bluuebunny/crossref_metadata_2025_split huggingface dataset:
1289-P: The Association between Time-in-Range, Mean Glucose, and Incidence of Hypoglycemia in Youth with Newly Diagnosed T1D
Authors: GU ANGELA , PRAHALAD PRIYA , MAAHS DAVID M. , ADDALA ANANTA , SCHEINKER DAVID 
Published: June 2020

New hypoglycemia guidelines define &lt;70 mg/dl as a clinical alert for hypoglycemia and &lt;54 mg/dl as clinically significant hypoglycemia. Fear of hypoglycemia is a significant barrier to increased time in range (TIR, 70-180 mg/dl). We examined the association between incidence of hypoglycemia and TIR and mean glucose (MG).
CGM data were collected from youth starting CGM within 1 month of a T1D diagnosis. For each patient, for each two-week period, TIR, MG, and percent time in hypoglycemia (Hyp) (&lt;70) and clinically significant hypoglycemia (csHyp) (&lt;54) were calculated. The associations between each of TIR, MG and each of Hyp and csHyp in each two-week period were modelled with multivariate linear regression, controlling for age, race, sex, insurance type, CGM wear time, and partial clinical remission status (Table 1).
In total, 1049 two-week periods from 51 patients were reviewed; 41% of these patients were female, the mean age was 9.4 years, and patients wore their CGMs an average of 89% within each two-week period. For csHyp, there was a non-significant negative association with TIR and a significant negative association with MG (p&lt;0.001). For Hyp, there was a significant association with TIR and MG (Table 1).
We found no association between csHyp and TIR. These findings suggest that high TIR may be maintained without increasing csHyp. Further study should examine the use of CGM to improve TIR.

Disclosure
A. Gu: None. P. Prahalad: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. A. Addala: None. D. Scheinker: None.
1295-P: Newly Diagnosed Pediatric Patients with Type 1 Diabetes Show Steady Decline in Glucose Time-in-Range (TIR) over 1 Year: Pilot Study
Authors: ZAHARIEVA DESSI , PRAHALAD PRIYA , ADDALA ANANTA , SCHEINKER DAVID , DESAI MANISHA , HOOD KOREY K. , LEVERENZ BRIANNA , MAAHS DAVID M. 
Published: June 2020

Optimal glycemic control is associated with improved T1D outcomes. However, in the U.S. over the last decade, glycemic control has worsened. We aimed to monitor glucose time-in-range (TIR) in the first year after diagnosis in pediatric T1D to identify the time when glucose control worsens. Newly diagnosed patients (N=67) with T1D were commenced on continuous glucose monitoring (CGM). Data was uploaded to Dexcom Clarity and analyzed retrospectively. Sample size differences at each time period vary due to patient enrollment start dates. All data was analyzed by mixed model and Tukey’s multiple comparison test. In 67 children (mean age 10±5 yrs, A1c at onset 12.1±1.9%) glucose TIR decreased from 64±21% to 55±18% at 10±9 days to 361±23 days post-diagnosis (P=0.03, Table). Mean glucose increased from 146±28 mg/dL at nadir to 172±29 mg/dL at 361±23 days post-diagnosis (P=0.001). CGM wear time also increased from 83±20% to 95±9% at 10±9 days to 361±23 days post-diagnosis (P=0.04). Time spent &lt;70 mg/dL was 2±3% throughout. Newly diagnosed pediatric T1D patients continue to wear CGM throughout the first year of diagnosis. The apparent increase in mean CGM glucose and decrease in TIR as early as 205±9 days post-diagnosis presents an opportunity for more frequent monitoring and unified education by healthcare providers to target tighter glucose control for this population.

Disclosure
D. Zaharieva: Speaker’s Bureau; Self; Ascensia Diabetes Care, Insulet Corporation, Medtronic. P. Prahalad: None. A. Addala: None. D. Scheinker: None. M. Desai: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. B. Leverenz: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care.
130-LB: Retrospective Evaluation of Treatment Patterns in a Real-Life Setting Environment with Dapagliflozin or DPP-4 Inhibitors as Add-On Therapy in Uncontrolled DM2 Patients Who Previously Failed on Other Regimens
Authors: ESPINOZA-PERALTA DIEGO , GONZÁLEZ-CANTÚ ARNULFO , SILVA ALEJANDRA I. , COLLADO JUAN G. , ROGEL-MANZANARES JORGE DAVID , HERNÁNDEZ-ALARCÓN JIMENA H. , NORIEGA-MUÑOZ ANA G. 
Published: June 2020

Mexico is one of LatinAmerica countries with the highest prevalence (14.4%) of DM. Medical institutions face the challenge to provide medical care to T2DM patients that failed to several antidiabetic regimens. We conducted a retrospective study to assess the response to dapagliflozin (Dapa) or DPP-4-inhibitors (DPP-4i) as added-on therapy in T2DM patients with failure to previous medications.
Objectives: Compare subjects with ≥5% improvement of the weighted sum of the three variables of the composite variable (HbA1c plus body weight (BW) plus blood pressure (BP) by the end of the 74-week observation period from index date) and proportion of patient achieving HBA1c of 7%.
Inclusion Criteria: T2DM subjects ≥18 years old with failure to any previous antidiabetic medication and HbA1c% ≥7 that started Dapa or DPP-4i as add-on to other antidiabetic drugs from August 2014 to Jun 2018.
Statistical Methods and Analysis: A propensity score matching model (nearest neighbor algorithm) was used, covariates included were treatment regimen, TC, LDL-c, HbA1c, BW, systolic BP and age.
Results: Of 1800 subjects, 221 met statistical matching criteria. No differences in basal characteristics of age, SBP, CrCl, but DAPA group had higher basal HbA1c (8.68±1.59 vs. 8.19±1.4, p&lt;0.01). Dapa group had a significant improvement (&gt;5%) in the composite variable compared to DPP-4i at 24 (76.9% vs. 46%, p&lt;0.01), 52 (82.4% vs. 49.5%, p&lt;0.01) and 76 weeks(84.6% vs. 39.2%, p&lt;0.01). Patients with HbA1c goal of &lt;7% in Dapa group compared to iDPP-4 at 24 (44.3% vs. 29.9%, p&lt;0.01), 52 (48.9% vs. 29.1%, p&lt;0.01) and 76 weeks (51.9% vs. 21.8%, p&lt;0.01).
Conclusion: In patients with uncontrolled T2DM who have failed to previous antidiabetic therapies, the add-on of dapagliflozin significantly provides reductions of HbA1c, glucose, weight and blood with more patients achieving glucose control goals compared to iDPP-4.

Disclosure
D. Espinoza-Peralta: None. A. González-Cantú: None. A.I. Silva: Employee; Self; AstraZeneca. J.G. Collado: None. J. Rogel-Manzanares: None. J.H. Hernández-Alarcón: None. A.G. Noriega-Muñoz: None.
1305-P: Cyber School: A Help or Hindrance for Youth with Diabetes?
Authors: MARCH CHRISTINE , LEIKAM LINDSAY M. , SIMINERIO LINDA M. , MILLER ELIZABETH , LIBMAN INGRID 
Published: June 2020

Cyber school (CS) is an online alternative to K-12 education with variable academic performance. Little is known about the health status and school achievement of youth with diabetes (DM) in CS compared to their peers. All youth with type 1 or type 2 diabetes enrolled in CS for the academic year 2017-18 were identified from a large pediatric diabetes center and matched to control subjects by diagnosis, race, sex, age and duration of DM. A retrospective chart review was conducted to identify variables such as hemoglobin a1c (HbA1c), body mass index (BMI) percentile, use of devices, adherence to recommended screenings, comorbidities, and health care utilization. Eighty youth attending CS were identified (5% of school age clinic population): 73 (91%) with type 1 DM, mean duration 6.0±4.0 years, 76 (95%) white, 48 (60%) female, mean age 14.5±3.0 years. Matching was adequate (p&gt;0.99 all parameters). Mean HbA1c was higher in those attending CS compared to controls (9.0±1.9 vs. 8.3±1.5%, p=0.001), with no difference in BMI percentiles (72.6±27.4 vs. 76.2±22.8, p=0.4). Fewer youth in CS used insulin pumps (37% vs. 60%, p=0.01) or continuous glucose monitors, though this did not reach statistical significance (29% vs. 42%, p=0.08). Youth in CS were less likely to have recommended annual vision (58% vs. 76%, p=0.02) and dental exams (63% vs. 84%, p=0.002). Mental health diagnoses were more common among CS youth (46% vs. 20%, p&lt;0.001) and they more often met PHQ-9 criteria for depression (42% vs. 24%, p=0.04). Youth in CS more commonly missed two or more routine diabetes appointments (31% vs. 18%, p=0.04) and had at least two emergency department visits (16% vs. 5%, p=0.02). Regarding academics, more youth in CS were documented as failing a grade or needing to make up credits (11% vs. 1%, p=0.009). In summary, CS was associated with concerning health metrics and perhaps academic outcomes. CS enrollment may reflect a high-risk population of youth with DM. Special attention from DM providers may help focus additional resources and tailor counseling to this population.

Disclosure
C. March: None. L.M. Leikam: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. E. Miller: None. I. Libman: Consultant; Self; Novo Nordisk A/S.

Funding
National Institutes of Health (DK007729)
1313-P: Associations of Executive Function (EF) Problems with Demographic and Diabetes Factors in Teens with T1D from the EU and U.S.
Authors: GOETHALS EVELINE R. , WIT MAARTJE DE , VOLKENING LISA K. , LUYCKX KOEN , CASTEELS KRISTINA , LAFFEL LORI M. 
Published: June 2020

Aim: EF (ability to initiate, plan, monitor behavior) impacts self-care and glycemic control in teens with T1D. We examined demographics, insulin therapy, A1c, and EF in 3 international cohorts of teens with T1D.
Methods: Parents of 337 teens (13-18) with T1D from Belgium (BE), Netherlands (NL), and U.S. completed the BRIEF to assess teen EF. Parents/medical records provided demographic and diabetes data. BRIEF score ≥60 (composite score or either of 2 main indices) defined EF problems. Logistic regression determined associations of EF problems with A1c (&lt;7.5 vs. ≥7.5%), controlling for country, sex, T1D duration, and pump use.
Results: Teens (54% male; 27% BE, 24% NL, 49% U.S.) were 15.0±1.5 yrs old with T1D duration 7.4±4.0 years, A1c 8.1±1.2%, 61% pump. Teens from BE, NL, U.S. differed with respect to A1c (7.4±1.0, 8.1±1.3, 8.5±1.2%) and pump use (27%, 72%, 74%) (all p&lt;.01). Overall, 30% had EF problems (26% BE, 32% NL, 32% U.S.). Generally, teens with EF problems had higher A1c vs. those without (Table). Pump use was less common in teens with EF problems in NL and U.S. and more common in BE. Odds of A1c ≥7.5% was 2.0 (95% CI 1.1, 3.6; p=.03) in teens with EF problems.
Conclusion: In an international sample, teens with T1D and EF problems were twice as likely to have suboptimal A1c. Given country differences in pump use in teens with EF problems, future studies can assess potential benefit of technology in at-risk teens.

Disclosure
E.R. Goethals: None. M. de Wit: None. L.K. Volkening: None. K. Luyckx: None. K. Casteels: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US.

Funding
Iacocca Family Foundation; National Institutes of Health (P30DK036836, R01DK095273, K12DK094721); JDRF (2-SRA-2014-253-M-B)
1314-P: A Low HbA1c during the First 2 Years Correlates with a Higher Percentage of HbA1c ≤6.5% (48 mmol/mol) and Lower Percentage &gt;8.0% (64 mmol/mol) on a Clinic Level
Authors: HANAS RAGNAR , HANBERGER LENA , LYCKÅ AUSTE PUNDZIUTE , SAMUELSSON ULF , SVENSSON ANN-MARIE , AKESSON KARIN 
Published: June 2020

Background: The mean HbA1c in children and adolescents varies between countries, but there is a considerable variation also between clinics within a country. The Swedish HbA1c target in children and adolescents is ≤6.5% (48 mmol/mol). Our aim was to compare early metabolic control with percentage of patients with HbA1c ≤6.5% (A1c6.5) and &gt;8.0% (64 mmol/mol) (A1c8) for all clinics in Sweden.
Methods: In this register-based nationwide cohort with type 1 diabetes, 98% of children and adolescents &lt;18 years in Sweden were covered. We captured HbA1c for all patients (last value recorded in 2019) and calculated the mean. We then compared the mean HbA1c of all patients with up to 2 years duration with the percentage of patients with A1c6.5 and A1c8.
Results: Mean overall HbA1c was 7.0% (95% CI 7.0-7.1) (53.3 mmol/mol, 95% CI 52.6-54.0) (n=7433) and for those with 0-2 years' duration 6.6% (95% CI 6.5-6.7) (49.1 mmol/mol, (95% CI 48.2-50.0) (n=1911). The mean overall percentage of patients with A1c6.5 was 35.3% (95% CI 32.4-38.2) (n=2575) and A1c8 was 13.2 (95% CI 11.5-14.8) (n=958). The correlation between mean HbA1c 0-2 y. and A1c6.5 was -0.80 (p&lt;0.001) and A1c8 0.48 (p=0.004).
Conclusions: An intensive treatment program at the onset of diabetes resulting in a low HbA1c early on is a good investment to increase HbA1c values within target and to minimize high HbA1c values.

Disclosure
R. Hanas: Advisory Panel; Self; Abbott, Novo Nordisk A/S. Speaker’s Bureau; Self; Sanofi. Other Relationship; Self; AstraZeneca. L. Hanberger: None. U. Samuelsson: None. A. Svensson: None. K. Akesson: None.
1322-P: Communication Frequency between Visits Is Associated with Improved Glycemic Control in Pediatric Diabetes
Authors: ABEL KIMBER-LEE , VERMA ROHINI , THOMAS CHRYSTAL G. , WEST MARGARET , GLANCEY CHRISTINE , TRACEY JULIA , ARCARA KRISTIN , MAGGE SHEELA N. , WOLF RISA 
Published: June 2020

Background: Children with diabetes are advised to see their diabetes team every 3 months. While we encourage patients and caregivers to communicate between visits, there is limited evidence to support this recommendation. Therefore, we assessed patterns of communication between visits and whether communication frequency via phone and electronic messaging (EMs) is associated with glycemic control. We hypothesized that patients who communicate more frequently will have better glycemic control as measured by hemoglobin A1c (HbA1c).
Methods: We assessed communication patterns via EMs and phone calls in children with type 1 and type 2 diabetes over a 1-year period at an urban academic pediatric diabetes center. Demographic and clinical data were extracted from the electronic medical record. The association between frequency of communication and HbA1c was analyzed using regression analysis.
Results: 122 patients were included in this analysis, of which 99 (80%) had T1D, 23 (20%) had T2D. Mean age 11.8y (SD 3.9), mean duration of diabetes 3.5y (SD 3.4), and mean HbA1c 9% (range 4.7-15%). Most patients/caregivers (101/122, 89%) communicated with the diabetes team between office visits. Communications were via phone (27%), EM (29%), or both (42%). Patients with more frequent communication had lower HbA1c values (p=0.008, β =-0.04). Method of communication was not associated with HbA1c.
Conclusions: More frequent communication with the diabetes team between visits is associated with improved glycemic control, irrespective of the method of communication. Thus, communication with patients should be tailored to their preference.

Disclosure
K. Abel: None. R. Verma: None. C.G. Thomas: None. M. West: None. C. Glancey: None. J. Tracey: None. K. Arcara: None. S.N. Magge: None. R. Wolf: None.
1330-P: Molecular Biomarkers during Gestational Diabetes Mellitus
Authors: DIAS STEPHANIE , ADAM SUMAIYA , RHEEDER PAUL , LOUW JOHAN , PHEIFFER CARMEN 
Published: June 2020

Background/Aim: Gestational diabetes mellitus (GDM) is associated with short- and long-term complication in both mothers and offspring. Molecular mechanisms are attracting increased interest for their potential as biomarkers for GDM that could lead to improved detection of GDM with positive effects on health outcomes. The aim of this study was to explore the potential of DNA methylation and single nucleotide polymorphisms (SNPs) to serve as molecular biomarkers for GDM in South African women.
Methods: Genome-wide DNA methylation using a MethylationEPIC BeadChip Array (n=24) and gene-specific methylation of the adiponectin (ADIPOQ) gene using bisulfite pyrosequencing (n=286) were profiled in the peripheral blood of women with or without GDM. In addition, variants ADIPOQ rs266729 and rs17300539, and methylenetetrahydrofolate reductase (MTHFR) rs1801133 were quantified using quantitative real-time PCR (n=449).
Results: Genome-wide methylation analysis identified 1046 differentially methylated CpG sites (associated with 939 genes), of which 148 CpG sites were hypermethylated and 898 CpG sites were hypomethylated (p&lt;0.01). Among the top five CpG sites, one CpG mapped to the calmodulin-binding transcription activator 1 (CAMTA1) gene, which has been shown to regulate insulin production and secretion. Two CpG sites (-3410: p=0.048 and -3400: p=0.004) in the ADIPOQ promoter were hypomethylated during GDM in Human Immunodeficiency Virus (HIV) negative, but not in HIV positive women. Lastly, no association between ADIPOQ and MTHFR polymorphisms and GDM was observed in our population.
Discussion: DNA methylation may offer potential as molecular biomarkers for GDM in a South African population. Future longitudinal studies in larger samples that include both HIV negative and positive pregnant women are warranted to explore the candidacy of DNA methylation as molecular biomarkers for GDM.

Disclosure
S. Dias: None. S. Adam: None. P. Rheeder: None. J. Louw: None. C. Pheiffer: None.

Funding
National Research Foundation (99391); South African Medical Research Council
1334-P: Hyperglycemia-Induced Eye Malformations through Dysregulation of Autophagy in the Mouse Embryo
Authors: LU WENHUI , YANG PEIXIN 
Published: June 2020

Accumulating evidence indicates that autophagy is essential for development and its dysregulation is involved in maternal diabetes-induced fetal malformations. Maternal diabetes induces fetal eye defects by reducing macular thickness and macular volume. We utilized the Streptozotocin-induced type 1 diabetes model to investigate the role of autophagy in maternal diabetes-induced embryonic eye defects. We found that maternal diabetes induced eye defects in the embryonic day (E15) embryos including anophthalmia, microphthalmia. The Haematoxylin Eosin staining showed some severe defects: coloboma, smaller lens, and smaller volume of eyes. In some cases, there were failures to fully develop eye structures. In these embryonic eye defects, the thickness of retinal was significantly thinner than that in the nondiabetic group. Our hypothesis is that maternal diabetes induces embryonic eye malformations by suppressing autophagy. Maternal diabetes increased cell apoptosis and suppressed cell proliferation in retinal of the eye. We found that autophagy-related genes (ATGs) was robustly expressed in the lens and retina of the eyes of mouse embryos and was suppressed by maternal diabetes. Maternal diabetes suppressed the expression of pax6, a key gene in visual system development. Taken together, our data demonstrates that autophagy is important for eye development and maternal diabetes induces embryonic eye defects by inhibiting autophagy.

Disclosure
W. Lu: None. P. Yang: None.

Funding
National Institutes of Health (R01DK083243, R01DK101972, R01HL131737, R01HL134368, R01DK103024)
1338-P: Second Heart Field-Specific Deletion of Dnmt3a and Dnmt3b Ameliorates Maternal Diabetes-Cardiac Septation Defects, but Increases Hypoplastic Left Heart Syndrome
Authors: YE FEI , YANG PEIXIN 
Published: June 2020

Maternal diabetes is a common risk factor for congenital heart defects (CHDs) in infants, suggesting hyperglycemia disrupts specific morphogenesis events in the embryonic heart. DNA methylation plays important roles in embryonic development. Our previous study demonstrated that global DNA methylation is significantly increased in early stage embryos from diabetic pregnancy compared to that from nondiabetic pregnancy. Isl1 marks the second heart field cardiac progenitor population, which contribute to outflow tract, right ventricle, and much of the atria. We hypothesize that conditional knockout of Dnmt3a and Dnmt3b will ameliorate maternal diabetes-induced CHDs derived from the defects of the second heart field. We used the well-established type 1 diabetic embryopathy mouse model, in which diabetes was induced by streptozotocin for our in vivo studies. To determine if conditional deletion of Dnmt3a and/or Dnmt3b in the second heart field progenitors ameliorates specific CHDs in diabetic pregnancy, we induced diabetic embryopathy in Dnmt3af/f/3bf/f female mice, which bred with Dnmt3af/w/Dnmt3bf/w;Isl1-Cre male mice, embryos were harvested at embryonic day 12.5 (E12.5) to determine DNA methylation activity and at E17.5 for the presence of CHDs. Embryos of diabetic dams had a 50% CHDs, double deletion of Dnmt3a and Dnmt3b significantly ameliorated CHDs derived from the defect of the second heart field from 27% to 0%, while dramatically enhanced CHD derived from the first heart field incidence 23% to 50%, mainly Hypoplastic left heart syndrome (HLHS). Our study demonstrates that DNA methylation plays an important role in the regulation of diabetic pregnancies. CHD of SHF are rescued by dKO of Dnmt3a/3b, while CHD of SHF enhanced. This suggests that targeting of DNA methylation may be a viable strategy for suppression of congenital heart defects in fetuses of diabetic pregnancies.

Disclosure
F. Ye: None. P. Yang: None.

Funding
National Institutes of Health (1R01134368)
1345-P: Long-Term Follow-Up of Children with Intrauterine Glyburide Exposure
Authors: RODENSTEIN MARISSA S. , BIANCO MONICA E. , RAMCHAL MAEGAN , SILTON REBECCA L. , MURIAS MICHAEL , JOSEFSON JAMI L. 
Published: June 2020

Outcome data in children exposed to glyburide for maternal treatment of gestational diabetes mellitus (GDM) is lacking. Insulin is the standard of care for GDM medical management, yet glyburide use is increasing and this medication crosses the placenta. The study objective was to evaluate physical and neurodevelopmental outcomes of 5-10 year old children born to GDM mothers treated with glyburide or insulin. Children had anthropometric measures including body composition with air displacement plethysmography, and underwent a neurodevelopmental assessment with performance-based tests to evaluate executive functions of working memory and inhibition. Analysis included paired t-tests, chi-square test, and multivariate analysis of variance (MANOVA). Participants, n=51, 25 glyburide-exposed, 26 insulin-exposed were age and sex-matched between groups. Mean age was 7.7 years and 45% were female. Ethnicity and maternal education differed between groups: glyburide-exposed were primarily Hispanic (80%) and had lower maternal education level compared to insulin-exposed (50% Hispanic). Anthropometric means were: BMI 18.8 kg/m2 (sd 5.1), BMI%ile 67.7% (32.3), waist circumference z-score 0.6 (1.1), body fat 21.9% (11.6), triceps z-score 0.8 (1.2), subscapular z-score 1.1 (1.1), sum of 3 skinfolds, triceps, subscapular, iliac crest 39.3 mm (26.0), systolic bp 101 (10.1), diastolic bp 63 (8.2). Among participants, 17.6% had an overweight BMI and 23.5% had an obese BMI. No significant differences were identified in these measures or rates of overweight/obese BMI between groups. A MANOVA with maternal education as a covariate showed that the glyburide-exposed group had significantly lower scores on a visual-spatial working memory test compared to the insulin-exposed group (p=0.03). No differences were observed on an inhibition test.
In summary, children with intrauterine glyburide exposure had reduced spatial working memory yet similar physical measurements compared to children with insulin exposure.

Disclosure
M.S. Rodenstein: None. M.E. Bianco: None. M. Ramchal: None. R.L. Silton: None. M. Murias: None. J.L. Josefson: None.

Funding
Evergreen Invitational and Institute for Innovations in Developmental Sciences