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OBJECTIVE: To evaluate glycemic outcomes in the Wireless Innovation for Seniors with Diabetes Mellitus (WISDM) randomized clinical trial (RCT) participants during an observational extension phase. RESEARCH DESIGN AND METHODS: WISDM RCT was a 26-week RCT comparing continuous glucose monitoring (CGM) with blood glucose monitoring (BGM) in 203 adults aged ≥60 years with type 1 diabetes. Of the 198 participants who completed the RCT, 100 (98%) CGM group participants continued CGM (CGM-CGM cohort) and 94 (98%) BGM group participants initiated CGM (BGM-CGM cohort) for an additional 26 weeks. RESULTS: CGM was used a median of >90% of the time at 52 weeks in both cohorts. In the CGM-CGM cohort, median time

Integrated behavioral healthcare (IBH) is the “standard of care” to address psychosocial factors impacting diabetes outcomes; it is not standard in practice. This longitudinal, retrospective, chart-review examines IBH impact on glycemic control in an adult diabetes clinic. Adults (n = 374) with ≥ 1 behavioral health encounter, ≥ 2 hemoglobin A1c (HbA1c) values, and HbA1c value > 8% at initial IBH visit were included. Mixed effects linear piecewise models examined differences in slope trajectories for 365 days pre- and post-IBH intervention. Pre-intervention slope was not significant (z = − 1.09, p = 0.28). The post-intervention slope was significant (z = − 6.44, p 1% in HbA1c over the following year. These results suggest that IBH significantly improves patients’ metabolic status. Next steps for IBH research are offered.

Secondary (recycled) Al is increasingly used in castings due to its lower cost and carbon footprint relative to primary Al. However, the presence of certain impurity elements in secondary Al degrades its properties, often requiring dilution or downgrading. Scavenging impurities with reactive alloying additions can limit impurity impact and broaden the use of secondary Al. This report will detail the initial results of using Ce to microstructurally tie up Cu impurities present in a model secondary Al alloy (A356) with high Cu impurity. The results show that targeted Ce additions to A356 can be used to scavenge Cu impurities by forming complex intermetallics and inhibit intergranular corrosion susceptibility associated with Cu impurities. Supplemental data for this article is available online at

Introduction We report a case of a patient with Graves’ Disease (GD) associated with thymic hyperplasia (TH) which regressed with treatment of GD. The association between these two conditions is under recognized. The causative mechanisms between TH associated with GD are still under investigation. Case Description A 39-year-old male patient presented with hemoptysis, dyspnea, palpitations, tremors and unintentional weight loss. His TSH was suppressed to < 0. 005 and free T4 was elevated to 5.51. As part of his work up a CT scan was performed which revealed a prominent anterior mediastinal mass. He was started on Methimazole and Atenolol. Lab work confirming positive TSI and TRAB antibodies consistent with Graves’ disease. At follow up, he opted for radioactive iodine ablation therapy with 20mCi. He had failure of therapy and was resumed on Methimazole. He ultimately underwent total thyroidectomy with subsequent thyroid hormone replacement with Levothyroxine 150mcg daily. His thyroid function tests normalized, and his symptoms resolved. A repeat CT thorax was performed which showed complete resolution of his mediastinal mass, consistent with GD associated TH. Conclusions GD associated TH was first described in 1914. Data supports TSH receptor antibody mediated thymic enlargement1. TH can be classified in two morphological types, lymphoid hyperplasia unassociated with thymic enlargement and true TH in which an increase in thymic volume is evident 2. Thymic cortical tissue expansion seems to be due to a hyperthyroid state involving increased levels of thymulin, a protein involved in lymphocyte differentiation whereas lymphoid hyperplasia correlates with the immune process in GD 2. Antithyroid drug therapy reduces circulating thyroid hormone levels causing a generalized immunosuppressive effect. This reduces hyperplasia of lymphatic organs including the thymus 3. There are no current guidelines for the management and surveillance of thymic hyperplasia in GD as the course and timeline of regression of TH can vary widely. Thymic biopsies are performed frequently to rule out malignancy, however, it is important to raise awareness that GD associated TH has a benign course and generally resolves with management of the underlying GD 3. It is imperative to avoid unnecessary invasive procedures and their subsequent complications in such GD patients. References: 1] Dalla Costa M (2014) Thymic hyperplasia in patients with Graves’ disease. J Endocrinol invest 37: 1175-1179. 2] Nakamura S (2012) Thymic enlargement in two cases of Graves’ disease. Internal Med 51: 673-674.3] Nakamura T et al (2004) A case of thymic enlargement in hyperthyroidism in a young woman. Thyroid 14: 307-310. Presentation: No date and time listed

This article discusses Rousseau’s theory of the genesis and development of a “post-liberal self” and its political implications. In his Emile, or Education, Rousseau explores the distinctive featur...

This paper proposes a reconstruction of Georg Lukács’ thesis of reification by viewing it through the normative theory of consciousness. As I see it, reification of consciousness is the result of the ways that norms that have been patterned by external social systems come to be absorbed into the background structures of cognition. As a result, consciousness becomes increasingly fitted to these normative patterns. A web of norms therefore comes to heteronomously link consciousness and social systems via processes of socialisation. I end with a consideration of how a theory of critical judgment can be used to overcome this reification of consciousness, all the while sticking to Lukács’ basic line of argument.

Processing materials under magnetic fields is an underexplored technique to improve structure and mechanical properties in metals and alloys. Magnetic fields can alter phase stability, modify diffusion characteristics, and alter material flow substantially. In castings, magnetic fields can be used during melting of the alloy, during solidification, or during postprocessing operations such as heat treatment to achieve structural changes. This work investigates the effectiveness of thermomagnetic processing during heat treatment of Al alloys containing in the Al–Cu, Al–Si–Cu, and Al–Mg–Ce systems. We demonstrate an improvement in mechanical properties and a reduction in required heat treatment times for all alloys.

In this paper, I outline a theory of critical social ontology derived from the fundamental ideas of Marx and the later work on the ontology of social being by Georg Lukács. I argue that we can discern categories of social being that can aid in the project of diagnostic social critique, but also that these categories can be used to formulate an ethical theory that we can ground in this critical social ontology. I therefore defend the thesis, against postmetaphysical thinkers that have argued to the contrary, that a satisfactory and critical theory of ethics can and indeed must be rooted in a theory of ontology. I end with some reflections on how critical social ontology can help combat the problem of reification and help us think through issues of ethical or normative concern.

In this paper, I argue that Marx’s political and social theory expresses ideas that we can characterize as ‘radical republican’ in nature. By this term, I mean a theory of the nature of human being...

Background Patients with poorly controlled type 2 diabetes (T2D) experience increased morbidity, increased mortality, and higher cost of care. Self-monitoring of blood glucose (SMBG) is a critical component of diabetes self-management with established diabetes outcome benefits. Technological advancements in blood glucose meters, including cellular-connected devices that automatically upload SMBG data to secure cloud-based databases, allow for improved sharing and monitoring of SMBG data. Real-time monitoring of SMBG data presents opportunities to provide timely support to patients that is responsive to abnormal SMBG recordings. Such diabetes remote monitoring programs can provide patients with poorly controlled T2D additional support needed to improve critical outcomes. Objective To evaluate 6 months of a diabetes remote monitoring program facilitated by cellular-connected glucose meter, access to a diabetes coach, and support responsive to abnormal blood glucose recordings greater than 400 mg/dL or below 50 mg/dL in adults with poorly controlled T2D. Methods Patients (N=119) receiving care at a diabetes center of excellence participated in a two-arm, 12-month randomized crossover study. The intervention included a cellular-connected glucose meter and phone-based diabetes coaching provided by Livongo Health. The coach answered questions, assisted in goal setting, and provided support in response to abnormal glucose levels. One group received the intervention for 6 months before returning to usual care (IV/UC). The other group received usual care before enrolling in the intervention (UC/IV) for 6 months. Change in hemoglobin A1c (HbA1c) was the primary outcome, and change in treatment satisfaction was the secondary outcome. Results Improvements in mean HbA1c were seen in both groups during the first 6 months (IV/UC −1.1%, SD 1.5 vs UC/IV −0.8%, SD 1.5; P Conclusions Patients enrolled in the diabetes remote monitoring program intervention experienced improvements in HbA1c and treatment satisfaction similar to usual care at a specialty diabetes center. Future studies on diabetes remote monitoring programs should incorporate scheduled coaching components and involve family members and caregivers. Trial Registration ClinicalTrials.gov NCT03124043; https://clinicaltrials.gov/ct2/show/NCT03124043

Infinium methylation arrays are widely used to robustly measure methylation of DNA in humans. However, such arrays are not available for the vast majority of non-human mammals. Moreover, even if species-specific arrays were available, probe differences between them would confound cross-species comparisons. To address these challenges, we developed the Mammalian Methylation Array, a single custom Infinium array that measures cytosine methylation levels of 36 thousand CpG sites that are well conserved across species within the mammalian class. By design, the probes on the array tolerate cross-species mutations. To design the array, we developed the Conserved Methylation Array Probe Selector (CMAPS) algorithm, which takes as input a multi-species sequence alignment and probe design constraints. A greedy search algorithm was used to identify oligonucleotide sequences (probes) with high coverage across different mammalian species. We annotate the probes on the array with respect to genes in 159 different species and provide details on the sequence context including CpG island status and chromatin states. Our calibration experiments demonstrate the high fidelity of this array in humans, rats, and mice. The mammalian methylation array has several strengths: it applies to all mammalian species even those that have not yet been sequenced, it provides deep coverage of specific cytosines facilitating the development of highly robust epigenetic biomarkers, and it covers highly conserved CpGs which greatly increases the probability that biological insights gained in one species will readily translate to others. The mammalian methylation array is expected to find many applications in preclinical studies, comparative biology, and epigenetic studies of aging and development.

This chapter outlines an ontological approach to understanding social pathology. I begin by outlining what a critical social ontology consists of before elaborating categories for diagnostic critique. My thesis is that a social ontology is one that grasps the structural dynamics of social relations and considers the ways that these can be either rationally organised (or what I call anabolic social forms) or pathologically organised (or what I call katabolically organised). The main idea is that social pathology is not to be restricted to inter-cognitive or neo-Idealist frames (such as pathologies of recognition or communication) but rather to be located in the architecture and functional characteristics of social forms themselves. I end with a consideration of the relation between this ontological approach to social pathology and the idea of critical judgement or what I term ‘phronetic criticism’ that is not merely diagnostic in orientation, but contains within it the seeds of alternative praxis for social transformation.

BACKGROUND Patients with poorly controlled type 2 diabetes (T2D) experience increased morbidity, increased mortality, and higher cost of care. Self-monitoring of blood glucose (SMBG) is a critical component of diabetes self-management with established diabetes outcome benefits. Technological advancements in blood glucose meters, including cellular-connected devices that automatically upload SMBG data to secure cloud-based databases, allow for improved sharing and monitoring of SMBG data. Real-time monitoring of SMBG data presents opportunities to provide timely support to patients that is responsive to abnormal SMBG recordings. Such diabetes remote monitoring programs can provide patients with poorly controlled T2D additional support needed to improve critical outcomes. OBJECTIVE To evaluate 6 months of a diabetes remote monitoring program facilitated by cellular-connected glucose meter, access to a diabetes coach, and support responsive to abnormal blood glucose recordings greater than 400 mg/dL or below 50 mg/dL in adults with poorly controlled T2D. METHODS Patients (N=119) receiving care at a diabetes center of excellence participated in a two-arm, 12-month randomized crossover study. The intervention included a cellular-connected glucose meter and phone-based diabetes coaching provided by Livongo Health. The coach answered questions, assisted in goal setting, and provided support in response to abnormal glucose levels. One group received the intervention for 6 months before returning to usual care (IV/UC). The other group received usual care before enrolling in the intervention (UC/IV) for 6 months. Change in hemoglobin A1c (HbA1c) was the primary outcome, and change in treatment satisfaction was the secondary outcome. RESULTS Improvements in mean HbA1c were seen in both groups during the first 6 months (IV/UC −1.1%, SD 1.5 vs UC/IV −0.8%, SD 1.5; P1c in IV/UC (mean HbA1c change +0.2, SD 1.7, P=.41); however, those in UC/IV showed further improvement (mean HbA1c change −0.4%, SD 1.0, P=.008). A mixed-effects model showed no significant treatment effect (IV vs UC) over 12 months (P=.06). However, participants with higher baseline HbA1c and those in the first time period experienced greater improvements in HbA1c. Both groups reported similar improvements in treatment satisfaction throughout the study. CONCLUSIONS Patients enrolled in the diabetes remote monitoring program intervention experienced improvements in HbA1c and treatment satisfaction similar to usual care at a specialty diabetes center. Future studies on diabetes remote monitoring programs should incorporate scheduled coaching components and involve family members and caregivers. CLINICALTRIAL ClinicalTrials.gov NCT03124043; https://clinicaltrials.gov/ct2/show/NCT03124043

IntroductionDNA methylation data facilitate the development of accurate molecular estimators of chronological age, or ‘epigenetic clocks.’ We present a robust epigenetic clock for the beluga whale, Delphinapterus leucas, developed for an endangered population in Cook Inlet, Alaska, USA.Methods and ResultsWe used a custom methylation array to measure methylation levels at 37,491 cytosine-guanine sites (CpGs) from skin samples of dead whales (n = 67) whose chronological ages were estimated based on tooth growth layer groups. Using these calibration data, a penalized regression model selected 23 CpGs, providing an R2 = 0.92 for the training data; and an R2 = 0.74 and median absolute age error = 2.9 years for the leave one out cross-validation. We applied the epigenetic clock to an independent data set of 38 skin samples collected with a biopsy dart from living whales between 2016 and 2018. Age estimates ranged from 11 to 27 years. We also report sex correlations in CpG data and describe an approach of identifying the sex of an animal using DNA methylation.DiscussionThe epigenetic estimators of age and sex presented here have broad applications for conservation and management of Cook Inlet beluga whales and potentially other cetaceans.

Amyotrophic lateral sclerosis (ALS) is a complex late-onset, neurodegenerative disease with a genetic contribution to disease liability. Genome-wide association studies have identified eleven risk loci to date, including the TNIP1/GPX3 locus on chromosome five. Current association analysis data alone cannot determine the most plausible risk gene in this locus. Here, we undertake a comprehensive suite of studies to provide objective evidence to support or reject the relevance of these two genes. We use bioinformatic integration of genetic association data with omics reference data sets, in-vitro and in-vivo approaches to narrow down the likely candidate. TNIP1 and GPX3 are implicated in-silico (rs10463311 is an eQTL for these two genes). In-vivo expression analyses in ALS cases identify that GPX3 expression decreases with increased disability and rate of progression. Validation in-vivo, indicate GPX3 loss-of-function causes motor deficits in zebrafish embryos. Taken together, these results support GPX3 as being the ALS risk gene in this locus which has implications for understanding disease mechanisms and targeted therapeutic approaches.