bluuebunny/crossref_metadata_2025_split huggingface dataset:
142-OR: Adiposity and Mortality among U.S. Hispanic/Latino Adults
Authors: ZHANG YANBO , CHEN GUO-CHONG , SOTRES-ALVAREZ DANIELA , PERREIRA KRISTA M. , GALLO LINDA , LLABRE MARIA M. , CAI JIANWEN , XUE XIAONAN , ISASI CARMEN R. , KAPLAN ROBERT , QI QIBIN 
Published: June 2023

Adiposity has been linked with mortality among Whites/Asians, but evidence from Hispanics is limited. We included 15855 adults from the Hispanic Community Health Study/Study of Latinos (2008-11). BMI, waist circumference (WC), waist-to-hip ratio (WHR), and body fat percentage (BF%) were measured, and Cox regressions estimated their relations with mortality. Over 153828 person years (median 10 years), 651 deaths occurred. With adjustment of sociodemographic and lifestyle covariates (Figure; Model 1), no dose-response relation of BMI or BF% with mortality was found. Compared with normal weight (BMI&lt;25 kg/m2), only severe obesity (BMI≥35 kg/m2) was associated with higher mortality (HR=1.58, 95% CI 1.08-2.31). Central obesity was associated with higher mortality with HRs (95% CIs) of 1.41 (1.01-1.97) comparing WC of &gt;102/88 cm (for men/women) vs ≤94/80 cm and 1.70 (1.14-2.53) comparing WHR of ≥0.90/0.85 vs &lt;0.90/0.85. With further adjustment of baseline comorbidities (Figure; Model 2), only WHR remained associated with mortality. BMI was highly correlated with BF% and WC (r&gt;0.84) but not WHR (r=0.54). WHR remained associated with mortality after further adjusting for BMI. Sex suggestively modified the relation of WHR with mortality which was stronger among women. Among US Hispanic/Latino adults, only severe obesity was associated with higher mortality. WHR could predict mortality better and should be evaluated in bodyweight management.

Disclosure
Y.Zhang: None. R.Kaplan: None. Q.Qi: None. G.Chen: None. D.Sotres-alvarez: None. K.M.Perreira: None. L.Gallo: None. M.M.Llabre: None. J.Cai: None. X.Xue: None. C.R.Isasi: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK119268, R01DK120870, P30DK111022); National Heart, Lung, and Blood Institute (HHSN268201300001I/N01-HC-65233, HHSN268201300004I/N01-HC-65234, HHSN268201300002I/N01-HC-65235, HHSN268201300003I/N01-HC-65236, HHSN268201300005I/N01-HC-65237)
1421-P: Ten-Year Trend in Socioeconomic Inequalities in the Prevalence and Incidence of Pharmacologically Treated Type 2 Diabetes in France—2010–2020
Authors: GUION MARIE , MANDEREAU-BRUNO LAURENCE , GORIA SARAH , FOSSE-EDORH SANDRINE , COSSON EMMANUEL 
Published: June 2023

The aim was to describe the association between socio-economic inequalities (SEI) and the prevalence/incidence of pharmacologically-treated type 2 diabetes (T2D) in France over the 2010-2020 period. Diabetes cases were identified using a validated algorithm in the French national health data system. Analyses were restricted to adults ≥45 years to focus on T2D. SEI were measured, each year, via the French Deprivation index (FDep, by population quintiles; Q1: corresponding to the less deprived municipalities) for metropolitan France. The relative risks (RR) of being T2D (prevalence) and developing T2D (incidence) in Q2, Q3, Q4 and Q5 were estimated by sex over the period via Poisson regression. Denominators were the French health consumers (from 24,228,526 in 2010 to 29,772,928 in 2020) for prevalence and the at risk population for incidence. A positive gradient was observed in the RR of T2D prevalence and incidence by FDep quintiles in all years. The influence of SEI (reference Q1) on T2D prevalence increased over the period for men in Q2, Q3, Q4 and Q5, and for women in Q3, Q4 and Q5; and on T2D incidence for men in Q4 and Q5. To conclude, SEI were positively associated with the prevalence/incidence of pharmacologically-treated T2D in metropolitan France. Further, the association increased over last decade for prevalence, and only in most deprived men for incidence.

Disclosure
M.Guion: None. L.Mandereau-bruno: None. S.Goria: None. S.Fosse-edorh: None. E.Cosson: Board Member; Abbott, Medtronic.

Funding
Fondation de France (00107045)
1422-P: The Impact of Type 2 Diabetes Mellitus on the Clinical Outcome of Breast Cancer
Authors: JI KIM YU , GOAK INSUN , YONG JIN HEUNG , SUN PARK TAE , AE LEE KYUNG 
Published: June 2023

Objectives: Women with breast cancer and diabetes have worse outcomes than those with breast cancer without diabetes. The objective of this study was to investigate the impact of pre-existing diabetes on breast cancer prognosis.
Methods and Materials: This was a retrospective observational study using Cancer database from a single tertiary center. The study population included women aged ≥20 years with breast cancer diagnosed between 1 January 2014 and 31 December 2018. Patients were categorized by diabetes status (T2D: n=111, non-T2D: n= 889). The clinicopathological features and outcomes were collected and compared between women with and without diabetes. Cox proportional hazard regression was used to estimate adjusted hazard ratios for overall mortality.
Results: Compared to non-T2D patients, T2D patients were significantly older, had higher BMI, were more post-menopausal state at breast cancer diagnosis, had more comorbid conditions, and were in lower educational states. There were no statistically significant differences in tumor characteristics, including metastasis, lymph nodes, grade, and extent of surgery. Women with T2D had a significantly increased risk of overall mortality after adjusting for demographic and traditional risk factors for breast cancer (HR=2.15; 95%CI=1.10-4.20). Compared to patients with pre-existing T2D (n=111), patients with newly diagnosed T2D after receiving a breast cancer diagnosis (n=34) had a lower risk of breast cancer recurrence (HR=0.30; 95%CI=0.10-0.94).
Conclusion: Our study showed that pre-existing T2D and T2D itself increase the risk of recurrence and total mortality among patients with breast cancer. These findings provide important prognostic information for the treatment of women with both T2D and breast cancer. Therefore, diabetes deserves additional attention to assess possible causal relationships that potentially could be modified to improve outcomes.

Disclosure
Y.Kim: None. I.Goak: None. H.Jin: None. T.Park: None. K.Lee: None.
1423-P: Glycemic Status at Three-Year Follow-up in LANDMARC—Longitudinal Nationwide Study on Real-World Outcomes of Type 2 Diabetes in India
Authors: JOSHI SHASHANK R. , DAS ASHOK K. , PRASANNA KUMAR K.M. , MITHAL AMBRISH , KALRA SANJAY , GOPALAKRISHNAN UNNIKRISHNAN AMBIKA , THACKER HEMANT , SETHI BIPIN , CHOWDHURY SUBHANKAR , SUGUMARAN AMARNATH , SATPATHY ASHWINI , GADEKAR ARVIND , MENON SHALINI K. , NEOGI RENUKA , CHODANKAR DEEPA , TRIVEDI CHIRAG , KUMAR WANGNOO SUBHASH , ZARGAR ABDUL H. , RAIS NADEEM 
Published: June 2023

Glycemic change from baseline to 3 years was examined in LANDMARC — a prospective observational study (CTRI/2017/05/008452) — that included participants with type 2 diabetes (T2D) taking ≥2 antihyperglycemic medications (with/without glycemic control). Of 6222 evaluable participants (mean baseline values - age: 52.1 years, T2D duration: 8.6 years and A1C: 8.05%), 5273 completed 3-year follow-up visit. All glycemic parameters improved significantly (p&lt;0.0001) from baseline (A1C: -0.68% [1.65]; FPG: -16.51 mg/dL [55.38]; and PPG -27.07 mg/dL [80.10]). The number of participants in the 7-7.9% A1C subgroup increased from baseline to the end of 3 years; 21.79% (1356/6222) achieved optimum glycemic control of A1C &lt;7%. Glycemic control was not affected by cardiovascular risk factors; while in the subgroups of complications, participants with myocardial infarction, heart failure, and unstable angina showed suboptimal glycemic control (Table). In conclusion, although there was a significant improvement in all the glycemic parameters from baseline, a large majority of the participants remained uncontrolled in terms of achieving target HbA1c. This emphasizes the need for optimizing diabetes management in India.

Disclosure
S.R.Joshi: Advisory Panel; Biocon, Zydus Cadila, Torrent Pharmaceuticals Ltd, Franco India, Consultant; Glenmark Pharmaceuticals, Twin Health, Speaker's Bureau; Abbott Nutrition, Sanofi, Abbott, Novo Nordisk, Lupin Pharmaceuticals, Inc. A.Sugumaran: Employee; Sanofi. A.Satpathy: Employee; Sanofi. A.Gadekar: Employee; Sanofi. S.K.Menon: Employee; Sanofi. R.Neogi: Employee; Sanofi. D.Chodankar: Employee; Sanofi. C.Trivedi: None. S.Wangnoo: None. A.H.Zargar: None. N.Rais: Advisory Panel; Bayer Consumer Care AG, Board Member; Abbott, Biocon. A.K.Das: n/a. K.Kumar: None. A.Mithal: Advisory Panel; Eris Lifesciences Ltd., Consultant; Glenmark Pharmaceuticals, Lupin Pharmaceuticals, Inc., USV Private Limited, Research Support; Sanofi, Speaker's Bureau; Novo Nordisk, Boehringer-Ingelheim, AstraZeneca, Sun Pharmaceutical Industries Ltd., Novartis. S.Kalra: Speaker's Bureau; Abbott, Bayer Inc., Novo Nordisk, Sanofi. A.Unnikrishnan: Speaker's Bureau; Sanofi, AstraZeneca, Boehringer-Ingelheim, Intas Pharmaceuticals Ltd. H.Thacker: None. B.Sethi: None. S.Chowdhury: None.

Funding
Sanofi India
1426-P: Socioeconomic Disparities in Mortality among Young Adults with Diabetes—A Nationwide Cohort Study in South Korea
Authors: YOON KIM JI , HOON KIM NAM , GON KIM SIN 
Published: June 2023

Objectives: This study aimed to estimate the overall and cause-specific mortality risk according to socioeconomic status (SES) and age among patients with diabetes.
Research Design and Methods: From the Korean National Health Insurance Service Cohort (2008-2019), 1,240,780 adults aged 20-79 years (604,975 patients with diabetes and 635,805 controls without diabetes) were included. The risk of mortality from any causes, cardiovascular disease, diabetes, and cancer was estimated according to the patients’ SES and compared with age- and sex-matched controls without diabetes. The SES was categorized into three groups (tercile) by subjects’ income. Subgroup analyses were done according to the individuals’ age group (20-39, 40-59, and 60-79 years).
Results: Overall, 48,420 deaths occurred during a follow-up. Compared with individuals without diabetes, the adjusted hazard ratios (HR) of all-cause mortality of patients with diabetes were 1.25 (95% confidence interval (CI), 1.23-1.28) in the highest SES, 1.56 (95% CI, 1.53-1.59) in the middle SES, and 1.78 (95% CI, 1.74-1.82) in the lowest SES group. The inverse relationship between SES and mortality risk was prominent in younger patients; the HRs of all-cause mortality in the lowest SES group were 4.00 (95% CI, 3.25-4.93) in patients aged 20-39 years, 2.71 (95% CI, 2.59-2.84) in those aged 40-59 years, and 1.58 (95% CI, 1.54-1.62) in those aged 60-79 years. A similar association was observed in cause-specific mortality.
Conclusion: Low SES increased the risks of all-cause mortality and mortality from cardiovascular disease, diabetes, and cancer in patients with diabetes. This association is more prominent in younger patients than in older patients.

Disclosure
J.Kim: None. N.Kim: None. S.Kim: None.
1428-P: Type 2 Diabetes Drug Utilization by Claims-Based and Self-Reported Weight Status
Authors: WOLLERSHEIM PAUL , BACON SAM , THOMPSON NELS , CLARK CALLAHAN 
Published: June 2023

Background: Weight is an increasingly important component of care goals and treatment selection for people with type 2 diabetes (T2D). Over 80% of people with T2D have obesity, yet population-level assessments can be challenging as weight is often underreported in administrative data.
Methods: We conducted a cross-sectional descriptive analysis of 8,680 commercially insured adults enrolled in a virtual specialty clinic (Level2) for at least one year using de-identified administrative claims and patient-reported BMI in a research database. Diabetes drug prevalence was measured using fill rates and stratified by claims-based and self-reported weight, to describe differences. Claims and diabetes drug fills from 9/15/2021 to 9/15/2022 were included.
Results: Overall, 25.1% (n = 2183) had an obesity-related claim. Of the subset with a self-reported BMI, 76.3% (n = 366) had obesity and 50.1% (n = 187) had at least one obesity-related claim. Diabetes drug fills (Table 1) varied by class, BMI strata, and BMI source. After biguanides, GLP-1 RAs were the most filled class, with utilization varying from 21% (self-reported BMI 25 to 30 kg/m2) to 34% (claims-based BMI &gt; 40 kg/m2).
Conclusion: Despite the importance of weight in T2D care, it remains underreported in administrative data assets. Using administrative data together with accurate measures of weight, including from self-report, can inform T2D practice and program design.

Disclosure
P.Wollersheim: Employee; Level2. S.Bacon: Employee; Optum Labs, Research Support; Level2. N.Thompson: Employee; Level2, Stock/Shareholder; UnitedHealth Group. C.Clark: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group.
1429-P: Newly Diagnosed Diabetes Is Associated with Higher Mortality and Longer Length of Stay in Hospitalized Patients
Authors: JANG SEOL A. , MIN KIM KYOUNG , SIK KIM CHUL , WON PARK SEOK 
Published: June 2023

Several studies have shown that hyperglycemia and a history of diabetes mellitus (DM) are liked to poor outcomes in hospitalized patients. However, about one third of patients with diabetes are left undiagnosed until they admitted to the hospital. The impacts of undiagnosed or newly diagnosed diabetes on hospitalization-related outcomes are not well studied. In this study, we aimed to evaluate hospitalization-related outcomes in hospitalized patents according to their diabetic status at admission. This is a retrospective cohort study, and all subjects aged 20 years or older admitted to Yongin Severance hospital between March 2020 and February 2022 were included. Subjects were divided into no DM group, known DM group by a history of diabetes or taking any antidiabetic medications, and newly diagnosed DM group by results of laboratory test including HbA1c. We compared hospitalization-related outcomes such as in-hospital mortality rate and the length of hospital stay. A total of 33,166 subjects was enrolled. At hospitalization, 6,572 (19.8%) subjects were classified as known DM and another 2,634 (7.9%) subjects were classified as newly diagnosed DM. In-hospital mortality was highest in newly diagnosed DM group (hazard ratio [HR] 5.81, 95% confidence interval [CI] 4.90-6.89, p&lt;0.001) followed by known DM group (HR 2.08, 95% CI 1.74-2.47, p&lt;0.001) compared to no DM group. The length of hospital stay was significantly increased in newly diagnosed DM (15.5±19.3 days) compared with no DM (6.5±7.9 days) and known DM group (8.6±11.1 days) (p&lt;0.001). After adjusting for multiple covariates, newly diagnosed diabetes was independently associated with increased in-hospital mortality (p&lt;0.001). In conclusion, diabetic status at admission was associated with poor outcomes in hospitalized patients. Those with a newly diagnosed diabetes showed particularly high risk of in-hospital mortality and even longer length of hospital stay.

Disclosure
S.A. Jang: None. K. Kim: None. C. Kim: None. S. Park: None.
1430-P: Early Real-World Experiences with Tirzepatide
Authors: LAMBERT NATALIE , JARVIS MEGAN , FESTER JENNA , MCCOY ROZALINA G. , ARD JAMY D. , CLARK CALLAHAN 
Published: June 2023

Online communities offer real-world data about interactions with new treatments prior to visibility in clinical or administrative data assets. We evaluated early tirzepatide initiation experiences reported in online health narratives after its May 2022 FDA approval for type 2 diabetes. At data extraction, &lt; 10 tirzepatide claims were in OptumLabs’ deidentified administrative data. We extracted all publicly available posts (N=786) from r/Mounjaro (5/22 to 9/22), a Reddit community of 16,200 members. Categorical coding (agreement = .99) assessed the demographics, clinical history, treatment effects, and side effects from SURPASS trials and captured open-ended details of experiences. Most posts (67.3%) posed a question and included the r/Mounjaro users’ tirzepatide status (78.1%). Of narratives describing active tirzepatide use (N=465; 59.2%), common SURPASS side effects were decreased appetite (21.9%), nausea (11.2%), abdominal discomfort (5.8%), and diarrhea (5.2%). Common poster-defined side effects were fatigue (6.5%), body aches/stiffness (4.1%), and burping (4.1%). Posters reported tirzepatide use for weight (8.4%) more than glucose (0.4%) and obtained prescriptions from virtual clinics (7.1%) more than primary care (4.1%) or obesity specialists (0.4%). While missing some clinical details, online health narratives offer accelerated insights and can inform practice prior to traditional observational data availability.

Disclosure
N.Lambert: Employee; Optum Labs. M.Jarvis: Employee; Optum Labs, UnitedHealth Group, Stock/Shareholder; Oramed Pharmaceuticals, UnitedHealth Group, Dexcom, Inc., Apple, Hologic Inc., Intuitive Surgical. J.Fester: None. R.G.Mccoy: Consultant; Emmi. J.D.Ard: Advisory Panel; Novo Nordisk, Consultant; Eli Lilly and Company, Intuitive Surgical, Regeneron, Other Relationship; Optum Labs, Weight Watchers International, Research Support; Nestlé Health Science, Boehringer Ingelheim Inc., Epitomee, KVK Tech. C.Clark: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group.
1433-P: Relationships between HbA1c Levels and Diabetes Management Practices—NHANES Data, 2007–2018
Authors: YOUNG CLIPPER F. , MYUNG CHERRY 
Published: June 2023

Objective: To evaluate the relationships between HbA1c levels and the recommended diabetes management practices captured in the National Health and Nutrition Examination Survey (NHAHES) datasets between 2007 and 2018 in adults with diabetes.
Methods: This study utilized a cross-sectional approach. Logistic regression models were created, adjusting for covariates while examining the relationships between diabetes management practices and HbA1c levels.
Results: The study included 4,623 individuals with an average age of 62 years (SD 0.19). Of these individuals, 33.8% were non-Hispanic Whites, 26.9% non-Hispanic Blacks, 17.4% Mexican Americans, 10.7% other Hispanics, and 11.3% other races. The following table summarizes these relationships' odds ratios, 95% confidence intervals, and p-values.
Conclusion: From 2007 to 2018, participants who saw a diabetes specialist once or less per month were less likely to have a lower A1c level (&lt; 9%). Those who reported checking their feet, reducing fat/calories in their diet, and taking Insulin were significantly more likely to have a lower A1c level than their counterparts. These significant findings confirm the importance of the recommended diabetes management (e.g., nutrition and medication) at the national level, reinforcing the ongoing large-scale public health campaigns that are warranted to support the existing messages to patients with diabetes.

Disclosure
C.F.Young: Other Relationship; Abbott Diabetes. C.Myung: None.
1435-P: Therapeutic Patterns at Three-Year Follow-up in LANDMARC—Longitudinal Nationwide Study on Real-World Outcomes of Type 2 Diabetes in India
Authors: THACKER HEMANT , DAS ASHOK K. , JOSHI SHASHANK R. , MITHAL AMBRISH , KALRA SANJAY , GOPALAKRISHNAN UNNIKRISHNAN AMBIKA , PRASANNA KUMAR K.M. , SETHI BIPIN , CHOWDHURY SUBHANKAR , SUGUMARAN AMARNATH , SATPATHY ASHWINI , GADEKAR ARVIND , MENON SHALINI K. , NEOGI RENUKA , CHODANKAR DEEPA , TRIVEDI CHIRAG , KUMAR WANGNOO SUBHASH , ZARGAR ABDUL H. , RAIS NADEEM 
Published: June 2023

Therapy patterns across various subgroups were examined at the end of third year (yr) in LANDMARC, a prospective observational study (CTRI/2017/05/008452), that included participants with T2D on ≥2 antihyperglycemic medications. Of 6222 evaluable participants (mean baseline values - age: 52.1 yrs, T2D duration: 8.6 yrs and A1C: 8.05%), 5273 completed 3-yr follow-up visit. Therapeutic management was at the discretion of the treating physician. At the end of the third yr, the proportion of participants taking insulin + OAD increased (baseline: 23.95%; 3-yrs: 34.86%); while those taking only OADs decreased (baseline: 74.51%; 3-yrs: 63.30%). Among injectable glucose-lowering drugs, there was an increase in basal, prandial and premix insulin. Biguanides and sulfonylureas were the most commonly used OAD classes, the highest increase in OAD addition was seen for DPP4 inhibitors (baseline: 3043/6222, 48.91%; 3-yrs: 3287/5264, 62.44%) followed by SGLT2 inhibitors (baseline: 654/6222, 10.51%; 3-yrs: 1231/5264, 23.39%). Overall, glycemic parameters improved in the insulin subgroup compared to the insulin naïve subgroup (p&lt;0.0001). No difference in change of glycemic parameters was noted in those on basal vs. premix insulin (Table). Overall, 3-yr data indicate that timely intensification of therapy may play an important role in improving glycemic parameters.

Disclosure
H.Thacker: None. A.Sugumaran: Employee; Sanofi. A.Satpathy: Employee; Sanofi. A.Gadekar: Employee; Sanofi. S.K.Menon: Employee; Sanofi. R.Neogi: Employee; Sanofi. D.Chodankar: Employee; Sanofi. C.Trivedi: None. S.Wangnoo: None. A.H.Zargar: None. N.Rais: Advisory Panel; Bayer Consumer Care AG, Board Member; Abbott, Biocon. A.K.Das: n/a. S.R.Joshi: Advisory Panel; Biocon, Zydus Cadila, Torrent Pharmaceuticals Ltd, Franco India, Consultant; Glenmark Pharmaceuticals, Twin Health, Speaker's Bureau; Abbott Nutrition, Sanofi, Abbott, Novo Nordisk, Lupin Pharmaceuticals, Inc. A.Mithal: Advisory Panel; Eris Lifesciences Ltd., Consultant; Glenmark Pharmaceuticals, Lupin Pharmaceuticals, Inc., USV Private Limited, Research Support; Sanofi, Speaker's Bureau; Novo Nordisk, Boehringer-Ingelheim, AstraZeneca, Sun Pharmaceutical Industries Ltd., Novartis. S.Kalra: Speaker's Bureau; Abbott, Bayer Inc., Novo Nordisk, Sanofi. A.Unnikrishnan: Speaker's Bureau; Sanofi, AstraZeneca, Boehringer-Ingelheim, Intas Pharmaceuticals Ltd. K.Kumar: None. B.Sethi: None. S.Chowdhury: None.

Funding
Sanofi India
1438-P: Diabetes after Cardiac Transplant with Low-Dose Everolimus and Tacrolimus
Authors: RAVEN LISA M. , MUIR CHRISTOPHER A. , POULIOPOULOS JIM , MACDONALD PETER S. , JABBOUR ANDREW , GREENFIELD JERRY 
Published: June 2023

Background: Although modern immunosuppressants improve survival post-transplant, they are associated with long-term metabolic complications, such as post-transplant diabetes mellitus (PTDM). Calcineurin inhibitor-sparing regimens using everolimus attenuate some complications such as left ventricular hypertrophy. However, the metabolic effects of everolimus following transplant are less clear.
Aims: To compare incidence of diabetes in heart transplant recipients exposed to low-dose everolimus and tacrolimus versus standard-dose tacrolimus.
Methods: Post-hoc analysis in participants of a randomised open-label clinical trial of low-dose everolimus and tacrolimus versus standard-dose tacrolimus in heart transplant recipients.
Results: There were 39 participants in the trial, mean follow up was 6.4 ± 1.5 years. There was a high rate of pre-existing diabetes (26%) and newly-diagnosed PTDM (36%) during follow-up (Figure 1). Half the patients who developed PTDM in the everolimus-tacrolimus group (n=4/8) ceased diabetes medications during follow-up, which was not observed in patients on standard tacrolimus (n=0/6).
Conclusion: This study suggests that treatment with everolimus may improve PTDM outcomes relative to treatment with standard doses of calcineurin inhibitor. These findings should be further studied in prospective randomised trials.

Disclosure
L.M.Raven: None. C.A.Muir: None. J.Pouliopoulos: None. P.S.Macdonald: Advisory Panel; AstraZeneca, Boehringer Ingelheim Inc., Other Relationship; Novartis. A.Jabbour: None. J.Greenfield: None.