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Background: Patients with uncontrolled type 2 diabetes mellitus (T2DM) require close follow-up, support, and education to achieve glycemic control, especially during the initiation or intensification of insulin therapy and self-care management. This study aimed to describe and evaluate the impact of implementing a hybrid model of in-person and telemedicine care and education on glycemic control for patients with uncontrolled T2DM (hemoglobin A1c [HbA1c] ?9%) during the coronavirus disease pandemic. Methods: This prospective multicenter-cohort pre-/post-intervention study was conducted on patients with uncontrolled T2DM. This study included three chronic illness centers affiliated with the Family and Community Medicine Department at Prince Sultan Military Medical City in Riyadh, Saudi Arabia. A hybrid model of in-person (onsite) and telemedicine care and education was developed. This involved implementing initial in-person care at the physicians' clinic and initial in-person education at the diabetes education clinic, followed by telemedicine services of tele-follow-ups, support, and education for an average 4-month follow-up period. Results: Of the enrolled 181 patients, more than half of the participants were women (n?=?103, 56.9%). The mean age of participants (standard deviation) was 58.64???11.23 years and the mean duration of diabetes mellitus was 13.80???8.55 years. The majority of the patients (n?=?144; 79.6%) were on insulin therapy. Overall, in all three centers, the hybrid model had significantly reduced HbA1c from 10.47???1.23% to 7.87???1.59% (mean difference of reduction 2.59% [95% confidence interval (CI)?=?2.34?2.85%], p?0.001). At the level of each center, HbA1c was reduced significantly with mean differences of 3.17% (95% CI?=?2.81?3.53%), 2.49% (95% CI?=?1.92?3.06%), and 2.16% (95% CI?=?1.76?2.57%) at centers A, B, and C, respectively (all p?

Determining the sex and age of individuals can be an essential element of conservation management, wildlife monitoring, and demographic analysis. For many members of the family Rallidae, distinguishing between males and females is challenging, even when the bird is in the hand. The Sora ( Porzana carolina ), a secretive rail that occupies freshwater wetlands throughout the United States and Canada, represents a species that is challenging to sex in the field. Morphometric measurements can help sex birds of an array of species, including rails. However, no comprehensive morphometric model has been fully validated for sexing Soras. We used DNA analysis to confirm the sex of Soras captured in the field and logistic regression models to determine which morphological features were the best predictors of sex. Measurements from 108 Soras (31 hatch year females (HY-F), 29 hatch year males (HY-M), 22 after hatch year females (AHY-F), and 26 after hatch year males (AHY-M) were used to create our logistic regression model. Color definition and connectivity of the auricular patch to eye or nape was used as an additional characteristic in adult birds. Our top-ranked model was further validated using a sample of 72 individuals exhibiting intermediate traits that would be particularly challenging to distinguish in the field. Our top performing model incorporated culmen length and tarsometatarsus length as the features most predictive of sex and had an overall accuracy of 85%. If higher accuracy is desired, an inconclusive band, which eliminates birds of low model score, i.e., scores indicative of inconclusive sex (below + or - 1.2), can be used. The accuracy of remaining birds (75% of sample) will be increased to 95%. Our model shows that simple measurements of culmen and tarsometatarsus is useful in discriminating the sex of a large percentage of live-caught Soras. This morphometric model will facilitate further demographic studies of this species and may be useful in designing morphometric studies of other species in the family Rallidae.

The present study examined the content of applied behavior analytic therapy (ABA therapy) on skill acquisition and intelligence test scores of twenty-eight children with autism and related disabilities. Using a randomized controlled trial, we compared (a) traditional ABA consisting of verbal behavior techniques developed by Skinner (Verbal behavior, Appleton-Century-Crofts, New York, 1957), (b) comprehensive ABA which added techniques post-Skinner's theory of language, and (c) waitlist control. Results obtained indicated that even though skill acquisition improved equally across both intervention groups compared to the control, highest intelligence score changes were shown for participants in the comprehensive ABA group (F: 2, 24 = 9.198, p = 0.001). With increasing emphasis on client outcomes, the present data suggest that when hours of intervention are kept constant, ABA service providers may be at an advantage by incorporating techniques that are typically considered beyond the traditional ABA ideas of Skinner's account of language development.

Diabetes mellitus is a metabolic disease characterised by elevated levels of blood glucose and is a leading cause of disability and mortality. Uncontrolled type 2 diabetes leads to complications such as retinopathy, nephropathy and neuropathy. Improved treatment of hyperglycaemia is likely to delay the onset and progression of microvascular and neuropathic complications.This article describes the efforts of 18 governmental hospitals in the Kingdom of Saudi Arabia that enrolled in a collaborative improvement project to improve the poor glycaemic control (HbA1c >9% to be less than 15%) of patients with diabetes by the end of 2021 among all the chronic illness clinics in the enrolled military hospitals. Enrolled hospitals were required to implement an evidence-based change package that included the implementation of diabetes clinical practice guidelines with standardised assessment and care planning tools. Furthermore, care delivery was standardised using a standard clinic scope of service that focused on multidisciplinary care teams. Finally, hospitals were required to implement diabetes registries that were used by case managers for poorly controlled patients.The project timetable was from October 2018 to December 2021. Diabetes poor control (HbA1c >9%) showed improved mean difference of 12.7% (34.9% baseline, 22.2% after) with a p value of 0.01. Diabetes optimal testing significantly improved from 41% at the start of the project in the fourth quarter of 2018, reaching 78% by the end of the fourth quarter of 2021. Variation between hospitals showed a significant reduction in the first quarter of 2021.The collaborative multilevel approach of standardising the care based on the best available evidence through policies, guidelines and protocols, patient-focused care and integrated care plan by a multidisciplinary team was associated with noticeable improvement in all key performance indicators of the project.

The present study examined the content of applied behavior analytic therapy (ABA therapy) on skill acquisition and intelligence test scores of twenty-eight children with autism and related disabilities. Using a randomized controlled trial, we compared (a) traditional ABA consisting of verbal behavior techniques developed by Skinner (Verbal behavior, Appleton-Century-Crofts, New York, 1957 (See CR61)), (b) comprehensive ABA which added techniques post-Skinner's theory of language, and (c) waitlist control. Results obtained indicated that even though skill acquisition improved equally across both intervention groups compared to the control, highest intelligence score changes were shown for participants in the comprehensive ABA group (F: 2, 24 = 9.198, p = 0.001). With increasing emphasis on client outcomes, the present data suggest that when hours of intervention are kept constant, ABA service providers may be at an advantage by incorporating techniques that are typically considered beyond the traditional ABA ideas of Skinner's account of language development., Author(s): Mark R. Dixon [sup.1], Dana Paliliunas [sup.1], Becky F. Barron [sup.1], Ayla M. Schmick [sup.1], Caleb R. Stanley [sup.1] Author Affiliations: (1) grid.411026.0, 0000 0001 1090 2313, Behavior Analysis [...]

Abstract Cytotoxicity is a vital effector mechanism used by immune cells to combat pathogens and cancer cells. While conventional cytotoxicity assays rely on averaged end-point measures, crucial insights on the dynamics and heterogeneity of effector and target cell interactions cannot be extracted, emphasizing the need for dynamic single-cell analysis. Here, we present a fully automated droplet-based microfluidic platform that allowed the real-time monitoring of effector-target cell interactions and killing, allowing the screening of over 60,000 droplets identifying 2000 individual cellular interactions monitored over 10 h. During the course of incubation, we observed that the dynamics of cytotoxicity within the Natural Killer (NK) cell population varies significantly over the time. Around 20% of the total NK cells in droplets showed positive cytotoxicity against paired K562 cells, most of which was exhibited within first 4 h of cellular interaction. Using our single cell analysis platform, we demonstrated that the population of NK cells is composed of individual cells with different strength in their effector functions, a behavior masked in conventional studies. Moreover, the versatility of our platform will allow the dynamic and resolved study of interactions between immune cell types and the finding and characterization of functional sub-populations, opening novel ways towards both fundamental and translational research.

Introduction: During the initial weeks of the COVID-19 pandemic, there was limited information and evidence about therapeutic interventions for management of COVID-19 infections. Consequently, fever clinics were established in Saudi Arabia to provide supportive treatment for all COVID-19 patients as specialised clinics. During the early months of 2020, Hydroxychloroquine (HCQ) was being used as part of the Saudi Ministry of Health (MoH) protocol for management of COVID-19 infections. Aim: To report the experience with implementing fever clinic utilising the HCQ-based protocol for adults with mild and moderate symptoms of COVID-19, and provide further evidence regarding the efficacy and safety of HCQ. Materials and Methods: A prospective observational study was conducted in one of the primary healthcare centres in Saudi Arabia. All patients with suspected or confirmed COVID19 who visited the fever clinic and met the eligibility criteria of starting HCQ based protocol were included in the study. Beside supportive treatment, the intervention dose of HCQ was 400 mg twice a day for one day followed by 200 mg twice a day for another four days. Statistical Package for Social Sciences (SPSS) version 22 was used for data analyses. Results: A total of 108 patients with mean age of 36 years with Standard Deviation (SD) of 9.3 were included in the study. The mean Body Mass Index (BMI) was 27.1 (SD 4.9). In addition, 73.1% of the patients were males and 25% were smokers. The study findings showed that the fever clinic was effective in managing the symptoms of COVID-19 and treating the patients regardless of the use or completion of HCQ. In particular, on day 6, cough improved in >85% of the patients and fever was resolved in >83% of patients. However, there were no statistically significant differences among the patients who received/completed HCQ and those who did not start or complete the protocol in terms of negative conversion based on the Nasopharyngeal (NP) swab real time Reverse-Transcriptase Polymerase Chain Reaction (RTPCR) by day 14, and resolution/improvement of symptoms on day 6 (p>0.05). Conclusion: This study documented the experience of implementing a fever clinic to manage the suspected and confirmed COVID19 patients with mild to moderate symptoms during the initial phase of the pandemic in Saudi Arabia. The study findings revealed that the concept of fever clinics was useful for managing suspected and confirmed cases. At the same time, there were no additional benefits of HCQ compared to the supportive treatment in this study.

Background and aim: Telemedicine could be used to provide diabetes care with positive clinical outcomes. Consequently, this study evaluated the cost-effectiveness of telemedicine for patients with uncontrolled type 2 diabetes mellitus (i.e. HbA1c >9). Patients and methods: This was a retrospective chart review of patients with uncontrolled type 2 diabetes attending an outpatient integrated care clinic. The study consisted of two arms, namely a telemedicine care model and a traditional care model with 100 patients in each. The clinical effectiveness (i.e. reduction in HbA1c) and the total cost in both arms were determined, and the incremental cost-effectiveness ratio was calculated. This study adopted propensity score matching. Results: The patients in the telemedicine care model had a mean reduction in their HbA1c level of 1.82 (95% CI = 1.56–2.09, p

This study describes high school students' use of smart technology to enhance leisure-time physical activity. Participants included 109 students who completed an informational survey comprised of questions examining non-school sport and physical activity hours, daily video game hours, and use of Kinect active video games and smartphone apps. Students engage in 1.99 hr/week of physical activity (SD = 1.13), play video games an average of 0.46 hr/day (SD = 0.69), and use 1.21 active video games (SD = 1.43) and 0.52 smartphone apps (SD = 0.75). Results show that students are minimally familiar with active video games and smartphone apps, but fail to meet physical activity recommendations set by the American College of Sports Medicine. Additionally, students can benefit immensely from structured instruction on health benefits and incorporation of such technology. Recommendations for application include explicit classroom instruction, teacher encouragement, and reinforcement throughout coursework.

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Context: Available therapies for type 2 diabetes mellitus (T2DM) do not adequately control glycemia in the long term as they do not address the issue of declining beta cell function and do not impact positively on weight or cardiovascular concerns associated with the disease. Aims: To measure changes in hemoglobin A1c, weight, and hypoglycemia after the addition of liraglutide to 3 therapeutic regimens of patients with T2DM. Settings and Design: An observational cohort study that was implemented in Al-Wazarat Health Center in Riyadh, Saudi Arabia. Methods and Materials: The study included 38 T2DM patients who were screened for initiation of liraglutide in combination with their treatment regimens; sulphonylurea, sulphonylurea with basal insulin (glargine), and multiple daily injections of insulin. The cohort was followed for 12 months, and the liraglutide was started with 0.6 mg dose that escalated to 1.2 and 1.8 mg. Glycemic level and weight were measured 3 times, whereas hypoglycemia was measured 2 times. Statistical Analysis Used: Quantitative continuous paired data were compared using a paired t-test and the nonparametric Wilcoxon signed rank test. Results: There was a statistically significant reduction of hemoglobin A1c with 1.2 mg dose (mean difference = 0.84%, P = 0.003). There were no statistically significant differences regarding the effect of liraglutide in addition to the 3 treatment regimens on patients' weight (P = 0.08, 0.472, 0.08, respectively). Regarding hypoglycemia, liraglutide has showed minimal effect. Conclusions: Sustained effect of liraglutide on glycemic control in patients with T2DM without any major hypoglycemic episodes.

The present study evaluated the efficacy of a stimulus-equivalence training procedure in teaching basic geography skills to two children with autism. The procedures were taken directly from a standardized training curriculum based in stimulus equivalence theory called "Promoting the Emergence of Advanced Knowledge Equivalence Module" (PEAK-E). Results suggest that the procedures were efficacious in directly training several geographical relations, as well as promoting the derivation of several untrained relations for three countries and their corresponding continents. In addition, responding generalized from selecting countries on a tabletop paper map to selecting countries on an interactive touchscreen map.

Patients with diabetes have a higher risk of severe infection and mortality due to COVID-19. Considering the current limited effective pharmacological treatments, vaccination remains one of the most effective means to control the pandemic. The current study aimed to determine the prevalence of COVID-19 infection and the rate of COVID-19 vaccination coverage among patients with type 2 diabetes mellitus. The patients were identified from a diabetes hospital registry at Prince Sultan Military Medical City, Riyadh, Saudi Arabia in July 2021. The history of COVID-19 infection and the vaccination status were retrieved from the National Health Electronic Surveillance Network (HESN) program and the Seha platform, respectively. A total of 11,573 patients were included in this study (representing 99.5% of all patients in the registry). A total of 1981 patients (17.1%) had a history of confirmed COVID-19 infection. The rate of vaccination with a 1st dose was 84.8% (n = 9811), while the rate of full vaccination with the 2nd dose was 55.5% (n = 6422). The analysis showed that a higher proportion of male patients were fully vaccinated than female patients (61.0% versus 51.2%, p < 0.001). There were statistically significant differences among the age groups, with the full vaccination rate ranging from 59.0% for the 61–70-year-old age group to 49.0% for the > 80-year-old age group (p < 0.001). The patients with no previous history of COVID-19 infection were more likely to get fully vaccinated than those with a previous history of the infection (63.9% versus 14.6%, respectively, p < 0.001). The factors associated with a higher likelihood of unvaccinated status included the female gender (adjusted odds ratio (aOR) = 1.705 (95% confidence interval (CI): 1.528–1.902)), elderly patients in the age group of 61–70 (aOR (95% CI) = 1.390 (1.102–1.753)), the age group of 71–80 (aOR (95% CI) = 1.924 (1.499–2.470)) and the age group of >80 (aOR (95% CI) = 3.081 (2.252–4.214), and prior history of COVID-19 infection (aOR (95% CI) = 2.501 (2.223–2.813)). In conclusion, a considerable proportion of patients with type 2 diabetes had confirmed COVID-19 infection. Continued targeted efforts are needed to accelerate vaccination coverage rates among patients with diabetes in general and the particular subgroups identified in this study.

Abstract Background Long intervals between patient visits and limited time with patients can result in clinical inertia and suboptimal achievement of treatment goals. These obstacles can be improved with a multidisciplinary care program. The present study aimed to assess the impact of such a program on glycemic control and cardiovascular risk factors. Methods In a randomized, parallel-group trial, we assigned 263 patients with poorly controlled type 2 diabetes mellitus (T2DM) to either a control group, standard care program, or a multidisciplinary care program involving a senior family physician, clinical pharmacy specialist, dietician, diabetic educator, health educator, and social worker. The participants were followed for a median of 10 months, between September 2013 and September 2014. Glycated hemoglobin (HbA1c), fasting blood glucose (FBG), lipid profiles, and blood pressure (BP) were measured. The assignment was blinded for the assessors of the study outcomes. The study registry number is. Results In the intervention group, there were statistically significant (p

Introduction: Glucagon-like peptide 1 receptor agonist (GLP-1 RA) is a class of hypoglycemic medications. Semaglutide once-weekly (QW) and liraglutide once-daily (OD) significantly improved glycemic control compared to placebo. To date, no long-term phase III trials directly comparing semaglutide and liraglutide are available. This network meta-analysis (NMA) aims to compare the long-term efficacy of semaglutide and liraglutide. Methods: PubMed, Embase, and Cochrane Library were searched from inception until June 2019 to identify relevant articles. Nine long-term randomized controlled trials comparing once-weekly semaglutide or liraglutide with placebo or other active comparisons were identified. The outcomes of interest were changes in HbA1c and weight after 52 weeks. A Bayesian framework and NMA were used for data synthesis. This is a sub-study of the protocol registered in PROSPERO (number CRD42018091598). Results: The data showed significant superiority in HbA1c reduction of semaglutide 1 mg QW over liraglutide 1.2 and 1.8 mg with a treatment difference of 0.47% and 0.3%, respectively. Semaglutide 0.5 mg QW was found to be significantly superior to liraglutide 1.2 mg in HbA1c reduction with a treatment difference of 0.17%. Regarding weight reduction analysis, semaglutide 0.5 and 1 mg QW were significantly associated with a greater reduction than liraglutide 0.6 mg with a treatment difference of 2.42 and 3.06 kg, respectively. However, no significant reduction was found in comparison to liraglutide 1.2 and 1.8 mg. Conclusions: Semaglutide improved the control of blood glucose and body weight. The capacity of long-term glycemic control and body weight control of semaglutide appears to be more effective than other GLP-1 RAs, including liraglutide. However, considering the number of included studies and potential limitations, more large-scale, head-to-head, well-designed randomized-controlled trials (RCTs) are needed to confirm these findings.

IntroductionCardiovascular autonomic neuropathy (CAN) and gastroparesis are two types of diabetic autonomic neuropathy which could affect patients' quality of life and carry significant morbidity and mortality outcomes. The aim of this study was to estimate the prevalence and risk factors of both CAN and gastroparesis symptoms among patients with type 2 diabetes mellitus (T2DM) at primary health care level.MethodsA cross-sectional study was conducted among 400 adults with T2DM from April 1, 2017 to March 20, 2018. CAN was defined by the presence of any of the followings: resting tachycardia, orthostatic hypotension or prolonged corrected QT interval in the electrocardiogram. Gastroparesis symptoms were assessed using a validated questionnaire: the Gastroparesis Cardinal Symptom Index.ResultsThe mean age of study participants and disease duration were 55.26 ± 10.65 years and 10.77 ± 6.89 years, respectively. CAN was present in 15.3% of the participants. Hypertension, smoking, antihypertensive use, body mass index, dyslipidemia and albuminuria were significantly higher in participants with CAN than those without CAN (pConclusionAmong Saudi adults with T2DM at primary care level, the prevalence of CAN is significant and is independently related to disease duration and hypertension, indicating the importance of CAN screening, especially for those with prolonged disease duration, and the importance of controlling blood pressure in order to prevent CAN or its consequences. The prevalence of gastroparesis symptoms is 6% and is independently related to metformin use, and therefore, symptomatic screening is required to decide which patients need further evaluation.

AIMS:To compare the prevalence of vitamin B12 deficiency and peripheral neuropathy between two groups of type 2 diabetes mellitus (T2DM) patients treated with or without metformin, and to determine factors associated with vitamin B12 deficiency therapy and dietary intake of vitamin B12. METHODS:In this retrospective study, we recruited 412 individuals with T2DM: 319 taking metformin, and 93 non-metformin users. Demographics, dietary assessment for vitamin B12 intakes, and medical history were collected. Participants were assessed for peripheral neuropathy. Blood specimens were collected and checked for serum vitamin B12 levels. The differences between the two groups were analyzed using an independent t-test for continuous data, and the Chi-squared or Fisher's exact test was used for categorical data. The relationship of vitamin B12 deficiency with demographics and clinical characteristics was modeled using logistic regression. RESULTS:The prevalence of B12 deficiency was 7.8% overall, but 9.4% and 2.2% in metformin users and non-metformin users, respectively. The odds ratio for serum vitamin B12 deficiency in metformin users was 4.72 (95% CI, 1.11-20.15, P = 0.036). There were no significant differences in a test of peripheral neuropathy between the metformin users and non-metformin users (P > 0.05). Low levels of vitamin B12 occurred when metformin was taken at a dose of more than 2,000 mg/day (AOR, 21.67; 95% CI, 2.87-163.47) or for more than 4 years (AOR, 6.35; 95% CI, 1.47-24.47). CONCLUSION:Individuals with T2DM treated with metformin, particularly those who use metformin at large dosages (> 2,000 mg/day) and for a longer duration (> 4 years), should be regularly screened for vitamin B12 deficiency and metformin is associated with B12 deficiency, but this is not associated with peripheral neuropathy.