The Discrepancy Between Hemoglobin A1c and Glucose Management Indicators in 26 Patients Treated With Continuous Glucose Monitoring in an Internal Medicine Residency Clinic.

We conducted a retrospective observational cohort study between 2020 and 2023 in 26 patients with type 1 and type 2 diabetes mellitus (DM) who were using 3-4 injections per day of insulin and were monitored by continuous glucose monitoring (CGM). The goal of this retrospective observational cohort study is to compare these two metrics in an internal medicine community primary care residency clinic. We used CGM devices, Dexcom G6 and G7, and Freestyle Libre 3. The goal was to compare the patient's hemoglobin A1c (HbA1c) taken during their clinic visit by phlebotomy as a marker for diabetic control with an estimated HbA1c glucose management indicator (GMI) derived from the 30-day CGM readings. HbA1c is derived from the blood, while the GMI value is derived from the interstitial fluid. Both parameters were taken within 30 days of each other. GMI was taken in the last 30 days. We excluded patients with known anemia, chronic kidney disease, polycythemia, cirrhosis of the liver, or metabolic dysfunction associated with steatohepatitis (MASH) because disease states can affect the measured HbA1c. Also, pregnant and African American patients were excluded. We concluded the measured HbA1c was 0.34% (4 mmol/mol) higher than the CGM-derived GMI. The relationship between factors that affect glycemic control was discussed in the article, as well as the future utilization of them in improving diabetic control and management. As the use of CGM continues to grow, addressing differences between laboratory-measured HbA1c and CGM-derived GMI is critical.

Effects of the Incubation Period of Pleurotus ostreatus on the Chemical Composition and Nutrient Availability of Solid-State-Fermented Corn Stover.

The current study aimed to optimize and improve the feeding value of Pleurotus ostreatus-fermented corn stover by evaluating the effects of five solid-state fermentation times and three in vitro fermentation periods on the chemical composition, dry matter disappearance (DMD), microbial mass and volatile fatty acid (VFA) production of treated and untreated corn stover. The study utilized a 3 × 5 factorial design, with eight replicates per treatment. Dry matter, crude protein (CP), ash and non-fiber carbohydrate (NFC) contents increased quadratically (p < 0.05) with increases in the solid-state fermentation time. Increases of 44.4-59.1%, 20.6-78.6% and 40.5-121% were noted for the CP, ash and NFC contents, respectively. Organic matter, ether extract, neutral detergent fiber and hemicellulose contents decreased quadratically (p < 0.05) across the treatments. Similar trends were noted for DM and fiber disappearance in the treatments. The total gas production and in vitro true dry matter digestibility (IVTDMD) increased quadratically, while microbial mass and in vitro apparent DMD increased in a linear manner. The total VFA, propionate and butyrate contents increased linearly. Both the acetate content and the A:P ratio decreased in a linear manner. The results show that the rumen fermentation pathway favors the production of propionate, with increases in propionate production of 7.46 and 8.30% after 2 and 4 wk, respectively. The study showed that a 2 wk period of solid-state fermentation is sufficient to provide a bio-transformed cow-calf feed resource from P. ostreatus-treated corn stover.

Comparison of biomarkers of exposure among US adult smokers, users of electronic nicotine delivery systems, dual users and nonusers, 2018-2019.

The harm caused by cigarette smoking is overwhelmingly due to byproducts of tobacco combustion. Electronic Nicotine Delivery Systems (ENDS) provide nicotine to users without combustion, and may support tobacco harm reduction among cigarette smokers who would not otherwise quit in the near term. Analyses of Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study compared biomarkers of exposure (BOE) levels for nicotine, 3 metals, 2 tobacco-specific nitrosamines and 14 smoking-related volatile organic compounds in 151 exclusive ENDS users, 1341 exclusive cigarette smokers, 115 dual users (cigarettes and ENDS), and 1846 past 30-day nonusers of tobacco, adjusting for demographics. Nicotine exposure in ENDS users and dual users did not significantly differ from smokers. Among ENDS users, 16 of 18 other BOEs were significantly lower than smokers'; 9 BOEs were not significantly different from nonusers. Among dual users smoking < 10 cigarettes/day, 15 of 18 non-nicotine BOEs were significantly lower than smokers', whereas in dual users smoking ≥ 10 cigarettes per day none of the BOEs significantly differed from smokers'. In this representative sample of US adults, exclusive use of ENDS (vs. cigarette smoking) was associated with much lower exposures to many harmful chemicals associated with smoking-related disease. BOE levels in dual users were directly related to their cigarette consumption. These BOE data provide further evidence that ENDS expose users to substantially lower levels of toxicants than combustible cigarettes, confirming their potential for harm reduction.

Cigarette Smoking Trajectories in Adult Former Smokers Using the JUUL System.

Objective: In this study, we assessed cigarette smoking over 12 months among adult former smokers who newly purchased a JUUL Starter Kit (JSK). Methods: Prevalence of past 30-day smoking and factors associated with smoking were assessed among adult (age ≥ 21) former established smokers, stratified as recent (quitting ≤ 12 months) and long-term quitters (> 12 months), who purchased a JSK and completed ≥ 1 of 6 follow-up assessments (N = 4786). Results: Recent quitters had higher rates (16.6%-19.9%) of past 30-day smoking than long-term quitters (6.4%-9.2%) across the 12-month period; smoking prevalence did not significantly increase over time in either subgroup. Few participants (6.5% of recent quitters, 2.8% of long-term quitters) reported smoking at both 9 and 12 months, a pattern that might indicate persistent smoking. Past 30-day JUUL use remained high (≥ 87%) across the 12 months. Participants who used JUUL more frequently were less likely to smoke. Conclusions: Among former smokers who purchased JUUL, prevalence rates of smoking were low and stable across the 12-month period, suggesting there was not a growing cohort of former smokers resuming smoking. Smoking was more common in recent quitters than long-term quitters. Greater use of JUUL was associated with reduced odds of smoking resumption.

Smoking Trajectories of Adult Never Smokers 12 Months after First Purchase of a JUUL Starter Kit.

Objectives: We assessed adult never smokers' trajectories of smoking over 12 months after a first-time JUUL Starter Kit (JSK) purchase. Methods: Adult (≥ 21) never smokers (N = 3853) who purchased a JSK were recruited into an observational naturalistic study. Analyses distinguished those who had previously used ENDS (NS+E, N = 2848) from those who had not (NS-NE, N = 1005). Participants were invited to complete follow-up assessments at 1, 2, 3, 6, 9, and 12 months. "Smoking" was defined as any past-30-day smoking ("even a puff"). Results: Past-30-day smoking was reported by 5.01% of NS+E at month one, and 7.56% at month 12; for NS-NE, these were 10.23% and 12.35%. In both groups, < 5% reported smoking at both 9 and 12 months. Across follow-ups, 25%-49% of those reporting having smoked then said they were now smoking "not at all"; the remainder reported low frequency (10-12 days-per-month) and quantity (2-4 cigarettes-per-day) of smoking. Past-30-day use of JUUL remained at ≥ 80% across follow-ups. Each additional day-per-month of JUUL use decreased the odds of smoking by 1%. Conclusions: Some adult never smokers who purchased a JSK reported smoking during the suceeding year; smoking was light and intermittent. Participants who used JUUL more frequently were less likely to smoke.

Efficacy of implementing intermittent STOP THE BLEED® reviews on long term retention of hemorrhage control skills of first year medical students.

CONTEXT: Some medical schools integrate STOP THE BLEED® training into their curricula to teach students how to identify and stop life threatening bleeds; these classes that are taught as single day didactic and hands-on training sessions without posttraining reviews. To improve retention and confidence in hemorrhage control, additional review opportunities are necessary. OBJECTIVES: To investigate whether intermittent STOP THE BLEED® reviews were effective for long term retention of hemorrhage control skills and improving perceived confidence. METHODS: First year osteopathic medical students were asked to complete an eight item survey (five Likert scale and three quiz format questions) before (pretraining) and after (posttraining) completing a STOP THE BLEED® training session. After the surveys were collected, students were randomly assigned to one of two study groups. Over a 12 week intervention period, each group watched a 4 min STOP THE BLEED® review video (intervention group) or a "distractor" video (control group) at 4 week intervals. After the 12 weeks, the students were asked to complete an 11 item survey. RESULTS: Scores on the posttraining survey were higher than the pretraining survey. The median score on the five Likert scale items was 23 points for the posttraining survey and 14 points for the pretraining survey. Two of the three knowledge based quiz format questions significantly improved from pretraining to posttraining (both p<0.001). On the 11 item postintervention survey, both groups performed similarly on the three quiz questions (all p>0.18), but the intervention group had much higher scores on the Likert scale items than the control group regarding their confidence in their ability to identify and control bleeding (intervention group median = 21.4 points vs. control group median = 16.8 points). CONCLUSIONS: Intermittent review videos for STOP THE BLEED® training improved medical students' confidence in their hemorrhage control skills, but the videos did not improve their ability to correctly answer quiz-format questions compared with the control group.

Legionella - A threat to groundwater: Pathogen transport in recharge basin.

This study elucidates the potential risk posed by Legionella during aquifer recharge practices. Experiments were conducted using pilot-scale column simulating infiltration of bacterial surrogate and pathogen, E. coli and Legionella pneumophila, under central Arizona recharge basin conditions. A column was packed with a loamy sand media collected from a recharge basin and was fitted with six sampling ports at soil depths of 15, 30, 60, 92, 122cm and acclimated for a month with tertiary treated wastewater. Transport of Legionella appeared to be delayed compared to E. coli. The breakthrough of E. coli and Legionella at 122cm depth occurred at 3 and 24h, respectively. Slow transport of Legionella is consistent with its pleomorphic nature and variation in size and shape under low nutrient conditions. Legionella persisted for a longer time in the column, but at lower concentrations. Given the novel results of this study, the transport of Legionella into groundwater aquifers can occur through engineering recharge basin conditions creating a potential public health risk.

Effects of model error on cardiac electrical wave state reconstruction using data assimilation.

Reentrant electrical scroll waves have been shown to underlie many cardiac arrhythmias, but the inability to observe locations away from the heart surfaces and the restriction of observations to only one or two state variables have made understanding arrhythmia mechanisms challenging. Recently, we showed that data assimilation from spatiotemporally sparse surrogate observations could be used to reconstruct a reliable time series of state estimates of reentrant cardiac electrical waves including unobserved variables in one and three spatial dimensions. However, real cardiac tissue is unlikely to be described accurately by mathematical models because of errors in model formulation and parameterization as well as intrinsic but poorly described spatial heterogeneity of electrophysiological properties in the heart. Here, we extend our previous work to assess how model error affects the accuracy of cardiac state estimates achieved using data assimilation with the Local Ensemble Transform Kalman Filter. We focus on one-dimensional states of discordant alternans characterized by significant wavelength oscillations. We demonstrate that data assimilation can provide high-quality estimates under a wide range of model error conditions, ranging from varying one or more parameter values to using an entirely different model to generate the truth state. We illustrate how multiplicative and additive inflation can be used to reduce error in the state estimates. Even when the truth state contains underlying spatial heterogeneity, we show that using a homogeneous model in the data assimilation algorithm can achieve good results. Overall, we find data assimilation to be a robust approach for reconstructing complex cardiac electrical states corresponding to arrhythmias even in the presence of model error.

Predictors, spatial distribution, and occurrence of woody invasive plants in subtropical urban ecosystems.

We examined the spatial distribution, occurrence, and socioecological predictors of woody invasive plants (WIP) in two subtropical, coastal urban ecosystems: San Juan, Puerto Rico and Miami-Dade, United States. These two cities have similar climates and ecosystems typical of subtropical regions but differ in socioeconomics, topography, and urbanization processes. Using permanent plot data, available forest inventory protocols and statistical analyses of geographic and socioeconomic spatial predictors, we found that landscape level distribution and occurrence of WIPs was not clustered. We also characterized WIP composition and occurrence using logistic models, and found they were strongly related to the proportional area of residential land uses. However, the magnitude and trend of increase depended on median household income and grass cover. In San Juan, WIP occurrence was higher in areas of high residential cover when incomes were low or grass cover was low, whereas the opposite was true in Miami-Dade. Although Miami-Dade had greater invasive shrub cover and numbers of WIP species, San Juan had far greater invasive tree density, basal area and crown cover. This study provides an approach for incorporating field and available census data in geospatial distribution models of WIPs in cities throughout the globe. Findings indicate that identifying spatial predictors of WIPs depends on site-specific factors and the ecological scale of the predictor. Thus, mapping protocols and policies to eradicate urban WIPs should target indicators of a relevant scale specific to the area of interest for their improved and proactive management.