bluuebunny/crossref_metadata_2025_split huggingface dataset:
966-P: Reducing Patient No-Show Rates in a Diabetes Clinic
Authors: JAFRI FARZAN , GUNASEKARAN UMA 
Published: May 2022

Background: Patients missing scheduled appointments, or no-shows, is a pervasive issue across outpatient clinics. The estimated no-show rate among primary care clinics ranges between 14% and 50%. No-shows are estimated to cost the US healthcare system $150 billion a year. At many clinics no-shows have necessitated overbooking clinic slots to maintain efficiency. Ultimately, patient no-shows and the overbooking they necessitate causes problems for both the patient and provider.
Methods: We used the PDSA (plan/do/study/act) cycle from quality improvement methodology. We determined the baseline no-show rate at the Parkland Diabetes Clinic, an endocrinology clinic with 16 providers (including specialists and advance practice providers) which sees ∼1200 visits a month. The baseline no-show rate from June 2018 to May 20was ∼31.9% ± 2.19. We then examined clinic processes to determine reasons for no-shows through process mapping and root cause analysis. Mapping of the scheduling process identified process inefficiencies. Phone call surveys were conducted with patients with high no-show rates. Using the process map and survey data, we brainstormed interventions to target root causes of no-shows. Our first intervention was ensuring that every patient received a phone call reminder for their appointment. Our second intervention was limiting the degree to which a third-party call center handled scheduling for the Diabetes clinic.
Results: Interventions were implemented in August 2020, and subsequent data collected from November 2020 to October 2021 was analyzed to see changes in the no-show rate. The average no-show rate during this post-intervention period was ∼22.2% ± 2.50 (t-test, p &lt;0.05) , a significant decrease from the baseline rate of ∼31.9% ± 2.19. We predict this reduction will result in more consistent follow-up care, less risk of disease progression, and increased clinical efficiency. Our next step will be to transition our interventions into long-term sustainable solutions to maintain the lower no-show rate.

Disclosure
F.Jafri: None. U.Gunasekaran: None.
967-P: Decentralizing Diabetes Specialty Care Improves Glycemic Control
Authors: GUNASEKARAN UMA 
Published: May 2022

Parkland Health and Hospital System (PHHS) is the Dallas County safety-net health system and serves indigent Dallas County residents. PHHS has primary care clinics (COPCs) located in underserved areas of the county to provide easier access to its residents. The Diabetes Specialty Clinic (DSC) is located next to the Parkland Hospital, but this location can be difficult to access for patients with limited means. We studied the effect of co-locating a diabetes specialty practice (H-DSC) at a community primary care practice (Hatcher Station COPC (HSC)) by comparing the A1c change between the patients managed by primary care providers at HSC alone or by specialists at H-DSC. Table 1 displays the results of this study. The data show that there was a significant reduction in A1c in the HSC patients seen by primary care and H-DSC patients of -0.2% and -0.5% respectively. There is also a significant difference in baseline and final A1cs between both groups that show that H-DSC patients had poorer baseline glycemic control but also greater improvement in glycemic control. H-DSC patients were also being seen by their primary care providers at HSC, and without the co-location of the DSC to H-DSC, many of these patients would not have accessed care at the DSC main location. This suggests that co-locating diabetes specialty services at local, easy-to-access primary care centers at a safety-net health system can improve the glycemic control of patients with diabetes.

Disclosure
U.Gunasekaran: None.
977-P: Utilization of Glucose Management Team–Conducted Remote Patient Visits Decreases Hospital Readmissions for Patients with Diabetes
Authors: JOHNS ALLISON , PRICE CATHERINE E. , ALOI JOSEPH A. , BURNS CYNTHIA 
Published: May 2022

Introduction: Hospital readmissions are more common in persons admitted with diabetes as a primary diagnosis, accounting for approximately 20% of unplanned readmissions.1 Poor clinical outcomes and higher costs result.2 Helping people remain out of the hospital with improved diabetes self-management is both patient-centered and cost effective.1 Remote patient care improves access to care, removes transportation as a barrier and lessens the time required versus in person diabetes visits.3
Methods: The glucose management team (GMT) at Atrium Health Wake Forest Baptist Medical Center, comprised of advanced practice providers and an endocrinologist, offered post-discharge telehealth visits within 7 days to patients with insulin treated complex diabetes from 1/1 - 3/24/21. Patients’ diabetes regimens and glucose readings were reviewed and recommendations for treatment changes were offered.
Results: A total of 88 patients were scheduled for post-discharge visits, and 55.7% (n=49) participated in a scheduled telehealth visit, while 36.4% did not (n=32) . Of patients who no-showed, there were zero 30 day readmissions and fourteen 90 day readmissions (43.8%) . Of patients who had a telehealth visit, there were two 30 day readmissions (4%) and eleven 90 day readmissions (22.4%) . Odds ratio for 90 day readmission was 2.69 (p=0.042) in those who did not attend a post-discharge telehealth visit.
Conclusion: While 30-day readmissions were higher in the group that had a telehealth visit, this may be due to global struggles with nonadherence in the no-show group. An odds ratio of over 2.5 for 90 day readmission compared to patients who completed a post-discharge telehealth visit supports this view. Post-discharge telehealth visits decreased unplanned readmissions at 90 days by providing access to expert clinicians for support, instruction on self-directed glucose management and treatment regimen recommendations.

Disclosure
A.Johns: None. C.E.Price: None. J.A.Aloi: Research Support; Abbott Diabetes, Medtronic. C.Burns: None.
98-OR: Prediction of Cardiovascular Disease in People with Type 1 Diabetes with Novel Omics Biomarkers
Authors: PYLE LAURA , VIGERS TIMOTHY B. , JOHNSON RANDI K. , ZHANG QIBIN , SNELL-BERGEON JANET K. 
Published: May 2022

Introduction: Type 1 diabetes (T1D) increases risk for cardiovascular disease (CVD) at least 2-4 fold, with only half the excess risk explained by known risk factors. We sought to identify novel proteomic, lipidomic, and metabolomic biomarkers of CVD in T1D.
Methods: We first built a predictive model of coronary artery calcium progression (CACp) using LASSO regression of clinical variables measured at baseline in 365 participants with T1D in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study. The selected model was refit to a subgroup of 102 participants with complete clinical information and measured omics markers (targeted and untargeted metabolomics, global proteomics, glycated proteomics, and lipidomics) . Omics biomarkers were identified for inclusion in the final model by retaining the top markers that predicted CACp by moderated t-tests and sPLS-DA models.
Results: The table shows variables retained in the clinical model (AUC=0.91) and in the model with biomarkers added (AUC=0.94) . Higher age, urine albumin:creatinine, and insulin dose predicted CACp in both models. Longer duration of T1D predicted CACp in the clinical model. In the model with D-Glucosamine/D-galactosamine and glycated fibrinogen peptides, D-Glucosamine/D-Galactosamine predicted CACp.
Conclusion: Novel metabolites improved prediction of CACp in people with T1D.

Disclosure
L.Pyle: None. T.B.Vigers: None. R.K.Johnson: None. Q.Zhang: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc.

Funding
American Heart Association (17CSA33570025) , NIH (P30-DK116073)
983-P: Prediabetes A1C Is Associated with Metabolic Disease in Girls with PCOS and Obesity
Authors: FINN ERIN , REYES YESENIA GARCIA , TAYLOR ANYA E. , GARFIELD AMANDA L. , VIVAS CAMILO A. , FULLER KELLY , BERGMAN BRYAN C. , NADEAU KRISTEN J. , CREE-GREEN MELANIE 
Published: May 2022

Polycystic Ovary Syndrome (PCOS) is associated with metabolic diseases, including diabetes, and metformin is indicated if a1c is ≥5.7 demonstrating prediabetes/diabetes. To determine when to prescribe metformin, 2018 PCOS guidelines advise only an OGTT to screen, whereas ADA guidelines also include A1c. We sought to determine patterns of dysglycemia and metabolic disease in youth with PCOS and obesity. Data from girls (age 12-21 yrs, n=110) with obesity and untreated PCOS were examined. Metabolic assessments included fasting labs, 4-hour oral sugar tolerance test (OSTT, 75 g glucose, 25 g fructose) with Oral Minimal Modeling, liver fat assessment by MRI, and endogenous glucose release (Ra) with isotope tracers (N=31) . Data were divided by A1c (&lt;5.7 vs. ≥5.7%) and compared by t-test. Pearson’s correlations were used to compare A1c to metabolic variables across the cohort. Prediabetes A1c was found in 27% (n=30, A1c 5.8±0.2% vs. n=80, A1c 5.3±0.2%) . Glucose concentrations, insulin sensitivity (IS) , and obesity related measures were worse with a1c≥5.7% and correlated with increasing A1c. Lower IS and higher liver fat were most strongly correlated to a1c. There were no differences in clinical or laboratory hyperandrogenism by A1c category, nor correlation with A1c (Table) . A1c testing is less burdensome than OGTT and can identify girls with PCOS and obesity at increased metabolic disease risk who may benefit from metformin.

Disclosure
E.Finn: None. Y.Garcia reyes: None. A.E.Taylor: None. A.L.Garfield: None. C.A.Vivas: None. K.Fuller: None. B.C.Bergman: Research Support; Eli Lilly and Company. K.J.Nadeau: None. M.Cree-green: None.

Funding
National Institutes of Health (R01DK120612) , (K23DK107871) , (UL1 TR002535) , (P30 DK048520) , (K12HD057022) ;Doris Duke Foundation (CDSA) , (CDSA COVID extension) , (2015212) ; Childrens Hospital Colorado; Boettcher Web Waring Foundation
988-P: Higher Environmental Pollution Burden Scores Associate with Lower Insulin Sensitivity in Minority Children with Overweight and Obesity
Authors: BARRAGAN KARINA , WEIGENSBERG MARC , TOLEDO-CORRAL CLAUDIA M. 
Published: May 2022

Background: Epidemiological evidence in children suggests that environmental pollution, such as ambient and traffic air pollution exposure, is associated with type 2 diabetes risk; however cumulative exposure to various environmental pollutants has not been well examined. The objective of this study was to determine if cumulative measures of environmental pollutants were associated with insulin sensitivity (SI) , acute insulin response (AIR) and disposition index (DI) in minority children.
Methods: Participants (N=135, Mage = 14.4 ± 2.9 years; 59% male; 57% Latinx and 43% Black) had a 13-time point frequently sampled intravenous glucose tolerance test. Glucose and insulin values were used in minimal modelling (MinMod Millennium) for determination of SI, AIR, and DI. Self-reported mailing addresses were geocoded to identify census tract number and associated pollution burden scores (1-10) derived by CalEnviroScreen 3.0 (CES 3.0) . Multivariable linear regression was used to test relationships while considering for age, ethnicity, sex, and total body fat percentage (by DEXA) . Due to positive skewness, SI, AIR and DI were natural log transformed.
Results: Higher pollution burden score was associated with lower lnSI, after adjusting for covariates (β= -0.150, 95%CI= -0.280, -0.020, p=0.024) . There was a positive, but non-significant association with pollution burden score and lnAIR (β= 0.114, 95%CI= -0.006, 2.35, p=0.063) . An inverse, but non-significant, association was observed between pollution burden scores and lnDI (β= -0.34, 95%CI= -.140, 0.71, p=0.518) .
Conclusion: Using a publicly available environmental pollution risk score, we show that high environmental pollution exposures associated with lower SI, but not AIR or DI. Our findings provide further evidence of the link between ambient environmental factors and type 2 diabetes risk.

Disclosure
K.Barragan: None. M.Weigensberg: None. C.M.Toledo-corral: None.

Funding
NIH P60MD00254
989-P: Impaired Coronary Arterial Dilation in Youth-Onset Type 2 Diabetes
Authors: VILLALOBOS-PEREZ ALFREDO , FEELEY JENNA , ABD-ELMONIEM KHALED Z. , DIETSCHE KATRINA B. , DIXON SYDNEY A. , MATTA JATIN R. , STAGLIANO MICHAEL S. , MABUNDO LILIAN , SHOUPPE EILEEN L. , GHARIB AHMED M. , WALTER MARY , CHUNG STEPHANIE T. 
Published: May 2022

Young adults with type 2 diabetes (T2D-Y) have increased risk of subclinical atherosclerotic cardiovascular disease (ASCVD) . Cardiac magnetic resonance imaging (MRI) may guide risk stratification by noninvasively quantifying coronary wall thickness (CWT, an indicator of ASCVD) and endothelial function (arterial dilation during isometric hand grip exercise, IHE) . The utility of these novel MRI biomarkers in T2D-Y is unknown. We hypothesized that T2D-Y would be associated with increased CWT and impaired endothelial function. In T2D-Y (6 male, age 19.8±1.6y, BMI 37±7kg/m2) and 12 healthy controls (5 male, age 22.7±2.9 y, BMI 24±5 kg/m2) we measured CWT and coronary and brachial dilation during IHE with a 3.0 Tesla MRI. T2D-Y had higher HbA1c (6.5 ± 0.8 vs. 5.1 ± 0.6%, P&lt;0.01) , C reactive protein (5.16 ± 5.35 vs. 1.25 ± 2.25 mg/L) , systolic blood pressure (129±13 vs. 116±14 mmHg) , heart rate (84±13 vs. 72±9 beats/min (all P&lt;0.05) . T2D-Y had lower HDL cholesterol (40±vs. 66±15 mg/dL, P=0.002) but similar LDL-cholesterol and triglycerides. CWT was not different (1.26±0.12 vs. 1.34±0.14 mm, P=0.18) but coronary and brachial arterial dilation was impaired in T2D-Y (Figure) . Overall, compared to health peers, T2D-Y had comparable CWT but impaired coronary and brachial arterial dilation occurred in the absence of traditional risk factors such as severe hyperglycemia, frank hypertension or dyslipidemia.

Disclosure
A. Villalobos-Perez: None. J. Feeley: None. K.Z. Abd-Elmoniem: None. K.B. Dietsche: None. J.R. Matta: None. M.S. Stagliano: None. L. Mabundo: None. E.L. Shouppe: None. M. Walter: None. S.T. Chung: None.

Funding
NIDDK/NIH Intramural Research Program
991-P: Metformin Plasma Concentration as a Biomarker of Treatment Responsiveness in Youth-Onset Type 2 Diabetes
Authors: DIETSCHE KATRINA B. , ZENNO ANNA , VILLALOBOS-PEREZ ALFREDO , DIXON SYDNEY A. , STAGLIANO MICHAEL S. , MABUNDO LILIAN , SHOUPPE EILEEN L. , ESTRADA DORIS E. , MEYERS ABBY , COGEN FRAN R. , WALTER MARY , WALTER PETER , CHUNG STEPHANIE T. 
Published: May 2022

Metformin is the first-line therapy for youth-onset type 2 diabetes mellitus (Y-T2D) but is suboptimal in up to 50% of youth. The reasons for increased failure rates are unknown. Metformin plasma concentration reflects total body distribution and kinetics but is not used clinically in adults because peak metformin concentration varies widely. Few studies, and none in youth, have measured trough therapeutic concentration as a potential biomarker of response. We hypothesized that trough metformin plasma concentrations after short-term therapy would be associated with treatment response. In this secondary analysis of a randomized trial of metformin alone vs. metformin and liraglutide (combo) therapy Y-T2D youth, we determined the relationship of metformin concentration with glycemia. Nineteen Y-T2D: age 15.4±2.1 (12-20y) mean±SD (range) , 61% female, Tanner Stage IV-V, BMI 40.0±8.0 (22.1-53.4 kg/m2) were randomized to 2000mg/day metformin (n=10) or 2000mg metformin+ 1.8mg liraglutide (combo, n=8) for 3 months after a 5-7 day drug-free run-in period. At baseline, youth on combo had higher HbA1c (7.1±0.7; 6.2±0.6%, P=0.006) but had similar BMI, fasting glucose, and 2hr glucose on OGTT. Metformin concentrations increased (combo:337±559 vs. metformin: 420±433 (1.6-1537 ng/mL) , P=0.7) and negatively correlated with change in 2hr glucose (combo: r=-0.9, P=0.002; metformin: r=-0.73, P=0.02) , fasting glucose (combo: r=-0.59, P=0.13; metformin: r=-0.64, P=0.06) , and change in HbA1c (combo: r=-0.89, P=0.01, metformin: r=0.31, P=0.4) . Metformin adherence measured by pill counts was 78% with no difference by group (combo: 80±20; metformin: 75±16%) . Metformin concentrations were not associated with percent adherence to medication or change in weight (P&gt;0.10) . Overall, metformin concentrations were widely variable in Y-T2D but associated with improvements in glycemia after 3 months and should be explored as a viable biomarker for predicting treatment response in Y-T2D.

Disclosure
K.B. Dietsche: None. A. Zenno: None. S.A. Dixon: None. L. Mabundo: None. E.L. Shouppe: None. D.E. Estrada: None. F.R. Cogen: None. M. Walter: None. P. Walter: None. S.T. Chung: None.

Funding
NIDDK/NIH Intramural Research Program
PENGARUH PENERAPAN MODEL PEMBELAJARAN KLARIFIKASI NILAI BERBASIS MULTIKULTUR TERHADAP KARAKTER PESERTA DIDIK KELAS VIII SMP
Authors: N.A. Udayana  , I.M.Candiasa  , I.G.L.A. Parwata  
Published: May 2022

Penelitian ini bertujuan untuk mengkaji pengaruh model pembelajaran klarifikasi nilai berbasis multikultur terhadap karakter dengan mempertimbangkan sikap sosial pada peserta didik Kelas VIII SMP N 3 Tegallalang dengan pendekatan eksperimen post test only control group design. Populasi terdiri dari 158 peserta didik terbagi dalam lima kelas. Pengujian kesetaraan kelas dilakukan dengan uji F dari hasil penilaian tengah semester (PTS), semua kelas setara. Selanjutnya dipilih secara random 4 kelas sebagai sampel, dan dipilih menjadi kelas eksperimen dan kontrol. Selanjutnya diberikan tes sikap sosial untuk memilih kelompok sosial tinggi dan rendah. Kelompok eksperimen diberikan teknik pembelajaran klarifikasi nilai berbasis multikultur dan kelompok kontrol diberikan model pembelajaran konvensional. Data karakter peserta didik dikumpulkan dengan angket menggunakan skala Likert. Analisis data untuk uji hipotesis dengan analisis varians (ANAVA) dua jalur, dilanjutkan uji Tukey pada taraf signifikansi 5%. Diperoleh hasil seperti berikut. 1) Terdapat perbedaan karakter antara peserta didik yang mengikuti pembelajaran dengan model pembelajaran klarifikasi nilai berbasis multikultur dan karakter peserta didik yang mengikuti pembelajaran konvensional. 2) Terdapat pengaruh interaksi antara model pembelajaran dan sikap sosial terhadap karakter siswa. 3) Untuk siswa dengan sikap sosial tinggi, karakter peserta didik yang mengikuti pembelajaran dengan model pembelajaran klarifikasi nilai berbasis multikultur lebih baik daripada yang mengikuti pembelajaran konvensional. 4) Untuk siswa dengan sikap sosial rendah, karakter peserta didik yang mengikuti pembelajaran dengan model pembelajaran konvensional lebih baik daripada yang mengikuti pembelajaran klarifikasi nilai berbasis multikultur. Dengan demikian disimpulkan bahwa penerapan model pembelajaran klarifikasi nilai berbasis multikultur dan sikap sosial berpengaruh terhadap karakter peserta didik.
PENGARUH KONSELING BEHAVIORA DAN JENIS KELAMIN TERHADAP MOTIVASI BERPRESTASI SISWA
Authors: N.P. Rusmayani  , N.M.S. Mertasari  , I.G. Ratnaya  
Published: May 2022

Penelitian ini bertujuan mengetahui pengaruh konseling behavioral dan jenis kelamin terhadap motivasi berprestasi peserta didik kelas VIII SMP Negeri di kecamatan Tegallalang. Penelitian ini adalah penelitian eksperimen semu dengan rancangan factorial desain. Populasi penelitian ini adalah peserta didik kelas VIII SMP Negeri 3 Tegallalang yang berjumlah 158 orang. Sedangkan sampel dalam penelitian ini adalah sebanyak 96 orang.Instrumen yang digunakan dalam penelitian ini adalah kuisioner, dari hasil terkait motivasi berprestasi, selanjutnya diolah menggunakan pearson product moment dan analisis data menggunakan anava dua jalur. Hasil penelitian ini menunjukkan bahwa: 1) terdapat perbedaan motivasi berprestasi antara peserta didik yang mengikuti teknik modeling dan teknik asertif (Fhitung = 77,98 >Ftabe(0,05) = 2,47), 2) terdapat perbedaan motivasi berprestasi yang signifikan ntara peserta didik laki-laki dan perempuan (Fhitung = 24,16 > Ftabe(0,05) = 2,47), 3) terdapat pengaruh interaksi yang signifikan antara model konseling dengan jenis kelamin terhadap motivasi berprestasi peserta didik (Fhitung = 341,17 > Ftabe(0,05) = 2,47), 4) motivasi berprestasi peserta didik yang mengikuti teknik modeling lebih rendah dari pada peserta didik yang mengikuti teknik asertif pada siswa laki-laki (μA1B1=168,46 <μA2B1=176,88), 5) motivasi berprestasi siswa yang mengikuti teknik modeling lebih tinggi dari pada siswa yang mengikuti teknik asertif pada siswa perempuan (μA1B2= 189,75>μA2B2=164,79), 6) motivasi berprestasi siswa laki-laki lebih rendah daripada peserta didik perempuan yang mengikuti teknik modeling (μA1B1= 168,46<μA1B2=189,75), dan 7) motivasi berprestasi peserta didik laki-laki lebih tinggi dari pada peserta didik perempuan yang mengikuti teknik asertif (μA2B1= 176,88>μA1B2=164,79). Dengan demikian, penerapan teknik modeling memiliki pengaruh positif terhadap motivasi berprestasi peserta didik perempuan, sedangkan penerapan teknik asertif memiliki pengaruh positif terhadap motivasi berprestasi peserta didik laki- laki.
Pembelajaran Matematika Berbantuan LKS Berbasis Discovery Learning dengan Pendekatan Kontekstual terhadap Kemampuan Komunikasi Matematis Siswa Kelas VIII
Authors: Aprioda Aprioda , Setiawan Irwan , Rosmaiyadi Rosmaiyadi , Utami Citra 
Published: May 2022

Tujuan penelitian ini untuk: 1) mengetahui apakah kemampuan komunikasi matematis siswa yang diajarkan dengan menggunakan LKS berbasis discovery learning dan pendekatan kontekstual melebihi dengan yang diajarkan menggunakan LKS berbasis langsung; 2) mengetahui KKM siswa melalui LKS berbasis discovery learning dan pendekatan kontekstual; 3) mengetahui keterlaksanaan proses pembelajaran dengan menggunakan LKS berbasis discovery learning dan pendekatan kontekstual; 4) mengetahui self-confidence siswa ketika diajarkan dengan menggunakan LKS berbasis discovery learning dan pendekatan kontekstual. Deasin Penelitian True Eksperimental Design dan Posttest-Only Control Design. Teknik analisis yang digunakan berupa uji-t dua sampel independen, uji-t satu sampel, uji proporsi satu sampel, rata-rata presentase keterlaksanaan, dan rata-rata skor self-confidence siswa. Populasi penelitian merupakan seluruh siswa kelas VIII SMPN 17 Singkawang. Sampel penelitian yaitu kelas VIII A (eksperimen) dan kelas VIII B (kontrol). Hasil penelitian berupa: 1) kemampuan komunikasi matematis siswa yang diajarkan dengan LKS berbasis discovery learning dan pendekatan kontekstual lebih baik dari yang menggunakan LKS berbasis langsung; 2) ketuntasan nilai belajar mencapai KKM; 3) keterlaksanaan proses belajar terlaksana sangat baik; 4) self-confidence siswa tergolong tinggi