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The objective of this study was to describe a predictive modeling approach to risk stratify people with type 2 diabetes for diabetes self-management education and support (DSMES) services. With data from a large health system, a predictive model including age, glycated hemoglobin (HbA1c), and insulin use among other factors, was developed to assess risk of future high HbA1c. The model was retrospectively applied to a cohort of people who received DSMES over a 2-year period to assess the impact of DSMES on glycemia by risk strata. Of 6934 eligible people, 4014 (58%) were in the composite low-risk group and 2604 (38%) were in the composite high-risk group. Mean HbA1c change after DSMES was -0.38% in the low-risk group and -0.84% in the high-risk group. This analysis demonstrates the potential application of predictive modeling as one approach to target DSMES resources to people who will benefit most.

Aim and objective This study aims to investigate the association between parity and dental caries among US women. Materials and methods National Health and Nutrition Examination Survey (NHANES 2001-2004) data for parous women aged 20-45 years were used for our analysis (n = 1,914). The association between parity (number of pregnancies resulted in live births) and caries experience [the decayed, missing, and filling teeth (DMFT) index] was analyzed using bivariate and multivariate regression analyses. SAS software version 9.1 was used for the statistical analyses. We used survey procedures (e.g., SURVEYFREQ, SURVEYMEANS, and SURVEYREG) that incorporate information on the appropriate weights to account for NHANES's complex sampling design. Results The bivariate analysis showed a trend of increase in dental caries experience among parous women as the number of live births increased (p = 0.007). After adjusting for confounders, such as age, socioeconomic status (SES), dental care coverage, and utilization, a significant association was still observed between parity level and dental caries experience (p = 0.009). Conclusion Our results suggest that higher parity can be associated with dental caries experience among US women of reproductive age. Clinical significance Clinicians should be aware of this finding to promote better oral health care and education among women with increased parity.

Personalized medicine aims to match the right drug with the right patient by using specific features of the individual patient's tumor. However, current strategies of personalized therapy matching provide treatment opportunities for less than 10% of patients with cancer. A promising method may be drug profiling of patient biopsy specimens with single-cell resolution to directly quantify drug effects. We prospectively tested an image-based single-cell functional precision medicine (scFPM) approach to guide treatments in 143 patients with advanced aggressive hematologic cancers. Fifty-six patients (39%) were treated according to scFPM results. At a median follow-up of 23.9 months, 30 patients (54%) demonstrated a clinical benefit of more than 1.3-fold enhanced progression-free survival compared with their previous therapy. Twelve patients (40% of responders) experienced exceptional responses lasting three times longer than expected for their respective disease. We conclude that therapy matching by scFPM is clinically feasible and effective in advanced aggressive hematologic cancers. Significance: This is the first precision medicine trial using a functional assay to instruct n-of-one therapies in oncology. It illustrates that for patients lacking standard therapies, high-content assay-based scFPM can have a significant value in clinical therapy guidance based on functional dependencies of each patient's cancer. See related commentary by Letai, p. 290. This article is highlighted in the In This Issue feature, p. 275

Objective: The aim of this study is to examine the effect of diet drinks on dental erosion among a representative sample of US adults. Methods: Adult dietary and dental data were analyzed from the 2003–2004 cycle of the National Health and Nutrition Examination Survey. Erosion was measured with a modified tooth wear index and was analyzed as a dichotomous variable. Cluster analysis was performed, and the cluster number was based on having a separate diet drink cluster and the R2 values. Survey procedure and sample weights were used. Results: Most of the population (80%) had some form of dental erosive lesions. When compared with the total sample, people with erosion were more likely to be male (52.5%) and older. People with no erosive lesions were younger (42.3%) and non-Hispanic Black (21.2%). Cluster analysis resulted in 4 distinct clusters: high water, high diet drinks, high coffee/tea, and high soda. The respective percentage of individuals in each cluster who had erosion was 78.9%, 85%, 83.9%, and 76.2%, where the “high diet drinks” cluster showed the highest erosion ( P = 0.28). Logistic regression modeling showed that the “high diet drinks” cluster had increased odds of erosion (odds ratio = 1.27; 95% CI = 0.58 to 2.77) when compared with the “high water” cluster, but the relationship was not statistically significant. Conclusion: High diet drinks consumption slightly increased the odds of dental erosion among US adults, although this relationship was not statistically significant. It is thus not yet clear that dentists should recommend diet drinks, as they might be linked to systemic diseases. Further research is needed to explore more about risk factors of erosion. Knowledge Transfer Statement: The findings of this study are suggestive, though not significantly, that diet drinks may increase risk for dental erosion. While further research is needed, it is not clear that dentists should recommend these drinks as healthy substitutes for sugary drinks.

Survivors of acute respiratory distress syndrome (ARDS) experience challenges that persist well beyond the time of hospital discharge. Impairment in physical function, cognitive function, and mental health are common and may last for years. The current coronavirus disease 2019 pandemic is drastically increasing the incidence of ARDS worldwide, and long-term impairments will remain lasting effects of the pandemic. Evaluation of the ARDS survivor should be comprehensive, and common domains of impairment that have emerged from long-term outcomes research over the past 2 decades should be systematically evaluated.

In recent years, electromagnetic compatibility (EMC) has become progressively important because of the rise in the number of electronic auxiliary devices in motor vehicles. This article presents an angle modulated switching strategy for fractional horsepower drives. It allows decreasing the size of the necessary EMC filter, for the example case drive used, down to less than 50%, from nine to four capacitors. Simultaneously, it reduces the radiated electromagnetic emissions over a wide frequency range by almost 10 $\,\text{dB}_{\mu \text{V/m}}$ . The EMC measurements performed in a shielded chamber are compared with the results for two conventional switching strategies. Subsequently, the influence of the presented switching strategy on the efficiency and on the emitted airborne and structure-borne noise is investigated.

Graft-versus-host disease (GVHD) is the leading cause of mortality after hematopoietic stem cell transplantation and primarily affects barrier organs such as the skin. One-third of cases are refractory to steroid treatment resulting in poor outcomes and the need for novel therapies. Longitudinal analysis of T-cell transcriptomes in patients before the appearance of GVHD symptoms revealed the upregulation of anti-apoptotic regulator B-cell lymphoma 2 (BCL2) at GVHD initiation. To determine the potential of BCL2 inhibition in active GVHD, we analyzed tissues of 88 patients with acute or chronic GVHD. BCL2 RNA was elevated in multiple organs affected by GVHD and expression correlated with transplant-related mortality and steroid-refractory GVHD. BCL2-expressing lymphocytes were present in skin lesions and peripheral blood of patients with acute and chronic GVHD. Inhibition of BCL2 increased the CD4 to CD8 ratio in allogeneic T cells in vitro and induced apoptosis of T cells from patients with steroid-pretreated chronic GVHD ex vivo. In addition, the higher ratio of regulatory to nonregulatory T cells upon blockage of BCL2 could add to the anti-inflammatory effect of BCL2 blockage. Collectively, our results highlight BCL2 as an important factor for GVHD development and introduce BCL2 inhibition as previously unreported and urgently needed targeted therapy in the treatment of steroid-refractory GVHD.

Bronchoscopy is an aerosol-generating procedure with important diagnostic and therapeutic indications However, in the era of the coronavirus disease 2019 (COVID-19) pandemic, airway procedures can put health care providers at an increased risk of exposure and transmission of COVID-19 We have reviewed and summarized guidelines from various societies of respiratory medicine to stratify the indications for bronchoscopy and optimize preprocedural, procedural, and postprocedural preparation Appropriate measures can help decrease exposure to health care workers when performing this aerosol-generating procedure © 2020 Lippincott Williams and Wilkins All rights reserved

Objectives Patients with APS are at increased risk of thromboembolism. Neutrophils have been shown to play a role in inducing thrombosis. We aimed to investigate differences in neutrophil subpopulations, their potential of activation and neutrophil extracellular trap (NET) formation comparing high and low-density neutrophils (HDNs/LDNs) as well as subpopulations in patients with APS and controls to gain deeper insight into their potential role in thrombotic manifestations in patients with APS. Methods HDNs and LDNs of 20 patients with APS and 20 healthy donors were isolated by density gradient centrifugation and stimulated. Neutrophil subpopulations, their activation and NET release were assessed by flow cytometry. Results LDNs of both groups showed higher baseline activation, lower response to stimulation (regulation of activation markers CD11b/CD66b), but higher NET formation compared with HDNs. In patients with APS, the absolute number of LDNs was higher compared with controls. HDNs of APS patients showed higher spontaneous activation [%CD11b high: median (interquartile range): 2.78% (0.58–10.24) vs 0.56% (0.19–1.37)] and response to stimulation with ionomycin compared with HDNs of healthy donors [%CD11b high: 98.20 (61.08–99.13) vs 35.50% (13.50–93.85)], whereas no difference was found in LDNs. NET formation was increased in patients’ HDNs upon stimulation. Conclusion HDNs and LDNs act differently, unstimulated and upon various stimulations in both healthy controls and APS patients. Differences in HDNs and LDNs between patients with APS and healthy controls indicate that neutrophils may enhance the risk of thrombosis in these patients and could thus be a target for prevention of thrombosis in APS.

Background Experimental evidence shows postnatal exposure to anesthesia negatively affects brain development. The PDZ2 domain, mediating protein–protein interactions of the postsynaptic density-95 protein, serves as a molecular target for several inhaled anesthetics. The authors hypothesized that early postnatal disruption of postsynaptic density-95 PDZ2 domain interactions has persistent effects on dendritic spines and cognitive function. Methods One-week-old mice were exposed to 1.5% isoflurane for 4 h or injected with 8 mg/kg active postsynaptic density-95 wild-type PDZ2 peptide along with their respective controls. A subset of these mice also received 4 mg/kg of the nitric oxide donor molsidomine. Hippocampal spine density, long-term potentiation, novel object recognition memory, and fear learning and memory were evaluated in mice. Results Exposure of 7-day-old mice to isoflurane or postsynaptic density-95 wild-type PDZ2 peptide relative to controls causes: (1) a long-term decrease in mushroom spines at 7 weeks (mean ± SD [spines per micrometer]): control (0.8 ± 0.2) versus isoflurane (0.4 ± 0.2), P < 0.0001, and PDZ2MUT (0.7 ± 0.2) versus PDZ2WT (0.4 ± 0.2), P < 0.001; (2) deficits in object recognition at 6 weeks (mean ± SD [recognition index]): naïve (70 ± 8) versus isoflurane (55 ± 14), P = 0.010, and control (65 ± 13) versus isoflurane (55 ± 14), P = 0.045, and PDZ2MUT (64 ±11) versus PDZ2WT (53 ± 18), P = 0.045; and (3) deficits in fear learning at 7 weeks and memory at 8 weeks (mean ± SD [% freezing duration]): Learning, control (69 ± 12) versus isoflurane (52 ± 13), P < 0.0001, and PDZ2MUT (65 ± 14) versus PDZ2WT (55 ± 14) P = 0.011, and Memory, control (80 ± 17) versus isoflurane (56 ± 23), P < 0.0001 and PDZ2MUT (73 ± 18) versus PDZ2WT (44 ± 19) P < 0.0001. Impairment in long-term potentiation has fully recovered here at 7 weeks (mean ± SD [% baseline]): control (140 ± 3) versus isoflurane (137 ± 8), P = 0.560, and PDZ2MUT (136 ± 17) versus PDZ2WT (128 ± 11), P = 0.512. The isoflurane induced decrease in mushroom spines was preventable by introduction of a nitric oxide donor. Conclusions Early disruption of PDZ2 domain-mediated protein–protein interactions mimics isoflurane in decreasing mushroom spine density and causing learning and memory deficits in mice. Prevention of the decrease in mushroom spine density with a nitric oxide donor supports a role for neuronal nitric oxide synthase pathway in mediating this cellular change associated with cognitive impairment. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

99mTc-PHC-102 is a 99mTc-labeled derivative of acetazolamide, a high-affinity small organic ligand of Carbonic Anhydrase IX (CAIX). 99mTc-PHC-102 has previously shown favourable in vivo biodistribution properties in mouse models of CAIX-positive clear cell renal cell carcinoma (ccRCC) and colorectal cancer. In this study, we aimed to explore the targeting performance of 99mTc-PHC-102 in single-photon emission computed tomography (SPECT) in patients with RCC, while also assessing the safety and tolerability of the radiotracer. Methods: We studied five patients with localized or metastatic clear cell renal cell carcinoma (ccRCC) in a microdosing regimen, after the administration of 100 µg total CAIX ligand and 600-800 MBq 99mTc-PHC-102. Tissue distribution and residence time in normal organs and tumors were analysed by serial SPECT/CT scans at three time points (30 minutes, 2, and 6 hours) after intravenous administration. Results: In the five patients studied, 99mTc-PHC-102 was well tolerated and no study drug-related adverse events were recorded. The radiotracer showed a rapid initial uptake in the stomach, kidneys and gallbladder, which cleared over time. Localization of the study drug in primary tumors of five patients was observed with favourable tumour-to-background ratios. 99mTc-PHC-102-SPECT/CT allowed the identification of four previously unknown lung and lymph node metastases in two patients. Conclusion:99mTc-PHC-102 is a promising SPECT tracer for the imaging of patients with clear cell renal cell carcinoma. This tracer has the potential to identify primary and metastatic lesions in different anatomical locations. 99mTc-PHC-102 might also serve as companion diagnostic agent for future CAIX-targeting therapeutics.

Background The effect of sugared beverages on dental caries has been widely studied in dental literature. A major limitation of these studies was examining the beverages as a single source. To overcome this limitation, a few studies used cluster analysis to group people into similar beverage consumption patterns. These studies did not differentiate between sugared beverages and diet drinks. Therefore the aim of this study is to examine the effect of consuming diet drinks on dental caries among US children by using cluster analysis. Methods In this cross-sectional study, the authors analyzed the dietary data of children aged 3 through 10 years, using 2 24-hour recall interviews in the 2011-2014 National Health and Nutrition Examination Survey data. Cluster analysis has been used to overcome the limitations of examining the beverages as a single source. Clusters were identified based on the R2 statistic and the local peak of pseudo-F statistics. Survey procedure and sample weights were used to account for the complex National Health and Nutrition Examination Survey sampling design. Results Six beverage consumption clusters were identified: high soda, high 100% juice, high juice drinks, high diet drinks, high milk, and high water. Regression analysis showed that the high soda cluster had a tendency to increase caries risk (odds ratio [OR], 1.69, 95% confidence interval [CI], 0.9 to 3.1), while the high diet drinks cluster had neutral effect compared with the high water cluster (OR, 0.94, 95% CI, 0.5 to 1.8). Conclusions The results of this study suggest that diet drinks have no adverse effect on teeth among US children. Additional well-designed longitudinal studies should be conducted to establish the effect of diet drinks on caries when consumed during childhood. Practical Implications Although this study did not show an association between caries and diet drinks, dental practitioners should be cautious about recommending these drinks, as they have been linked to systemic diseases. In addition, the American Academy of Pediatrics and National Academy of Medicine do not recommend that children consume these beverages.

Prediction of movement intentions from electromyographic (EMG) signals is typically performed with a pattern recognition approach, wherein a short dataframe of raw EMG is compressed into an instantaneous feature-encoding that is meaningful for classification. However, EMG signals are time-varying, implying that a frame-wise approach may not sufficiently incorporate temporal context into predictions, leading to erratic and unstable prediction behavior. Objective: We demonstrate that sequential prediction models and, specifically, temporal convolutional networks are able to leverage useful temporal information from EMG to achieve superior predictive performance. Methods: We compare this approach to other sequential and frame-wise models predicting 3 simultaneous hand and wrist degrees-of-freedom from 2 amputee and 13 non-amputee human subjects in a minimally constrained experiment. We also compare these models on the publicly available Ninapro and CapgMyo amputee and non-amputee datasets. Results: Temporal convolutional networks yield predictions that are more accurate and stable $(p than frame-wise models, especially during inter-class transitions, with an average response delay of 4.6 ms $(p and simpler feature-encoding. Their performance can be further improved with adaptive reinforcement training. Significance: Sequential models that incorporate temporal information from EMG achieve superior movement prediction performance and these models allow for novel types of interactive training. Conclusions: Addressing EMG decoding as a sequential modeling problem will lead to enhancements in the reliability, responsiveness, and movement complexity available from prosthesis control systems.

The need to increase electrification in the automotive industry has been well recognized. Overshadowed by their larger counterparts used for the car’s traction is the increasing number of small electric drives used in automotive applications. As a matter of fact, up to 100 of such drives are used within a typical mid-sized car. This includes performance-, safety-, and comfort-related auxiliary drives, of which around 10 % are used as parts of pumping and fan systems. With such “small drives,” i.e., fractional horsepower (FHP) drives at the lower end of the power spectrum, volume, mass, and efficiency have so far only been attributed secondary importance. Yet, the increasing demands on the automotive industry have also resulted in renewed interest not only in the performance parameters of these auxiliary drives, such as energy conversion efficiency, size, and cost, but also in electromagnetic emission, noise, and fault tolerance. This survey article presents selected results on recent achievements in these rather new fields of research and outlines fundamental research questions.

Background and PurposeHypertension is rapidly increasing in the Kingdom of Saudi Arabia (KSA), particularly among men. Assessment of hypertension self-care behaviors is a critical step to promoting blood pressure control. This study aimed to evaluate the Hypertension Self-Care Profile (HBP-SCP) among Saudi men in KSA.MethodsThe HBP-SCP self-efficacy and behavior scales were translated into Arabic and tested on a convenience sample of 160 Saudi men with hypertension. Cronbach's alpha and factor analysis were conducted using SPSS.ResultsInternal consistency of the Arabic HBP self-care and self-efficacy scales was 0.84 and 0.90, respectively. Factor loading ranged from 0.25 to 0.70 for HBP self-care behaviors and from 0.28 to 0.77 for HBP self-efficacy.ConclusionsThe Arabic HBP-SCP is acceptable in its reliability and validity for measuring HBP self-care behaviors and self-efficacy among Saudi men with hypertension.

Heart disease is a leading cause of death in the US. Recent advances in the Internet of Things (IoT) provide a great opportunity to realize smart and connected health systems through IoT monitoring...

ObjectivesTo measure the rate of benzodiazepine receptor agonist (BZA) dependence in older veterans with insomnia symptoms chronically using BZAs and to assess for associations between high posttraumatic stress disorder (PTSD) risk and BZA dependence.MethodsA cross-sectional study was conducted among veterans aged 55years and older with insomnia symptoms (current or historical) and chronic use of BZAs (≥3months). Measurements included the Primary Care-PTSD screen (score >2 indicates high PTSD risk) and Benzodiazepine Dependence Questionnaire. Logistic regression was used to test for associations between PTSD risk and BZA dependence.ResultsA high PTSD risk was observed in 40% of the participants (N=33). One-fifth (21.7%, N =18) of participants met the criteria for benzodiazepine dependence (score ≥23 on Benzodiazepine Dependence Questionnaire). Veterans with high PTSD risk were significantly more likely to have BZA dependence (odds ratio 10.09, 95% CI [2.39, 42.54], p =.002).ConclusionsIn older veterans with insomnia symptoms and chronic use of BZAs, high PTSD risk is associated with elevated risk for BZA dependence, which may make discontinuation of these medications difficult.Clinical implicationsClinicians should consider the strong association between PTSD symptoms and benzodiazepine dependence when developing plans to taper a BZA in veterans with these symptoms.

Although liver biopsies (LBs) are being increasingly performed under endoscopic ultrasound (EUS) guidance, there are limited data comparing outcomes with current standard-of-care, transabdominal ultrasound (US)-guided percutaneous (PC) methods. In a randomised trial, we observed that the PC, US-guided method yielded significantly more optimal specimens, defined as specimen length of 25 mm or greater and presence of at least 11 complete portal tracts, compared with the EUS-guided method (57.9% vs 23.8%, p=0.028). Also, the PC method resulted in worse initial postprocedural pain but was less costly (US$1824 vs US$3240, p

In this article, we present a skull database containing 500 healthy skulls segmented from high-resolution head computed-tomography (CT) scans and 29 defective skulls segmented from craniotomy head CTs. Each healthy skull contains the complete anatomical structures of human skulls, including the cranial bones, facial bones and other subtle structures. For each craniotomy skull, a part of the cranial bone is missing, leaving a defect on the skull. The defects have various sizes, shapes and positions, depending on the specific pathological conditions of each patient. Along with each craniotomy skull, a cranial implant, which is designed manually by an expert and can fit with the defect, is provided. Considering the large volume of the healthy skull collection, the dataset can be used to study the geometry/shape variabilities of human skulls and create a robust statistical model of the shape of human skulls, which can be used for various tasks such as cranial implant design. The craniotomy collection can serve as an evaluation set for automatic cranial implant design algorithms.

INTRODUCTION The Supplemental Nutrition Assistance Programme (SNAP) is a federal programme aimed to alleviate hunger and improve food insecurity. The impact of SNAP participation on overall health has been studied. However, little is known about the effects of SNAP participation on oral health. We aimed to investigate the association between participating in SNAP and dental caries and to explore the role of food insecurity as a moderator in this relationship. METHODS We obtained data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014.The primary outcome was untreated dental caries (none vs. one or more). Self-reported SNAP participation status in the past 12 months was the predictor, and food security was the moderator. Food security was measured as overall food security status (full food secure/ food insecure) and household-level food security (full, marginal, low and very low). Bivariate and multiple logistic regression analyses were conducted to evaluate the relationship between SNAP and dental caries, and whether food insecurity moderates this relationship. Statistical analysis was carried out in September 2020. RESULTS Our results suggested that after adjusting for potential confounders, SNAP participants were more likely to have untreated dental caries than non-SNAP participants (odds ratio: 1.6; 95% CI: 1.2-2.0). Food security status did not alter the relationship between SNAP participation and untreated dental caries. CONCLUSIONS Food security status did not alter the relationship between SNAP participation and untreated dental caries. SNAP participation was associated with untreated dental caries among U.S. adults, and this was not affected by their food security status.

ObjectiveTo characterize the incidence, type, and risk factors of severe infections (SI) in patients with autoimmune kidney diseases treated with rituximab (RTX).MethodsWe conducted a multicenter retrospective cohort study of adult patients with immune-related kidney diseases treated with at least one course of RTX between 2015 and 2019. As a part of the ABCDE Registry, detailed data on RTX application and SI were collected. SI were defined by Common Terminology Criteria for Adverse Events v5.0 as infectious complications grade 3 and above. Patients were dichotomized between “nephrotic” and “nephritic” indications. The primary outcome was the incidence of SI within 12 months after the first RTX application.ResultsA total of 144 patients were included. Twenty-five patients (17.4%) presented with SI, mostly within the first 3 months after RTX administration. Most patients in the nephritic group had ANCA-associated vasculitis, while membranous nephropathy was the leading entity in the nephrotic group. Respiratory infections were the leading SI (n= 10, 40%), followed by urinary tract (n=3, 12%) and gastrointestinal infections (n=2, 8%). On multivariable analysis, body mass index (BMI, 24.6 kg/m2versus 26.9 kg/m2, HR: 0.88; 95%CI: 0.79-0.99; p=0.039) and baseline creatinine (HR: 1.25; 95%CI: 1.04-1.49; p=0.017) were significantly associated with SI. All patients in the nephritic group (n=19; 100%) who experienced a SI received oral glucocorticoid (GC) treatment at the time of infection. Hypogammaglobulinemia was frequent (58.5%) but not associated with SI.ConclusionsAfter RTX administration, impaired kidney function and lower BMI are independent risk factors for SI. Patients with nephritic glomerular diseases having concomitant GC treatment might be at higher risk of developing SI.

Objectives:In critical care it is crucial to appropriately assess the risk of mortality for each patient. This is especially relevant in pediatrics, with its need for accurate and repeatable scoring. Aim of this study was to evaluate an age-adapted version of the expanded Simplified Acute Physiology Score II; (p-SAPS II), a repeatable, newly-designed scoring system compared to established scores (Pediatric Sequential Organ Failure Assessment Score/pSOFA, Pediatric Logistic Organ Dysfunction Score-2/PELOD-2 and Pediatric Index of Mortality 3/PIM3).Design:This retrospective cohort pilot study included data collected from patients admitted to the Pediatric Intensive Care Unit (PICU) at the Medical University of Vienna between July 2017 through December 2018.Patients:231 admissions were included, comprising neonates (gestational age of ≥ 37 weeks) and patients up to 18 years of age with a PICU stay longer than 48 h.Main Outcomes:Mortality risk prediction and discrimination between survivors and non-survivors were the main outcomes of this study. The primary statistical methods for evaluating the performance of each score were the area under the receiver operating characteristic curve (AUROC) and goodness-of-fit test.Results:Highest AUROC curve was calculated for p-SAPS II (AUC = 0.86; 95% CI: 0.77–0.96;p< 0.001). This was significantly higher than the AUROCs of PELOD-2/pSOFA but not of PIM3. However, in a logistic regression model including p-SAPS II and PIM3 as covariates, p-SAPS II had a significant effect on the accuracy of prediction (p= 0.003). Nevertheless, according to the goodness-of-fit test for p-SAPS II and PIM3, p-SAPS II overestimated the number of deaths, whereas PIM3 showed acceptable estimations. Repeatability testing showed increasing AUROC values for p-SAPS II throughout the clinical stay (0.96 at day 28) but still no significant difference to PIM 3. The prediction accuracy, although improved over the days and even exceeded PIM 3.Conclusions:The newly-created p-SAPS II performed better than the established PIM3 in terms of discriminating between survivors and non-survivors. Furthermore, p-SAPS II can be assessed repeatably throughout a patient's PICU stay what improves mortality prediction. However, there is still a need to optimize calibration of the score to accurately predict mortality sooner throughout the clinical stay.

Introduction: Diseases such as celiac disease, environmental enteric dysfunction, infectious gastroenteritis, type II diabetes and inflammatory bowel disease are associated with increased gut permeability. Dual sugar absorption tests, such as the lactulose to rhamnose ratio (L:R) test, are the current standard for measuring gut permeability. Although easy to administer in adults, the L:R test has a number of drawbacks. These include an inability to assess for spatial heterogeneity in gut permeability that may distinguish different disease severity or pathology, additional sample collection for immunoassays, and challenges in carrying out the test in certain populations such as infants and small children. Here, we demonstrate a minimally invasive probe for real-time localized gut permeability evaluation through gut potential difference (GPD) measurement.Materials and Methods: The probe has an outer diameter of 1.2 mm diameter and can be deployed in the gut of unsedated subjects via a transnasal introduction tube (TNIT) that is akin to an intestinal feeding tube. The GPD probe consists of an Ag/AgCl electrode, an optical probe and a perfusion channel all housed within a transparent sheath. Lactated Ringer’s (LR) solution is pumped through the perfusion channel to provide ionic contact between the electrodes and the gut lining. The optical probe captures non-scanning (M-mode) OCT images to confirm electrode contact with the gut lining. A separate skin patch probe is placed over an abraded skin area to provide reference for the GPD measurements. Swine studies were conducted to validate the GPD probe. GPD in the duodenum was modulated by perfusing 45 ml of 45 mM glucose.Results: GPD values of −13.1 ± 2.8 mV were measured in the duodenum across four swine studies. The change in GPD in the duodenum with the addition of glucose was −10.5 ± 2.4 mV (p < 0.001). M-mode OCT images provided electrode-tissue contact information, which was vital in ascertaining the probe’s proximity to the gut mucosa.Conclusion: We developed and demonstrated a minimally invasive method for investigating gastrointestinal permeability consisting of an image guided GPD probe that can be used in unsedated subjects.

Background: Aggressive hematological malignancies in relapsed/refractory setting bear a dire prognosis with low cure rates and short survival. Matching these patients to therapies is challenged by complexity due to spatial and temporal tumor evolution and incomplete understanding of genotype to phenotype correlations. Direct functional testing could address these impediments. The EXALT trial is an interventional, one-arm study designed to assess the clinical value of next generation functional drug screening (ngFDS). An interim analysis on 17 patients suggested a clinical benefit (Snijder et al., Lancet Hematol. 2017). Methods: We applied image-based ngFDS to quantify differential ex-vivo sensitivity of primary patient tumor cells to respective non-tumor cells towards 136 small molecule drugs, including EMA approved for any indication or experimental. We screened bone marrow, peripheral blood or lymph node material from 143 patients who suffered from late stage aggressive hematological malignancies (acute leukemias, aggressive B- and T-cell lymphomas) , discussed the results in a multidisciplinary tumor board and recommended treatments to physicians (A). The primary endpoint of this study was the percentage of patients reaching a PFS-ratio (PFS(ngFDS treatment)/PFS(previous treatment)) of ≥1.3 with an H0 hypothesis < 15% patients. The secondary endpoint was overall response rate (ORR) defined as proportion of patients reaching complete remission (CR) or partial remission (PR). Additionally, we performed a post hoc analysis to evaluate the matching of ngFDS to drugs used in actual treatment (matching score of received treatment). Results: 56 (39%) patients were evaluable and treated according to ngFDS based recommendations. With 30 of 56 (54%) ngFDS guided patients experiencing a PFS ratio of ≥1.3, the primary study endpoint was reached. 11 patients (37%) had ongoing response at censoring date (B). The median follow-up was 718 days. The median number of days from sampling to treatment was 21 (range 4-77). The ngFDS treatment regimens consisted of a median of 2 drugs (range: 1-6). ORR was 55% for all evaluable ngFDS treated patients, 60% for the lymphoid subgroup and 41% for the myeloid subgroup. Patients on ngFDS guided treatment with performance status ECOG ≤ 1 had a median PFS of 207 days compared to a median PFS of 29 days for patients with higher ECOG (p < 0.001, C). 24 of 39 (62%) patients with ECOG ≤ 1 had a PFS ratio of ≥1.3 (D). In disease specific subgroup analysis median PFS of T-cell lymphoma patients was 235 days versus 60 days for B-cell lymphoma patients (p = 0.018, E). Age (≤60 vs. >60), sex, lineage (myeloid vs. lymphoid), number of previous treatment lines (≤2 vs. >2), and clinical presentation (leukemia vs. lymphoma) did not have an impact on PFS of ngFDS guided treatment. Post hoc analysis including additional 17 non-ngFDS treated patients demonstrated that only patients receiving treatment with a positive ngFDS matching score demonstrated clinical benefit (HR: 0.53, p=0.005; vs. HR: 1.4, p=0.4). ngFDS matched treatments resulted in higher PFS for patients with tumor samples that had a cancer cell fraction of 10-50% in comparison to patients with samples of lower or higher cancer cell percentage (HR:0.35, p=0.01). Conclusion: ngFDS could be integrated in the routine clinical work flow. ngFDS guided treatments led to high rates of PFS prolongation compared to previous treatments of individual patients. ngFDS guided treatment is feasible and effective in patients with late stage aggressive hematological malignancies. These results prompted a prospective randomized trial comparing treatment guidance based on ngFDS or comprehensive genomic profiling or physician's choice (EXALT-2 trial, NCT04470947). Figure Disclosures Vladimer: Allcyte GmbH: Current Employment, Current equity holder in private company, Other: Founder. Jaeger:Karyopharm: Honoraria; Amgen: Honoraria; Gilead: Honoraria, Research Funding; BMS/Celgene: Consultancy, Honoraria, Research Funding; True North: Honoraria, Research Funding; Miltenyi: Consultancy, Honoraria; CDR Life AG: Consultancy, Research Funding; F. Hoffmann-La Roche: Honoraria, Research Funding; Infinity: Honoraria; Takeda: Honoraria; Novartis: Consultancy, Honoraria, Research Funding; AbbVie: Honoraria. Krall:Allcyte GmbH: Current Employment, Current equity holder in private company, Other: Founder. Valent:Allcyte GmbH: Research Funding; Cellgene: Honoraria, Research Funding; Pfizer: Honoraria. Wolf:Celgene: Honoraria, Research Funding. Zielinski:MSD: Consultancy, Honoraria, Speakers Bureau; Roche: Consultancy, Honoraria, Speakers Bureau; Novartis: Consultancy, Honoraria, Speakers Bureau; BMS: Consultancy, Honoraria, Speakers Bureau; Imugene: Consultancy, Honoraria, Speakers Bureau; Ariad: Consultancy, Honoraria, Speakers Bureau; Pfizer: Consultancy, Honoraria, Speakers Bureau; Merrimack: Consultancy, Honoraria, Speakers Bureau; Merck KGaA: Consultancy, Honoraria, Speakers Bureau; Fibrogen: Consultancy, Honoraria, Speakers Bureau; AstraZeneca: Consultancy, Honoraria, Speakers Bureau; Tesaro: Consultancy, Honoraria, Speakers Bureau; Gilead: Consultancy, Honoraria, Speakers Bureau; Servier: Consultancy, Honoraria, Speakers Bureau; Shire: Consultancy, Honoraria, Speakers Bureau; Eli Lilly: Consultancy, Honoraria, Speakers Bureau; Athenex: Consultancy, Honoraria, Speakers Bureau. Superti-Furga:Allcyte GmbH: Current equity holder in private company, Other: Founder. Snijder:Allcyte GmbH: Current equity holder in private company, Other: Founder. Staber:Roche: Consultancy, Honoraria, Research Funding; Astra Zeneca: Consultancy, Honoraria; Celgene/ BMS: Consultancy, Honoraria; msd: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria.

This study was designed to examine prenatal marijuana use in pregnant women with disabilities related to mental health. Almost one-third (28.8%) of 3805 pregnant women reported a mental hea...

Background Data for hospital antibiograms are typically compiled from all patients, regardless of disposition, demographics and other comorbidities. Objective We hypothesized that the sensitivity patterns for urinary pathogens would differ significantly from the hospital antibiogram in patients that were discharged from the emergency department (ED). Methods We evaluated a retrospective cohort of all adult patients with positive urine cultures treated in the 2016 calendar year at an inner-city academic ED. Positive urine cultures defined by our institution’s microbiology department. Investigators conducted a structured review of an electronic medical record (EMR) to collect demographic, historical and microbiology records. We utilized a one-sample test of proportion to compare the sensitivity of each organism for discharged patients to the hospital published antibiogram. Alpha set at 0.05. Results During the study period, 414 patients were discharged from the ED and found to have positive urine cultures; 20% age > 60 years old, 85% female, 79% Hispanic, 33% diabetic. The most common organisms was E. coli (78%). E. coli was sensitive to Trimethoprim-Sulfamethoxazole for 59% vs. 58% in our antibiogram (p = 0.77), Ciprofloxacin 81% vs. 69% (p

Purpose The purpose of this qualitative study was to explore the effectiveness of Glucose to Goal (G2G), a diabetes self-management education and support (DSMES) model for primary care (PC). Methods PC providers and staff were recruited from 5 PC practices participating in the 18-month intervention to participate in focus groups and interviews, which were used to gain insights about their perspectives on DSMES and how G2G was implemented across the intervention. Data were collected by qualitative researchers at baseline, midpoint, and study completion. Results At baseline, PC participants held a favorable view of DSMES and welcomed having a diabetes educator (DE) in their practice. Most participants suggested DEs would be helpful in meeting patients’ nutrition needs but should give therapeutic advice only with a doctor’s oversight. Participants anticipated that having a DE onsite would mitigate transportation, scheduling, communication, and cost barriers. Participant viewpoints about G2G remained unchanged from midpoint to study end, while barriers regarding location and transportation were perceived as being reduced by having a DE in the practice. Despite referral rates remaining low in some practices, many concerns stated at earlier timepoints appeared to have been attenuated by G2G components (eg, bringing the DE onsite, preidentifying patients, and DE ability to communicate and make diabetes management recommendations). Conclusions This study demonstrates that G2G, providing DSMES in PC, appeared to be a welcome service where acceptance of and enthusiasm for the model grew over the course of the intervention.

Purpose The outer stent lumen can be located either deeper (in or under Tenon's layer) or more superficially in the conjunctival stroma after the transscleral XEN Glaucoma Gel Microstent (XEN‐GGM; Allergan Plc., USA) implantation. The present study aimed to investigate the effect of the postoperative conjunctival implant position on surgical success and intraocular pressure (IOP) after XEN‐GGM. Methods Prospective data from 66 consecutive open‐angle glaucoma eyes of 54 patients were collected preoperatively and 1 and 2 weeks, and 1, 6 and 12 months postoperatively. The layer of implantation was determined in the first month postoperatively as intra‐ and subtenon or intraconjunctival depending on the location of the outer lumen of the stent in OCT (Visante OCT; Zeiss, Germany). Primary outcome measures were differences in relative IOP reduction at 12 months between the two groups. Further, complete and qualified surgical success, number of secondary needlings and number of IOP‐lowering medications and absolute IOP were assessed. Results Relative IOP reduction was higher in intra‐ and subtenon group (n = 37/66, 56%) at week 1 (−54% versus −19%, p

Background We investigated the influence of population‐wide COVID‐19 lockdown measures implemented on 16, March 2020 on routine and emergency care of cancer outpatients at a tertiary care cancer centre in Vienna, Austria. Methods We compared the number/visits of cancer outpatients receiving oncological therapies at the oncologic day clinic (DC) and admissions at the emergency department (ED) of our institution in time periods before (pre‐lockdown period: 1 January – 15 March 2020) and after (post‐lockdown period: 16 March– 31 May 2020) lockdown implementation with the respective reference periods of 2018 and 2019. Additionally, we analysed Emergency Severity Index (ESI) score of unplanned cancer patient presentations to the ED in the same post‐lockdown time periods. Patient outcome was described as 3‐month mortality rate (3‐MM). Results In total, 16 703 visits at the DC and 2664 patient visits for the respective time periods were recorded at the ED. No decrease in patient visits was observed at the DC after lockdown implementation (P = .351), whereas a substantial decrease in patient visits at the ED was seen (P

Purpose The purpose of this study was to evaluate the impact of a primary care (PC)-based delivery model on diabetes self-management education and support (DSMES) referrals and participation. Despite evidence that DSMES is a critical component of diabetes care, referrals and participation remain low. Methods PC practices were assigned to the intervention (n = 6) or usual care (n = 6). Intervention practices had direct access to a diabetes educator (DE) and applied patient-centered medical home elements to DSMES delivery. Usual care practices referred patients to traditional hospital-based outpatient DSMES programs. DSMES referrals and participation were examined for patients with diabetes, 18 to 75 years old, presenting to PC over 18 months (n = 4,894) and compared between groups. Results Compared to the usual care group, a higher percentage of patients in the intervention practices were referred to DSMES (18.4% vs 13.4%; P < .0001), and of those referred, a higher percentage of patients in the intervention practices participated in DSMES (34.9% vs 26.1%; P = .02). Patient-level factors predicting referrals were obesity (odds ratio [OR] = 1.6), higher A1C (OR = 1.4), female (OR = 1.3), and younger age (OR = 0.98). The only patient-level factor that predicted DSMES participation was lower A1C (OR = 0.9). Conclusions This study demonstrates the positive influence of a PC-based intervention on DSMES referral and participation. However, modest improvements in DSMES rates, even with targeted efforts to address reported barriers, raise questions as to what is truly needed to drive meaningful change.

The high prevalence of diabetes mellitus (DM) and shortage of Diabetes Care and Education Specialists (DCES) in rural communities requires providers and patients to travel long distances to access care. This burden impedes optimal DM management and increases cost. Telemedicine for Reach, Education, Access, Treatment, and Ongoing Support (TREAT-ON) is a Diabetes Education and Support (DSMES) model, where a DCES provides DSMES to patients identified as high risk (A1c >9% or unplanned care). TREAT-ON was initiated in February 2020, where DSMES was provided via telemedicine (TM) visits, previously delivered face-to-face (F2F) to high-risk patients. In this retrospective study, the DCES overall costs (fuel, tolls, and postage), travel time for care delivery, and number of patients seen over a 6-month period (March-August 2019) was compared to (March-August 2020) after TM practices were adopted. From March to August 2019, 59 of 91 patient referrals were completed, compared to 110 of 167 referrals from March to August 2020. The percentage of successful referrals were similar in both groups (64.8% vs. 65.9%). However, the percent of referrals declined by patients were higher in 2019 (18.7%) vs. 2020 (9.0%). Of 59 referrals completed in 2019, 54 were F2F and five TM whereas in 2020 twelve were F2F and 98 TM. Lower average cost per patient was noted in 2020 ($38.85 vs. $6.20). A similar reduction in average travel time per patient was seen, 99 min vs. 16 min in 2020. TREAT-ON model translated to a direct cost savings of $1,606 and reduction of DCES travel time of 67.6 hours equating to a gain of 8.4 workdays opening care opportunities for an additional 67 new referrals. DSMES is a pillar of DM care and alternative methods to expand DSMES services remain imperative. Our early TREAT-ON data shows that telemedicine offers a time and cost-effective approach to DSMES with potential to reach a larger population when compared to traditional F2F visits, and helps to address a current DSCES shortage. Disclosure E. Gammoh: None. P. A. Johnson: None. J. S. Krall: Research Support; Self; Becton, Dickinson and Company, Sanofi. J. Ng: Research Support; Self; Sanofi-Aventis. L. M. Siminerio: Advisory Panel; Self; Abbott Diabetes, Bayer U. S., Research Support; Self; Becton, Dickinson and Company. A. Bandi: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1R34DK123370-01)

People with type 2 diabetes mellitus (T2DM) continue to be reluctant to begin insulin therapy. Methods to assure education access and support are critically important. To supplement health care provider efforts, the BD Diabetes Care App was developed to offer information on injection administration and self-management strategies. Ongoing support is built into the app in the form of articles and videos related to starting and using insulin. The purpose of this study was to evaluate patient and educator usability of and satisfaction with the app. Methods: Patients >18 years with T2DM, new to or identified as having issues with insulin therapy were recruited from in- and outpatient settings. Participants received insulin education according to standard practice and were then introduced to the app. Over the study period, participants were able to use the app as much or as little as preferred; use was tracked with app analytics. HbA1c was measured at baseline and 3 months and satisfaction surveys were administered. Results: Participants (n=22) were 27% female, 73% White Non-Hispanic, mean age 55 years, with baseline mean HbA1c of 11%. Glycemic control significantly improved during the study period, with an average reduction in HbA1c of 3.2±2.9%. All participants used the app; 86% launched it within one day of enrollment. Average use was 11 times over the course of the study, 55% were considered highly engaged (consistently used app over the course of study). Participants were most likely to access curriculum (articles and videos) about insulin pen therapy followed by living with diabetes. Most participants found the app easy to use (75%), visually appealing (81%), to contain helpful content, especially articles (77%); 73% said that they would recommend the app to another person with diabetes. Educators reported high satisfaction and a positive experience in using the app. Conclusion: The BD Diabetes Care App offers a promising approach to support patients starting and using insulin. Disclosure L. M. Siminerio: Advisory Panel; Self; Abbott Diabetes, Bayer U. S., Research Support; Self; Becton, Dickinson and Company. L. L. Bednarz: Other Relationship; Self; Medtronic, Tandem Diabetes Care. C. Dejesus: None. J. Ng: Research Support; Self; Sanofi-Aventis. S. L. Reynolds: None. J. S. Krall: Research Support; Self; Becton, Dickinson and Company, Sanofi. Funding BD

Diabetes self-management education and support (DSMES) is known to improve diabetes treatment outcomes, but this limited resource is not always targeted toward the highest risk patients in current models of care. Predictive modeling, which relies on large data sets to predict outcomes, is one tool which can be used to direct resources to patients with the greatest need for these services. University of Pittsburgh Medical Center (UPMC) diabetes care providers along with members of the clinical analytics team created a predictive model, including patient age, HbA1c, and insulin use among other factors, to assess individual patient risk of future poor glycemic control. The model was applied to patients who received DSMES via diabetes care and education specialists (DCES) from December 2018 to December 2020 to evaluate the impact of DSMES according to risk strata. Patients were categorized into high, medium and low risk groups based on clinical data prior their initial DSMES encounter. HbA1c change was calculated using the HbA1c prior to DSMES and most recent HbA1c. Of 1,247 patients eligible for retrospective assessment, 50% were categorized as low risk (n=621), 4% (n=55) medium, and 46% high risk (n=571). Mean HbA1c change after DSMES was -0.54% for low risk, -0.72% for medium risk, and -1.19% for the high risk group. Mean HbA1c after DSMES was 7.6% for low risk, 9.7% for medium risk and 9.6% for high risk patients. 57.5% of low, 59% of medium and 46.6% of high risk patients were seen by an endocrinologist. In this analysis, high risk patients who received DSMES had larger improvement in HbA1c and were less likely to be seen by an endocrinologist. To optimize utilization of diabetes care regarding DCES, predictive modeling can be used to target resources to the highest risk patients. Disclosure M. Zupa: None. J. S. Krall: Research Support; Self; Becton, Dickinson and Company, Sanofi. K. Collins: None. J. Ng: Research Support; Self; Sanofi-Aventis. L. M. Siminerio: Advisory Panel; Self; Abbott Diabetes, Bayer U. S., Research Support; Self; Becton, Dickinson and Company. Funding National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK007052-45)

Ongoing support is critical to DSMES effectiveness, but difficult to realize, particularly in underserved areas with limited resources. The purpose of this study, initiated February 2020, was to evaluate the feasibility and acceptability of Telemedicine for Reach, Education, Access, Treatment, and Ongoing Support (TREAT-ON), a DSMES model delivered primarily through direct-to-home videoconferencing. Methods: High risk patients with diabetes (A1c >9% or unplanned care) from rural federally qualified health centers were referred to TREAT-ON. Participants completed an initial face-to-face or virtual visit with a Diabetes Care and Education Specialist (DCES) to assess needs and develop self-management treatment plan and behavioral goals. Planned follow-up visits, used to support achieving and sustaining goals and outcomes, were conducted through videoconferencing. To assess feasibility and acceptability over first 3-months of participation, visit frequency, duration, completion rates, and technology issues were tracked and patients completed the Telehealth Usability Questionnaire (TUQ). Results: Participants (n=25) were 60% female, 92% White, mean age 47.6±13.6y, mean A1c 11.5±1.8% and 76% had Medicare or Medicaid. They participated in 3 video visits, on average, lasting a mean of 35 minutes/visit. Of all scheduled video visits (n=99), 71% were successfully completed and 23% had technology issues (difficulty setting up system, connectivity issues). The TUQ revealed that participants were highly satisfied with the TREAT-ON videoconferencing approach (4.7/5), finding it useful (4.5/5), easy to learn/use (4.5/5), reliable (4.3/5), with quality interface (4.6/5) and interaction (4.7/5). Conclusion: This telehealth DSMES model offers a promising approach to improve opportunities for ongoing support to vulnerable individuals in underserved communities. Disclosure J. S. Krall: Research Support; Self; Becton, Dickinson and Company, Sanofi. J. Ng: Research Support; Self; Sanofi-Aventis. P. A. Johnson: None. S. L. Reynolds: None. L. M. Siminerio: Advisory Panel; Self; Abbott Diabetes, Bayer U. S., Research Support; Self; Becton, Dickinson and Company. Funding National Institute of Diabetes And Digestive and Kidney Diseases (R34DK123370)

Surgery especially in the emergent setting carries higher rates of morbidity and mortality. The aim of our study was to evaluate the impact of preoperative anemia on outcomes for patients undergoing colectomy for acute diverticulitis in both elective and emergent settings. We performed a 4-year analysis of the ACS-NSQIP and included adult patients with acute diverticulitis who underwent colectomy. Patients were stratified into two groups based on preoperative hemoglobin levels, preop anemia and no-preop Anemia. Outcome measures were 30-day complications, anastomotic leaks, readmissions, mortality, and intra-/postoperative blood transfusion. We also performed a sub-analysis for patients who underwent emergent colectomy. Six thousand nine hundred sixty-three patients were included in the analysis, of which 37% (n = 2571) had preoperative anemia. Patients in the anemia group were more likely to have higher ASA class and receive blood 72-h preoperatively (5.4% vs. 0.2%, p

OBJECTIVES The purpose of this study was to examine the association between food insecurity and untreated dental caries using a nationally representative sample of US adults. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014 on adults aged 18 years and older were analysed (n = 10 723). Primary predictors were overall food security (food-secure/ food-insecure) and household food security (full, marginal, low and very low). The main outcome was any untreated dental caries (none/ ≥ one). Multiple logistic regression analyses were done to estimate the adjusted odds ratio after controlling for confounders. RESULTS Food-insecure adults were more likely to have untreated dental caries than food-secure adults after adjusting for potential confounders (OR: 1.2; 95% CI: 0.9-1.5). Adults from households with marginal (OR:1.4; 95% CI:1.5-2.2), low (OR:1.3, 95% CI:1.3-2.0) and very low food security (OR:1.3; 95% CI:0.9-1.5) had higher odds of untreated caries than adults from households with full food security. Following age stratification, marginal, low and very low food-secure adults had higher prevalence of untreated dental caries than full food-secure adults across all age groups. CONCLUSIONS Our findings suggest that food-insecure adults had higher odds of untreated dental caries than food-secure adults. These findings highlight the importance of assessing food insecurity as a risk factor for dental caries. Longitudinal cohort studies are recommended to determine causal mechanisms.

Article Title and Bibliographic Information Association between metabolic syndrome and tooth loss: A systematic review and meta-analysis. Souza ML, Massignan C, Glazer Peres K, Aurelio Peres M. J Am Dent Assoc 2019;150(12):1027-1039.e7. Source of Funding Government. Foundation for Research and Innovation Support of Santa Catarina State (Brazil), Coordination of Improvement of Higher Level Personnel (Brazil). Type of Study/Design Systematic review with meta-analysis of data.

Background:The use of regenerative medicine, such as autologous chondrocyte implantation (ACI), matrix associated stem cell therapy (MAST) and bone marrow derived stem cell therapy against arthritis is the gold standard for certain indications. However, the clinical improvement of patients using these novel therapies remains heterogeneous and the reasons for this are not fully understood. The impact of age is always a concern for patients and doctors and elderly patients can only be mobilized with lower total collected CD34+ cells, older age correlates with inferior results, fatty degeneration of the bone marrow, delayed fracture-healing and osteoporosis, but solid data are missing. Purpose:This is the first study to determine the average quantity of leukocytes and CD 34+ cells and their relationship in human bone marrow. Study design: Descriptive Laboratory Study Methods:We evaluated the laboratory results of 873 patients (aged 1-90 years), who underwent stem cell transplantation for non malignant diseases. Results:We found no age-related decrease regarding the number and the vitality of leukocytes and CD 34+ stem cells. The number of bone marrow derived leucocytes and CD 34+ cells showed a strong and significant correlation.Conclusion:The amount of bone marrow derived stem cells can be predicted by leukocytes. This study makes further research possible in order to link clinical outcome to the absolute number of stem cells and leukocytes.An upper age-limit for stem cell therapy can therefore not be defined from the donor-site perspective.Clinical Relevance:The number of leucocytes might be used to predict the amount of stem cells in order to select the ideal patient.

Advanced sensing technologies, driven by the Internet of Things, have caused a sharp increase in data availability within the healthcare system. The newfound availability of data offers an unprecedented opportunity to develop new analytical methods to improve the quality of patient care. Data availability, however, is a double-edged sword. Malicious attacks and data breaches are increasingly seen in the healthcare field, which result in costly disruptions to operations. Adversaries exploit analytic models to infer participation in a dataset or estimate sensitivity attributes about a target patient. This paper is aimed at developing a differentially private gradient-based mechanism and assessing its utility in mitigating the impact of these attack risks within the context of the intensive care units. Experimental results showed that this methodology is capable of greatly reducing the risk of model inversion while retaining model accuracy. Thus, health systems that employ this technique can be given more peace of mind that high-quality services can be delivered in such a way that privacy is preserved.

Adolescents and young adults (AYA) with DM have increased risk of poor outcomes. The DTP was created to equip AYA with knowledge, support, and skills to foster successful lifelong DM self-management. This 1-year (4 visits) program pairs clinical care with peer-group discussions led by a multidisciplinary team focused on informed decision making of issues relevant to AYA with DM. The purpose of this study was to characterize the population referred to DTP and evaluate concerns, program adherence and outcomes. Medical records were reviewed and surveys administered. To date 153 AYA were referred (51% females, 99% T1DM, age at 1st visit 18.8±1.4 yrs, age at onset 9.7±4.7 yrs, HbA1c 9±2%). In ranking concerns of 5 complications (retinopathy, neuropathy, reproductive health complications, nephropathy and hypertension) at the 1st DTP visit, 60% of males and 57% of females who completed the survey rated retinopathy as their number 1 or 2 concern. Reproductive health and hypertension were listed as their least concern by 43% of males and 42% of females respectively. In terms of program adherence, the majority (60%, n=92) completed DTP on schedule (1 year). Of these, 42% transferred to adult care, 52% continued care at the institution and 6% were lost to follow up. Of those who did not complete DTP over 1 year (40%), 25% transferred to adult care before DTP completion, 60% are completing DTP in more than 1 year, and 15% were lost to follow up. Those who transferred to adult care (irrespective of program completion time), versus those who did not, had lower HbA1c at all DTP visits (e.g., 1st visit: 8.1 ± 1.4% vs. 9.4 ± 1.7%, p=0.01). In terms of outcomes for those that completed the program, no differences were found in HbA1c from the 1st to 4th visit. In conclusion, AYA referred to DTP appear to be a high-risk population based on their HbA1c and suboptimal program adherence. This highlights the need for methods (e.g., telehealth) to continue to engage this population and ongoing self-management support. Disclosure I. Libman: Consultant; Self; Novo Nordisk A/S. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. A.F. Fischl: None. J. Finney: None. A.M. Diaz: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. D. Charron-Prochownik: None. D.J. Becker: None. Funding David Paul Diabetes Transition Care Research Initiative Fund

With 1.5 million Americans diagnosed with diabetes mellitus (DM) annually, 84.1 million with prediabetes, and 245 billion in medical costs, efforts to characterize those at highest risk are warranted. Predictive modeling is a methodology that can proactively identify patients and allocate resources like a DM education intervention, known to ensure effective, cost-saving care. Members of the University of Pittsburgh Medical Center (UPMC) endocrine division partnered with the Clinical Data Analytics Department to develop a predictive model using clinical data from patient electronic medical records (EMR), Medical and socioeconomic profiles were used to predict future glycemic control from any patient with a type 2 DM diagnosis or any patient with two HbA1c readings ≥6.5% within 1 year. SHapley Additive exPlanations (SHAP), atheoretic approach used to explain output of a machine learning model, was used to analyze variables of 38,173 patients meeting inclusion criteria. Prior elevated HbA1C levels, younger age at presentation, and previous insulin therapy provided the highest prediction of future poor glycemic control. Predictive modeling is a useful method to foretell future glycemic control. Identifying patients at “high risk” for poor outcomes can allow for efficient deployment early in the disease course for DE services proven to improve outcomes with the potential to reduce health care costs. Disclosure H. Alquadan: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. J. Ng: None.

Background: AYA women with T1D are vulnerable to poor glycemic control which could increase their risks of RH complications. ADA recommends starting preconception counseling (PC) at puberty. Purpose to explore concerns for and preventative behaviors regarding RH complications in AYA females with T1D. Methods: New AYA patients attending a diabetes transition clinic at a pediatric teaching hospital completed a short survey on concerns for diabetes-related complications and preventative actions taken: ranking their concerns on a scale 1=most important to 5=least important from a list of five complications. They identified any actions ever taken to prevent complications by a list of items and an open-ended response. This reports on female participant (n=49; ages 17-22) responses regarding RH complications at baseline prior to any peer-group information sessions. Descriptive analyses were used for quantitative and qualitative data. Open-ended data were clustered and analyzed to identify themes with 2 researchers reaching agreement. Results: Only 29% of AYA female participants (n=14) ranked RH complications as most important concern (rank of 1) and 12% (n=6) ranked it as important (rank of 2); while 20% (n=10) ranked RH complications as least important (rank of 5). Several participants (n=33) checked off one or more behaviors they have taken to prevent RH complications (e.g., control glucose, discussed family planning with health provider). Themes for ’other preventative actions’ remained broad, “healthy lifestyle” and “self-management.” Almost all (88%; n=29/33) believe RH complications can be prevented. Conclusion: Less than half of AYA females ranked RH complications as an important concern, which could reflect unawareness. Although most have taken some general preventive actions, enhancing other more specific behaviors to decrease their risks that were not identified could be targeted for future interventions through PC. Disclosure D. Charron-Prochownik: None. A.F. Fischl: None. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. J. Finney: None. H. Abujaradeh: None. D.J. Becker: None. A.M. Diaz: None. I. Libman: Consultant; Self; Novo Nordisk A/S. Funding David Paul Diabetes Transition Care Research Initiative Fund