Gotowa bibliografia na temat „153/.076”

Abstract Introduction Biological changes during adolescence naturally delay the circadian sleep-wake cycle. Adolescents struggle between the imposed timing of their sleep-wake cycle by social demands and their desired one, resulting in circadian misalignment. Circadian misalignment has been associated with a higher risk for mental health problems. We examined whether objective and subjective metrics of circadian misalignment are associated with internalizing symptoms (IS) and externalizing behaviors (EB) in adolescents. Methods We studied 376 adolescents from the Penn State Child Cohort (median 16 years; 47% female; 21% racial/ethnic minority) who had a minimum of 3-nights of at-home actigraphy (ACT), and 9-h in-lab polysomnography (PSG). ACT-measured sleep midpoint (SM) was calculated as the central point of the sleep period, while sleep regularity (SR) was calculated as the intra-individual standard deviation of the SM. Circadian preference (CP) was measured with the Morningness-Eveningness Questionnaire. IS and EB were measured by parent- or self-report on Achenbach System of Empirically Based Assessment using developmentally-appropriate forms and norms. Stepwise linear regression models adjusted for demographics (sex, race/ethnicity, age, BMI percentile), sleep disorders (insomnia, PSG-apnea/hypopnea index) and insufficient sleep (ACT-mean sleep duration, ACT-sleep duration variability). Results Both CP (r=-.118, p=.022) and SR (r=.116, p=.024) were associated with IS, however, they competed between each other in regression models resulting in marginally significant associations (β=-.094, p=.079 and β=.092, p=.084, respectively) that were further attenuated after adjusting individually for covariables (β=-.072, p=.190 and β=.076, p=.163, respectively). Both CP (r=-.230, p<.001) and SR (r=.140, p=.006) were associated with EB; however, only CP (β=-.153, p=.004) remained significantly associated with EB after adjusting for covariables (β=-.130, p=.016). Conclusion Assessing self-reported eveningness is a useful and inexpensive tool to identify adolescents in whom circadian misalignment contributes to mood and behavioral problems. However, it appears that its combination with objective assessments, particularly irregularity of the sleep-wake cycle, may yield the most predictive results. Support (if any) NIH R01HL136587, R01MH118308, UL1TR000127

Abstract Type 2 diabetes begins as conversion of normal glucose metabolism (NGM) to prediabetes, and 5-10% per year of people with prediabetes progress to diabetes. Therefore, understanding evolution of prediabetes is mandatory to know how type 2 diabetes starts. However, the process of conversion of NGM to prediabetes, which may be ethnicity-specific, has poorly been investigated. We analyzed 599 Japanese adults with NGM (fasting plasma glucose (FPG) <100 mg·dL-1 and 2-h PG at 75 g oral glucose tolerance (OGTT) <140 mg·dL-1) (male 62%, the mean age, body mass index (BMI), fasting IRI/FPG and 2-h IRI/PG, 52 years, 23.1 kg·m-2, 4.1 μU·mL-1/92 mg·dL-1 and 24.5 μU·mL-1/104 mg·dL-1, respectively). They received follow-up OGTTs at a mean of 3.7 years later (2,061 person-years observation). Prediabetes developed in 179 (impaired fasting glucose 102, impaired glucose tolerance 39, and impaired fasting glucose/impaired glucose tolerance 28). By the screening univariate analysis, Fatty Liver Index (FLI), FPG, ISIMATSUDA (index of basal and post-glucose whole body insulin sensitivity (Si) and Stumvoll's first phase (Stumvoll-1, an index of glucose-stimulated acute (∼10 min) insulin secretion (Isec) were robust risk factors for incident prediabetes. In contrast, indices of basal Si such as HOMA-IR, and basal, 30 min, or later phase index of Isec such as HOMAbeta and insulinogenic index, respectively, were not significant risk for prediabetes. In multivariate Cox model adjusted for age and sex, HR (95%CI) per 1 IQR increase were FLI 1.303 (1. 063-1.586), P <0. 01; FPG 1.400 (1. 076-1.840), P <0. 01; ISIMATSUDA 0.841 (0.712-0.963), P = 0. 03; Stumvoll-1 0.764 (0.622-0.935) P <0. 01. Note that FLI and FPG are risk factors and ISIMATSUDA and Stumvoll-1 are protective factors. Notably, FLI was a risk even after adjustment for BMI. The best cutoff values differentiating prediabetes Progressors from Nonprogressors obtained by the ROC curve using entire range of each risk factor was ≥12.4 for FLI, ≥95 mg·dL-1 for FPG, ≤11.99 for ISIMATSUDA and ≤486.3 for Stumvoll-1, and incidence of prediabetes was progressively high as 10/127 (6%), 34/153 (22%), 56/189 (30%), 53/106 (50%) and 16/24 (67%) among the participants with no, one, two, three and four unfavorable discriminating values for progression, respectively. AUC of ROC curve (AUROC) for the combination of the quadrumvirate was as large as 0.729 (0.661-0.788) with high precision as sensitivity 73.4% and specificity 63.8%. In conclusion, at the beginning of type 2 diabetes in the Japanese population who are non-obese and insulin-sensitive as shown, hepatic steatosis, the high normal FPG, attenuation of whole-body insulin sensitivity, lowered acute phase glucose-induced insulin release (the quadrumvirate) are synergistically and independently, with comparable strength each other, related to the development of prediabetes. Presentation: No date and time listed

This paper presents the findings on tire–pavement noise on various types of pavements by using an on-board sound intensity (OBSI) method. Mitigation of traffic noise has become an increasingly important consideration for highway agencies when constructing new highways or improving the existing systems. As a competitive alternative for noise mitigation, quieter pavement may provide advantages that noise barriers do not have, or to where sound barriers are not suited. The first step in developing quieter pavement is identifying the noise levels of different types of highway pavements. To reach the ultimate goals of quieter pavement development, this research has focused on the most imperative task, i.e., to measure the noise levels of different types of pavements in North Carolina (NC). Pavement noise levels of 61 highway sites including 153 test sections around 30 counties for nine types of pavements across North Carolina have been investigated. A thorough literature review was conducted and OBSI testing equipment with sound intensity measuring process was established during this study. The results of OBSI data indicate that the tire–pavement noise levels of the six dense graded surface courses in NC are in a lower range, from 98.2 to 99.6 dBA, comparing with other dense graded surface friction courses in other states. The overall findings indicate that relatively quieter pavements have been used in North Carolina. The OBSI data collected will provide valuable information in future research for quieter pavement development and traffic noise management.

Abstract Stocking of hatchery-raised fish is an important part of the pallid sturgeon Scaphirhynchus albus recovery program. In the wild, juvenile pallid sturgeon consume primarily aquatic insects, although little is known about specific dietary needs. In hatchery settings, pallid sturgeon are fed commercial diets that are formulated for salmonids. To compare food consumption, growth, and energy status of pallid sturgeon fed artificial or natural diets, we conducted a laboratory study using 24 juvenile pallid sturgeon (initial fork length 153–236 mm). Pallid sturgeon were fed a daily ration of either commercial pellets (1 mm, slow sinking; 45% protein, 19% fat) or chironomid larvae for 5 wk. Natural-fed pallid sturgeon exhibited a greater specific growth rate (2.12% d−1) than pellet-fed fish (0.06% d−1). Similarly, relative condition was greater for natural-fed sturgeon (Kn = 1.11) than that observed for pellet-fed fish (Kn = 0.87). In contrast, the hepatosomatic index was significantly higher in pellet-fed fish (2.5%), indicating a high lipid diet compared with natural-fed sturgeon (1.4%). Given the importance of natural diets to fish digestion and growth, it is suggested that a more holistic approach be applied in the development of a practical diet for pallid sturgeon that incorporates attributes of natural prey.

Background: According to CDC, Coronavirus disease 2019 (COVID-19) is caused by a new coronavirus which was first identified in Wuhan, China, in December 2019. Although most people who have COVID-19 have mild symptoms, it can also cause severe illness and even death. Some groups, including older adults and people who have certain underlying medical conditions, are at increased risk of severe illness. On February 11, 2020, the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak. The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. Objectives: Analysis of COVID 19 data in the Davanagere district from April 2020 to August 2020. Methods: In this current study the secondary data is obtained from the Official Website of Government of Karnataka, Covid-19 Informational Portal – Media Bulletin. By using different indicators Davanagere district covid data is further used to calculate Attack rate, Case fatality rate and complete case fatality rate. Results: In this study it is found that, in the month of April there were no covid positive cases reported till fourth week of month, by fourth week, total two positive cases were reported the first case being encountered on 28th April 2020, with discharge of those patient in the end of the month. The attack rate has steeped up from 8.018 to 355.74 per one lakh population i.e. about 44 times more than initial months of pandemic. The strict preventive measures were followed by public and government too. So the prevalence rate is less in May, June and went on increasing once the unlocking is done. In summer the total positive cases steeping up from 2 cases to 154 total positive cases for the month April to May, and there is steady in rise of total positive cases for the month June with total positive cases of 153. In the beginning of summer there were fewer cases as pandemic was just begun and chances of transmission were very less. As monsoon appeared in June last week there is surge in total positive cases. With added burden of Unlock 1.0 phase, as public started moving out from home without any freak of infection. Conclusion: In this study it is found that due to strict nationwide lockdown and social distancing, hygiene practices among the Davanagere people has made it possible to restrict the spread of covid among the people, although the international immigration of Davanagere residents lead to transmission of infection. Further removal of lockdown after three months has lead to three fold spread of disease. Also there is rise in death rate, attack rate and case fatality in Davanagere district.

76 Background: Cancer (CA) is one of the leading causes of death worldwide. In 2020 CA was the second leading cause of mortality in the US. Novel treatments for various malignancies are discovered each passing year. Despite these advancements, some patients refuse to receive treatment. Our study focused on characterizing the group of patients with advanced malignancies who refused therapy. Methods: We performed a retrospective chart review of patients diagnosed with advanced malignancies, aged 18-75 years, between 01/01/ 2010 and 12/31/2015, who refused any therapy. We used Geisinger Health System’s data. Results: Our search provided 644 patients who met our inclusion criteria. The mean age of patients was 63.2 years (standard deviation (σ) 8.3). Female patients made up 40.4% (260/644), while 59.6% (384/644) were male. Most patients were Caucasian (96.9%, 624/644), 1.9% (12/644) were Black; 0.6% (4/644) were Asian, and 0.6% (4/644) were of unknown racial background. Marital status was evenly distributed with 50.0% (322/644) being married and 50.0% (322/644) being non-married. Most of the study population (52.3%, 337/644) had government-funded insurance at the time of CA diagnosis; 46.6% (300/644) had private insurance, and 1.1% (7/644) had no insurance. Stage 3 disease, according to American Joint Committee on Cancer staging was noted in 21.1% (136/644), while 78.9% (508/644) had stage 4 disease. The mean BMI was 28.2 (σ 8.3). Most patients were either overweight or obese (60.6%, 350/577; 67 patients did not have data on BMI available). A history of cigarette smoking was present in 73.0% (438/600). Adenocarcinomas (323/639, 50.5%) were the most prominent histological subtype. The most common site of malignancy was the respiratory system (220/644, 34.2%). Only 9.6% (62/644) of patients had a history of previous CA, while a family history of CA was present in 29.5% (190/644). Most patients (62.1%, 400/644) had a Charleston Comorbidity Index (CCI) > 5; the mean CCI was 6.4 (σ 3.7). In 17.1% (110/644) a palliative medicine referral was made. Substance use disorders were present in 23.8% (153/644); 14.4% (93/644) had a history of depression, and anxiety 10.1% (65/644). Conclusions: Male patients made up a larger proportion of the group of advanced-stage patients who declined therapy. The racial distribution in this group of patients appeared to reflect the local population. Most patients who refused therapy had stage 4 disease, and they appeared to have severe underlying comorbidities, with an average CCI >5. Despite treatment refusal, a surprisingly low percentage of patients were referred to palliative medicine.[Table: see text][Table: see text]

Purpose To examine factors that facilitate an understanding of the relationship between two important, and often interchangeably used, concepts in diabetes management: compliance and adherence. Design A cross-sectional survey. Setting Online data collection. Subjects 365 respondents at least 18 years of age and currently in treatment for diabetes. Measures We measured patients’ compliance, adherence, mindfulness, and perceptions about physician-patient communication, as well as their demographic characteristics. Analysis A moderated mediation analysis was conducted to examine the conditioned indirect effect of compliance on adherence. Results The direct effect of compliance on adherence was positive and significant (β = .378, SE = .073, P < .05, BootCI [.234, .521]), but the compliance-adherence association was also partially mediated by patient’s potential for mindful non-adherence. A higher level of compliance increased potential for mindful non-adherence (β = .716, SE = .082, P < .05, BootCI [.555, .876]), and, in turn, the increased potential for mindful non-adherence reduced adherence (β = −.107, SE = .045, P < .05, BootCI [–.196, −.018]). This detrimental mediating effect of potential for mindful non-adherence was contingent on the perceived quality of physician-patient communication (index = .076, SE = .038, 95% BootCI [.003, .153]), indicating that the positive perception significantly reduced the negative mediating effect of potential for mindful non-adherence on adherence. Conclusion Given that patients with diabetes are involved in a complex self-care, an established partnership and collaboration between patient and doctor is essential to promoting adherence; when the treatment coincides with the patient’s beliefs and needs, mindful non-adherence is less likely to occur.

Background: Hyperglycemia occurs in 22% to 46% of hospitalized patients, negatively affecting patient outcomes, including mortality, inpatient complications, length of stay, and hospital costs. Achieving inpatient glycemic control is challenging due to inconsistent caloric intake, changes from home medications, a catabolic state in the setting of acute illness, consequences of acute inflammation, intercurrent infection, and limitations in labor-intensive glucose monitoring and insulin administration. Method: We conducted a retrospective cross-sectional analysis at the University of California San Francisco hospitals between September 3, 2020 and September 2, 2021, comparing point-of-care glucose measurements in patients on nil per os (NPO), continuous total parenteral nutrition, or continuous tube feeding assigned to our novel automated self-adjusting subcutaneous insulin algorithm (SQIA) or conventional, physician-driven insulin dosing. We also evaluated physician efficiency by tracking the number of insulin orders placed or modified. Results: The proportion of glucose in range (70-180 mg/dL) was higher in the SQIA group than in the conventional group (71.0% vs 69.0%, P = .153). The SQIA led to a lower proportion of severe hyperglycemia (>250 mg/dL; 5.8% vs 7.2%, P = .017), hypoglycemia (54-69 mg/dL; 0.8% vs 1.2%, P = .029), and severe hypoglycemia (<54 mg/dL; 0.3% vs 0.5%, P = .076) events. The number of orders a physician had to place while a patient was on the SQIA was reduced by a factor of more than 12, when compared with while a patient was on conventional insulin dosing. Conclusions: The SQIA reduced severe hyperglycemia, hypoglycemia, and severe hypoglycemia compared with conventional insulin dosing. It also improved physician efficiency by reducing the number of order modifications a physician had to place.

ImportanceInvestigating disparities in service coverage of pediatric optometrists and pediatric ophthalmologists in relation to patient demographics will illuminate vulnerable populations and inform future interventions.ObjectiveTo characterize the geographic distribution of pediatric eye care practitioners and analyze its association with population demographics.Design, Setting, and ParticipantsIn this cross-sectional study, 4 public databases were used to identify the addresses of pediatric optometrists and pediatric ophthalmologists in the US in April 2023. Addresses were geocoded, and population demographic data were collected. Pediatric optometrists and pediatric ophthalmologists listed in the public databases, as well as respondents to the 2020 US census, were included in this study. Data were analyzed from April to July 2023.ExposuresPublic databases and US census data of eye practitioners and their practice locations.Main Outcomes and MeasuresGeographic distribution of pediatric optometrists and pediatric ophthalmologists as listed in public databases and correlations between service coverage and US population demographics.ResultsA total of 586 pediatric optometrists (302 female [51.5%]) and 1060 pediatric ophthalmologists (590 male [55.7%]) were identified. Among US counties, 203 (6.5%) had at least 1 pediatric optometrist, and 308 (9.7%) had at least 1 pediatric ophthalmologist, showing substantial geographic overlap (odds ratio, 12.7; 95% CI, 9.4-17.4; P &amp;lt; .001). In the 2834 counties without pediatric ophthalmologists, 2731 (96.4%) lacked pediatric optometrists. There were more pediatric ophthalmologists per million people (3.3) compared with pediatric optometrists per million people (2.5) across all states (difference, 0.8; 95% CI, 0-1.9; P = .047). Among counties with practitioners, the median (IQR) number of pediatric optometrists per million people was 7.8 (0.4-245.0), surpassing the median (IQR) number of pediatric ophthalmologists per million people, 5.5 (1.0-117.0). Counties with pediatric ophthalmologists had higher mean (SD) household incomes than counties with pediatric optometrists ($76 126.87 [$21 879.23] vs $68 681.77 [$18 336.40]; difference, −$7445.10; 95% CI, $2519.51-$12 370.69; P = .003) and higher mean (SD) population with bachelor’s degrees than counties with pediatric optometrists (79 016 [82 503] vs 23 076 [44 025]; difference, −55 940; 95% CI, −73 035 to −38 845; P &amp;lt; .001), whereas counties with neither specialist type had the lowest mean (SD) household income ($57 714.03 [$2731.00] vs $78 388.67 [$18 499.21]; difference, −$20 675.00; 95% CI, −$21 550.90 to −$19 799.10; P &amp;lt; .001) and mean (SD) population with bachelor’s degrees (5113 [12 875] vs 167 015 [216 486]; difference, −161 902; 95% CI, −170 388.9 to −153 415.1; P &amp;lt; .001) compared with counties with practitioners.Conclusions and RelevanceGeographic disparities in pediatric eye care access, compounded by socioeconomic differences, underscore the urgency of augmenting practitioner support in underserved areas.