bluuebunny/crossref_metadata_2025_split huggingface dataset:
1075-P: Therapeutic Inertia of Glycemic Management in Hospital Setting
Authors: LINN AUNG NAY , BAPANA MARY J. , WIN KHAING , MAUNG ERICA , HANANI CHRISTOPHER , JHAVERI SAMEER , AMOS ASHTON , COVACI ANDREA , MARQUESS ALEXIS , LAPE MEGAN E. 
Published: June 2023

Among hospitalized patients, glycemic variability, hyperglycemia and hypoglycemia are associated with increased mortality and other adverse outcomes. Therapeutic inertia, defined as failure to intensify or de-intensify when treatment goal is not met, is found as one of the major obstacles in achieving appropriate glycemic control in the outpatient setting. However, there are very scare data on therapeutic inertia among hospitalized patients with hyperglycemia. Our study looked at hyperglycemia (BG&gt;200) and hypoglycemia (BG&lt;70) rate in hospitalized patients with diabetes admitted in June of 2021 as well as the rate of intensification and de-intensification of insulin within 8 hours of abnormal BG level as defined above. Our study showed that there were treatment adjustment in only 20% of the day with abnormal BG level.

Disclosure
N.Aung: None. M.E.Lape: None. M.J.Bapana: None. K.Win: None. E.Maung: None. C.Hanani: None. S.Jhaveri: None. A.Amos: None. A.Covaci: None. A.Marquess: None.
1080-P: Missed Opportunities to Address Hypoglycemia Risk in Older Adults with Type 2 Diabetes during Symptom-Driven Primary Care Visits
Authors: TANG EMILY , PETERSON ILANA , BOARD CHRISTINE , GRANT RICHARD W. 
Published: June 2023

Older adults with type 2 diabetes (T2D) treated with insulin and/or sulfonylureas (SUs) are at increased risk for hypoglycemia-related adverse events (e.g. falls, decreased quality of life, and death). Because aging is associated with changes in physiology, visual acuity, and dietary habits, diabetes treatment regimens require regular re-assessment. However, despite the importance of ensuring safe diabetes care in older adults, prior research has shown that diabetes is often not addressed during primary care visits due to limited time and competing demands. We tested the hypothesis that diabetes management in primary care occurs less frequently during visits scheduled for acute symptoms/concerns (i.e., “reactive visits”) vs. pre-scheduled annual/physical exam visits intended for health maintenance (i.e., “proactive visits”). We conducted structured chart abstraction for 123 older adults with T2D prescribed insulin and/or SUs to examine the association of visit context (reactive vs proactive) with physician-documented diabetes management, defined as any documentation of diabetes control, blood sugar levels, or diabetes-related medications. Patients were 78.6 ± 3.65 years old, 52.8% were women, pre-visit HbA1c was 7.4% ±0.9%. We found that diabetes documentation in these patients was much less frequent in reactive vs. proactive visits (50.7% vs. 69.8%, p = 0.02). In a logistic model, this association remained significant after controlling for demographic differences (aOR 2.4, 95% CI = 1.1-5.3). In this model, HbA1c ≥8% was also independently associated with diabetes documentation (aOR 3.3 [1.1-10.1]). Treatment with insulin or SUs exposes aging adults to a high risk of hypoglycemia, especially during times of change. Although chart documentation may underestimate actual visit interactions, our results suggest that visits made to discuss acute concerns are a missed opportunity to review and address diabetes care in high-risk patients.

Disclosure
E.Tang: None. I.Peterson: None. C.Board: None. R.W.Grant: None.

Funding
Patient-Centered Outcomes Research Institute (CDR-2019C1-16126)
1085-P: Defragmenting Patient Care via a Multidisciplinary Diabetes Clinic
Authors: IQBAL ANIRA , CECILIA LANSANG M. , ZIMMERMAN ROBERT S. , ISAACS DIANA , BENA JAMES F. , MORREN JOHN , SINGH RISHI , THOMAS GEORGE , GRIEBELER MARCIO L. , PARKER MARCIE , SMITH-COLEMAN ARI , MARQUARDT ROBERT J. , MAIER MICHAEL A. 
Published: June 2023

Aim : Diabetes mellitus (DM) care delivery is often fragmented because of logistical constraints. We examined if cohesive short-term multidisciplinary care improves diabetes-related outcomes.
Methods: This was a prospective, non-randomized pilot study. Adults with type 2 DM, A1C ≥8% and ≥1 comorbidity attended either 1) a multidisciplinary clinic (endocrinologist, pharmacist, diabetes educator/nutritionist and at least one specialty e.g. cardiology, nephrology, ophthalmology on the same/next day), or 2) conventional visits spread apart. A1C (primary outcome) and other variables were collected at baseline, 6 months (exit from active part of study), and 12 months (6 months from exit).
Results: There were 20 patients per arm (55.3% female, mean ± SD age 53.8 ± 11.3 y, BMI 40.1 ± 10.0 kg/m2, A1C 10.1 ± 2.1%). Of the patients that have reached the 6-mo mark so far, intervention group showed a significant decrease in A1C (n=14, from 10 ± 1.4 to 8.7 ± 1.8, delta -1.4 ± 1.4; p=0.003), while there was no significant change in the control group (n=6, from 9.6 ± 2.5 to 7.6 ± 1.3, delta -2.0 ± 2.9; p=0.15) (Figure 1).
Conclusion: The ADA endorses an evidence-based model of a collaborative, multidisciplinary team to provide care for people with diabetes. However, achieving this can be difficult in a large, progressively subspecialized healthcare system. Initial data from our study shows defragmenting patient care can improve A1C over a conventional model.

Disclosure
A.Iqbal: None. M.Parker: None. A.Smith-coleman: None. R.J.Marquardt: None. M.A.Maier: Speaker's Bureau; Smith+Nephew. M.Lansang: Research Support; Dexcom, Inc., Abbott, Alertgy Inc. R.S.Zimmerman: Speaker's Bureau; Xeris Pharmaceuticals, Inc. D.Isaacs: Speaker's Bureau; Dexcom, Inc., Abbott, Eli Lilly and Company, Medtronic, Novo Nordisk. J.F.Bena: None. J.Morren: None. R.Singh: Consultant; Genentech, Inc., Iveric Bio, Alcon Research, LLC, Regeneron, Novartis, REGENXBIO Inc. G.Thomas: None. M.L.Griebeler: None.

Funding
Cleveland Clinic Healthcare Delivery & Implementation Science Center
1087-P: Managing Diabetes in the Delta—Effect of Access to Endocrinology Services in an Underserved Area
Authors: BRINDLEY CLAIRE , JAMES WESLEY , BENNETT JONATHAN R. , MATTHEWS KAREN F. 
Published: June 2023

Background: The Mississippi Delta has one of the highest rates of diabetes in the nation, but patients in these rural, minority-majority counties have lower access to specialty care. At the start of a hybrid diabetes management program at two rural health clinics in the Delta, 53.1% of patients with diabetes had uncontrolled HbA1c levels. We analyze the specific effect of integrating endocrinology specialists into this intervention. Patients could access this care via telemedicine or in-person.
Methods: We conducted a quasi-experimental study with clinical data from electronic health records for patients diagnosed with diabetes or prediabetes (aged ≥ 18). We followed two cohorts of the same patients over time for the first 18 months of the program, each matched on elevated HbA1c levels (≥8% at baseline). The treatment group comprised program participants; the control group comprised general clinic patients at-risk of diabetes. We also followed patients in the treatment group who received endocrine services in addition to other program benefits.
Results: Among the control group, HbA1c increased an average of 0.04 points; the treatment group saw an average decrease of 0.42 points. The treatment group's endocrinology subset saw an even greater decrease of 0.85 points. The average HbA1c score for this group went down three points in a two-year period (7/20-7/22).
Conclusions: The study results indicate that receiving coordinated endocrinology services has been especially effective in reducing HbA1c levels among program participants. As care continuity is associated with better glycemic control for diabetic patients, sustained program participation will likely help the patient population best manage their diabetes and avoid further adverse health outcomes. Additionally, as this diabetes program takes place in a rural, low-income minority area with low access to specialty care, the results demonstrate promising practices for strengthening the rural health care system.

Disclosure
C.Brindley: None. W.James: None. J.R.Bennett: None. K.F.Matthews: None.

Funding
Health Resources and Services Administration, Federal Office of Rural Health Policy (HRSA-20-025, D06RH37500)
1093-P: Incretins and Cardiac Autonomic Function in Youth with Obesity across the Glycemia Spectrum
Authors: EL AYASH HEBA , BACHA FIDA 
Published: June 2023

Incretins, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) have been related to vascular function with variable effects depending on obesity status in adults. The relationship of incretins to vascular function in youth is unclear. We hypothesized that endothelial and cardiac autonomic dysfunction (CAD) are related to lower GLP-1 and GIP in response to glucose ingestion in youth with dysglycemia compared with those with overweight (OW) or normal weight (NW) and normal glucose tolerance (NGT). Adolescents [50 male/52 female; 15.6±1.8 yrs; 24 NW-NGT, 22 OW-NGT, 27 prediabetes and 29 with type 2 diabetes (T2D)] underwent assessment of body composition (DXA scan), 2-hour oral glucose tolerance test (OGTT) with calculation of whole body insulin sensitivity index (WBISI), area under the curve (AUC) of glucose (BG), GLP-1 and GIP. Reactive hyperemia index (RHI), and heart rate variability (HRV), were measured by peripheral arterial tonometry. For HRV, a higher LF/HF (low frequency to high frequency ratio) is indicative of CAD with loss of parasympathetic tone and decreased HRV. The ratios of AUC-GLP-1 and AUC-GIP to AUC-BG were lower in the groups with dysglycemia compared NGT groups (p=0.016 and 0.001, respectively). GLP-1 and GIP were not related to RHI. Fasting and AUC-GLP-1, but not GIP, negatively related to LF/HF (r=-0.37, p=0.002 and r=-0.43, p&lt;0.001 respectively). In a linear regression model with LnLF/HF as the dependent variable, AUC-BG (β=0.31, p=0.04) and AUC-GLP-1 (β=-0.44, p=0.002) contributed to the variance in LnLF/HF independent of %body fat, hs-CRP, WBISI, age, sex, race-ethnicity and Tanner stage (R2= 0.27, p=0.04). Youth with obesity and dysglycemia have impaired incretin response. Glycemia is negatively, whereas GLP-1 is positively associated with HRV after accounting for adiposity, WBIS and inflammation. GLP-1 may be an important determinant of CA function in youth with obesity across the glycemia spectrum.

Disclosure
H.El ayash: None. F.Bacha: Other Relationship; Takeda Pharmaceutical Co., Ltd., AstraZeneca.

Funding
U.S. Department of Agriculture-Agricultural Research Service
110-OR: Autonomous Artificial Intelligence Diabetic Eye Exams to Mitigate Disparities in Screening Completion
Authors: ZEHRA ANUM , BROMBERGER LEE A. , PAN BERNARD , SHEHADEH ALIYAH , PATEL DHRUVA , BROWN ELIZABETH A. , CHANNA ROOMASA , ALVIN LIU T.Y. , LEHMANN HAROLD , ABRÀMOFF MICHAEL D. , WOLF RISA M. 
Published: June 2023

Diabetic retinopathy (DR) is a complication of diabetes that can result in vision loss, but early detection and treatment through screening can prevent this. Few individuals with diabetes meet recommended DR screening guidelines, and racial/ethnic minority youth are less likely to undergo recommended screening. We sought to determine if implementing point of care (POC) autonomous artificial intelligence (AI) screening could mitigate disparities in diabetic eye exam completion.
In a preregistered prospective study, ACCESS2, youth with type 1 and type 2 diabetes meeting American Diabetes Association criteria for needing DR screening underwent point of care autonomous AI diabetic eye exams at diabetes clinic visits. Completion rates of diabetic eye screening exams were compared prior to and after implementation of autonomous AI using chi-square tests.
A total of 152 youth with T1D (69.7%) and T2D (30.3%) were enrolled, mean age 15.5y, 45.4% non-Hispanic (NH) White, with duration of diabetes of 5.7y, and median HbA1c of 8%. A greater percentage of NH White participants reported any prior diabetic eye exam compared to non-white and Hispanic participants (92.8% v 65.1%, p&lt;0.001). Multivariable analysis demonstrated that even when controlling for age, sex, HbA1c, Medicaid insurance, diabetes type and duration of diabetes, non-white youth are less likely to have had a prior diabetic eye exam (OR 0.26, CI: 0.07-0.93, p=0.04). After undergoing POC autonomous AI diabetic eye exams, completion rates were 99% for participants in all subgroups.
Implementation of autonomous AI at the point of care increases access to and completion of diabetic eye exams, and promotes health equity for minority youth with diabetes.

Disclosure
A.Zehra: None. M.D.Abràmoff: Board Member; Digital Diagnostics, Consultant; AbbVie Inc., NovaGo Therapeutics AG, Other Relationship; Digital Diagnostics, Stock/Shareholder; Digital Diagnostics. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. L.A.Bromberger: None. B.Pan: None. A.Shehadeh: None. D.Patel: None. E.A.Brown: None. R.Channa: None. T.Liu: None. H.Lehmann: None.

Funding
National Eye Institute (R01EY033233, 5K23EY030911-03)
1108-P: Physical Activity in Adolescents and Young Adults (AYA) with Type 2 Diabetes (T2D) or Prediabetes—The Role of Motivation
Authors: ELLEN VAJRAVELU MARY , RODRIGUEZ GONZALEZ ADRIANA , HEWITT BRIANNA , KRISKA ANDREA , MITCHELL JONATHAN , HELGESON VICKI , AMARAL SANDRA , ARSLANIAN SILVA A. 
Published: June 2023

Background: Adolescents with T2D engage in little moderate-to-vigorous PA. Although autonomous (internally driven) motivation is associated with PA engagement in healthy individuals, whether this is true for AYA with T2D or prediabetes is unknown.
Methods: Participants were 13-22 years old with T2D or prediabetes who were enrolled in an ongoing trial (NCT04874415) to promote PA. Prior to randomization, we assessed autonomous motivation to exercise (Relative Autonomy Index, RAI) using the Behavioral Regulation to Exercise Questionnaire-3. To assess PA, AYA completed PACE+ survey (days active &lt;60 min in last and typical weeks) and used a wrist-worn activity tracker for 14 days. Associations between RAI and PA were assessed using Pearson correlation and linear regression.
Results: Participants (n=33; 19F; 19 T2D, 14 prediabetes) were 15.9 ± 2.0 years and racially diverse (57% non-White). Correlation between RAI and step count was strong (r=0.5, p=0.001), and the highest RAI quartiles achieved &lt;3000 more steps/day than the lowest (p&lt;0.05). RAI also correlated with PACE+ days active/week (r=0.4, p=0.01). Relationships persisted after adjustment for age, sex, race, and T2D.
Conclusion: Greater autonomous motivation to exercise was associated with higher objective and subjective PA. Autonomous motivation may be a target for behavioral intervention in AYA with T2D or prediabetes.

Disclosure
M.Vajravelu: None. A.Rodriguez gonzalez: None. B.Hewitt: None. A.Kriska: None. J.Mitchell: None. V.Helgeson: None. S.Amaral: Advisory Panel; Bristol-Myers Squibb Company. S.A.Arslanian: Advisory Panel; Novo Nordisk, Eli Lilly and Company, Consultant; Société des Produits Nestlé SA,, Other Relationship; Eli Lilly and Company, AstraZeneca, Research Support; Novo Nordisk, Eli Lilly and Company.

Funding
National Institutes of Health (K23DK125719, UL1TR001857)
1110-P: Role of Ethnicity in Weight Gain after 12 Months of Exacaftor/Tezacaftor/Ivacaftor in Children with Cystic Fibrosis
Authors: VAVRINA KAY , PILLAI RADHIKA , RAYAS MARIA S. 
Published: June 2023

Malnutrition, fat malabsorption/vitamin D deficiency, and pulmonary decline traditionally characterize cystic fibrosis (CF). Fortunately, &gt;90% of patients with CF ≥ 6 yrs old are now eligible for exacaftor/tezacaftor/ivacaftor (ETI) therapy which vastly improves lung function and nutrition by partially correcting the CF mutation. However, overweight/obesity is a rising concern. Although previously rare conditions of high blood pressure (BP) and dyslipidemia are also emerging in adults, pediatric CF data is limited. Moreover, data is lacking in minoritized groups such as Hispanics, who in the non-CF population are more prone to obesity when compared to non-Hispanic whites (NHW). To evaluate the impact of ethnicity on changes in body mass index (BMI) and obesity-related conditions, we performed a retrospective chart review of patients ≤18yrs old treated with ETI for at least 12 mo at our CF Center. Demographics including self-reported ethnicity (Hispanic vs NHW) and BMI, BP, A1c, liver profile, Vitamin D, lipids, and lung function (FEV1) at baseline and 12 mo post-ETI initiation were extracted from the medical record. Thirty-five children with CF [54% Hispanic, 57% male, age 13±3 yrs] were assessed. At baseline, Hispanics were more likely to have Medicaid, higher FEV1, and lower Vitamin D (all p&lt;0.05). Nine (26%) children [7 Hispanic, 2 NHW] were overweight/obese. Post-ETI, BMI and FEV1 (both p&lt;0.001) increased similarly in Hispanics and NHW, and Vitamin D improved in Hispanics (interaction, p&lt;0.05). Lipid data was limited to 3 patients, therefore excluded from analyses. Post-ETI, 13 (37%) children were overweight/obese [8 Hispanic, 5 NHW]. Overweight/obesity is a rising complication in our ethnically diverse CF center. Both Hispanic and NHW children experienced increases in BMI after 12 mo of ETI therapy. Obesity research is imperative to inform CF nutrition guidelines and obesity-related screening (i.e., lipids) for children receiving ETI therapy.

Disclosure
K.Vavrina: Speaker's Bureau; AbbVie Inc., Chiesi USA, Inc., Alcresta Therapeutics. R.Pillai: None. M.S.Rayas: None.

Funding
National Institutes of Health (KL2TR002646)
1111-P: Arterial Change Determinants in Children and Adolescents with T1DM and T2DM
Authors: JOO EUNYOUNG , KIM SUJIN , LEE JIEUN 
Published: June 2023

Introduction) The Carotid Intima Media Thickness (cIMT) and Brachial-ankle pulse wave velocity (baPWV) are good measurement of arterial change. But Few studies have been conducted about the relative factors of those two markers of children and adolescents with DM. We evaluated factors associated with IMT levels and PWV levels in adults to children and adolescents.
Methods) Retrospective cohort study of children and adolescents (10-19yrs) with diabetes performed cIMT and/or baPWV at a single center from December 2007 to August 2021 was conducted. Subjects were submitted demographic variables (age, sex, height, weight, duration of illness, presence of metabolic syndrome and microvascular complications), Blood pressure, laboratory data (HbA1, lipid panel, creatinine), cIMT, PWV.
Result) Of 212 participants studied, 101 had type 1 diabetes (mean age15.5±2.1 years, M:F =46:54) and 111 had type 2 diabetes (mean age 14.2±2.2yrs, M:F =62:48). The mean duration of diabetes was 6.2 (±3.8) years in T1DM patients and 2.1 (±2.4) years in T2DM patients. Mean PWV was 934.1 (±121.5) cm/sec and mean cIMT max was 0.50 (±0.05)mm in T1DM. Mean PWV was 942.3 (±120.7)cm/sec and mean cIMT max was 0.55 (±0.06) mm in T2DM. Overall, cIMT and PWV were increased with age.(pearson r= 0.556, p&lt;0.001) cIMT and PWV in patients with T1DM were high, but there was no association with height, systolic BP, HbA1c, BMI-Z, TG, duration of illness. In patient with Type 2 DM, cIMT (linear regression analysis, r2=0.294, β=0.223, P=0.001) and PWV increased with duration (r2=0.140, β=0.239, P=0.05), systolic BP increased cIMT (p=0.02)and PWV (p =0.042)
Discussion) Adolescents with T1DM have high level of PWV and cIMT level but there was no association with diabetes control state, hyperlipidemia, blood pressure and duration. But there was association with duration in T2DM. Further research is needed to establish pediatric model for predicting outcome in pediatric diabetes.
Keyword: T1DM, T2DM, Pulse wave velocity, carotid Intima Media Thickness

Disclosure
E.Joo: None. S.Kim: None. J.Lee: None.
1115-P: Advanced Medical Therapy (AMT) for Youth-Onset Type 2 Diabetes (T2D)—Early Results from the Run-in Phase of ST2OMP
Authors: SHAH AMY S. , KELSEY MEGAN M. , JENKINS TODD M. , SCHAAF LISA R. , XANTHAKOS STAVRA , TROUT ANDREW T. , BAUMGARTNER AMY , RIEGLER ALLEN , KRISHNAN NISHA , BAILEY ALEXANDER , INGE THOMAS , HELMRATH MICHAEL , NADEAU KRISTEN J. 
Published: June 2023

The Surgical or Medical Treatment for Pediatric Type 2 Diabetes (ST2OMP) study is a prospective open label clinical trial comparing metabolic bariatric surgery (MBS) to AMT for teens with youth-onset T2D. Prior to study group assignment, youth participate in a 6-month run-in period and receive AMT defined as multidrug, treat-to-target medical therapy to achieve an HbA1c &lt;6.5%. Here, we examine the effects of AMT on metabolic parameters during run-in on the initial 51 participants. Participants in ST2OMP (57% female, 30% Black, 38% Hispanic, 25% White) were a mean age of 16.8 years, median diabetes duration 1.1 years, and median HbA1c 6.5% at screening (49% with HbA1c &lt;6.5%). During run-in, metformin or pioglitazone use alone decreased (35.3% to 31.4%), as did insulin use (37.3% to 31.4%), while use of SGLT-2 inhibitors or GLP-1 agonists alone, or dual or triple therapy without insulin increased (21.6% to 31.4%). There was a small decrease in BMI, triglycerides and ALT, but a small increase in systolic and diastolic BP and total cholesterol, and decrease in HDL. At completion of run-in, 49% had an HbA1c of &lt;6.5%. During a 6-month run-in period, AMT, using alternatives to insulin resulted in reduced need for insulin with favorable effects in some metabolic parameters, without worsening glycemic control. Full cohort recruitment and two-year follow-up in ST2OMP will determine the benefits of AMT vs. MBS.

Disclosure
A.S.Shah: None. A.Bailey: None. T.Inge: None. M.Helmrath: None. K.J.Nadeau: None. M.M.Kelsey: Other Relationship; Boehringer Ingelheim Inc., Janssen Pharmaceuticals, Inc., Rhythm Pharmaceuticals, Inc., Lilly. T.M.Jenkins: None. L.R.Schaaf: None. S.Xanthakos: None. A.T.Trout: Consultant; Lantheus, General Electric Co., Research Support; Canon America Medical Systems, Siemens, Perspectum Ltd. A.Baumgartner: None. A.Riegler: None. N.Krishnan: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK119450)
1116-P: Increase in the Incidence of Type 2 Diabetes in Children &lt;11 Years during the COVID-19 Pandemic
Authors: SASIDHARAN PILLAI SABITHA , HAS PHINNARA , TOPOR LISA S. , FREDETTE MEGHAN E. 
Published: June 2023

Objectives: To analyze the incidence and characteristics of new-onset type 2 diabetes (T2D) in youth &lt; 11years prior to and during the COVID-19 pandemic, and to compare the metabolic parameters at presentation in younger (&lt; 11 years) versus older youth (11-21 years). Study methods: We performed a retrospective chart review of newly diagnosed T2D among youth &lt; 21 years at Hasbro Children's Hospital between 1/1/2017 and 12/31/2021. We analyzed the incidence of cases presenting at &lt; 11 years pre (1/1/2017 to 2/29/20) and during (3/1/20-12/31/21) the COVID-19 pandemic. We compared metabolic parameters of those presenting &lt; 11years to ≥ 11 years during the pandemic. Results:Eight youth &lt; 11 years (8/145, (5.5 %)) presented with new-onset T2D during the study period (Table1), and all presented during the pandemic (8/89, 9%). Compared to older youth, those &lt; 11years had higher BMI percentile (166% of the 95th%tile ± 38.4 vs. 139.4% ± 42.6, p=0.03), and were more likely to have diastolic hypertension (62.5% vs. 23.8%, p=0.03).
Conclusions: We report an abrupt rise in the incidence of new-onset T2D in children &lt; 11 years during the COVID-19 pandemic. Compared to older youth, younger children were more obese, and were more likely to have diastolic hypertension. Further study is needed to elucidate contributing factors to this concerning finding, and to further aid in pediatric T2D prevention.

Disclosure
S.Sasidharan pillai: None. P.Has: None. L.S.Topor: None. M.E.Fredette: None.