnosis remains high. This study assesses prevalence of and factors associated with undiagnosed stage 3 CKD in patients with pre-existing type 2 diabetes (T2D) .

Methods: REVEAL-CKD is a multi-national secondary data study. Data were extracted from THIN (Cegedim Health Data, France) and Disease Analyzer (IQVIA, Germany) . Patients were aged ≥18 years with 2 consecutive estimated glomerular filtration rate (eGFR) results 30-59 mL/min/1.73 m2 recorded 90-730 days apart in 2015-2021. T2D was identified by a diagnosis code before 2nd eGFR. Patients with no CKD code before 1st eGFR and ≤6 months after 2nd eGFR were considered undiagnosed.

Results: The cohorts included 3,532 patients with T2D and stage 3 CKD in France and 6,935 in Germany. In both cohorts, undiagnosed CKD was high (94% and 74%, respectively) , and was greater in those aged ≥65 years and in females. In patients with additional pre-existing comorbidities undiagnosed CKD remained high, ranging between 65% - 96% (Table 1) .

Conclusion: A high prevalence of undiagnosed CKD in patients with T2D was observed for France and Germany. Older patients and females were particularly vulnerable to undiagnosed CKD. Considerable opportunities exist to increase early identification and proactive management of CKD to slow progression and improve outcomes.

Disclosure

M.P. Schneider: Consultant; AstraZeneca. J.B. Virgitti: Advisory Panel; AstraZeneca, Lilly, Novo Nordisk. E. Peach: Employee; AstraZeneca. Stock/Shareholder; AstraZeneca. S. Barone: Employee; AstraZeneca. M. Arnold: Employee; AstraZeneca. N. Tangri: Consultant; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Otsuka America Pharmaceutical, Inc., Pulsedata, Renibus, Tricida, Inc. Stock/Shareholder; Clinpredict, Klinrisk.
1250-P: Identifying Pediatric A-ß+ Ketosis-Prone Diabetes (KPD)
Authors: KUBOTA-MISHRA ELIZABETH A. , HUANG XIAOFAN C. , MINARD CHARLES G. , ASTUDILLO MARCELA , REFAEY AHMAD K. , MONTES GRACIELA , SISLEY STEPHANIE , BALASUBRAMANYAM ASHOK , REDONDO MARIA J. , TOSUR MUSTAFA ,   RADIANT STUDY GROUP
Published: May 2022

KPD is characterized by diabetic ketoacidosis (DKA) in persons lacking the phenotype of autoimmune type 1 diabetes. The validated "Aβ" system classifies 4 KPD subgroups in adults, one of which (A-β+ KPD) is an atypical form that otherwise resembles type 2 diabetes (T2D) . Although recognized in children, better understanding of the prevalence and characteristics of pediatric A-β+ KPD is needed. The Rare and Atypical Diabetes Network (RADIANT) has modified the criteria for A-β+ KPD to: DKA within 6 months of diagnosis (dx) , not on SGLT2i, off insulin within 6 months of DKA with HbA1c <7% on oral agents alone, and negative islet autoantibodies. We compared clinical characteristics of pediatric T2D with and without DKA at dx, and in the former group estimated the prevalence of A-β+ KPD. A retrospective chart review identified 716 children with T2D over 3 years at Texas Children’s Hospital. Mean age at dx was 13.7 ± 2.4 yr; 63% females; 59% Hispanic, 29% African American (AA) , 9% non-Hispanic white, 3% others. Of them, 57 (8%) presented with DKA with negative antibodies. Children with DKA at dx, vs. those without it, were more often AA (45% vs. 28%, p=0.008) , male (60% vs. 35%, p=<0.001) and older (14.4 vs. 13.6 y/o, p=0.02) ; had lower random C-peptide (1.4 vs. 4.23 ng/mL, p<0.001) , higher glucose (375 vs. 240 mg/dL, p<0.001) , higher BMI-z score (2.38 vs. 2.25, p=0.02) and higher HbA1c (12.1 vs. 9.4%, p<0.001) at dx. In a multivariable model with age, sex, race, C-peptide, glucose, HbA1c and BMI z-score at dx, older age (p=0.004) , lower C-peptide (p<0.0001) , higher glucose (p=0.003) and BMI z-score (p=0.004) remained significantly associated with DKA. Eight children with DKA (14%) met all RADIANT criteria for A-β+ KPD. Most of the other children with DKA failed KPD criteria because they remained on insulin treatment for >6 months. Children with T2D and DKA at dx were more likely to be older, had lower C-peptide and higher glucose and BMI-z score at dx. Of them, 14% met all RADIANT A-β+ KPD criteria and are eligible for enrollment in RADIANT.

Disclosure

E.A.Kubota-mishra: None. M.Tosur: Advisory Panel; Provention Bio, Inc. Radiant study group: n/a. X.C.Huang: None. C.G.Minard: None. M.Astudillo: None. A.K.Refaey: None. G.Montes: None. S.Sisley: Speaker's Bureau; Rhythm Pharmaceuticals, Inc. A.Balasubramanyam: None. M.J.Redondo: Advisory Panel; Provention Bio, Inc.