bluuebunny/crossref_metadata_2025_split huggingface dataset:
960-P: Personalized Diabetes Management Using Data from Continuous Glucose Monitors
Authors: MILLER DANIEL R. , WARD ANDREW T. , MAAHS DAVID M. , SCHEINKER DAVID 
Published: June 2019

Expansion of continuous glucose monitor (CGM) use in type 1 diabetes (T1D) patients has not fully translated into personalized, timely glucose management. We propose a standardized approach based on individual CGM data to set patient-specific disease-management targets and monitor progress. We developed tools to measure daily mean glucose (MG), time-in-range between 70-180 mg/dL (TIR), and glucose variability (GV); set patient-specific targets for these metrics; and detect deviation from these targets. We simulate the proposed approach on 2,668,063 hours of CGM data from 299 T1D patients.
To simulate a patient’s clinic visit after CGM use, their first 90 days of CGM data were used to generate personalized targets. To simulate patient disease management post-visit, the subsequent 14 days of data were used to generate alerts on each day which deviated from their target. The number of daily alerts for static targets (&gt;65% TIR) vs. personalized targets (at least 5% improvement over the preceding 90-day average TIR) were compared.
The evaluation included all 248 patients with at least 104 days of data. Patient-specific personalized glucose targets varied significantly. Of these 248 patients, 150 had a historical mean TIR higher than the static target of 65%. For the 98 patients with TIR &lt;65%, the number of alerts for deviations from target TIR were fewer for personalized than for static targets (7.14 vs. 8.42 during the 14-day window.
Personalized glucose targets based on each patient’s CGM history offer several advantages over static targets set without knowledge of the patient history. Personalized targets may be more achievable; for patients with high TIR targets to maintain performance may be more appropriate than lower static targets; and personalized targets may be set to produce fewer unnecessary alarms. Automated analyses of CGM data may empower care teams to support personalized, timely disease management.

Disclosure
D.R. Miller: None. A.T. Ward: None. D.M. Maahs: Advisory Panel; Self; Novo Nordisk Inc. Consultant; Self; Abbott, Sanofi. Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. D. Scheinker: Advisory Panel; Self; Carta Healthcare.
964-P: CGM-Tele Monitoring in Older Adults with T1D: Results of a Pilot Study
Authors: HARMEL MARK D. , RUELAS VALERIE F. , NYKAZA EDWARD T. , PETERS ANNE L. 
Published: June 2019

T1D management in older individuals can be difficult due to an increased risk for hypoglycemia and other co-morbidities. CGM can help lower rates of hypoglycemia; however, in practice, patient data is only reviewed at clinic visits, rather than in near real-time by the diabetes care team. This pilot study tested if patients could be remotely monitored daily through a CGM system (Dexcom G5/6) that communicated via smart phone to a Tidepool designed dashboard. Alerts were set for: ≥4 hours without CGM signal, ≥2 hours 54-70 mg/dl, and 15 mins &lt;54 mg/dl. If alerts occurred, the CDE performed telemedicine outreach following a protocol. Ten individuals with T1D ≥65 years were enrolled. Patients were 72+5.3 years; duration of diabetes 39.1+16.5 years; 50% were on CSII. At baseline, the CGM was connected to the monitoring system, followed by 2 weeks of system checks. Remote monitoring was activated at week 2 continuing to week 14. Three patients didn’t complete the study. One had connection issues, one didn't want to wear the CGM; the third had spousal health issues. The CDE/system was capable of identifying the desired findings (Table). An A1C was measured at baseline and 14 weeks. The A1C didn’t change, 7.2% +0.95 vs. 7.3% +0.99. This trial proved it was possible to monitor well-controlled seniors with T1D using an automated system with daily alerts to identify episodes of hypoglycemia and time off CGM. Further research is needed to assess the alert system efficacy.

Disclosure
M.D. Harmel: Advisory Panel; Spouse/Partner; Abbott, Becton, Dickinson and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., MannKind Corporation, Merck & Co., Inc., Novo Nordisk Inc., Omada Health, Inc., OptumRx, Inc., Sanofi, Zafgen, Inc. Consultant; Self; MannKind Corporation. Research Support; Spouse/Partner; AstraZeneca, Dexcom, Inc., MannKind Corporation. Speaker's Bureau; Spouse/Partner; Novo Nordisk Inc. V.F. Ruelas: None. E.T. Nykaza: None. A.L. Peters: Advisory Panel; Self; Abbott, Becton, Dickinson and Company, Bigfoot Biomedical, Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., Livongo Health, MannKind Corporation, Medscape, Merck & Co., Inc., Omada Health, Inc., OptumRx, Inc., Sanofi US, Zafgen, Inc. Research Support; Self; AstraZeneca, Dexcom, Inc., Jaeb Center for Health Research, MannKind Corporation, National Institute of Diabetes and Digestive and Kidney Diseases. Speaker's Bureau; Self; Novo Nordisk Inc.
97-OR: Leptin's Hunger-Suppressing Effects Are Mediated by the Hypothalamic-Pituitary-Adrenocortical Axis
Authors: PERRY RACHEL J. , RESCH JON , DOUGLASS AMELIA M. , MADARA JOSEPH , SONG JOONGYU D. , WU CHEN , LOWELL BRADFORD , SHULMAN GERALD I. 
Published: June 2019

Leptin deficiency is known to promote hyperphagia, but the mechanism for this is unknown. Here we show that hypoleptinemia-driven hypercorticosteronemia promotes hyperphagia in fasting (40.3±4.9 kcal consumed in 2 hour after a 48 hour fast vs. 2.4±1.0 kcal after a 6 hour fast, P&lt;0.0001) and poorly-controlled type 1 diabetes (T1D) (28.4±2.5 vs. 13.3±2.9 kcal, P&lt;0.01) in rats. Correcting hypoleptinemia with a 6 hour leptin infusion reversed hypercorticosteronemia and reduced food intake to control rates in both models (48 hour fast+leptin 5.2±2.2 kcal, P&lt;0.0001; T1D+leptin 8.1±1.9 kcal, P&lt;0.0001), while restoring hypercorticosteronemia abrogated the anorexic effect of leptin (48 hour fast+leptin+corticosterone 29.5±3.1 kcal, T1D+leptin+corticosterone 30.0±2.7 kcal, both P&lt;0.001 vs. leptin-treated). Treatment with a glucocorticoid receptor antagonist, mifepristone, reversed hyperphagia (48 hour fast 8.8±4.3 kcal, T1D 15.0±2.3 kcal; both P&lt;0.05). In adrenalectomized mice treated with low-dose corticosterone, food intake following a fast was markedly reduced, whereas high-dose corticosterone restored hyperphagia. Hypercorticosteronemia induced by hypoglycemia drove hyperphagia independent of leptin and insulin (hypoglycemic-hyperinsulinemic: 42.5±2.3 kcal, euglycemic-hyperinsulinemic: 1.8±1.9 kcal, euglycemic-hyperinsulinemic-corticosterone-treated: 32.0±4.6 kcal; both P&lt;0.001 vs. euglycemic) which was reversed by mifepristone (14.6±2.3 kcal, P&lt;0.0001 vs. hypoglycemic).
Finally, we show that hypercorticosteronemia increases feeding behavior through corticosterone-mediated stimulation of AgRP neuron activity: overexpression of 11β-hydroxysteroid dehydrogenase 2 in AgRP neurons abrogated the hyperphagic effect of corticosterone. Together these data provide new insights into hypoleptinemia-induced hyperphagia and reveal that corticosterone-driven AgRP neuron activity drives hyperphagia during starvation, T1D, and hypoglycemia.

Disclosure
R.J. Perry: Research Support; Self; AstraZeneca. J. Resch: None. A.M. Douglass: None. J. Madara: None. J.D. Song: None. C. Wu: None. B. Lowell: None. G.I. Shulman: Advisory Panel; Self; AstraZeneca, Janssen Research & Development, Merck & Co., Inc. Advisory Panel; Spouse/Partner; Merck & Co., Inc. Board Member; Self; Novo Nordisk A/S. Consultant; Self; Aegerion Pharmaceuticals, IMetabolic BioPharma Corporation, Longitude Capital, Nimbus Discovery, Inc., Staten Biotechnology B.V.

Funding
National Institutes of Health (R01DK113984, P30DK059635, T32DK101019, K99/R00CA215315, R01NS087568, UL1TR000142, T32DK007058, R01DK075632, R01DK089044, R01DK096010, R01DK111401)
970-P: The Clinical Accuracy Evaluation of Noninvasive Glucometer Based on Metabolic Heat Conformation Method: A Multicenter Study
Authors: LI ANG , GENG ZHANXIAO , LI SHUZHE , GUO XIAOHUI , ZHANG JUNQING , TANG FEI 
Published: June 2019

Objective: To evaluate the accuracy of noninvasive glucometer based on metabolic heat conformation (MHC) method by multicenter clinical trial.
Methods: This study was a multi-center, open, self-controlled trial. Venous plasma glucose measured by the hexokinase method was taken as reference level. The screening period was 1 to 7 days before the test, and a fasting blood glucose of the subjects who enrolled to this study was recorded as a calibration value. Subjects were tested at 3 time points successively on experimental day: fasting, 2-hour and 4-hour postprandial. On each time point, the noninvasive glucose measurement was performed at first, and followed by venous blood sample collection within 5 minutes. The subjects ate the 80 g standard noodle meal after the fasting test. The meal should be finished within 15 minutes.
Results: 3 centers participated with 210 subjects (M/F=98/112, average age is 61.2 year-old, 200 with T2DM, 7 with T1DM, 3 with prediabetes) were enrolled. The correlation coefficient of noninvasive glucose value and the serum glucose value in fasting, 2h and 4h postprandial status was 0.79, 0.61, 0.63 respectively.
Conclusion: The noninvasive glucometer based on MHC method showed a good correlation with the venous plasma glucose, especially in fasting state.

Disclosure
A. Li: None. Z. Geng: None. S. Li: None. X. Guo: None. J. Zhang: None. F. Tang: None.
987-P: Real-World Weight Change, Adherence, and Discontinuation among Type 2 Diabetes (T2D) Patients Initiating GLP-1 Receptor Agonists (GLP-1RAs) in the UK
Authors: WEISS TRACEY , IGLAY KRISTY , CARR RICHARD D. , MISHRA AJAY PRATAP , YANG LINGFENG , RAJPATHAK SWAPNIL 
Published: June 2019

Background: GLP-1 RAs are an injectable class of medications with demonstrated weight loss in clinical trials. However, weight changes related to GLP-1RA use have not been well-characterized in a real-world setting. Further, there are limited real-world data on patient adherence to and discontinuation of GLP-1RAs.
Methods: Using the UK Clinical Practice Research Datalink (CPRD) database (2010-2016), we conducted a retrospective cohort study of UK T2D patients ≥ 18 years of age initiating GLP-1RAs to evaluate one-year weight change, as well as GLP-1 RA adherence and discontinuation. Included patients initiated GLP-1RA as monotherapy or as dual therapy with metformin. GLP-1 RA adherence was assessed using the proportion of days covered (PDC) among all GLP-1 RA initiators with two or more prescriptions. Discontinuation was defined as any GLP-1 RA therapy gap &gt;90 days during follow-up.
Results: 589 patients met the study criteria; Female: 56.4%, median age: 54 years, and median BMI: 41.2 kg/m2. The median one-year weight change was -3.1 kg; 72.1% of patients experienced weight loss while the rest of patients reported weight gain. Furthermore, only 32.6% of patients had a weight loss that is typically considered clinically-meaningful (≥5%). In terms of adherence, 64.5% of patients were considered adherent (PDC ≥80%) while 45.2% of patients discontinued GLP-1RA by 1 year.
Conclusion: Less than one-third of patients initiating GLP-1RA achieved ≥5% weight loss. Further, approximately one-third of patients were non-adherent to therapy and nearly half discontinued treatment within a year. Further investigation on the impact of GLP-1 RA adherence and discontinuation on real-world effectiveness is warranted.

Disclosure
T. Weiss: Employee; Self; Merck & Co., Inc. K. Iglay: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. R.D. Carr: Employee; Self; Merck & Co., Inc. Speaker's Bureau; Spouse/Partner; Eli Lilly and Company, Merck & Co., Inc. A.P. Mishra: None. L. Yang: Employee; Self; Bristol-Myers Squibb Company, Merck & Co., Inc. S. Rajpathak: None.
989-P: MEDI0382, an Oxyntomodulin-Like Peptide with Targeted GLP-1/Glucagon Receptor Activity: Safety Study in Subjects of Japanese and Chinese Descent
Authors: ROBERTSON DARREN , PETRONE MARCELLA , TSAI LAN-FENG , GASSER ROBERT A. 
Published: June 2019

Background: MEDI0382 is an oxyntomodulin-like peptide with targeted GLP-1/glucagon receptor activity that is under development for type 2 diabetes mellitus. This study was conducted in subjects of Japanese and Chinese descent to facilitate expansion of its global clinical development in Japan and China.
Methods: This phase 1, randomized, blinded study evaluated the safety, tolerability, pharmacokinetics, and immunogenicity of single subcutaneous (SC) doses of MEDI0382. In part A, 24 subjects of Japanese descent across 3 cohorts (8 per cohort) received single SC doses of MEDI0382 at a dose of 50 µg (cohort 1), 100 µg (cohort 2), or 150 µg (cohort 3) or placebo in a 3:1 ratio. In part B, 8 subjects of Chinese descent received a single SC dose of MEDI0382 at 100 µg or placebo in a 3:1 ratio (cohort 4).
Results: In part A, the incidence of treatment-emergent adverse events (TEAEs) was highest in the 150-μg group (5 of 6 subjects). In part B, 2 of 6 subjects in the MEDI0382 group reported TEAEs. Nausea, headache, and vomiting were most common. A trend of increased pulse rate post-dose was seen in subjects of Japanese descent in the MEDI0382 100- and 150-µg groups. No clinically meaningful changes from baseline in vital signs were observed in part B. Median tmax values were 6.15-8.16 h at doses of 50-150 μg, both in subjects of Japanese and Chinese descent. In part A subjects receiving MEDI0382 100 and 150 µg, postprandial mean glucose levels remained closer to baseline levels as compared with changes seen with MEDI0382 50 µg or placebo.
Discussion: The safety profile of single doses of MEDI0382 at doses of 50, 100, and 150 µg supports its further development in subjects of Japanese and Chinese descent. The pharmacokinetic data for MEDI0382 in the range of 50-150 µg also support its further clinical development in subjects of Japanese and Chinese descent.

Disclosure
D. Robertson: Employee; Self; AstraZeneca. Employee; Spouse/Partner; GlaxoSmithKline plc. Stock/Shareholder; Self; AstraZeneca. M. Petrone: Employee; Self; MedImmune. L. Tsai: Employee; Self; MedImmune. Other Relationship; Self; AstraZeneca. R.A. Gasser: Employee; Self; AstraZeneca, MedImmune.

Funding
AstraZeneca
996-P: Therapeutic Effect of a Novel Long-Acting GLP-1/GIP/Glucagon Triple Agonist (HM15211) in a Dyslipidemia Animal Model
Authors: CHOI JAEHYUK , JO HYOSANG , KIM JUNG KUK , LEE SANG DON , LEE SANG HYUN , CHOI IN YOUNG 
Published: June 2019

Dyslipidemia is a well-established risk factor for cardiovascular disease. Although an efficacy has been demonstrated for several drugs including HMGCR inhibitor and PCSK9 inhibitor, overall outcome was still in doubt due to heterogeneity of this disease. Thus, targeting multiple pathways may provide promising efficacy in broad patient population. Previously, we showed that a long-acting GLP-1/GIP/Glucagon triple agonist, HM15211, not only provided efficient weight loss, but also improved lipid profiles in DIO mice. Of note, unlike current drugs possessing a single target, HM15211 could affect multiple pathways in lipid metabolism, suggesting HM15211 as a potential therapeutic option for dyslipidemia. Here, we investigated the effect of HM15211 on dyslipidemia and its mode of action (MoA). In high fructose-fed hamsters, HM15211 showed greater LDL lowering (-69.3% vs. Veh.) than evolocumab, PCSK9 Ab (-17.9% vs. Veh.). To elucidate the responsible MoA, HepG2 cells were treated with HM15211, and significantly increased LDLR expression (4.1-fold for HM15211, 2.3-fold for evolocumab vs. CTL) was observed. Consistently, the amount of LDL uptake (3.6-fold for HM15211, 2.8-fold for evolocumab vs. CTL) indicated enhanced LDL clearance by HM15211 via increasing LDLR expression even greater than evolocumab. To further identify the HM15211 target, the activity status of HMGCR, the key enzyme for cholesterol synthesis, was evaluated. Surprisingly, HM15211 progressively induced phosphorylation and degradation of HMGCR, thereby inhibiting its enzymatic activity. In case of free fatty acid (FFA) metabolism, HM15211 led to a favorable gene expression signature associated with β-oxidation and enhanced β-oxidation. Increased ApoA1 may explain, at least in part, the increase of HDL by HM15211.
In conclusion, we propose that by targeting multiple steps essential for LDL and FFA metabolism, HM15211 could provide therapeutic benefits for dyslipidemia patients.

Disclosure
J. Choi: None. H. Jo: None. J. Kim: None. S. Lee: Employee; Self; Hanmi Pharm. Co., Ltd. S. Lee: Employee; Self; Hanmi Pharm. Co., Ltd. I. Choi: Employee; Self; Hanmi Pharm. Co., Ltd.
Koordinatorordninger som samordningstiltak – tre mulige paradokser
Authors: Vik Erlend , Aarseth Turid 
Published: June 2019

Koordinatorordninger i helsetjenesten er temaet for dette kapittelet, der vi undersøker både bakgrunnen for og spesielle utfordringer ved denne typen samordningstiltak. Det teoretiske utgangspunktet er Luhmanns systemteori og en forståelse av helsetjenesten som funksjonelt differensiert. Samordning handler her om å kunne få til kobling mellom ulike delsystemer.
Vi ser samhandlingsreformen som et tidsskille, og har gjennomført en dokument­analyse av nasjonale styringsdokumenter i perioden 2008–2018. Gjennomgangen avdekket 14 ulike koordinatorordninger, hvorav åtte var spesifikt rettet mot pasienter med sammensatte behov. Problembeskrivelsene i styringsdokumentene og trekk ved utformingen av koordinatorordningene danner grunnlag for å identifisere tre mulige paradokser. Det første handler om at koordinatorordningene – gjennom å være opptatt av å håndtere grenser mellom delsystemer – kan bidra til å bevare den funksjonelle differensieringen heller enn å redusere den. Det andre viser til at selve organiseringen av koordinatorordningene kan forsterke den funksjonelle differensieringen, mens det tredje synliggjør at ordningene i seg selv bidrar til økt kompleksitet, ved at det oppstår behov for å koordinere koordinatorene.
The Educating Role of Visual Arts
Authors: Palhares -  University of Minho Sandra 
Published: June 2019

This article discusses contemporary visual arts education current changes. Visual Arts Education is frequently underestimated by most European Curriculum which often gave and still gives priority to other knowledge areas. Nevertheless, culture industries like museums and a wide range of culture and social organizations are doing the opposite, leading visual art education to an increasingly dissemination, even if it is always less than we all expect. This article also focus on a current shift and which seems to be a kind of paradox: visual art education services from alternative culture institutions are becoming integrated on school activities. By recognizing Visual Art Education Value, culture institutions are trying to develop different approaches in order to engage visual arts with communities. By informing and promoting creative thinking, they are trying to reach community involvement and, consequently, breaking down barriers when necessary. In a more and more globalized world, it is urgent to rethink culture, ethnical, social, economical and political diversities and here is where visual arts education can become a more active player. Art always allowed man to create different worlds in our world as Nelson Goodman affirmed. By creating new worlds, art offers possibilities on new world perspectives and therefore it also might make possible a great miracle, which is the possibility of changing into a better world! Isn´t that what next Documenta 14 is doing? Documenta 14, Kassel, considered the world's largest and most prestigious exhibition of contemporary art, will be held in Athens, Greece, and Kassel, Germany, under the following theme: Learning from Athens. Both - visual art education and contemporary art - seem to share this wish and determination in changing to a better world by implicating local, national and international community. And Art always seemed to be a great `educator´ throughout mankind history.
Modernidade, art brésilien du 20e siècle (Paris, 1987)
Authors: Bechelany Camila Campelo 
Published: June 2019

A partir de uma análise da narrativa curatorial da exposição Modernidade art brésilien du 20e siècle (Paris, 1987-1988) e da recepção crítica desta na França e no Brasil, pretendemos refletir sobre as possibilidades e os limites de um "modernismo brasileiro" no contexto inicial da globalização da arte, em meados da década de 1980. Esta reflexão pode nos conduzir a uma leitura da história da arte internacional de uma perspectiva brasileira e à compreensão do sistema internacional de arte como um campo simbólico multi-centralizado.
Uma leitura comparada das artes selvagens
Authors: André Sylvie 
Published: June 2019

Durante a segunda guerra mundial, Claude Lévi-Strauss e André Breton se encontraram no navio que os conduzia a Nova York. Viviam a mesma experiência de intelectuais expatriados. Tristes Trópicos (1955) pode ser lido como o resultado de trocas com Breton e outros escritores, em que a forma e a contribuição literárias são onipresentes afin de avaliar a originalidade e as contribuições do próprio texto antropológico. Nesta obra, Lévi-Strauss se interroga especificamente sobre todas as formas de relato do “Além” e sobre as condições do conhecimento científico das sociedades humanas. A partir de seus primeiros artigos até Antropologia estrutural (1958), Lévi-Strauss desenvolve algumas definições interessantes da atividade criadora em relação aos mitos. Especularmente, pode-se notar a importância do encontro do etnólogo com André Breton e a visão da arte que ele estava desenvolvendo: um tipo de arte cuja dimensão social estava afirmada com maior intensidade. Estando em contato com a etnologia e Claude Lévi-Strauss, André Breton concebe e desenvolve sua necessidade de criação de um mito contemporâneo que denominará ‘os grandes transparentes’. Em 1955 o etnólogo propõe um questionário para a preparação de L’Art magique. Por meio da correspondência entre o poeta e o etnólogo, podemos apreciar as discussões e o que alimentou suas concepções pessoais.
A China, Ai Weiwei e Andy Warhol
Authors: Frangi Giuseppe 
Published: June 2019

A nova arte chinesa do início do terceiro milênio adquiriu, com extraordinária rapidez, uma posição predominante a nível global. Entre os trinta artistas nascidos após 1950 e que têm cotações superiores a um milhão de dólares, a metade vem da China. Como se explica um fenômeno de tais dimensões? Quais os fatores que permitiram à nova arte chinesa conquistar os colecionadores ocidentais? Para tanto, a China demonstrou que sabe se deixar permear, sem problemas, por uma cultura pop; mas, desta maneira, criou as condições da própria indispensabilidade ao sistema, entregando nas mãos de sua leadership um poderoso instrumento para libertar a imagem do país.