bluuebunny/crossref_metadata_2025_split huggingface dataset:
899-P: Combinations of the Mitochondrial Protonophore TLC-6740 and/or the ACC2 Inhibitor TLC-3595 Provide Additive Glycemic Benefits to Semaglutide (SEMA) in db/db Mice
Authors: VIJAYAKUMAR ARCHANA , SRODA NATALIE , MURAKAMI EISUKE , WENG STEVE , MYERS ROBERT P. , SUBRAMANIAN MANI , SHULMAN GERALD I. 
Published: June 2024

Background: TLC-6740, a liver-targeted mitochondrial uncoupler, and TLC-3595, a selective ACC2 inhibitor, are in development for obesity and diabetes. By enhancing substrate oxidation, 6740 and 3595 have complementary mechanisms to GLP-1R agonists. Here, we assessed effects of 6740, 3595, and SEMA monotherapy (mono) and combinations (combos) in db/db mice.
Methods: Male db/db mice (fasting glucose, FG&gt;180mg/dL) were treated for 4 wk with vehicle (Veh), 6740, 3595, or SEMA mono or dual/triple combos. At 3 wk, an oral glucose tolerance test (oGTT) was performed and incremental AUC (iAUC) of glucose was calculated normalizing for glycemia before glucose bolus.
Results: FG was lower in all groups vs Veh with the greatest reductions in 6740+3595, 6740+SEMA, and 6740+3595+SEMA combos (-42 to -56%) (Fig). While HbA1c was lower with all monos vs Veh (-0.6 to -1.0%), combos had the greatest effect (-1.4 to -1.7%). Food intake was lower in all SEMA groups, but only SEMA+3595 caused weight loss (-11%). oGTT iAUC was reduced vs Veh with only ‘6740 mono (-26%) and SEMA combos with 6740 (-40%), 3595 (-31%), and 6740+3595 (-41%).
Conclusions: In db/db mice, 6740 improved glucose tolerance, FG, and HbA1c similarly to SEMA. Addition of 6740 and/or 3595 to SEMA improved glycemic parameters, supporting evaluation of combinations with GLP-1R agonists for diabetes.

Disclosure
A. Vijayakumar: Employee; OrsoBio, Inc. N. Sroda: Employee; OrsoBio, Inc. E. Murakami: Employee; OrsoBio, Inc. S. Weng: Employee; OrsoBio, Inc. R.P. Myers: Employee; OrsoBio, Inc. M. Subramanian: Board Member; OrsoBio, Inc. G.I. Shulman: None.
909-P: Impact of SGLT2 Inhibition on Glucosuria in HNF1A-MODY
Authors: MAAGENSEN HENRIK , JENSEN JOHANNE S. , OFFERSGAARD HØYERUP STINE , THUESEN ANNE CATHRINE B. , KROGH JESPER , ROSSING PETER , HANSEN TORBEN , KNOP FILIP K. , HAEDERSDAL SOFIE , VILSBØLL TINA 
Published: June 2024

Introduction & Objective: Pathogenic variants in HNF1A cause maturity-onset diabetes of the young type 3 (HNF1A-MODY, MODY3) which is associated with relative hyper-glucosuria that has been attributed to lower expression of sodium-glucose cotransporter 2 (SGLT2) in HNF1A knockout mice; questioning SGLT2 as a relevant treatment target in these individuals.
Methods: In a randomized, double-blind, crossover study, persons with MODY3 and type 2 diabetes (T2D) underwent two three-step hyperglycemic clamps targeted at 10, 14, and 18 mmol/L (1h each) with and without acute SGLT2 inhibition (25 mg empagliflozin or placebo 2h before clamp).
Results: Participants characteristics: MODY3 (N = 11, 5 men; age (mean, SD) 49 ± 15 years; BMI 24.5 ± 3.9 kg/m2; HbA1c 6.7 ± 0.7%; eGFR 109 ± 14 mL/min/1.73 m2); T2D (n = 10, 8 men; age 63 ± 7 years; BMI 26.4 ± 3.5 kg/m2; HbA1c 6.7 ± 0.6%; eGFR 93 ± 12 mL/min/1.73 m2). In both groups, SGLT2 inhibition had robust effects on urinary glucose excretion, urine volume, infused glucose, and plasma glucose AUC (data in table). No significant differences between groups in the effects of SGLT2 inhibition were observed.
Conclusion: The similar effects of SGLT2 inhibition in persons with MODY3 and T2D observed here, point to SGLT2 inhibition as a relevant glucose-lowering treatment strategy in persons with MODY3 despite the potentially lower SGLT2 expression.

Disclosure
H. Maagensen: None. J.S. Jensen: None. S. Offersgaard Høyerup: None. A.B. Thuesen: None. J. Krogh: None. P. Rossing: Other Relationship; AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Gilead Sciences, Inc., Novo Nordisk, Eli Lilly and Company, Novartis AG, Abbott Diagnostics. T. Hansen: None. F.K. Knop: Advisory Panel; AstraZeneca. Consultant; AstraZeneca. Speaker's Bureau; AstraZeneca. Advisory Panel; Boehringer-Ingelheim. Consultant; Boehringer-Ingelheim. Speaker's Bureau; Boehringer-Ingelheim. Advisory Panel; Eli Lilly and Company. Consultant; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. Advisory Panel; Novo Nordisk A/S. Consultant; Novo Nordisk A/S. Employee; Novo Nordisk A/S. Research Support; Novo Nordisk A/S. Speaker's Bureau; Novo Nordisk A/S. Stock/Shareholder; Novo Nordisk A/S. Advisory Panel; Sanofi. Speaker's Bureau; Lundbeck. Advisory Panel; Zealand Pharma A/S. Consultant; Zealand Pharma A/S. Research Support; Zealand Pharma A/S. Speaker's Bureau; Zealand Pharma A/S. Stock/Shareholder; Zealand Pharma A/S. S. Haedersdal: None. T. Vilsbøll: Consultant; AstraZeneca. Advisory Panel; Boehringer-Ingelheim. Speaker's Bureau; Mundipharma. Advisory Panel; Novo Nordisk, Lilly Diabetes, Sanofi. Speaker's Bureau; Bayer Inc., Gilead Sciences, Inc. Advisory Panel; Sun Pharmaceutical Industries Ltd. Research Support; Lilly Diabetes.
917-P: Sotagliflozin vs. Empagliflozin or Placebo in Type 2 Diabetes on a DPP-4i +/- Metformin
Authors: PETERS ANNE L. , HARDIN MARQUETTE B. , CARROLL AMY K. , BANKS PHILLIP L. , ROSENSTOCK JULIO 
Published: June 2024

Clinical trials (inTandem, SOLOIST-WHF, and SCORED) utilizing sotagliflozin (SOTA), a dual SGLT1 and SGLT2 inhibitor, have demonstrated glycemic improvements in patients with type 1 diabetes (T1D) and reduced heart failure-related hospitalizations and cardiovascular mortality in patients with type 2 diabetes (T2D). The purpose of this study was to evaluate the superiority of SOTA vs placebo and noninferiority of SOTA vs empagliflozin (EMPA), a selective SGLT2 inhibitor, on HbA1c reduction in individuals with T2D who had inadequate glycemic control on a DPP4i with or without metformin. This phase 3, double-blind, placebo- and active-control, parallel-group 26-week trial randomized 770 participants (mean HbA1c 8.2%, age 59.4 yrs, T2D duration 9.2 yrs, BMI 32.2 kg/m2) to receive SOTA 400 mg once daily, EMPA 25 mg once daily, or matching placebos. Changes in HbA1c, postprandial glucose (PPG), fasting plasma glucose (FPG), body weight, and systolic blood pressure (SBP) were assessed, as well as adverse events. SOTA was superior to placebo and noninferior to EMPA in reducing HbA1c. Additionally, SOTA was superior to placebo for other metabolic measurements. Percentage of patients with at least 1 hypoglycemic event, Levels 1 - 3 included, was 4.5% in the placebo group, 0.7% in the SOTA group, and 2.9% in the EMPA group. Other adverse events in the SOTA group aligned with expectations associated with SGLTi therapy.

Disclosure
A.L. Peters: Advisory Panel; Lilly Diabetes, Vertex Pharmaceuticals Incorporated, Medscape. Research Support; Abbott, Insulet Corporation. M.B. Hardin: Employee; Lexicon Pharmaceuticals, Inc. A.K. Carroll: Employee; Lexicon Pharmaceuticals, Inc. P.L. Banks: Employee; Lexicon Pharmaceuticals, Inc. J. Rosenstock: Research Support; Biomea Fusion, Inc. Other Relationship; Lilly Diabetes. Research Support; Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Corcept Therapeutics. Other Relationship; Novo Nordisk. Research Support; Pfizer Inc. Other Relationship; Sanofi, Boehringer-Ingelheim. Research Support; Shionogi & Co., Ltd. Other Relationship; Structure Therapeutics, Inc. Advisory Panel; Terns Pharmaceuticals, Zealand Pharma A/S. Other Relationship; Applied Therapeutics, Hanmi Pharm. Co., Ltd., Oramed Pharmaceuticals. Advisory Panel; Scholar Rock.

Funding
Lexicon Pharmaceuticals, Inc.
934-P: Prescribing Patterns of Sodium–Glucose Cotransporter 2 Inhibitors in Patients with Heart Failure With or Without Type 2 Diabetes—A Continuing Review
Authors: WINTERS ASHLEY , LOPEZ MIGUEL , RAY GRETCHEN , ANDERSON JOE R. 
Published: June 2024

Introduction: The prevalence of heart failure (HF) continues to increase and guidelines strongly recommend initiation of quadruple pharmacologic therapy including a sodium glucose co-transport 2 inhibitor (SGLT2i) for patients with all classifications of HF irrespective of type 2 diabetes (T2D). We previously conducted a study to characterize SGLT2i prescribing rates among patients with HF with or without T2D which demonstrated low utilization of SGLT2i at only 6.2%. A limitation of this study was that data was collected prior to the release of updated guidelines.
Objective & Methods: The objective of this study is to further describe prescribing patterns of SGLT2i in patients with HF. The University of New Mexico (UNM) Health Sciences Center IRB approved this retrospective, single-center, descriptive chart review. Individuals ≥ 18 years of age were included if they had a documented diagnosis of HF and had been seen in a UNM clinic defined as primary care, cardiology, heart failure, nephrology, or endocrinology from 12/2021 to 12/2023.
Results: A total of 395 patients were included in the study; 148 with HFrEF, 63 with HFmEF, and 184 with HFpEF. The mean age was 68 years; 44% were female; 54% were Hispanic, 66% had established atherosclerotic cardiovascular disease, and 47% had T2D. SGLT2i were prescribed in 28.1% of patients overall, 45.9% of patients with T2D, and 12.4% of patients without T2D. Predictors of SGLT2i prescribing include: T2D (OR= 4.6; 95% CI, 2.60-8.06), HFrEF (OR= 2.0, 95% CI 1.12-3.45), HF clinic visit (OR 1.8, 95% CI 1.01-3.14), visit with pharmacists having prescriptive authority (OR=4.6, 95% CI 1.96-10.88), and number of specialty provider visits (OR= 1.1, 95% CI 1.03-1.13).
Conclusion: SGLT2i utilization has increased since our previous study was conducted. However, SGLT2i continue to be underprescribed in patients with HF with or without T2D despite current guideline recommendations.

Disclosure
A. Winters: None. M. Lopez: None. G. Ray: None. J.R. Anderson: None.
964-P: Real-World Access to Diabetes Technology and Achieved HbA1c Levels in Type 1 Diabetes by Race and Ethnicity
Authors: ROBINSON SARAH , KLONOFF DAVID C. , DEAN LISA , SCOTT ALEXANDRA , LANE RASHON , KERR DAVID 
Published: June 2024

Introduction: Recent research from specialist endocrine centers has highlighted racial disparities in access to care for individuals with type 1 diabetes (T1D). The aim of this study was to use real-world data to determine outcomes, including the use of technology, and achieved HbA1c levels for individuals with T1D in a large integrated healthcare delivery system in Northern California.
Methods: Using outpatient and hospital encounters from Sutter Health, individuals were included if most of the diabetic ICD codes between January 2021 and October 2023 were for T1D, and they had an insulin order. EHR extraction included physician orders, self-reported treatment, and self-reported race/ethnicity. One-way ANOVA and chi-squared test of independence were applied.
Results: A total of 7325 patients with T1D were identified. Minority groups were younger (Table). HbA1C values were significantly higher in Black and Hispanic populations compared to Whites. Excluding multiracial patients, continuous blood glucose monitors (CGM) and glucagon-like peptide 1 based therapies were also ordered at higher rates among minority groups. The use of hybrid closed-loop (HCL) systems is not significantly different among groups.
Conclusion: Although use of CGM occurred more frequently in minority groups, HbA1C values were higher compared to the White population. The use of HCL systems remails low across all groups.

Disclosure
S. Robinson: None. D.C. Klonoff: Consultant; Afon Technology Ltd, Better Therapeutics, Inc, Glucotrack, LIfecare, Nevro Corp., Novo Nordisk, Samsung, Thirdwayv Inc. L. Dean: None. A. Scott: None. R. Lane: None. D. Kerr: Advisory Panel; Abbott Diagnostics. Consultant; Sanofi, Better Therapeutics, Inc. Stock/Shareholder; Glooko, Inc.
975-P: Nocturnal Glucose Profile According to Predinner Insulin Injection Timing and Prandial and Basal Insulin Types in Type 1 Diabetes People Using Multiple Daily Injections—An Insulclock Connected Insulin Cap–Based Real-World Study
Authors: GOMEZ-PERALTA FERNANDO , VALLEDOR XOÁN , ABREU CRISTINA , FERNÁNDEZ-RUBIO ELSA , PUJANTE ALARCÓN PEDRO , AZRIEL SHARONA , CORCOY ROSA , RUIZ-VALDEPEÑAS LUIS 
Published: June 2024

Introduction & Objective: To analyze the influence of timing and type of predinner rapid insulin and basal insulin on the nocturnal glucose profile.
Methods: Real-world, retrospective study in T1D people using multiple daily injections. Ten hours from dinner of paired continuous glucose monitoring data and insulin injections automatically tracked with the connected cap Insulclock® were analyzed. Meal events were identified using the ROC detection methodology. Glucometrics were evaluated according to insulin injection time around the dinner and short- and long-acting analog types.
Results: Nocturnal profiles (n=775, 49 subjects) were analyzed. Higher nocturnal glucose AUC over 180 mg/dL was observed in delayed injections (mean &lt;u&gt;+&lt;/u&gt;SD; mg/dL x h): -45-15 min (n=136; 17.5%), 175.96 ±271.0; -15-0 min (n= 231; 29.8%), 164.0 ±237.1; 0+45 min (n= 408; 52.6%), 203.6 ±260.9, (p 0.049). Ultrarapid (FiAsp®) vs rapid insulin analogs use was associated with fewer events of glucose &lt;70 mg/dl (7.1 vs 13.6; p 0.0051) and TBR70 (1.67 vs 4.58%; p 0.0036). Events of glucose &lt;70 mg/dL and TBR70 adjusted by baseline glucose were similar by basal insulin type (glargine U300 vs degludec).
Conclusion: The timing and type of dinner prandial insulin affect the entire nocturnal glucose profile.

Disclosure
F. Gomez-Peralta: Advisory Panel; Abbott. Speaker's Bureau; Abbott. Advisory Panel; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Advisory Panel; Insulcloud S.L. Speaker's Bureau; Medtronic. Advisory Panel; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Advisory Panel; Sanofi. X. Valledor: Research Support; Insulcloud S.L. C. Abreu: None. E. Fernández-Rubio: Speaker's Bureau; Eli Lilly and Company, Medtronic, Novo Nordisk, Novalab. P. Pujante Alarcón: Speaker's Bureau; Dexcom, Inc., AstraZeneca, Novo Nordisk. S. Azriel: Speaker's Bureau; A. Menarini Diagnostics, Abbott, AstraZeneca, Boehringer-Ingelheim, Dexcom, Inc., Lilly Diabetes, Novartis Pharmaceuticals Corporation, Novo Nordisk Foundation, Sanofi. R. Corcoy: Other Relationship; Lilly Diabetes, Sanofi, Novo Nordisk, Roche Diabetes Care, Abbott Diagnostics, Dexcom, Inc., Menarini. Research Support; Ypsomed AG. Other Relationship; Medtronic. L. Ruiz-Valdepeñas: None.
992-P: Continuous Glucose Monitoring during Hospitalization in Patients with Total Pancreatectomy Reveals Significant Hyperglycemia
Authors: RAZA RIZVI SHAFAQ , BANERJEE AYAN , JEET KAUR RAVINDER , GUPTA SANDEEP , REID COREY , DESJARDINS DONNA , KENDRICK MICHAEL L. , TRUTY MARK , KUDVA YOGISH C. 
Published: June 2024

Introduction and Objectives: To our knowledge, only a few studies assessed continuous glucose monitoring (CGM) metrics in total pancreatectomy (TP) without islet autotransplantation during hospitalization.
Methods: We completed blinded CGM (Dexcom G6 Pro) studies in 28 subjects who had TP at Mayo Clinic, Rochester in a non-ICU setting and compared 2 cohorts (CGM data &lt; 30 days of TP vs. ≥ 30 days of TP). CGM glucose metrics were calculated as per ADA guidelines for hospitalized patients with diabetes mellitus (DM). CGM values were compared with point-of-care -testing glucose within 5 minutes.
Results: Baseline characteristics were 50% F, age 59.5 ± 8.2 yrs, BMI 26.7 ± 3.4 kg/m2, preexisting type 2 DM (Y/N=8/20) with mean duration of DM 7.9 ± 8.8 yrs, malignant/benign pancreatic tumor 25/3 and CGM data of 4.6 ± 3.2 days. Time in target range (140-180 mg/dL) was between 13-27% and time above range was ≥48 % in both cohorts. Time &lt;70 mg/dL was significantly higher in cohort 2 vs. cohort 1 (p=0.03). Overall, mean absolute relative difference (MARD) was 17.2% (± 4.9), median ARD was 19.4% and number of readings meeting % 20/20, was 68% with least accuracy on day 1. There was no device related adverse event.
Conclusion: Hospitalized TP patients spend more time above and below target range than within the target range demonstrating unmet needs of better glucose monitoring and better glycemic control.

Disclosure
S. Rizvi: None. A. Banerjee: None. R. Kaur: None. S. Gupta: None. C. Reid: None. D. Desjardins: None. M.L. Kendrick: None. M. Truty: None. Y.C. Kudva: Research Support; Dexcom, Inc. Other Relationship; Tandem Diabetes Care, Inc., Medtronic.
Pengaruh Budaya Organisasi Dan Lingkungan Kerja Terhadap Kinerja Karyawan Dengan Motivasi Sebagai Variabel Moderating Pada Toko Taqwa Mulia Batanghari
Authors: Suryadi  , Slamet Tedy Siswoyo  , Nila Tri Lestari  
Published: June 2024

The purpose of this research was to find out whether there was an influence of organizational culture and working environment towards the employee performance with motivation as a moderating variable at the taqwa mulia store at Batanghari sub-district. The research Methods applied Descriptive and quantitative approaches. The population and sample were the employees of taqwa mulia shop at Batanghari sub-district, with a total of 38 employees. The data collection technique used a questionnaire. The research data were analyzed by testing the prerequisites instrument, namely the Pearson product moment validity test. Furthermore, the reliability test used the Cronbach alpha test. Furthermore, to test the research hypothesis, the researcher utilized normality test, linearity test and homogeneity test. Next, a multiple linear regression test, T test, F test were performed and tested with the moderating variable in order to analyze the data of this study. Furthermore, data analysis were undertaken through moderated regression analysis (MRA) with the SPSS program. Based on the results of this study, it showed that: 1) organizational culture influenced the employee performance. 2) the working environment had a positive effect on the employee performance, 3) the organizational culture which was moderated by motivational variables had an acceptable value, so it can be concluded that motivational variables are able to moderate organizational culture on the employee performance. 4) the working environment is moderated by the variable motivation which has an acceptable value. Based on these results it can be concluded that the motivational variable is able to moderate organizational culture on employee performance.

Keywords ; Organizational Culture, Work Environment, Employee Performance, Motivation
The Readiness of the Undergraduate Students of the English Tadris Department at UIN Datokarama Palu in Using Google Classroom During Covid-19 Pandemic
Authors: Fana Riskiana  , Ruslin Ruslin , Yuni Amelia  
Published: June 2024

The spread of the coronavirus outbreak has forced educational institutions to transform learning activities in universities into network-based learning at home. Students unfamiliar with the online learning (google Classroom) system will face various challenges, especially in understanding lessons that cause learning outcomes to be less than optimal. Students' readiness is the first step in accepting and responding to the transformation of learning to achieve their learning goals. The Problems in this research are: (1) How is the readiness of students to implement online learning using Google Classroom? (2) What factors affect student’s readiness to use Google Classroom during the COVID-19 pandemic? It is qualitative descriptive research. The data collection techniques were a questionnaire and an interview. The results indicated that most English students are ready to face online learning using Google Classroom during the COVID-19 pandemic. Four indicators could be used to identify how students were ready for online learning. First, it was the skills of students in using Google Classroom. Second, the students understood how to use technological devices for learning including Google Classroom. Third, the students were ready to receive learning materials through Google Classroom. In addition, the students’ attitudes towards Google Classroom were categorized as sufficiently acceptable. This was shown by the average scores of students, which were 76%. Related to the factors that influenced students’ readiness for online learning, learning facilities and other infrastructures contributed to the readiness of students in learning English via Google Classroom during the Covid-19 Pandemic.
Students’ Perception Regarding the Use of Google Translate for English Text Translation
Authors: Mastang Mastang , Afifah Afifah , Fatima Fatima 
Published: June 2024

The use of digital tools in the learning process is common. Google Translate is used as an online translation tool to help the process of translating English texts. This research aims to discover the English Tadris Study Program students’ perception regarding using Google Translate to translate English texts at State Islamic University Datokarama Palu. The formulation of the problem is “How do the English Tadris Study Program students perceive the use of Google translate in translating English texts at State Islamic University Datokarama Palu?”. This research used a descriptive qualitative approach. The data were collected through questionnaires and interviews with 20 English Tadris Study Program batch 2020 students as research informants. The results showed that some students used Google Translate to translate English texts. The existence of Google Translate can help students with translation. Besides that, Google Translate helps students understand English texts. Some positive perceptions conveyed by the students from the results of the interview were about the use of Google translate, including easy access, help in knowing the pronunciation of a word, increasing vocabulary, and saving time in translating. However, there is a negative perception about using Google Translate, namely the accuracy of the translation results. The students argue that the translation results from Google Translate provide inaccurate translations, so it is recommended that translation results be rechecked using other translation media.
Prevalência de distúrbios da composição corporal em escolares de Rio Negro – PR
Authors: Schultz Luciene Martins , Petreça Daniel 
Published: June 2024

Este artigo teve como objetivo analisar a prevalência de sobrepeso e obesidade dos escolares de 9 a 10 anos das escolas municipais urbanas do município de Rio Negro – PR. A pesquisa foi de cunho descritivo de corte transversal. A amostra foi constituída de 212 escolares, sendo 95 meninos e 117 meninas apresentando média de idade de 9,64 (dp = 0,48) anos. Para determinar os padrões de Índice de Massa Corporal (IMC), percentual de gordura (%G) e distribuição da gordura corporal, foram mensurados os dados antropométricos: massa corporal, estatura, dobras cutâneas (tríceps e panturrilha medial) e perímetro de cintura. Assim, obteve-se o índice de massa corporal, classificando-o conforme protocolo do Center Diseases of Control (CDC, 2001) e percentual de gordura obtido por (ISAK, 2011), (TAYLOR et al 2000), (LOHMAN, 1987). Em relação à prevalência de excesso de peso (sobrepeso e obesidade), conforme a análise feita verificou-se um percentual maior nas meninas (44,2%) do que os meninos (31,6%) ao analisar o PC, foram obtidos (17,9%) e (12,8%). Em relação percentual de gordura, os valores de alto e muito alto foi de (28,4%) desses distúrbios nas meninas, nos meninos o (%G) moderadamente alto foi de (30,8%), as meninas só apresentaram (16,8%). Diante desses resultados, é importante salientar a necessidade de mais estudos sobre esse assunto, para que, a partir disso, medidas sejam tomadas, no sentido de que sejam implementados programas de conscientização, projetos nas escolas etc. a fim de que, em um futuro, se possa ter crianças mais saudáveis e, consequentemente, adultos saudáveis.