bluuebunny/crossref_metadata_2025_split huggingface dataset:
1373-P: The Prevalence and Risk Factors of Chronic Kidney Disease in Patients with Type 2 Diabetes in China—A Cross-Sectional Study
Authors: ZHU DALONG , MU YIMING , SHI LIXIN , XUE YAOMING , YU XUEFENG , WANG YANGANG , HONG TIANPEI , LI XIAOYING , MA JIANHUA 
Published: June 2023

Chronic Kidney Disease (CKD) is a major long-term complication of diabetes and the leading cause of end-stage kidney disease worldwide. It has become very important to regularly screen for early renal disease and rationally use medicines in patients with diabetes and CKD. This was a cross-sectional study, an analysis of baseline data from an ongoing prospective multicenter cohort study, ClinicalTrials.gov ID: NCT05047471. The subjects were outpatients and inpatients from 45 hospitals participating in the endocrinology department from December 2021 to September 2022. Univariate and multivariate binary logistic regression were used to identify risk factors correlated to CKD in patients with type 2 diabetes (T2D). A total of 9886 patients with T2D met our inclusion criteria, please refer to table 1 for the baseline characteristics. The prevalence, screening rate, and awareness rate of CKD was 32.5% [95%CI 31.6, 33.4], 55.3% [95%CI 54.3, 56.3], and 26% [95%CI 24.5, 27.6], respectively. The risk factors independently associated with CKD in patients with T2D were age, duration of T2D, hypertension, LDL-C elevated, poor glycemic control, diabetic foot, diabetic retinopathy, diabetic neuropathy etc., shown in table 2. This work will be helpful in promoting the standardized diagnosis and treatment of CKD in patients with T2D in China, and in arousing the attention of patients with T2D to CKD.

Disclosure
D.Zhu: None. Y.Mu: Speaker's Bureau; Abbott Diabetes, Boehringer Ingelheim Inc., Novo Nordisk (China), Sanifit. L.Shi: None. Y.Xue: None. X.Yu: None. Y.Wang: None. T.Hong: Speaker's Bureau; Novo Nordisk (China), Sanofi China, Eli Lilly and Company, Merck Sharp & Dohme Corp., Merck & Co., Inc., Boehringer Ingelheim Inc., AstraZeneca, Bayer Inc. X.Li: None. J.Ma: None.

Funding
Beijing Great Physician Commonwealth Foundation (DYJ20210621)
1378-P: Habitual High Sodium Intake Is Associated with Alterations in Glucose Homeostasis Including GLP-1 Secretion
Authors: DONKERS ANNA , HUBER HANNA , SCHIEREN ALINA , MANTRI AAKASH , SEEL WALDEMAR , STOFFEL-WAGNER BIRGIT , COENEN MARTIN , KRAWITZ PETER , HOLST JENS J. , STEHLE PETER , SIMON MARIE-CHRISTINE 
Published: June 2023

Objective: Although epidemiological studies robustly confirm the impact of a high sodium diet (HSD) in hypertension, the effect of HSD on glucose homeostasis and gut hormones has not been fully elucidated. We hypothesize that the metabolic effects of a HSD might be modulated by changes in the gut microbiome, as it was recently identified as a salt-sensitive compartment.
Methods: A cross-sectional analysis was carried out in 120 adults with metabolic syndrome traits (60 ± 7 years, BMI 31.1 kg/m2, 42% male). Dietary habits were assessed using a Food Frequency Questionnaire. Participants were divided into two groups (normal sodium diet (NSD) vs. HSD) with a cut off value of &lt; 2400 mg/d for NSD and ≥ 2400 mg/d for HSD, according to the recommended maximum intake for sodium by the German Nutrition Society. Fasting and postprandial blood samples were taken after performing an oral glucose tolerance test (OGTT) over 180 min for metabolic characterization, HOMA-IR was calculated. Gut microbiome composition was analyzed using 16S rRNA amplicon sequencing. Linear models were used to test for differences between HSD and NSD in metabolic parameters.
Results: Participants of the HSD group had higher fasting GLP-1 levels (p &lt; 0.05) in comparison to NSD, while the GLP-1 incremental area under the curve during OGTT was lower (p &lt; 0.01). In females, HOMA-IR was higher in the HSD group compared to the NSD group. Bacterial α- and β-diversity did not differ between groups. However, several bacterial taxa correlated with metabolic parameters. In HSD, Streptococcaceae and Veillonellaceae were positively associated with HOMA-IR, and Parabacteroides were inversely correlated with fasting GLP-1.
Conclusion: This analysis provides evidence that a HSD affects insulin resistance and GLP-1 secretion possibly modulated by specific bacterial taxa. Our results add on findings indicating an adverse impact of sodium intake on the development of diabetes, possibly with sex-specific differences.

Disclosure
A.Donkers: None. P.Stehle: None. M.Simon: None. H.Huber: None. A.Schieren: None. A.Mantri: None. W.Seel: None. B.Stoffel-wagner: None. M.Coenen: None. P.Krawitz: None. J.J.Holst: Advisory Panel; Novo Nordisk A/S, Eli Lilly and Company, Board Member; Bainan Biotech, Antag Therapeutics, Consultant; Alphasights, Eli Lilly and Company, ShouTi Pharma Inc., Zealand Pharma A/S, Other Relationship; Novo Nordisk, Novo Nordisk Pharma, Mayo Clinic, Boehringer-Ingelheim, Scohia Pharma Inc., Research Support; ARLA, European Union, Novo Nordisk Foundation.
1380-P: Heterogeneity in the Association of Diet and Obesity in Asian, Pacific Islander, and Multiracial People
Authors: GIBBS SOPHIA L. , BACONG ADRIAN M. , FRANKLAND TIMOTHY B. , LI JIANG , DAIDA YIHE G. , PALANIAPPAN LATHA , FORTMANN STEPHEN P. 
Published: June 2023

Background: Disaggregation of Asian, Pacific Islander (PI), and multiracial API people is needed to assess the subgroup-specific impact of diabetes. This study examined the association between diet quality and obesity.
Methods: We used CVD case-control data from two integrated healthcare systems. Diet was measured using the Rapid Eating and Activity for Patient Survey.
Results: Among all groups, Native Hawaiians had the lowest mean diet quality while Asian Indians had the highest diet quality (Table 1). Better diet was associated with lower odds of obesity in all groups except Japanese, Native Hawaiian, Other PI, and some multiracial groups after adjustment (Table 2).
Conclusion: For some race groups better diet quality was associated with lower odds of obesity. Future work should examine groups where this was not the case.

Disclosure
S.L.Gibbs: None. A.M.Bacong: None. T.B.Frankland: Research Support; Pfizer Inc., Stock/Shareholder; AbbVie Inc., Pfizer Inc., CVS Health Corp, Regeneron Pharmaceuticals Inc. J.Li: None. Y.G.Daida: Research Support; GlaxoSmithKline plc. L.Palaniappan: None. S.P.Fortmann: Research Support; Pfizer Inc.

Funding
National Heart, Lung, and Blood Institute (R01HL126172)
1385-P: Maternal Gestational Weight Gain and Children’s Genetic Susceptibility on Childhood Adiposity—A Longitudinal Cohort Study
Authors: LIU HUIKUN , LI WEIQIN , WANG LEISHEN , ZHANG SHUANG , LI WEI , YANG XILIN , LENG JUNHONG , HU GANG , WANG SHUO 
Published: June 2023

Few studies have assessed the association of early-life environmental and genetic factors with the risk of childhood adiposity. The aim of the present study was to investigate the interaction between maternal gestational weight gain (GWG) and children’s genetic susceptibility on childhood adiposity. The present study included 1038 mother-child pairs. Body mass index (BMI) for age Z-score (BMI-Z) and childhood overweight were evaluated according to the World Health Organization (WHO) growth reference. Genetic risk score (GRS) was established by aggregating alleles of 10 BMI susceptibility single-nucleotide polymorphisms identified from a recent study. Children born to mothers with excessive GWG had higher BMI-Z (P&lt;0.001), percentage of body fat (P&lt;0.001), and prevalence of overweight (28.4% vs 15.9%, P&lt;0.001) than those born to mothers with adequate GWG. Children’s BMI GRS was significantly and positively associated with BMI-Z, percentage of body fat and overweight risk (all P&lt;0.05). Stratified analyses showed the positive association of children’s BMI GRS with adiposity risk was especially concentrated among mothers with pre-pregnancy normal weight but excessive GWG. The present study identified an interactive effect between maternal GWG and children’s genetic susceptibility on childhood adiposity risk. The findings provided new insight into the etiology of childhood obesity and highlighted the importance of GWG management.

Disclosure
H.Liu: None. W.Li: None. L.Wang: None. S.Zhang: None. W.Li: None. X.Yang: None. J.Leng: None. G.Hu: None. S.Wang: None.

Funding
European Foundation for the Study of Diabetes/Chinese Diabetes Society/Lilly Programme for Collaborative Research between China and Europe; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790, R01DK132011); National Institute of General Medical Sciences (U54GM104940)
1387-P: Glutamic Acid Decarboxylase Autoantibodies (GADA) in Type 2 Diabetes Predict Glycemic Control over 16 Years
Authors: PILLA SCOTT J. , KNOWLER WILLIAM C. , BALASUBRAMANYAM ASHOK , HAMPE CHRISTIANE S. , PIETROPAOLO SUSAN , ANDERSON ANDREA M. , LI MO , ZHAO NI , ZEGER SCOTT L. , RAMELIUS ANITA , BENNET RASMUS , LERNMARK ÅKE , MATHIOUDAKIS NESTORAS N. , CLARK JEANNE , MARUTHUR NISA M. 
Published: June 2023

A minority of adults diagnosed with type 2 diabetes (T2D) have islet autoantibodies that may predict diabetes progression. We investigated the association between GADA, the most prevalent islet autoantibody, and longitudinal HbA1c in Look AHEAD (Action for Health in Diabetes), a trial that randomized adults with clinically-diagnosed T2D and overweight/obesity to intensive lifestyle intervention vs. control for 9.6 years, and then followed them observationally. GADA was measured by radioligand binding assay in 87% of the cohort at baseline and categorized as negative, low-level (35-199 U/mL) or high-level (≥200 U/mL). We analyzed the association between GADA category and HbA1c (yearly through year 4, then on alternating years) using linear mixed effects regression adjusted for age, sex, race/ethnicity, calendar time and study arm. Among 4,492 participants, the median age was 59 years and diabetes duration 5 years. GADA was low-level and high-level positive in 131 (2.9%) and 85 (1.9%), respectively. Over a median follow-up of 15.9 years, the modeled mean HbA1c was 7.24% in GADA-, 7.49% in low-level GADA, and 7.67% in high-level GADA (p&lt;0.001). GADA+ participants had consistently higher HbA1c over follow-up in both study arms (Figure). In conclusion, a substantial minority of adults with clinically-diagnosed T2D had GADA positivity that predicted worse glycemic control for more than a decade.

Disclosure
S.J.Pilla: None. A.Ramelius: None. R.Bennet: None. Å.Lernmark: Advisory Panel; Diamyd Medical. N.N.Mathioudakis: None. J.Clark: None. N.M.Maruthur: Other Relationship; Johns Hopkins HealthCare Solutions. W.C.Knowler: None. A.Balasubramanyam: None. C.S.Hampe: Employee; Immusoft corp. S.Pietropaolo: None. A.M.Anderson: None. M.Li: None. N.Zhao: None. S.L.Zeger: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK126825, K23DK128572)
1388-P: Clinical Features Associated with Glutamic Acid Decarboxylase Autoantibodies (GADA) in Adults with Type 2 Diabetes
Authors: PILLA SCOTT J. , KNOWLER WILLIAM C. , BALASUBRAMANYAM ASHOK , HAMPE CHRISTIANE S. , PIETROPAOLO SUSAN , ANDERSON ANDREA M. , LI MO , ZHAO NI , ZEGER SCOTT L. , RAMELIUS ANITA , BENNET RASMUS , LERNMARK ÅKE , MATHIOUDAKIS NESTORAS N. , CLARK JEANNE , MARUTHUR NISA M. 
Published: June 2023

Islet autoantibodies in adults classified as having type 2 diabetes (T2D) have been associated with lower adiposity and early insulin requirement. We examined the association between GADA, the most prevalent islet autoantibody, and baseline clinical features in Look AHEAD (Action for Health in Diabetes), a randomized trial of adults with clinically-diagnosed T2D and overweight/obesity from 16 geographically diverse U.S. study centers. GADA was measured by radioligand binding assay in 87% of the randomized cohort at study baseline and categorized as negative (GADA-), low-level (35-199 U/mL, GADA+) or high-level (≥200 U/mL, GADA++). We compared clinical features across GADA categories using Fisher’s exact or Kruskal-Wallis tests. There were 4,492 participants who had a median age 59 years and diabetes duration 5 years. Participants were 59% female, 67% white, 16% Black and 13% Hispanic. GADA was positive (≥35 U/mL) in 216 participants (4.8%); 131 were GADA+ (2.9%) and 85 GADA++ (1.9%). Insulin was used by 15% of GADA-, 25% of GADA+, and 40% of GADA++ (p&lt;0.001). The median HbA1c was 7.0% in GADA-, 7.1% in GADA+, and 7.4% in GADA++ (p=0.004). There was a history of hypothyroidism in 12% of GADA-, 14% of GADA+, and 29% of GADA++ (p&lt;0.001). There was a history of hyperthyroidism in 2% of GADA-, 2% of GADA+, and 7% of GADA++ (p=0.006). GADA level was not associated with age, sex, race/ethnicity, diabetes duration, BMI, waist circumference, or history of microvascular or macrovascular complications. In conclusion, a substantial minority of this population of adults with overweight/obesity who were clinically diagnosed as T2D have GADA positivity, and high levels were strongly associated with phenotypic differences including insulin use and thyroid disease. In contrast to prior studies, GADA was not associated with lower adiposity. These findings highlight the heterogeneity of this population and the need to further study the clinical implications of GADA positivity.

Disclosure
S.J.Pilla: None. A.Ramelius: None. R.Bennet: None. Å.Lernmark: Advisory Panel; Diamyd Medical. N.N.Mathioudakis: None. J.Clark: None. N.M.Maruthur: Other Relationship; Johns Hopkins HealthCare Solutions. W.C.Knowler: None. A.Balasubramanyam: None. C.S.Hampe: Employee; Immusoft corp. S.Pietropaolo: None. A.M.Anderson: None. M.Li: None. N.Zhao: None. S.L.Zeger: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK126825, K23DK128572)
1391-P: National Retrospective Cohort Study of COVID-19 Infection and Incident Diabetes in American-Indian/Alaska-Native People
Authors: KECK JAMES , BRESSLER SARA , BRUCE MICHAEL , CHUKWUMA UZO , LACY MARY E. 
Published: June 2023

Background: Studies report increased risk of incident diabetes following COVID-19 illness. American Indian/Alaska Native (AI/AN) people have had more frequent and severe COVID-19 illness and historically higher diabetes incidence than other racial/ethnic groups in the US. We examined the association between COVID-19 illness and incident diabetes in AI/AN people.
Methods: Using de-identified data from the Indian Health Service, we created three cohorts spanning two periods: COVID-19 cohort and no-COVID-19 cohort (no indication of COVID-19 infection) both from 3/1/2020-12/31/2021 and pre-COVID-19 cohort from 1/1/2018-2/28/2020. We used data from the year prior to cohort entry to exclude prevalent cases of diagnosed diabetes (diagnosis codes, labs, or diabetes medications) and assess baseline characteristics. During the study period we ascertained COVID-19 infection (diagnosis codes, labs) and incident diabetes. We calculated age-adjusted diabetes incidence rates and rate ratios comparing the COVID-19 cohort to the no-COVID-19 and pre-COVID-19 cohorts.
Results: Across cohorts, age, sex, and healthcare utilization differed. Age-adjusted diabetes incidence rates and rate ratios were significantly higher in the COVID-19 cohort (Table 1).
Conclusions: Clinically confirmed COVID-19 infection was associated with increased incident diabetes rates in AI/AN people.

Disclosure
J.Keck: None. S.Bressler: None. M.Bruce: None. U.Chukwuma: None. M.E.Lacy: None.

Funding
National Institutes of Health (R34DK132548-01S1)
1393-P: Remission Incidence and Associated Clinical Factors in New-Onset Type 2 Diabetes under Standard Medical Care—A Population-Based Study
Authors: SONG KI-HO , KIM JINYOUNG , HAN KYUNGDO , KWON HYUK-SANG 
Published: June 2023

The natural history of type 2 diabetes (T2D) is mostly progressive and patients often die from diabetes-related complications. However, T2D can sometimes improve enough to discontinue medications, and this phenomenon remains poorly understood. Using health examination data from the Korean National Health Insurance Service (KNHIS) for a new-onset T2D cohort, we investigated the incidence of diabetes remission and associated clinical factors. Remission was defined as normal fasting blood glucose levels &lt; 126 mg/dL, an alternative criterion for remission based on expert consensus; patients who reached normal fasting blood glucose levels measured at 2-year intervals after discontinuation of treatment were defined as achieving remission. New-onset T2D patients (N=114,874) from 2009 to 2012 were followed until 2017, and 2,429 patients (2.1%) experienced remission during the study period. No significant difference in age was reported between the remission and non-remission groups. Compared to the non-remission group, the remission group had lower baseline body mass index (25.4 kg/m2 vs. 25.7 kg/m2), lower baseline fasting glucose levels (157.7 mg/dL vs. 177.1mg/dL), and a lower prevalence of hypertension (47.7% vs. 52.2%) and hyperlipidemia (44.4% vs. 48.2%). When investigating treatment methods, the remission rate was lower in patients who used more than three oral hypoglycemic agents including sulfonylurea (5.43% vs. 14.4%), while the rate of insulin users was higher in the remission group (10.5% vs. 8.0%). When weight change within 2 years before and after remission was reviewed through health examination results, the group that succeeded in weight loss of 5% or more had a significantly higher rate of remission.
In summary, remission was observed at rates as low as 2.1% in patients in standard medical care settings. Weight loss and insulin therapy in early T2D patients are thought to lead a favorable prognosis in terms of remission.

Disclosure
K. Song: None. J. Kim: None. K. Han: None. H. Kwon: None.

Funding
National Research Foundation of Korea (2021R1A2C2013890)
1399-P: Lipoprotein Subfractions and Type 2 Diabetes Incidence in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) and Multiethnic Study of Atherosclerosis (MESA) Cohorts
Authors: GADGIL MEGHANA D. , HERRINGTON DAVID M. , SINGH SUKHMANI , KANDULA NAMRATHA R. , KANAYA ALKA M. 
Published: June 2023

Background: Atherogenic dyslipidemia is prevalent in individuals at risk for type 2 diabetes (T2D) but less is known about composition of lipoprotein subfractions in diverse racial/ethnic groups. We examined associations between lipoprotein subfractions and incident T2D among participants of the MASALA and MESA cohorts.
Methods: Adults aged 45-84 years without T2D and with fasting serum, demographic and clinical data at baseline and 2-5 year follow-up were included. Lipoprotein subfractions were measured at baseline using NMR spectrometry on a common platform. LASSO regularized logistic regression models adjusted for age, sex, race/ethnicity, lipid-lowering agents and waist circumference assessed odds of incident T2D with adjustment for multiple comparisons.
Results: Analyses included 3839 participants with average age of 62 years, 51% women, mean BMI 28 kg/m2 and 234 incident T2D cases. Triglycerides (TG) in LDL-5, LDL-6 and HDL-3 and HDL-4 were associated with odds of incident T2D and free cholesterol in HDL-1 was inversely associated (Table). There were no interactions by race.
Conclusions: TG in small, dense HDL and LDL were positively associated, while free cholesterol in large HDL was inversely related to odds of incident T2D at first follow-up in participants of the MESA and MASALA cohort studies.

Disclosure
M.D.Gadgil: None. D.M.Herrington: None. S.Singh: None. N.R.Kandula: None. A.M.Kanaya: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK119404-01A1); National Heart, Lung, and Blood Institute/National Center Research Resources/National Center for Advancing Translational Sciences (R01HL093009); National Institutes of Health (UL1RR024131); Medical Research Council/National Institute for Health and Care Research (NC-PC-12025); National Institute for Health and Care Research Imperial Biomedical Research Centre; National Heart, Lung, and Blood Institute (75N92020D00001, HHSN268201500003I, N01HC-95159, 75N92020D00005, N01HC-95160, 75N92020D00002, N01HC95161, 75N92020D00003, N01HC95162, 75N92020D00006, N01HC95163, 75N92020D00004, N01HC95164, 75N92020D00007, N01HC95165, N01HC95166, N01HC95167, N01HC95168, N01HC95169); National Center for Advancing Translational Sciences (UL1TR000040, UL1TR001079, UL1TR001420)
14-OR: Lifetime Medical Spending for Diabetes among Medicare Beneficiaries in the United States
Authors: WANG YU , SHAO YIXUE , IMPERATORE GIUSEPPINA , LUMAN ELIZABETH , HOLLIDAY CHRISTOPHER S. , ZHANG PING 
Published: June 2023

Information on lifetime medical cost of type 2 diabetes mellitus (DM) among Medicare beneficiaries is needed to assess potential economic benefits of the Medicare Diabetes Prevention Program (MDPP). We estimated lifetime incremental spending for DM by age of diagnosis and sex among Medicare beneficiaries using the 2001-2019 100% Medicare fee-for-service (FFS) claims database. We identified a cohort of persons with newly diagnosed DM in 2001 using International Classification of Diseases codes (E10 and E11), used a propensity score method to construct a non-DM comparison cohort, and then followed the two cohorts until death, discontinuation of plan coverage, or end of 2019. Lifetime medical expenditures for each cohort were estimated by aggregating the expected annual medical expenditures from age at DM diagnosis to death. Annual medical costs by age at diagnosis and sex before 2019 were derived from actual spending and those after 2019 were extrapolated using age and sex-specific expenditures from 2019. The survival rate was modeled by smoothing the annual survival rate using polynomial regression. Life-years lived with and lost to DM and lifetime excess medical expenditures of DM modeled from FFS claims cost overall and by sex are presented in the table. Despite a shorter lifespan, persons with DM had higher medical costs in their lifetime. MDPP may reduce this expenditure by helping beneficiaries prevent or delay DM.

Disclosure
Y.Wang: None. Y.Shao: Employee; Biogen. G.Imperatore: None. E.Luman: None. C.S.Holliday: None. P.Zhang: None.
140-LB: Use of Apparent Glycation Ratio (AGR) to Correct Average Glucose (AG) Estimation from CGM Profiles in T1DM, T2DM, and Prediabetes
Authors: SATO IMURO SANDRA E. , KERR DAVID , BEVIER WENDY C. , SABHARWAL ASHUTOSH 
Published: June 2023

Using HbA1c to reflect AG has limitations. The AGR has been proposed as a correction factor to compute a personalized estimated average glucose (peAG). Three CGM datasets with contemporary HbA1c values (mostly White individuals with T1D [REPLACE BG - RBG], and mainly Hispanic/Latinos with T2D and prediabetes [FARMING FOR LIFE-FFL and DIGITAL HEALTH - DH]) were used to estimate AGR. The RBG dataset was also used to compare peAG vs eAG. No significant differences in AGR were found across age, BMI, gender, or HbA1c in the FFL (n=105, 91% Hispanic/Latino, 32% T2D, age 54 ± 12 yr) and DH (n=26, 100% Hispanic/Latino, 39% T2D, age 50 ± 12 yr) data. However, the median AGRs (72.3 [69, 76.2] ml/g in FFL, and 75.3 [72.8, 83.8] ml/g in DH) were higher than the reference of 65.1 ml/g (p&lt;0.005) from predominantly White individuals. Using 3-month CGM data from RBG (n=57, 90% White, 100% T1D, age 50 ± 13 yr) to compute AGR, a Bland-Altman plot showed that confidence intervals narrowed when using peAG (Figure). Also, AG had a higher correlation with peAG compared to eAG. Bias in peAG/eAG-AG lost significance when HbA1c was measured 3 months after the CGM data for AGR.Hispanic/Latinos with or at risk of T2D may have higher AGR levels than the previously suggested value, implying an overestimation of AG values from HbA1c. The use of AGR and peAG in stable glycemia can provide a more accurate representation of AG than eAG.

Disclosure
S. E. Sato Imuro: None. D. Kerr: Consultant; Sanofi-Aventis U. S. W. C. Bevier: None. A. Sabharwal: None.

Funding
U.S. Department of Agriculture (2018-33800-28404); National Science Foundation (1648451); Elsevier Foundation; Sun Life Financial