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Lifestyle modification is an integral aspect for the management of type 2 diabetes (T2D). However, it is difficult to ensure the accuracy of personalized lifestyle advice. The study aims to analyse the real-world effectiveness of personalized glycemic response based Diabefly-Pro digital therapeutics for better glycemic control.Data from continuous glucose monitoring (CGM) of 64 participants with T2D was analysed. All participants were provided with modified lifestyle plan based on their personalized glycemic response. The CGM data was analysed for a period of 7 days, before and after the introduction of modified lifestyle plan. Primary outcome of the study was change in time in range (TIR). Secondary outcomes of the study were change in mean blood glucose, time above range (TAR), time below range (TBR) and glucose management indicator (GMI).Significant improvement in glycemic control was observed after the introduction of personalized lifestyle plan. Median reduction in mean blood glucose was from 139.5 (118.3 to 169.3) mg/dL to 122.0 (101.5 to 148.8) mg/dL (Personalized glycemic response-based Diabefly-Pro digital therapeutics program was effective in achieving better glycemic control in people with T2D.

BACKGROUND Digital therapeutic platforms facilitate health care through patient-centered strategies based on multidisciplinary teams and shared decision-making. Such platforms can be used for developing a dynamic model of diabetes care delivery, which can help in improving glycemic control by promoting long-term behavior changes in people with diabetes. OBJECTIVE This study aims to evaluate the real-world effectiveness of the Fitterfly Diabetes CGM digital therapeutics program for improving glycemic control in people with type 2 diabetes mellitus (T2DM) after the completion of 90 days in the program. METHODS We analyzed deidentified data of 109 participants in the Fitterfly Diabetes CGM program. This program was delivered through the Fitterfly mobile app coupled with continuous glucose monitoring (CGM) technology. This program consists of 3 phases: the first phase is observation, wherein the patient’s CGM readings are observed for 7 days (week 1); the second phase is the intervention; and the third phase aims at sustaining the lifestyle modification introduced during the second phase. The primary outcome of our study was the change in the participants’ hemoglobin A1c (HbA1c) levels after program completion. We also evaluated the changes in participant weight and BMI after the program, changes in the CGM metrics in the initial 2 weeks of the program, and the effects of participant engagement in the program on improving their clinical outcomes. RESULTS At the end of the 90 days of the program, the mean HbA1c levels, weight, and BMI of the participants were significantly reduced by 1.2% (SD 1.6%), 2.05 (SD 2.84) kg, and 0.74 (SD 1.02) kg/m2 from baseline values of 8.4% (SD 1.7%), 74.45 (SD 14.96) kg, and 27.44 (SD 4.69) kg/m2 in week 1, respectively (PPP1c reduction ≥1% and 38.5% (42/109) showed weight loss ≥4%. The average number of times the mobile app was opened by each participant during the program was 108.80 (SD 127.91) times. CONCLUSIONS Our study shows that participants in the Fitterfly Diabetes CGM program showed a significant improvement in their glycemic control and reduction in weight and BMI. They also showed a high level of engagement with the program. Weight reduction was significantly associated with higher participant engagement with the program. Thus, this digital therapeutic program can be considered as an effective tool for improving glycemic control in people with T2DM.

Objective: Exercise and physical activity are integral aspects for the effective management of diabetes. Unsupervised home exercise although very accessible is limited by poor adherence, risk of injury, and a higher dropout rate of participants. A fitness assessment by a qualified physiotherapist can help in understanding the baseline fitness of individuals and thus generating appropriate exercise prescriptions. The current study assesses the feasibility of video call-based fitness assessment for people with diabetes. The study also assesses the effect of current physical activity status and pain on performance in physical fitness tests. Methods: One hundred participants with type II diabetes (T2D) underwent 6-minute walk test (6MWT), 1-minute push-up test, wall sit test, 1-minute sit-up test, and V-sit and reach test for measuring different components of physical fitness such as aerobic capacity, upper body strength, lower body strength, core strength, and flexibility, respectively. The performance in physical fitness of participants was analyzed after the video consult along with pain complaints and current exercise status. Results: All the participants underwent the physical fitness test safely based on video call. Out of all the participants, a good range score was achieved by 52% in 6MWT, 17% in push-up test, 1% in wall sit test, 6% in sit-up test, and 9% in V-sit and reach test. Current physical activity status (aerobic exercise for minimum 20 minutes) did not show any association with performance in fitness tests (p = 0.89 for push-up test, p = 0.50 for wall sit test, p = 0.23 for sit-up test, and p = 0.10 for V-sit and reach test). Presence of upper body and lower body pain affected the performance in push-up test and wall sit test with 71.4% and 95.6% of participants achieving scores in poor to below-average range (p-value < 0.001). Conclusion: The study showed the safety and feasibility of conducting video call-based assessment of physical fitness by physiotherapists. The study also highlighted the poor glycemic control, high cardiovascular risk, and poor level of physical fitness in people with diabetes in India. Insights based on physical fitness, current physical activity status, and pain can help in developing personalized exercise plans for people with diabetes.

Introduction: Diabetes distress is a unique, often hidden, emotional burden and worry that an individual experiences while managing diabetes. Enhanced motivation and willingness are important components of one’s ability to manage the increasing demands of diabetes. Aim of this study is to analyse the effectiveness of digital therapeutics programs in providing evidence-based care that can help in better management of diabetes through long-term behaviour change. Methods: This study was conducted with 100 participants diagnosed with type 2 DM across India. They were enrolled in the Diabefly® digital therapeutics program for 90 days. Highly customized virtual stress management and behaviour therapy sessions were given to each participant along with nutrition and fitness sessions. Various digital interventions were shared at regular intervals. Initial and final assessment was done using Diabetes Distress Scale and Motivation and Attitude towards Changing Health. t - test was used to analyse the data. Results: Motivation levels among participants improved significantly by 9.39% from a baseline score of 33.70±4.24 to 37.42±4.50 (p=0.001) . Distress levels among participants decreased significantly by 24.21% from a baseline score of 1.90±0.77 to 1.35±0.45 (p=0.001) . Participants from joint families have higher interpersonal distress as compared to nuclear families (p=0.008) . Participants having diabetes for more than 5 years have higher physician distress (p=0.001) and interpersonal distress (p=0.005) as compared to newly diagnosed ones. Participants who are on insulin along with medications have higher physician distress (p=0.031) and interpersonal distress (p=0.020) in comparison to those who are just on medication or not on any medication. Conclusion: Remote behavioural interventions as part of a comprehensive 90 days Diabefly® program can be very effective in managing diabetes adequately. Disclosure N.Verma: Employee; Fitterfly HealthTech Private Limited. K.Samudra: None. T.Lathia: Advisory Panel; Abbott, AstraZeneca, Biocon, Boehringer Ingelheim International GmbH, Novartis Pharmaceuticals Corporation, Novo Nordisk, Sanofi. P.Vasan: Employee; Fitterfly Health Tech Pvt Ltd. N.Gupta: Employee; Fitterfly HealthTech Pvt Ltd. R.Verma: Employee; Fitterfly Healthtech Pvt Ltd, Wellthy Therapeutics Pvt Ltd. S.Kalra: Speaker's Bureau; Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. M.V.Padsalge: None. V.Methil: None. A.K.Singal: Other Relationship; Fitterfly Healthtech Pvt Ltd.

Background: In India, a significant number of people are still diagnosed with diabetes at a later stage or after the complications have started. The unawareness about the disease and financial burden associated with the diagnostic testing remains a challenge. The study was aimed at the digital administration of a prediabetes risk test questionnaire to understand the people who are at high risk and more prone to developing prediabetes and eventually diabetes. Methods: A prediabetes risk questionnaire was developed based on the American Diabetes association risk score test. The test was completed by 1722 participants across India. The test was based on risk factors like age, gender, race, BMI, family history of diabetes, history of high blood pressure, and physical activity status. The scoring was done for three groups including high risk (score >5) , medium risk (score 3-5) , and low risk (score Results: The risk of prediabetes was low in 21 %, medium in 65 % and high in 12 % of participants. Out of all the participants 44 % had age ≥ 40 years, 71% were male, 96 % were asian, 74 % had BMI ≥ 23 kg/m2, 59 % of total participants have a family history of diabetes (first-degree relatives) , 17 % had high blood pressure, and 44 % were performing physical activity below recommended level of 150 mins per week. Among people with BMI ≥ 23 kg/m2, 89 % were having either high or medium risk scores. Among young people (age < 40 years) , 67 % were having high or medium scores. The odds ratio for score in high or medium range for people with BMI ≥ 23 kg/m2 and age ≥ 40 years was 38.51 (95% CI: 24.19-61.30, P Conclusion: The study showed that out of all the participants, 77% had a high or medium risk score. The study highlights the importance of using a prediabetes risk calculator as a tool for improving awareness about the risk of developing prediabetes. Disclosure R.Verma: Employee; Fitterfly Healthtech Pvt Ltd, Wellthy Therapeutics Pvt Ltd. A.K.Singal: Other Relationship; Fitterfly Healthtech Pvt Ltd. R.Sahay: Advisory Panel; Torrent Pharmaceuticals , Speaker's Bureau; Dr. Reddy’s Laboratories Ltd., Eli Lilly and Company, Eris Lifesciences Ltd., Intas Pharmaceuticals Ltd., Novo Nordisk, USV Private Limited. G.Bantwal: None. S.Kalra: Speaker's Bureau; Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. A.D.Agnihotri: None. M.H.Tiwaskar: None. S.F.Ade: None. A.M.Juneja: None. O.J.Lakhani: Advisory Panel; FITTERFLY, Speaker's Bureau; Eli Lilly and Company, Novo Nordisk Global Business Services, Sanofi, Stock/Shareholder; Zydus Cadilla.

Background: Digital therapeutics platforms provide accessible and multidisciplinary care for the management of T2D. The current study explored the effectiveness of the Diabefly program for improving glycemic control in people with T2D. Methods: Diabefly program provides a combination of mobile application, remote lifestyle coaching, live video consultations by experts (psychologist, physiotherapist and nutritionist) , and digital logging of parameters. The outcome of the study was to evaluate the change in HbA1c, fasting blood sugar (FBS) , postprandial blood sugar (PPBS) , weight, and body mass index (BMI) at the beginning and end of the program. All the outcomes were evaluated using paired t-test with P Results: A significant mean reduction in HbA1c levels by 1.69 ± 1.91% from a baseline of 8.66 ± 2.05% was observed (P Conclusion: Effective glycemic control and significant weight reduction was achieved at the end of the program. Thus, Diabefly program can help in providing continuous support to implement lifestyle changes between quarterly doctor visits and greater usage of a remote lifestyle coaching can be a useful adjunct to doctor’s prescription for holistic management of diabetes. Disclosure R. Verma: Employee; Fitterfly Healthtech Pvt Ltd, Wellthy Therapeutics Pvt Ltd. M.A. Khader: Employee; Fitterfly HealthTech Pvt Ltd. T. Lathia: Advisory Panel; Abbott, AstraZeneca, Biocon, Boehringer Ingelheim International GmbH, Novartis Pharmaceuticals Corporation, Novo Nordisk, Sanofi. S. Guntur: Employee; Fitterfly Health Tech Pvt. Ltd. A.K. Singal: Other Relationship; Fitterfly Healthtech Pvt Ltd.

Background: Retrospective evaluation of glycemic responses correlated with lifestyle habits can help in mapping personalized glycemic responses (PGR) for individuals. PGR can aid in more specific nutritional interventions in individuals with diabetes ultimately aiding in better glycemic control and weight management. Methods: Participants (n=108, mean age 47.24± 12.28 years, 55.5% females) were enrolled in PGR based Diabefly program and were provided with support for lifestyle modification through a combination of expert led care and mobile application. The outcomes were analyzed at the beginning and end of the program. Paired t-test was used for analysis with P Results: After the program, the daily mean calorie intake significantly reduced by 9.34 ± 30.3 % from a baseline of 1466.93 ± 408.16 cal (P Conclusion: Significant change in dietary behavior was observed after the completion of the program. Effective weight reduction, waist circumference reduction, and improved glycemic control was also observed suggesting the potential of understanding PGR in an effective manner through the Diabefly program for improved outcomes. Disclosure R.Verma: Employee; Fitterfly Healthtech Pvt Ltd, Wellthy Therapeutics Pvt Ltd. A.K.Singal: Other Relationship; Fitterfly Healthtech Pvt Ltd. M.A.Khader: Employee; Fitterfly HealthTech Pvt Ltd. R.M.Ranadive: Employee; Fitterfly Healthtech Pvt Ltd. S.Budyal: None. A.A.Saraf: None. V.Raskar: None. A.Sarwate: None. M.V.Joshi: None. S.Joshi: Consultant; Fitterfly Health Tech Pvt Ltd, Wellthy Therapeutics Pvt Ltd.

Introduction: The human ear is the most defining feature of the face. The anatomical structure of the external ear is utilized for personal identification of living subjects in relation to criminal activity. Aim: To evaluate and compare the uniqueness of morphological and biometric variations of both ears for individualization among subpopulations of India in states of Punjab, Haryana and Jammu and Kashmir. To determine the Morphology and Biometrics of both ears in both male and female populations of Punjab, Haryana and Jammu and Kashmir. To study and compare the Ear Prints of population of three states and find a correlation between them. Materials and Methods: The present study was carried out randomly selected 120 students; 40 from Punjab (P), 40 from Haryana (H) and 40 from Jammu and Kashmir (J and K) population zones of India out of which 20 subjects were males and 20 were females from each population group of age between 18 to 25 years. Nine ear parameters were recorded twice using digital vernier calipers by single investigator and two indices (Ear Index and Lobule Index) were calculated for both the ears. Morphological ear shapes and lobule attachment were also noted.Chi-square test and one way ANOVA tests were performed on cross tabulations followed by turkey HSD test to evaluate significant relationship between both genders in three populations. Results: The highest total ear length in both ears (left and right) was noted in females of Haryana; followed by Punjab and J and K. Out of the total sample size, 60.41% ear lobes were free and 39.59% were attached. 100% Ear symmetry was seen in both ears among both genders of Haryana population and Oval ear shape was observed mostly followed by round, rectangular and triangular in Punjab and Haryana populations and no triangular morphology was observed in J and K population. The highest Ear Index in left ear was seen in both genders in population of Punjab whereas in that of right ear, highest ear index was seen in females of Haryana and males of Punjab population. The highest lobule index was noted in both the ears of females as well as males in Haryana population. Conclusion: The present study results of morphological examination and morpholometric variations of human ears can be used as supportive evidence as having a role in forensic sciences by the identification of landmarks variations in different ethnic groups.

Rampant cases related to circulation of fake currency notes have been reported worldwide. With the introduction of new banknotes (announced after demonetization) having advanced and exclusive security features, it is the need of the hour, especially for a forensic Scientists, to have an idea about these new features and the various methods to examine these features. Results presented in this paper are based on examination and comparison of original and suspected fake 2000 rupee Indian currency banknote utilizing physical examination methods and techniques such as physical, microscopic, digital image processing, etc. During the examination of original 2000 rupee banknote, it was found that some security features of this banknote are unique & exclusive and could not be forged by counterfeiters. Counterfeiter could only imitate most of the visual features of banknotes but some specific security features like OVI print, UV-fluorescent print, micro letters, etc. which are placed on all over the substrate of original banknote, could not be mimicked. However, imitation of the visual features, can at times deceives the public in general. The present case study presents a methodology which will be very useful and informative in assisting the forensic community in examination of fake currency banknotes and for future studies.

Background: Diabetes self-management education and support (DSMES) is integral towards maintaining continuity of care between physician visits especially for patients on insulin therapy to facilitate healthy coping. The present study explores the usage patterns and real-world effectiveness of the Wellthy CARE™ digital therapeutic (WDTx) platform in achieving glycemic control among patients with type 2 diabetes mellitus (T2DM) on insulin therapy. Methods: The WDTx platform consists of a smartphone application with a 52-week program to provide DSMES through self-monitoring of blood glucose, access to evidence-based content regarding insulin usage and remote guidance by a health coach to enable lifestyle modifications and healthy coping. All app interactions were analyzed at baseline and during the program to determine factors driving patient engagement and clinical outcomes. Results: Study participants (n=106) had a mean age of 51.4 years (SD 14.0 years) and consisted of 39 females (36.8%). Overall, a significant mean decrease in average blood sugar (ABS) by 29.9 mg/dl (95%CI 16.6-43.3 mg/dl, P Conclusion: This study thus demonstrates the effectiveness of the WDTx platform to impart critical DSMES, maintain continuity of care and improve clinical outcomes in patients with T2DM on insulin therapy. Disclosure R. R. Adhikary: Employee; Self; Wellthy Therapeutics Pvt Ltd. S. Kolwankar: Employee; Self; Wellthy Therapeutics Pvt Ltd. R. Verma: Consultant; Self; Wellthy Therapeutics Pvt Ltd. J. Bhatt: Employee; Self; Wellthy Therapeutics Pvt Ltd. K. L. Pakhale: None. R. Sahay: Advisory Panel; Self; Cipla Inc., USV Private Limited, Speaker's Bureau; Self; Eli Lilly and Company, Novo Nordisk Pharma Ltd.

Immobilized enzyme holds considerable potential for industrial applications. In this study, a thermostable xylanase from Geobacillus thermodenitrificans X1 was subjected to carrier free immobilization to generate xylanase cross-linked enzyme aggregates (Xy-CLEAs). Xy-CLEAs were prepared by using overnight precooled (at −20 °C) acetone as precipitant and glutaraldehyde (GA) as the cross-linker. A reaction time of 2 h, GA (0.01% v/v), protein concentration (1.67 mg/mL), 2 h precipitation time and protein to precipitant ratio of 1:10 were found to be the optimum conditions for Xy-CLEAs preparations. Morphological and structural characterization of CLEAs revealed their spherical shape with a diameter of 200–250 nm. In comparison to free xylanase, the immobilized xylanase had high relative activity at a diverse temperature and pH range. Thermostability and pH stability was also improved after immobilization of xylanase. CLEAs of xylanase proved to be commercially reliable as they retained 53.5% activity after being reused till six cycles and 86% activity after storage at 4 °Cfor 8 weeks.

Background Digital therapeutics are evidence-based therapeutic interventions driven by high-quality software programs for the treatment, prevention, or management of a medical disorder or disease. Many studies in the western population have shown the effectiveness of mobile app–based digital therapeutics for improving glycemic control in patients with type 2 diabetes (T2D). However, few studies have assessed similar outcomes in the South Asian population. Objective This study aims to investigate the real-world effectiveness of the Wellthy CARE digital therapeutic for improving glycemic control among the South Asian population of Indian origin. Methods We analyzed deidentified data from 102 patients with T2D from India enrolled in a 16-week structured self-management program delivered using the Wellthy CARE mobile app. Patients recorded their meals, weight, physical activity, and blood sugar in the app, and they received lessons on self-care behaviors (healthy eating, being active, monitoring, medication adherence, problem solving, healthy coping, and reducing risks); feedback provided by an artificial intelligence–powered chatbot; and periodic interactions with certified diabetes educators via voice calls and chats. The primary outcome of the program was a change in glycated hemoglobin A1c (HbA1c). Secondary outcomes included the difference between preintervention and postintervention fasting blood glucose (FBG) and postprandial blood glucose (PPBG) levels; changes in BMI and weight at the completion of 16 weeks; and the association between program engagement and the changes in HbA1c, FBG, and PPBG levels. Results At the end of 16 weeks, the average change in HbA1c was –0.49% (n=102; 95% CI −0.73 to 0.25; P Conclusions The use of the Wellthy CARE digital therapeutic for patients with T2D showed a significant reduction in the levels of HbA1c, FBG, and PPBG after 16 weeks. A higher level of participation showed improved glycemic control, suggesting the potential of the Wellthy CARE platform for better management of the disease.

We present a 31-year-old male without any comorbidities who presented to the emergency room (ER) with a 2-week history of polyuria, polydipsia, constipation, and fatigue. He also reported a weight loss of 40 lb over the last 3 months. During the interview, he mentioned having oily skin and acne all of his life. He denied palpitations, hyperhidrosis, or difficulty with sexual activity. Physical exam was striking for frontal bossing, prognathism, hypertrichosis, and large hands and feet, suggesting acromegaly. No acanthosis nigricans or acrochordons was noted. Initial lab work revealed the following: blood glucose 241 mg/dL, serum bicarbonate 12 mEq/L, anion gap 31, β-hydroxybutyrate >8 mmol/L, ketonuria on urinalysis, and HbA1c of 13.1%. Islet cell anti-GAD antibodies were negative.

Background: While diabetes mellitus from growth hormone related insulin resistance is not uncommon in GH secreting tumors, initial presentation with diabetic ketoacidosis is rare. Clinical Case: 31 YO male with no significant past medical history presented with c/o fatigue, 40 lb weight loss, polyuria, polydipsia. Clinical features of acromegaly with frontal bossing, protruding jaw, large hands and feet, thick spade like fingers, hammer toes, high arches and thickened fat pads on both feet were noted. Initial labs were consistent with DKA with anion of 31 mmol/L (0-20), blood glucose 241 mg/dl, bicarb 12 mmol/L (22-29), serum betahydroxy butyrate > 8 mmol/L (0-0.29), urine positive for glucose, ketones, protein. Patient was initially treated with IV insulin per DKA protocol, transitioned to subcutaneous insulin. MRI brain showed 2.1x1.3x2.1 cm pituitary macro adenoma. Labs showed elevated IGF1 LC/MS, S 1094 ng/ml (54-310), IGFBP3 14 mcg/ml (3.5-7), Z score IGF MS Mayo > 3 (-2 to +2), normal FSH 7.1 m unit/ml (1.5-12.4), normal LH 3.4 m unit/ml (1.7-8.6), normal prolactin 6 ng/ml (4-15), normal ACTH 10 pg/ml, cortisol 13.4 mcg/dl, low total testosterone 48.2 ng/dl (193-836), normal free testosterone 7.92 ng/dl (4.85-19), normal TSH 1.55 mc unit/ml (0.27-4.2) and free T4 1.17 ng/dl (0.93-1.7). The patient was discharged home on 120+ units of total daily dose of insulin, after initial hospital admission. He underwent trans sphenoidal resection of pituitary macro adenoma one month after his initial presentation. Surgical pathology confirmed growth hormone producing adenoma. He was successfully weaned off from insulin in one month following surgery. Conclusion: DKA is an unusual initial presentation of growth hormone producing tumors. As more cases are being reported it is important to be vigilant to look for DKA presentation in these patients and adjust/wean patients insulin once the growth hormone producing tumor is treated either with surgery or medications.

Insulinoma is a rare neuroendocrine tumor. It may occur sporadically or as part of the genetic tumor syndrome multiple endocrine neoplasia type 1 (MEN1). Diagnosis is challenging because of the small size of insulin producing tumors that lead to hyperinsulinemia. Advances in imaging modalities may provide more accurate diagnosis of primary tumors, metastasis, and tumor functional status. Advances allow for improved medical and surgical management with new tools for research of neuroendocrine tumors. Surgical excision of the primary tumor is often curative; however, insulinomas in MEN1 syndrome are often multifocal with a high rate of recurrence presenting unique challenges in management. Here, we present the case of a 34-year-old male with recurrent hypoglycemic episodes and hyperparathyroidism diagnosed with multiple pancreatic insulinomas secondary to MEN1. Furthermore, we provide a brief review of the literature and discuss the approach to diagnosis and management in patients with MEN1 syndrome and future areas of investigation.

BACKGROUND Digital therapeutics are evidence-based therapeutic interventions driven by high-quality software programs for the treatment, prevention, or management of a medical disorder or disease. Many studies in the western population have shown the effectiveness of mobile app–based digital therapeutics for improving glycemic control in patients with type 2 diabetes (T2D). However, few studies have assessed similar outcomes in the South Asian population. OBJECTIVE This study aims to investigate the real-world effectiveness of the Wellthy CARE digital therapeutic for improving glycemic control among the South Asian population of Indian origin. METHODS We analyzed deidentified data from 102 patients with T2D from India enrolled in a 16-week structured self-management program delivered using the Wellthy CARE mobile app. Patients recorded their meals, weight, physical activity, and blood sugar in the app, and they received lessons on self-care behaviors (healthy eating, being active, monitoring, medication adherence, problem solving, healthy coping, and reducing risks); feedback provided by an artificial intelligence–powered chatbot; and periodic interactions with certified diabetes educators via voice calls and chats. The primary outcome of the program was a change in glycated hemoglobin A1c (HbA1c). Secondary outcomes included the difference between preintervention and postintervention fasting blood glucose (FBG) and postprandial blood glucose (PPBG) levels; changes in BMI and weight at the completion of 16 weeks; and the association between program engagement and the changes in HbA1c, FBG, and PPBG levels. RESULTS At the end of 16 weeks, the average change in HbA1c was –0.49% (n=102; 95% CI −0.73 to 0.25; P1c levels, with a mean change of −1.16% (n=65; 95% CI −1.40 to −0.92; PP=.02) and PPBG levels were 188 mg/dL (n=51; 95% CI 172-203) and 166 mg/dL (n=51; 95% CI 153-180; P=.03), respectively. The mean changes in BMI and weight were –0.47 kg/m2 (n=59; 95% CI −0.22 to −0.71; PP1c, FBG, and PPBG levels as the program engagement increased. Patients in the highest tertile of program engagement had a significantly higher reduction in HbA1c (−0.84% vs −0.06%; P=.02), FBG (−21.4 mg/dL vs −0.18 mg/dL; P=.02), and PPBG levels (−22.03 mg/dL vs 2.35 mg/dL; P=.002) than those in the lowest tertile. CONCLUSIONS The use of the Wellthy CARE digital therapeutic for patients with T2D showed a significant reduction in the levels of HbA1c, FBG, and PPBG after 16 weeks. A higher level of participation showed improved glycemic control, suggesting the potential of the Wellthy CARE platform for better management of the disease.

Background: In any system of medicine the drug identification is the most essential task prior to any treatment plan. In Ayurved it has more significance as there are various plants available with similar characteristics but different mode of actions. Hence the correct identification of raw drugs becomes mandatory. Taking all these points into consideration Shalmali Kantaka Cream is selected in the present study. This formulation is not exactly mentioned anywhere in the texts but Acharya Chakradatta mentioned application of Shalmali and Payasa as Mukh kanti Vardhak lepa in kshudra Roga Adhyaya. So, the Shalmali Kantaka Cream is the modified formulation. Material & Methods: The present study was aimed at setting up a standard profile of Shalmali kantaka cream which was prepared using pharmacognostically authenticated raw drugs followed by subjecting it to detailed Pharmacognostical and physicochemical analysis as per standard protocol. Result & conclusion: The observations were systematically recorded. Pharmacognostical findings of raw drug i.e. Oil globules, Lignified fibres, stone cells, tannin content, Rossett crystals, lignified stone cell etc. Phytochemical results show that loss on drying was 0.84% w/w, Iodine value 42.34. HPTLC result shows 12 spots at 254 nm and 8 spots at 366 nm. Study confirm the authentication of ingredients present in the finished product which support the intended action of the formulation in Twak Prasadana.

Purpose: Organizations, being the competitive kind, aspire to rationalise, innovate and streamline their processes. Business Process Reengineering (BPR) is an attempt to adapt and readjust ...

In this paper, we are going to investigate insulin, a bio-molecule responsible for the onset of diabetes, which is generally diagnosed using the conventional ELISA method. Its picomolar concentration in blood and short life time was a challenge in developing a sensor sensitive to such small volumes. This paper presents an experimental study of the dielectric properties of hepes buffer solution with varying concentration of insulin, a peptide hormone at microwave frequency range. A composite whispering gallery electric mode ( $WGE_{800}$ ) microwave dielectric resonator with sapphire and polycarbonate disposable sample holding disc has been used at 17.59 GHz. From observations, imaginary part of permittivity has been found very sensitive to changes in insulin concentration ranging from $2.0327\times 10^{-8} \% $ to $21.9995\times 10^{-8} \% $ . Studies show that the present method has the potential to detect and sense ultralow concentration of bioanalyte with regression coefficient 0.943 and sensitivity of 0.039 for 10 pM change in insulin concentration.

In today’s scenario, Networking has become an integral part of daily life and with it, Security is a major concern. There is constant threat because it is almost impossible to be isolated from Internet. When we talk about Networking, Server-Client Infrastructure is to be considered. With such an active and important role in our life, Networking is a major area and we need to make sure that the network is not hacked by anyone i.e security is to be ensured. In this paper, first we discuss about Networking, then Server-Client Network Infrastructure and finally at the last we describe a way to manage security in Server-Client Network Infrastructure.

There is a growing concern regarding the adverse health effects due to indoor air pollution in developing countries including India. Hence, it becomes important to study the causes and sources of indoor air pollutants. This study presents the indoor concentrations of PM0.6 (particles with aerodynamic diameter less than 0.6μm) and identifies sources leading to indoor air pollution. Indoor air samples were collected at IIT Kanpur campus. Ninety-eight PM0.6 samples were collected during November 2013 to September 2014. PM0.6 concentration was measured using a single stage impactor type PM0.6 sampler. The average PM0.6 concentration indoor was about 94.44μg/m(3). Samples collected were then analysed for metal concentrations using ICP-OES (Inductively Coupled Plasma - Optical Emission Spectrometer). Eight metals Ba, Ca, Cr, Cu, Fe, Mg, Ni and Pb were quantified from PM samples using ICP-OES. Positive Matrix Factorization (PMF) was used for source apportionment of indoor air pollution. PMF is a factor analysis tool which helps in resolving the profile and contribution of the sources from an unknown mixture. Five possible sources of indoor pollutants were identified by factor analysis - (1) Coal combustion (21.8%) (2) Tobacco smoking (9.8%) (3) Wall dust (25.7%) (4) Soil particles (17.5%) (5) Wooden furniture/paper products (25.2%).

Smart materials are responsive to multiple stimuli like light, temperature, pH and redox reactions with specific changes in state. Various functionalities in miniaturised devices can be achieved through the application of "smart materials" that respond to changes in their surroundings. The change in state of the materials in the presence of a stimulus may be used for on demand alteration of flow patterns in devices, acting as microvalves, as scaffolds for cellular aggregation or as modalities for signal amplification. In this review, we discuss the concepts of smart trigger responsive materials and their applications in miniaturized devices both for organ-on-a-chip disease models and for point-of-care diagnostics. The emphasis is on leveraging the smartness of these materials for example, to allow on demand sample actuation, ion dependent spheroid models for cancer or light dependent contractility of muscle films for organ-on-a-chip applications. The review throws light on the current status, scope for technological enhancements, challenges for translation and future prospects of increased incorporation of smart materials as integral parts of miniaturized devices.

This chapter will discuss in detail about the different processes involved in conversion of lignocellulosic feedstocks into biogas and the shortcomings of the conventional processes. The different methods of physical, chemical, and biological pretreatment for the lignocellulose will be discussed. The chapter also addresses methods of biogas production, analysis, and the different biogas reactors.

Background Hypertensive disorders are the most common in pregnancy. Several studies showed a positive correlation between elevated maternal serum uric acid (UA), serum creatinine and adverse maternal and fetal outcomes, but only a few studies are available on serum cystatin C and maternal and fetal outcomes. The present study was undertaken to study the association of serum UA, creatinine and cystatin C with maternal and fetal outcomes. Methods Out of 116 pregnant women 69 women had no hypertension and 47 had hypertension with or without proteinuria. Serum UA, creatinine and cystatin C was measured by modified Uricase method, modified kinetic Jaffe's reaction and particle-enhanced immunonephelometric assay respectively. Multivariate logistic regression was performed to determine the independent effects of serum UA, creatinine and cystatin C on maternal and fetal outcomes using stata 13.1. Results The adjusted odds ratio (OR) was 3.73 (95% CI: 1.18-11.75; P=0.024) for UA; 15.79 (95% CI: 3.04-81.94; P=0.001) for creatinine and 2.03 (95% CI: 0.70-5.87; P=0.192) for cystatin C in hypertensive disorders of pregnancy. All the three renal parameters were not significantly associated with birth weight, gestational age of delivery and mode of delivery after adjusting for the confounding factors. Conclusions Serum creatinine and uric acid are independent risk factors for hypertensive disorders of pregnancy. High serum uric acid is associated with low birth weight and delivery by caesarian section whereas high serum creatinine with preterm delivery only before adjustment for confounding factors and not after adjustment. Serum cystatin C was not significantly associated with the maternal and fetal outcomes.