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PurposeThe study seeks to examine the effectiveness of implementing the ISO 9001 quality management system (QMS) on small and medium enterprises (SMEs) performance in Saudi Arabia. It explores ISO 9001 usefulness through the dimensions of continuous improvement, customer satisfaction focus and prevention of nonconformities. The study investigates two dimensions of firm performance's: operational performance and product/service quality.Design/methodology/approachThe study employs a quantitative method. A simple random sampling technique is used to collect study samples. A self-administered questionnaire is employed as the data collection tool. The study was based on 263 samples from SMEs in Saudi Arabia. Statistical analysis was carried out using SPSS/AMOS.FindingsPrevention of nonconformities, customer satisfaction focus and continues improvement had a positive significant correlation with operational performance and product/service quality. Moreover, the ISO 9001 QMS effectiveness construct showed a helpful and important correlation with the performance of the company.Originality/valueThe study offers empirical evidence to clarify ambiguous findings from past studies, as well as expounds knowledge on the effect of ISO 9001 on SMEs' performance through the lenses of operational performance and quality/service quality.

Purpose The purpose of this paper is to investigate the relationship between entrepreneurial orientation (EO) and firm performance (FP) through the mediating role of absorptive capacity (AC) in small and medium enterprises (SMEs) in the Kingdom of Saudi Arabia (KSA) as an emerging economy. Design/methodology/approach This paper used a quantitative research design. Data was collected using a self-administered online questionnaire. The study was based on 366 samples from Saudi Arabian workers at SMEs. Statistical analysis was carried out using SPSS/AMOS 26. Findings The paper provides empirical insights. It suggests the positively mediating role of AC in the relationship between EO and FP. The authors found a full positive mediating role of AC in the relationship between EO and FP in SMEs in the KSA. Research limitations/implications The study empirically confirms the role of EO through AC in enhancing a firm’s performance. Additionally, the research findings support SME owners and managers in increasing their firms’ performance by implementing AC dimensions (assimilation and acquisition) with existing entrepreneurial characteristics to boost and increase business and performance. Regardless of the implications, this paper has some limitations. For instance, this study was conducted only on SMEs in Saudi Arabia. Therefore, future researchers are encouraged to extend the study to other organization sizes or to extend the study to other industries. Originality/value This study contributes to the literature by demonstrating the importance of AC’s mediating role in EO’s impact on FP, extending the previous studies in the area. Moreover, this research investigates the study themes in a relatively new context, specifically SMEs in the KSA.

Background Diabetes mellitus is a common disease in Saudi Arabia. Patients with chronic diseases, such as diabetes, tend to use complementary and alternative medicine (CAM) either as an addition or alternative to their medical therapy. Many studies have evaluated the CAM herbal products used by patients with diabetes; however, there have been few and inconsistent studies on other types of CAM, and most studies on CAM have focused on their use in type 2 diabetes. Objective This study aimed to determine the prevalence and patterns of CAM use among patients with type 1 or type 2 diabetes in Riyadh, Kingdom of Saudi Arabia. Methods This cross-sectional study was conducted in an adult Saudi population at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Data were collected from December 2019 to February 2020 using a data collection form and patient interviews. Results We included 332 patients, 43% of whom had type 1 diabetes; 26% of the patients had previously used one or more types of CAM. Approximately 53% of CAM users had glycated hemoglobin (HbA1c) level of ≥9%. Among CAM users, 51% mentioned that their blood sugar readings were improved with CAM treatments. Mind-body therapy was the most commonly used CAM (54%), followed by biologically based CAM, including herbs (46%). The most commonly used herbal supplements were black cumin (42%), followed by fenugreek (28%), myrrh (24%), frankincense (22%), cinnamon (15%), garlic (15%), and onion (15%). Older age and employment status were predictors of CAM use in Saudi patients with diabetes. The main sources of knowledge about CAM were from family and friends. Conclusions CAM use is common among Saudi Arabian patients with diabetes. Patients with diabetes who are aged65 years and employment status were the main predictor of CAM use. Assessing CAM use is an important aspect of clinical encounters with Saudi patients, especially patients with type 1 diabetes.

Objectives: This study aimed to explore Saudi Arabian medical students’ perceptions of patient safety. Methods: A cross-sectional descriptive study was conducted in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, in September 2019. The Attitudes to Patient Safety Questionnaire (APSQ III) was used to explore undergraduate medical students’ attitudes towards and knowledge of PS. The main outcomes measured were the APSQ III’s nine domains. Data were analysed using Statistical Package for the Social Sciences and students’ attitudes were communicated as mean scores ± standard deviations. Results: A total of 301 participants were included in this study (response rate: 85.75%). Six domains reflected a positive attitude while three domains showed a neutral attitude. The domain of ‘team functioning’ had the highest mean score (5.8) followed by ‘working hours as a cause of error’ (5.6) and ‘error inevitability’ (5.4). There was a significant difference between gender in the domain ‘patient involvement in reducing error’ (P = 0.012) and ‘importance of patient safety (PS) in the curriculum’ (P = 0.001). In addition, the ‘importance of PS in the curriculum’ domain was significantly different across different age groups (P = 0.039). Conclusion: Medical students were highly interested in PS and recommended implementing a comprehensive undergraduate PS programme to fulfil their educational needs. Keywords: Undergraduate Medical Education; Patient Safety; Medical Errors; Attitude; Medical Students; Medical Ethics; Patient Care; Saudi Arabia.

BACKGROUND: Thyrotoxicosis is a common medical problem. Thyroid nuclear imaging with either I 123 or technetium-99m (Tc-99m) pertechnetate are used to determine the cause. Although I 123 has been the standard technique, Tc-99m pertechnetate is now commonly used, acceptable and easier to perform. The commonly used normal value of Tc-99m pertechnetate is 1–4%, but lower normal values have been reported in different populations. OBJECTIVE: Determine normal reference range of Tc-99m pertechne-tate thyroid uptake for thyroid scintigraphy in Saudi Arabia. DESIGN: Retrospective, cross-sectional. SETTING: Nuclear medicine service at tertiary care center in Riyadh. PATIENTS AND METHODS: We used data from biochemically euthyroid patients who underwent a thyroid Tc-99m pertechnetate scan while having parathyroid scintigraphy for hyperparathyroidism between April 2009 to April 2019. Medical records and biochemical thyroid function tests were reviewed and Tc-99m pertechnetate thyroid uptake values were determined for each patient. MAIN OUTCOME MEASURES: Thyroid uptake of Tc-99m pertechne-tate in euthyroid patients. SAMPLE SIZE: 167 RESULTS: The mean and median uptake of Tc-99m pertechnetate in euthyroid patients were 0.86% and 1.0%, respectively, and the inter-quartile range was 0.0–1.0%. The normal reference range in the study population was 0.2-2%. Thyroid uptake inversely correlated with age in females (r=−0.37, P P =.001), and for all patients (r=?0.39, P CONCLUSION: The range for normal thyroid Tc-99m pertechnetate was lower than the standard 1-4% range. Moreover, uptake decreased with age. Further studies are needed to establish the normal age-adjusted uptake for the thyroid Tc-99m pertechnetate scan. LIMITATIONS: Single center and retrospective. CONFLICT OF INTEREST: None.

Acromegaly is a rare disease resulting in clinical sequelae with significant morbidity and mortality due to the central tumor mass effect and prolonged growth hormone (GH) hypersecretion. The goal is to describe the epidemiology, clinical features, presence of comorbidities, and treatment outcomes of acromegaly in Saudi Arabia. Data was collected through a retrospective review of the charts of all patients diagnosed with acromegaly from nine major hospitals in Saudi Arabia over a period of more than 25 years. A total of 195 patients (116 males and 79 females), with a mean age at diagnosis of 43 ± 12 (males) and 46 ± 14 years (females), from nine major hospitals were identified and included in the analysis. All cases were caused by pituitary adenomas, of which 92.4% were macroadenomas. Headache, coarse facial features, acral growth, and sweating/oily skin were by far the most frequent presenting complaints. The most common comorbidities were diabetes mellitus (51.7%), followed by hypertension (50%) and visual field defect (30.5%). The vast majority (95%) of patients were treated surgically (98%). Twenty-four percent also received radiotherapy, and 74.4% received medical therapy. When stringent criteria were applied for assessment of outcomes of therapy, 28.7% of the patients were cured and 30.1% had their disease under control, while 28.7% were found to have active disease despite receiving multimodal therapy. Our findings highlight the need for a national acromegaly registry to enable early identification, evaluation, and selection of the best therapeutic approaches to improve the outcome and remission rate of the disease.

Introduction Medical students’ knowledge assessment is a challenge. Multiple-choice questions (MCQs) despite their limitations are commonly used for this purpose. The Concept Retrieval Technique (CRT) is a relatively new knowledge assessment method. In this study we investigated the use of CRT to assess a particular long-term knowledge of medical students from different study levels. Method One hundred forty-four medical students (50% females) participated in an Endocrinology CRT exam. The students were either in fourth, fifth-or sixth-year of the medical program. Fourth-year students were tested before they received an endocrinology course whereas students from the fifth- and sixth-year respectively took the course ten and twenty-four months before being tested. The CRT was rated by two raters independently. Results There was strong effect of year of study on the CRT score. Fourth-year students scored significantly lower than fifth- and sixth-year students. No significant differences in CRT score emerged between fifth- and sixth-year students. The inter-rater agreement was acceptable indicating that the CRT is a reliable assessment method. The CRT showed construct validity. Conclusion The CRT is an assessment tool that could assess long-term knowledge retention properly, and has the ability to differentiate students according to their study level.

Objective To predict the risk of malignancy in category III of the Bethesda System for Reporting Thyroid Cytopathology "Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS)" at King Abdulaziz Medical City, Riyadh, Saudi Arabia. It also intends to determine other possible contributing predictors of malignancy in thyroid nodules such as age, sex, and ultrasound (US) findings. Method This retrospectively designed study included 187 patients (mean age, 43.9 ± 14.1 years) with thyroid nodules, which were diagnosed as AUS/FLUS and all patients included had total thyroidectomy or lobectomy between January 2013 and December 2018 at King Abdulaziz Medical City in Riyadh, Saudi Arabia. The electronic medical records, US images, and final cytopathology and histopathology reports were reviewed and analyzed. Result The overall incidence of AUS/FLUS was (46.5%). Multivariate analysis of US features revealed that malignancy was significantly associated with nodules with irregular margins, microcalcification, multiple numbers (P < 0.001), and hypoechogenicity (P 0.04). Conclusion Despite the high rate of malignancy of nodules AUS/FLUS, it is still consistent with previously reported studies. The highly suspicious ultrasound features (irregular margins, microcalcification, multiple nodules, and hypoechogenicity) could be helpful in the diagnosis of thyroid cancer.

Background: While the association between depression and hypothyroidism is well established, the prevalence of depression among patients with hypothyroid who are being treated with levothyroxine in Saudi Arabia is still unknown. This study aimed to investigate the latter, as well as to explore the factors associated with depression among these patients. Methodology: A descriptive cross-sectional study using consecutive sampling was conducted at the National Guard Health Affairs, Riyadh, Saudi Arabia. The Patient Health Questionnaire-9 was used to assess the prevalence and levels of depression among patients with hypothyroidism, who were being treated with levothyroxine. The data were analyzed using Statistical Package for the Social Sciences version 20.0 software. Results: The study included 130 patients, of whom 89% were female. The prevalence of depression among hypothyroid patients was 70% (95% CI: 62%-78%), 30% had no/mild depression, 27% had moderate depression, and 43% had moderately severe/severe depression. There was a significant association between the prevalence of depression and lower levels of education up to high school (68%), patients older than 30 years of age (85%), and married/widowed patients (83%). Patients with moderately severe/severe depression had more difficulties in performing daily-life activities (91%), as well as higher levels of thyroid-stimulating hormone (TSH) of 2.91 mIU/l (Interquartile range: 1.60-7.05). Conclusions: There was a significant association between the prevalence of depression and hypothyroid patients who were being treated with levothyroxine, specifically in older patients, those with lower levels of education, and those with high TSH levels.

Awad Alshahrani,1–3 Mohammed AlDubayee,1–3 Mahmoud Zahra,3 Firas M Alsebayel,3 Nawaf Alammari,3 Faisal Alsudairy,3 Muath Almajed,3 Ahmad Aljada4 1Department of Medicine, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Kingdom of Saudi Arabia; 2King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Kingdom of Saudi Arabia; 3College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; 4Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Ahmad AljadaDepartment of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Kingdom of Saudi ArabiaTel +966 112158 834Email aaljada@alfaisal.eduBackground: Interactions between environmental factors, such as diet and lifestyle, and metabolic pathways are pivotal in understanding aging mechanisms. hNAA40, Nicotinamide phosphoribosyltransferase (NAMPT), and NAD-dependent protein deacetylase sirtuin-1 (SIRT-1) have been shown to exert important biological processes, including stress response and aging.Methods: hNAA40, NAMPT, and SIRT-1 mRNA expression in peripheral blood mononuclear cells (PBMC) were quantitated in 30 lean adult volunteers of normal weight, 30 obese, 20 drug-naïve obese Type 2 diabetes mellitus (T2DM), and 30 obese T2DM on Metformin. Similarly, hNAA40, NAMPT, and SIRT-1 expression in PBMC were quantitated in 36 normal healthy adults randomly assigned to three different groups (Glucose or Whey proteins or lipids; 300 kcal). Blood samples were obtained at 1, 2, and 3 hrs after the macronutrient intake.Results: There was an increase in hNAA40 and a decrease in NAMPT and SIRT-1 expression in PBMC from T2DM. Metformin treatment reverted hNAA40, NAMPT, and SIRT-1 expression levels to normal levels. Glucose intake resulted in a significant increase in expression of hNAA40 at 1 hr and decreased significantly at 3 hrs post intake. Lipid intake resulted in an increase in expression of hNAA40 at 2 hr post intake and returned to normal levels at 3 hrs. Neither glucose nor lipid intake resulted in a significant change in NAMPT or SIRT-1 expression. Whey proteins resulted in significantly lower expression of NAMPT at 3 hrs and did not alter the expression levels of SIRT-1 significantly.Conclusion: hNAA40, NAMPT, and SIRT-1 pathway could play a role in the determination of the healthy life-span. Metformin modulates this pathway.Keywords: hNAA40, nicotinamide phosphoribosyltransferase, NAMPT, sirtuin-1, T2DM, obesity, senescence

Background Vitamin D deficiency is a prevalent condition worldwide. Identification of optimal supplementation approaches for maintaining normal vitamin D level in healthy adults is still required. It has been clearly established that sun exposure and diet do not provide the recommended daily amount of vitamin D, and that vitamin D supplementation is needed to maintain normal levels in the Saudi population. The aim of this study was to compare the efficacy of two regimens, monthly and bimonthly doses of 50,000 International Units (IU) cholecalciferol (vitamin D3), in maintaining normal serum levels of 25-hydroxyvitamin D in Saudi adults. Methods This study was a randomized controlled trial conducted to compare the efficacy of three regimens in maintaining a normal level of vitamin D in adult individuals. The study took place at three primary healthcare centers in King Abdul-Aziz Medical City, Riyadh, Saudi Arabia. A total of 65 participants were enrolled and randomly divided into two intervention groups and one control group. All participants were contacted by researchers and followed up at their corresponding primary health care center for two successive visits. Results All 65 participants completed the study. The participants were mostly females (49; 75.4%); the mean age was 42.1 years (±13.5). The difference in vitamin D levels after three months of the trial was statistically significant among the three groups. A decrease in vitamin D level was recorded in the control group and in the once monthly intake of 50,000 IU group. The bimonthly intake of 50,000 IU group maintained statistically significant vitamin D levels > 75. Conclusion Bimonthly vitamin D3 supplementation appears to be an efficient regimen for maintaining a normal level of 25(OH)D, regardless of the amount of vitamin D obtained from diet and sun exposure.

Mohammed Al Dubayee,1– 3 Awad Alshahrani,1– 3 Dana Aljada,4 Mahmoud Zahra,5 Ahmed Alotaibi,1 Ibrahim Ababtain,1 Malik Alnaim,1 Ali Alahmari,1 Abdullah Aljarallah,1 Muhammad Affan Elahi,5 Hana MA Fakhoury5 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; 2King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; 3Department of Medicine, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia; 4College of Liberal Arts and Sciences, Hofstra University, Hempstead, NY, USA; 5Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi ArabiaCorrespondence: Mohammed Al DubayeeCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), P.O. Box 22490, Riyadh, Saudi ArabiaTel +966 11 801 1111 ext: 53551Email ALDUBAYEEMO@ngha.med.saIntroduction: Insulin resistance in obesity and type 2 diabetes mellitus (T2DM) is associated with cardiovascular complications such as atherosclerosis. On the other hand, the reduction of apoptosis in macrophages has been linked with accelerated atherosclerosis. Apoptosis is controlled by a different family of proteins including Bcl-2 and caspases.Methods: To examine apoptosis in insulin resistance, we assessed the mRNA expression by qRT-PCR of several Bcl-2 family members, as well as caspase-3, − 7, − 8, and − 9 in peripheral blood mononuclear cells (PBMCs) isolated from lean, obese, diabetic, and diabetic on metformin individuals.Results: PBMCs of diabetic individuals exhibited reduced expression of caspase-7 and increased expression of Bcl-10, Bad, Bax, Bid, and caspase-3. T2DM on metformin group had significantly higher Bad, Bax, and caspase-7 expression.Discussion: The moderate up-regulation of pro-apoptotic Bcl-10, Bax, Bad, Bid, and the effector caspase-3 coupled with inhibition of caspase-7 in circulating PBMCs of T2DM could be the result of increased inflammation in T2DM. Metformin treatment significantly inhibited the expression of Bcl-10, Bid, and caspase-3 and upregulated Bad/Bax/caspase-7 pathway suggesting the activation of Bad/Bax/caspase-7 apoptotic pathway. Further studies are warranted to elicit the underlying apoptotic pathways of PBMCs in T2DM and following metformin treatment.Keywords: apoptosis, T2DM, peripheral blood mononuclear cells, PBMC, caspase, BCl-10, BCl-2

Existing studies have predominantly explored the influence of supply chain resilience on the performance of firms in the context of developed economies. This study highlights the need for SMEs to be prepared to tackle uncertainties in business operations. Background: Small and Medium Enterprises (SMEs) play a critical role in every economy, and limited studies have highlighted the significance of resilience in the firms. Therefore, this study aims to determine the impact of supply chain resilience on SMEs’ performance in Saudi Arabia based on three dimensions of resilience, namely agility, robustness, and flexibility. It aims to investigate how they relate to the dimensions of SMEs’ performance, namely production performance and market/sales performance. This study also investigates the overall impact of supply chain resilience as a construct on SMEs’ performance. Methods: This study employed a quantitative research design to answer the research questions. A self-administered questionnaire was used to collect data. The study was based on 255 samples of managers in SMEs from Saudi Arabia. The hypothesized model has been tested using the SPSS/Amos 26. Results: Based on the findings, it has been found that supply chain agility and flexibility had a significant positive relationship with SMEs’ production and marketing/sales performances. Supply chain robustness demonstrated a significant positive relationship with SMEs’ production performance but not their marketing/sales performances. Overall, there was a significant positive relationship between supply chain resilience and SMEs’ performance. Conclusions: This study contributes to the body of literature on supply chain resilience by expounding knowledge on aspects such as agility, flexibility, and robustness. The study enhances our understanding of the role of supply chain resilience on SMEs’ performance in an emerging economy context.

Background: For a whole month, every year Muslims fast daily from dawn to sunset. Those with health conditions that put them at risk are exempted from fasting, yet most of patients with diabetes choose to fast. Clinical and metabolic complications of diabetes during this month are issues of concern for patients and their managing physicians. This study is designed to evaluate the impact of fasting Ramadan on safety of patients. Methods: A multicentercross-sectional survey was conducted in four hospitals under the Ministry of National Guard Health Affairs; King Abdulaziz Hospital,Al-Ahsa, Imam Abdulrahman bin Faisal Hospital, Dammam, King Abdulaziz Medicalcities, Riyadh and Jeddah. All patients with diabetes followed in the diabetes clinics of all four centers who fulfilled the study inclusion and exclusion criteria were approached within three months post Ramadan and consented for participation in the survey, then filled a self-administered validated questionnaire that consisted of 15 items. Results: Socio-demographic,clinical, and laboratory characteristics of 1438 patients with diabetes were analyzed. The majority 1207 (83.9%) had type II diabetes, and 828 (57.6%) were females.The mean age was 57.9 ± 14.9 years, and mean BMI 25.25 ± 5.39.The majority 1060 (73.7%) had concomitant diseases. 36 (2.5%)were on diet therapy alone, 147 (10.2%) on metformin monotherapy, and 261 (18.2%) on insulin therapy alone. The remaining 994 (69.1%) were on combination of insulin and oral agents. Health education was received on average by 688 (57.8%) of patients. Out of the 1191 (82.8%) who fasted the full month, 497 (41.7%) experienced acute glycemic complications. Multivariate analyses revealed that significant predictors for unsafe fasting were: type I diabetes [OR 1.8 (95%CI 1.2 - 2.8), p-value 0.007], insulin therapy [OR 1.8 (95% CI 1.4 - 2.3), p-value0.0001], previous history of breaking fast for glycemic reasons [OR 2.1 (95% CI1.5 - 2.9), p-value 0.0001], and not receiving health education [OR 1.6 (95% CI1.2 - 2.0), p-value 0.0006]. Blood sugar control, presence of concomitant diseases, and history of diabetes related hospitalization were not statistically significant predictors [(OR 1.25, 95% CI, 0.9 - 1.7, p-value 0.15),(1.3, 95% CI, 0.9 - 1.8, p-value 0.14), (1.1, 95% CI, 0.8 - 1.6, p-value 0.45)] respectively. Conclusion: A significant proportion of patients with diabetes do not receive specific education pertinent to fasting Ramadan. Lack of health education, in addition to; type I diabetes, insulin therapy, and previous experience of complications are predictors for unsafe fasting. This highlights the need for better structured educational programs and further research in the field.

Background: Fasting Ramadan is practiced by Muslims globally. Compliance with health team advice on ability to fast or not, medication and lifestyle adjustments are the corner stone of achieving optimal diabetes control and avoiding complications with fasting. We aimed in this study to evaluate the attitudes and practice of Muslim patients with diabetes during fasting Ramadan, and to assess their compliance with the medical instructions provided by their healthcare team. Methods: A cross-sectional study conducted in four Medical Centers under the Ministry of National Guard health affairs in four cities: Al-Ahsa, Dammam, Jeddah and Riyadh. All patients with diabetes followed in the diabetes clinics within three months post Ramadan and who met the study inclusion and exclusion criteria were approached and consented for participation in the study, and then filled a self-administered validated 15 items questionnaire. Results: Data for 1438 diabetics were analyzed; 1207 (83.9%) T2DM and 231 (16.1%) T1DM. The mean age was 57.9 ± 14.9 years. 270 (18.8%) suffered multiple comorbidities. 559 (46.3%) of T2DM vs 22 (9.5%) of T1DM were not familiar with the type of their diabetes. 883 (73.2%) of T2DM were on combination therapy. There was a significant difference between T1DM and T2DM in health education received from the treating physician 168 (72.7%) vs 574 (47.6%) and from a dietician 165 (71.4%) vs 613 (50.8%) (p Conclusion: The study shows low level of patient awareness and compliance to health providers advice. Results indicate prior hospitalization and being on insulin treatment as predictors of patient compliance. This signifies the need for better structured diabetes and fasting education programs. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Reaching good learning outcomes is not only dependent on the learning content; the teaching process itself needs to be enhanced by implementing pedagogical practices and exploiting the available technology. Most studies in the field of educational technology have focused on developing the learning content and resources while the instructors’ knowledge and expertise about the teaching process and pedagogical methods did not get sufficient attention. This have created a need to develop technological solutions that organize and facilitate the exchange of such knowledge. Best Teaching Practices (BTP) used by instructors in their daily teaching can be the ideal knowledge building blocks to expertise gathering, sharing and reuse. BTPs represent successful teaching experiences that have been used by instructors and have good effect on the teaching process and learning content understanding. This paper proposes a system that allows instructors to reuse their best teaching practices by providing them with an organized repository that automatically classify BTPs. In this paper we are interested in the classification of teaching computing courses using the standard computing classification of the Association for Computing Machinery (ACM).

This paper aims to explore the relationship that exists between the amount of hour’s employees in Northern Ireland, work per week, and their social wellbeing represented by the level of happiness and Health status. This study made use ofsecondary data adapted from the 2009 Northern Ireland Life and Times Survey (NILT). Also, the study provides an analytic account of factors that determine the number of hours spent at work. The paper indicates that in Northern Ireland, there is no significant correlation between the amount of hours employee spent at work and their social wellbeing. Also, the study found that other factors such as: care for someone at home, sex, employed or self-employed, employment status, thinking about work, and socio-economic group significantly predicts the amount of time an employee in Northern Ireland spends at work. The study concluded that the relationship between work hour and employee social wellbeing varies across countries and cultures.

mHealth is new technology that can help in the self-management of diabetes mellitus (DM), a highly prevalent metabolic disease. mHealth applications can enhance patient-provider communication, and improve health data capture and monitoring, patient education, and the provision of feedback. However, aspects related to the functions and content required in the application, as well as privacy, accuracy and the safety of patient data, should be managed. The use of mHealth in DM self-management can be optimized by overcoming technical, societal, and business barriers. Using appropriate behavioral change theories, the short and long-term effects of mHealth should be targeted. Providing interactive feedback is an important feature of any mHealth strategy, so as to ensure a closed-loop in DM management. Accuracy and validity of information included in the mHealth application is vital; therefore quality and appropriateness of the information should be assessed, and enhanced where necessary. Consideration for the perspectives of end-users is at the core of mHealth care. The effects of mHealth should be assessed in a real-world setting, rather than the current clinic-based studies. In conclusion, mHealth is a tool that provides an opportunity for integrated and coordinated DM care.

Background Although there is increasing evidence showing that cell senescence is increased in circulating PBMC in type 2 diabetes mellitus (T2DM), the data are contradictory. This study examined several senescence biomarkers, including LMNA/C transcript variants, p16INK4a, p53, and p21Cip1/WAF, in PBMC of T2DM patients and the effect of Metformin on these senescence markers. Methods Blood samples were obtained from 30 lean, 30 obese, 20 newly diagnosed type 2 diabetes mellitus (T2DM), and 30 T2DM on Metformin. PBMC were isolated and mRNA expression of the senescence biomarkers were quantified by RT-qPCR. The effect of ectopic expression of LMNA and LMNC in human monocytic cells lines (THP-1 and U937) on several inflammatory mediators were also examined. Results LMNA expression was significantly higher in PBMC of obese and T2DM patients. LMNC expression was significantly inhibited in T2DM patients. LMNAΔ10 and Progerin mRNA expression was not detected in PBMC of all groups. Expression of p16INK4a, p21Cip1/WAF and p53 were inhibited significantly in T2DM. Metformin treatment reverted LMNA, LMNC, and p53 expression levels to normal levels. Upregulation of LMNA in monocytic THP-1 and U937 cell lines induced CD68, TNFα, CCL2, IL-6 and NOS2. Conclusions These data support the notion that LMNA may mediate senescence in PBMCs of T2DM by upregulating inflammatory pathways. Metformin may exert its anti-inflammatory property by modulation of senescence mediator LMNA.

Background: Although peripheral blood mononuclear cells (PBMC) have been demonstrated to be in a pro-inflammatory state in obesity and type 2 Diabetes Mellitus (T2DM), characterization of circulating PBMC phenotypes in the obese and T2DM and the effect of Metformin on these phenotypes in humans is still ill-defined and remains to be determined. Methods: Thirty normal healthy adult volunteers of normal weight, 30 obese subjects, 20 obese newly diagnosed diabetics and 30 obese diabetics on Metformin were recruited for the study. Fasting blood samples were collected and PBMC were isolated from whole blood. Polarization markers (CD86, IL-6, TNFα, iNOS, CD36, CD11c, CD169, CD206, CD163, CD68, CD11b, CD16 and CD14) were measured by RT-qPCR. Gene expression fold changes were calculated using the 2ˆ(–delta delta Ct) method for RT-qPCR. Results: Obesity and T2DM are associated an increased CD68 marker in PBMC. mRNA expression of CD11b, CD11c, CD169 and CD163 were significantly reduced in PBMC from T2DM subjects whereas CD11c was significantly inhibited in PBMC from obese subjects. On the other hand, macrophage M1-like phenotype was observed in T2DM circulation as demonstrated by increased mRNA expression of CD16, IL-6, iNOS, TNFα, and CD36. There were no significant changes in CD14 and CD86 in the obese and T2DM when compared to the lean subjects. Metformin treatment in T2DM reverted CD11c, CD169, IL-6, iNOS, TNFα, and CD36 to levels comparable to lean subjects. CD206 mRNA expression was significantly upregulated in PBMC of T2DM while Metformin treatment inhibited CD206 expression levels. Conclusions: These data support the notion that PBMC in circulation in T2DM express different pattern of phenotypic markers than the patterns typically present in M1 and M2 like cells. These phenotypic markers could be representative of metabolically activated macrophages (MMe)-like cells. Metformin, on the other hand, reduces MMe-like cells in circulation.

Background: Three subsets of human monocytes in circulation have been identified and their characterization is still ill-defined. Although glucose and lipid intakes have been demonstrated to exert pro-inflammatory effects on mononuclear cells (MNCs) of healthy subjects, characterization of monocytes phenotypes following macronutrient (glucose, protein, and lipid) intake in humans remains to be determined. Methods: Thirty-six healthy, normal weight volunteers were recruited in the study. Subjects were randomly assigned into three groups, each group consisting of 12 participants. Each group drank equal calories (300 kcal) of either glucose or lipids or Whey proteins. Each subject served as his own control by drinking 300 mL of water 1 week before or after the caloric intake. Baseline blood samples were drawn at 0, 1, 2 and 3-hour intervals post caloric or water intakes. MNCs were isolated, and the expression levels of different cluster of differentiation (CD) markers (CD86, CD11c, CD169, CD206, CD163, CD36, CD68, CD11b, CD16, and CD14) and IL-6 were measured by RT-qPCR. Results: Equicaloric intake of either glucose or lipids or Whey proteins resulted in different monocyte phenotypes as demonstrated by changes in the expression levels of CD and polarization markers. Whey proteins intake resulted in significant mRNA upregulation in MNCs of CD68 and CD11b at 1, 2, and 3 hrs post intake while mRNA of IL-6 was significantly inhibited at 1 hr. Lipids intake, on the other hand, resulted in mRNA upregulation of CD11b at 2 and 3 hrs and CD206 at 1, 2 and 3 hrs. There were no significant changes in the other CD markers measured (CD86, CD163, CD169, CD36, CD16 and CD14) following either Whey proteins or lipids intakes. Glucose intake did not alter mRNA expression of any marker tested except CD206 at 3 hrs. Conclusions: Macronutrient intake alter the expression levels of polarization markers in MNCs of human subjects. A distinct population of different monocytes phenotypes may result in human circulation following the intake of different macronutrients. Further studies are required to characterize the immunomodulatory effects of macronutrients intake on monocytes phenotypes and their characteristics in humans.

The goal of this study is understanding phenomena which may help design electrode modifications enhancing efficiency of microbial fuel cells. Our hypothesis is that the rate of deposition is proportional to both composition of the outer cell membrane and the bulk concentration. We also suggest that ionic strength and ion identity can affect the efficiency of sticking after initial encounter. Shown here are electrochemical studies on effect of salt concentration on S. oneidensis MR-1 attachment and growth at ITO electrodes. Initial surface coverage of bacteria can be measured with respect to four metric. One metric is the observed lag time before currents increase during bacterial loading at the ITO surface. A second one is the current associated with that lag time. The third is the maximum anodic current that occurs after the lag period. Finally a cyclic voltammetric experiment following loading has a metric associated with the cathodic peak current. The peak current is very large for NaCl compare to CsCl. The final coverage (as measured by cathodic peak current in cyclic voltammetry, ipc) increases with increasing ionic strength (IS). We suggest that the behavior of cathodic peak current is very sensitive to the salt concentrations and bacteria harvest time. Our results clearly show a major difference in attachment and behavior of S. oneidensis MR-1 for NaCl compared to CsCl. CsCl inhibits all four metrics associated with loading at +0.2 vs Ag/AgCl (lag time, lag current, maximum loading current and cyclic voltammetric peak current).