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Blind humans face many problems to interact with their close by surroundings. The intention of this paper is to offer a device to help blind humans to navigate in addition to feel the barriers. We plan to propose an operating model that is taking walks stick with inconstructed ultrasonic sensor with a micro controller gadget. Detection and monitoring algorithms are laid out in terms of extricating the capabilities of photographs and motion pictures for protection and scrutiny applications. famous algorithms of item detection consist of You only look once (YOLO), area-based Convolutional Neural Networks (RCNN), quicker RCNN (F-RCNN). RCNN has higher accuracy in comparison to different algorithms, but YOLO surpasses whilst pace is considered over accuracy. &nbsp

Introduction Given the high rates of obesity and poor glycemic control among individuals with type 2 diabetes (T2D), this study examines current trends in HbA1c and body mass index (BMI) as well as the association between HbA1c and BMI among adults with T2D. Methods Data from the IBM® MarketScan® Explorys® Claims-EMR Data were used to construct eight annual cohorts for the years 2012–2019. Each annual cohort included adults identified with T2D who had at least one recorded HbA1c laboratory result and BMI value in the year of interest. Given these cohorts, trends in HbA1c and BMI were described over time using generalized estimating equation (GEE) tests. Results Results indicate that, over the study period from 2012–2019, average BMI increased significantly and there was a decrease in the percentage of adults with T2D who achieved glycemic control. In addition, for all years, higher BMI classification was associated with higher HbA1c values. When examining results for patients in different age groups, the findings were generally consistent with the overall population. In each age group, but most notably the age 18–44 group, the mean BMI increased over time and higher BMI was associated with higher HbA1c. Conclusion Given the increase in BMI and decreasing percentage of individuals achieving glycemic control among adults with T2D found over the study period, therapies which decrease BMI as well as HbA1c can potentially have a significant impact on the management of T2D. The growing proportion of the younger age group with higher mean BMI may remain a key subgroup of interest.

Introduction Type 2 diabetes (T2D) is extremely burdensome to people with T2D and associated with impaired health-related quality of life. This study explores the impact of T2D and potentially relevant outcomes for new therapies using a unique approach to in-depth qualitative interviews where people with T2D are asked to think about their future with T2D. Methods A cross-sectional qualitative interview study among people with T2D from the USA and UK. Interviews explored their treatment journey, perceptions of their future with T2D, and the value of achieving normoglycemia (explored through presentation of two vignettes with hypothetical medications that reduced hemoglobin A1c [HbA1c] levels

Limited US real-world evidence exists on the effect of substantial changes in weight on HbA1c among people with T2D. People with T2D were identified from 2010-2018 in the IQVIA Ambulatory EMR database. The date of the first observed weight value was defined as the index date and patients were required to have an additional weight value at 1 year (±90 days) post-index date. Patients were stratified by weight change between index and 1 year post-index date. HbA1c was evaluated at index, 6 months, and 1 year post-index date. Of the 1,061,354 patients evaluated, 20.2% gained weight, 53.9% had no weight change, and 10.6% lost 3-5%, 10.7% lost 5-10%, 2.8% lost 10-15%, and 1.7% lost ≥15% of their weight at the index date (i.e., index weight) at 1 year of follow-up. Of note, patients with the largest weight loss had the highest index weight (range: 203.7lb in patients with weight gain to 245.9lb in patients with ≥15% weight loss) . Mean index HbA1c was similar across subgroups as was the percent of patients with index HbA1c In summary, HbA1c reduction was greater with increasing amount of weight lost during the one year of follow-up. Patients with weight loss ≥15% reduced HbA1c by an average of 1.2% of the index value at 1 year of follow-up. Disclosure S.Shinde: None. V.Thieu: None. A.Kwan: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. K.F.Houghton: None. D.Schapiro: Employee; Eli Lilly and Company. J.Meyers: Other Relationship; Eli Lilly and Company.

Heather L Gelhorn,1 Melissa M Ross,1 Shraddha Shinde,2 Vivian Thuyanh Thieu,3 Kristina S Boye2 1Patient-Centered Research, Evidera, Inc, Bethesda, MD, USA; 2Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN, USA; 3Global Medical Affairs, Eli Lilly and Company, Indianapolis, IN, USACorrespondence: Heather L Gelhorn, Patient-Centered Research, Evidera, Inc, 7101 Wisconsin Ave, Suite 1400, Bethesda, MD, 20814, USA, Tel +1-970-363-7333, Email heather.gelhorn@evidera.comPurpose: To understand the perspectives of people with type 2 diabetes (T2D) on safely reaching near normoglycemia, defined as a glycated hemoglobin A1c (HbA1c) value of < 6%. HbA1c indicates the average blood sugar level over the past few months.Patients and Methods: This cross-sectional online quantitative survey of people with T2D asked about the current impacts of T2D, the anticipated benefits of safely achieving near normoglycemia among participants with a current HbA1c ≥ 6%, or the actual benefits of safely achieving near normoglycemia among participants who had an HbA1c < 6%. Participants reported on specific areas of psychological/emotional impact of T2D and the psychological/emotional benefits of achieving near normoglycemia.Results: Participants (N = 1000; United States = 500 and United Kingdom = 500) were 53.1% male and had a mean age of 62.9 years (SD = 13.3). The majority reported that the current HbA1c ≥ 6% (81.2%) and 49.2% had been diagnosed more than 10 years ago. The vast majority of participants (> 90%) indicated that achieving near normoglycemia was meaningful, with 95% of the participants indicating that achieving near normoglycemia would be of somewhat or extreme importance to them. In total, 93.8% of participants with a current HbA1c ≥ 6% and 80.3% of those with a current HbA1c < 6% anticipated/reported having experienced improvements as a result of achieving near normoglycemia. Among those who experienced or anticipated positive psychological/emotional impacts (n = 247), the most commonly reported impacts included less worry about future diabetes-related complications (79.8%), feeling in control over one’s life (72.9%), and overall health-related quality of life (59.9%).Conclusion: Achieving near normoglycemia is both meaningful and important to the majority of people with T2D, including both those who have and those who have not experienced reaching near normoglycemia. A wide range of specific impacts, including psychological/emotional concepts, are experienced by people with T2D, many of which may be improved through achieving near normoglycemia.Keywords: burden of disease, emotional impact, patient perspective, psychological impact, quality of life

Extremophilic microorganisms have the ability to survive under seemingly extreme environments such as extreme pH, temperature, pressure, oxygen levels, desiccation, salinity, radiation, and redox potential. Under such harsh conditions, other normal microbes would be destroyed. However, extremophiles are classified based on the environment in which they can survive. These extremophilic microorganisms have the ability to produce a variety of extremozymes and extremolytes under different harsh conditions. Thus, they are considered as potential candidates for their several biotechnological and commercial applications. This chapter provides an overview of the ecology of extremophiles and their biotechnological applications, including the production of extremophiles, extremozymes, and extremolytes as valuable resources for the future development of a bio-based economy.

Background Obesity is a heterogeneous chronic condition that has varying metabolic, structural, inflammatory, degenerative, neoplastic and psychological health effects. We aimed to identify common patterns of obesity-related conditions in a nationally representative sample. Methods Respondents age ≥18y with body mass index (BMI) >25 kg/m2 in NHANES 2017-2018 were clustered based on key obesity-related conditions including type 2 diabetes (T2D), dyslipidemia, hypertension (HTN), cardiovascular disease (CVD), chronic kidney disease (CKD), osteoarthritis, physical limitation (PL), cancer, depression, and anxiety. Hierarchical adaptive means clustering was employed with NHANES survey weights. An optimal number of clusters was chosen with the "elbow method." Patient characteristics were compared across clusters. Clusters were characterized by conditions with a ≥ 50% prevalence in descending order. Results Six clusters were identified among 3,084 respondents. Cluster 1 (15.8% of the respondents; mean age: 34.9y; female: 53.5%; mean BMI: 30.8) had no obesity-related conditions. Cluster 2 (27.7%; 47.3; 42.7%; 32.5) was dominated by HTN. Cluster 3 (9.9%; 58. 0; 44.1%; 33. 0) was dominated by CKD and HTN. Cluster 4 (13.2%; 55.1; 68. 0%; 33.7) was dominated by depression, HTN, PL and dyslipidemia. Cluster 5 (23.7%; 59.4; 50.7%; 32.6) was dominated by HTN, PL, CVD and dyslipidemia. Cluster 6 (10.1%; 67.8; 45. 0%; 34.3) was dominated by HTN, dyslipidemia, T2D, PL, and CVD. Clusters 4 and 6 incurred the highest healthcare use. Conclusions Adults with overweight and obesity in the US have distinct patterns of obesity-related conditions, the burden of which generally increased with obesity severity and age. Presentation: No date and time listed

Purpose Type 2 diabetes (T2D) medication adherence is poor and is impacted by individual drug characteristics. Treatment-associated weight change can affect medication-taking behavior. This review aimed to explore weight change on T2D therapy and consider its impact on adherence and discontinuation. Methods Searches were conducted in MEDLINE and EMBASE (2005 to September 2020), and among recent congress abstract books for studies providing data on medication adherence or discontinuation and weight change in people with T2D (PwD). Results Nine studies meeting the inclusion criteria were identified from 9188 bibliographic records. All three studies exploring weight change and discontinuation reported weight loss to be associated with higher persistence. Seven studies of varying design explored weight change and adherence. Four reported absolute weight change (kg) and adherence: one pooled data from different diabetes medications and demonstrated that self-reported adherence was significantly associated with weight loss; however, three studies found that weight change in adherent PwD was in the direction of the known weight profile (loss/gain) of the evaluated drug. Categorical weight loss (≥3%) and adherence were reported in two studies: one reported that numerically more adherent versus non-adherent PwD lost ≥3% weight regardless of the drug’s weight profile, the other showed that early weight loss with a glucagon-like peptide-1 agonist was significantly associated with better adherence. One study reported adherence by categorical weight change; as weight loss increased, adherence scores improved, regardless of drug type. Conclusion Findings suggest that discontinuation rates may be lower in PwD who lose as compared to those who gain weight on T2D treatment. The evidence base on adherence and weight change is more challenging to interpret due to the range of study designs. Given the importance of weight control in T2D, further research exploring the individual’s treatment, weight journey, and behaviors over time should be undertaken.

Obesity is the most common chronic disease in the U.S. Patients with obesity have many cardiovascular risk factors, often modifiable. It is important to identify patients with obesity at high risk of atherosclerotic cardiovascular disease (ASCVD) to be able to appropriately direct treatment and resources. We conducted an observational study of EMR data of 399,360 adults with BMI ≥ 25 kg/m2 and without baseline ASCVD between 2000 and 2019. We first identified a literature-based pool of risk factors for ASCVD onset and conducted variable selection by applying least absolute shrinkage and selection operator (LASSO) penalized Cox regression with ten-fold cross-validation on an 80% training dataset. We estimated a regular Cox model on the training dataset with selected variables and evaluated model performance on the remaining 20% dataset. Over the mean of 7.4 years of follow-up, 37,424 (11.7%) of study patients developed ASCVD. The predictive model achieved a Harrell’s C-statistic of 0.81. The greatest risk of ASCVD onset was associated with older age (HR 2.16 per 1 SD = 15.4 years; 95% CI 2.13- 2.20), heart failure (HR 1.85; 95% CI 1.74-1.97), valvular heart disease (HR 1.61; 95% CI 1.53-1.68) and stimulant abuse (HR 1.60; 95% CI 1.41-1.81). Female sex was associated with a lower risk of ASCVD (HR 0.64; 95% CI 0.63-0.65). Patient characteristics found in >5% of patients that carried additional risk included history of smoking (39.9% of patients; HR 1.40; 95% CI 1.37-1.43), proteinuria (5.5%; HR 1.33; 95% CI 1.29-1.38) and hypertension (23.6%; HR 1.29; 95% CI 1.26-1.32). Each standard deviation increase in BMI (5.3 kg/m2) was associated with a 1.15-fold (95% CI 1.14-1.16) increase in the risk of ASCVD onset. It is feasible to use predictive modeling to identify patients with overweight and obesity at high ASCVD risk. This approach could be utilized to guide population management and clinical treatment decisions. Disclosure A. Turchin: Consultant; Self; Proteomics International, Research Support; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Pfizer Inc., Sanofi, Stock/Shareholder; Self; Brio Systems. F. J. Morrison: None. M. Shubina: None. S. Shinde: Employee; Self; Eli Lilly and Company, Stock/Shareholder; Self; Eli Lilly and Company. N. Ahmad: Employee; Self; Eli Lilly and Company. H. Kan: Employee; Self; Eli Lilly and Company, Stock/Shareholder; Self; Bristol-Myers Squibb Company, GlaxoSmithKline plc. Funding Eli Lilly and Company

Obesity is the most common chronic disease in the U.S. Patients with obesity are at high risk for type 2 diabetes mellitus (T2DM); however, many of their risk factors for T2DM are modifiable. It is important to identify patients with obesity at high risk for T2DM to appropriately direct treatment and resources. We conducted an observational study of EMR data of 399,711 adults with BMI ≥ 25 kg/m2 and without baseline T2DM between 2000 and 2019. We first identified a literature-based pool of risk factors for T2DM onset and conducted variable selection by applying LASSO penalized Cox regression with ten-fold cross-validation on an 80% training dataset. We estimated a regular Cox model on the training dataset with selected variables and evaluated model performance on the remaining 20% dataset. Over a mean of 7.4 years of follow-up, 38,898 (9.8%) study patients developed T2DM. The predictive model achieved a Harrell’s C-statistic of 0.81. The greatest risk of T2DM was associated with gestational diabetes (HR 2.53; 95% CI 2.12-3.01), Asian and Hispanic race/ethnicity (HRs 2.38 and 1.94; 95% CIs 2.24-2.53 and 1.86-2.02, respectively), family history of DM (HR 2.00; 95% CI 1.95-2.04) and PCOS (HR 1.84; 95% CI 1.63-2.07). Female sex (HR 0.77; 95% CI 0.75-0.79), having a partner (HR 0.90; 95% CI 0.88-0.92) or commercial insurance (HR 0.86; 95% CI 0.84-0.88) were associated with a lower risk of T2DM. Characteristics found in >5% of patients that carried additional risk included proteinuria (5.0% of patients; HR 1.53; 95% CI 1.47-1.59), hypertension (23.9%; HR 1.21; 95% CI 1.18-1.25), high cholesterol (11.9%; HR 1.19; 95% CI 1.15-1.23), and history of smoking (40.5%; HR 1.18; 95% CI 1.15-1.21). Each standard deviation increase in BMI (5.2 kg/m2) was associated with a 1.51-fold (95% CI 1.49-1.52) increase in T2DM onset. It is feasible to use predictive modeling to identify patients with overweight and obesity at high risk of T2DM. This approach could be utilized to guide population management and clinical treatment decisions. Disclosure A. Turchin: Consultant; Self; Proteomics International, Research Support; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Pfizer Inc., Sanofi, Stock/Shareholder; Self; Brio Systems. F. J. Morrison: None. M. Shubina: None. S. Shinde: Employee; Self; Eli Lilly and Company, Stock/Shareholder; Self; Eli Lilly and Company. N. Ahmad: Employee; Self; Eli Lilly and Company. H. Kan: Employee; Self; Eli Lilly and Company, Stock/Shareholder; Self; Bristol-Myers Squibb Company, GlaxoSmithKline plc. Funding Eli Lilly and Company

In low and middle-income countries, access to cancer diagnosis and treatment is suboptimal. Further, compliance to cancer treatment is a major issue due to various reasons including financial barriers, lack of family support and fear of treatment. This article discusses the determinants of treatment completion in cancer patients of a government-run hospital, in a rural part of Punjab in India. The Sangrur hospital-based cancer registry data for the year 2018 have been used. We have registered 2,969 cancer cases, out of which 2,528 (85%) cases were eligible for the analysis. Of the total 2,528 cases, 1,362 (54%) cases completed the cancer directed treatment and 1,166 (46%) did not. The data have been collected from the electronic medical record (EMR) department and entered into CanReg5 software. The bivariate and multivariate binary logistic regression analysis was performed to see the effect of variables on the treatment completion. The results indicate that the elderly age group (>60 years) (odds ratio (OR): 0.52, (95% confidence interval (CI): 0.31–0.86)), distance from hospital (OR: 0.67, (95% CI: 0.50–0.89)) and access to government health schemes (OR: 0.13, (95% CI: 0.10–0.19)] have direct correlation with the treatment completion. The educated patients (OR: 1.49, (95% CI: 1.13–1.96)) and patients who received curative treatment (OR: 2.7, (95% CI: 1.88–3.88)) have shown 58% and 84% compliance to treatment completion, respectively. The other variables like the clinical extent of disease, religion, gender and income do not have any significant effect on the treatment completion. Determinants like age (young), education, distance from the hospital, curative treatment and availability of government health schemes for financial support have shown positive effects on treatment completion. These factors have to be considered by the cancer hospitals, health departments and policymakers while planning for cancer care or control in India.

Aims To examine body mass index (BMI) and HbA1c for individuals with type 2 diabetes (T2D) in the United States. Methods The retrospective study utilized data from IBM® MarketScan® Explorys® Claims-EMR Data for the years 2012–2019. Individuals with T2D and a recorded HbA1c laboratory result and BMI were included. The relationship between BMI and HbA1c was assessed descriptively and logistic regressions examined the relationship between benchmark BMI and the probability of having HbA1c above targets of 7% or 8% in the 1 year post-period. Results In our sample of 44,723 patients, results indicated that compared to individuals of normal weight, those classified as obese class I or obese class II were 24% more likely to have a last HbA1c ≥ 7% (Odds Ratio [OR] = 1.24; 95% Confidence Interval [CI] 1.14–1.35 for both obese class I and obese class II), while those classified as obese class III were 16% more likely (OR = 1.16; 95% CI 1.06–1.27). Results were similar when using a HbA1c threshold of 8%. Conclusions Given the importance of glycemic control for people with T2D, these results suggest that treatments which reduce rates of obesity may help to improve health outcomes.

Obesity is the most common chronic disease in the U.S. Patients with obesity have many risk factors for cancer, often modifiable. It is important to identify patients with obesity at high risk of cancer to be able to appropriately direct treatment and resources. Given that the risk pool is large, it is imperative to identify a clinically meaningful metric for risk stratification to help guide interventions. We conducted an observational study of electronic medical records data for 394,161 adults aged between 18 and 80, with BMI ≥ 25 kg/m2 and without baseline history of cancer between 2000 and 2019. We first identified a literature-based pool of risk factors for cancer onset and conducted variable selection by applying least absolute shrinkage and selection operator (LASSO) penalized Cox regression with ten-fold cross-validation on an 80% training dataset. Effects of the selected variables on risk of cancer (excluding non-melanoma skin cancer) onset were assessed using Cox regression on the 80% training dataset. The resulting model accuracy was evaluated using Cox regression on a withheld 20% validation dataset. Participants had a mean age of 46.7 (SD: 15.5) years and mean body mass index (BMI) of 30.5 (SD: 5.4) kg/m2; 51.9% were women. Over a mean of 7.5 years of follow-up, 34,679 (8.8%) of study patients developed cancer. The predictive model achieved a Harrell’s C-statistic of 0.73. The greatest risk of cancer incidence was associated with HIV infection (HR 2.22; 95% CI 1.88–2.63; 0.27% of patients), older age (HR 2.05 per 1 SD = 15.5 years; 95% CI 2.01- 2.09), hepatitis C infection (HR 1.48; 95% CI 1.34–1.63; 0.96% of patients), and family history of cancer (HR 1.44; 95% CI 1.41–1.48; 42.5% of patients). Additional patient characteristics found in >5% of patients that also carried risk included proteinuria (5.8% of patients; HR 1.23; 95% CI 1.18–1.29) and history of smoking (40.7% of patients; HR 1.20; 95% CI 1.17–1.23). Each standard deviation increase in BMI (5.4 kg/m2) was associated with a hazard ratio of 1.06 (95% CI 1.05–1.07) for incident cancer. It is feasible to use predictive modeling to identify patients with overweight and obesity at high cancer risk. This approach could be utilized to guide population management and clinical treatment decisions.

Macroencapsulation of phase change material (PCM) is one of the enhancement techniques to maximise heat transfer area between PCM and the surrounding heat transfer fluid (HTF). However, the selection of suitable encapsulation material, that can address the volumetric expansion problem and does not react with the core PCM, while being stable at elevated temperature, possesses a challenge. In this work, the thermo-mechanical characterisation of polymeric material is reported, which can be used for medium temperature (200–350 °C) solar applications. Three materials, such as polytetrafluoroethylene (PTFE), polyether ether ketone (PEEK) and polyether ketone ketone (PEKK) are chosen as an encapsulation material for storing a commercially available organic PCM, A164 in the capsule. Capsules of three materials are fabricated and the mechanical properties of the materials are evaluated after every 10 accelerated thermal cycles near the degradation temperature of the materials to understand their behaviour in extreme conditions. Dimensional and weight analyses of the macro encapsulated capsules is also performed to gauge any change in their physical properties. Thermo-mechanical properties show that the polymers chosen can be used as an encapsulation material for solar applications. Dimensional and weight analysis indicate no significant change in the properties of the polymers. High-temperature stability of these polymers even for extended duration indicates a maximum of 3 wt% change only. The compression test on these materials reveals that the PEKK can be used up to 275 °C with Young’s modulus decreases to 0.4 GPa. These results would form the ground for their applications as PCM-encapsulating materials targeting medium temperature solar applications.

Most published reports of patient safety in clinical practice focus largely on the culture of safety in complex health systems, separate from pre-approval and postmarketing research-related safety considerations for drugs, biologics, and other medical products. The science of safety requires a linked integrated perspective, i.e., an iterative process examining and relating safety concerns from drug or biologic discovery and development in preclinical stages, clinical trials and post-market use, research, surveillance, and potential regulatory changes. This commentary addresses the science of safety across the lifecycle of drug and biological products, regulatory considerations, barriers, and research needs. This paper provides a brief overview on how the functioning of healthcare systems affects the safety environment and describes how stakeholder involvement, research participation, and targeted education and training can help facilitate better safety measures and practices, provide improved quality of care to patients, and contribute to the science of safety. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties". Type: Commentary

Aim: This study assessed pharmacist’s knowledge and confidence in pharmacogenomics (PGx)-related concepts, and determined their needs with regard to education and training in PGx. Methods: A cross-sectional survey instrument was sent via postal mail to pharmacists (n = 319) who were randomly selected from the New York State database of licensed pharmacists. Descriptive and bivariate statistics were performed. Results: The response rate was 32% (n = 102). The majority (83%) of respondents had been exposed to basic concepts in genetics, while PGx was not an integral part of their education. Most respondents indicated being somewhat confident in their knowledge of PGx-related concepts. In addition, 64% of respondents reported being interested in attending 1–10 h of continuing education programs in PGx, and 42% of respondents indicated being interested in obtaining a certificate in PGx. Conclusion: Educational program development in the format of continuing education or certificate is needed to improve pharmacists’ education, confidence and training needs in PGx.

Objective: To examine the association between treprostinil sodium and pneumonia in patients with pulmonary arterial hypertension, utilizing and analyzing the reports submitted to the Food and Drug Administration (FDA) Adverse Even Reporting System (AERS) and the published literature. Methods: A total of 5,332926 reports of adverse events between January 2006 and June 2012 were downloaded from the FDA AERS. These adverse events were associated with all other drugs inclusive of Treprostinil Sodium. A literature review was conducted on PubMed using the terms treprostinil and pneumonia. Authorized pharmacovigilance tools were used to determine the proportional reporting ratio, the reporting odds ratio, and the information component given by the Bayesian confidence propagation neural network. Results: Based on the numerous adverse event pairs, 144 adverse events were listed as treprostinil sodium associated with pneumonia. The majority of the cases were seen in females (74%) and those between the ages of 51 and 75 years (63%). The most common route of drug administration among the cases was inhalation (73%). Conclusion: This study helps indicate an association between the treatment with Treprostinil sodium and the development of pneumonia in pulmonary hypertensive patients. Additional research is needed to confirm with the medical relevance of the analysis.