Real-World Prevalence of Type 2 Diabetes Remission in a U.S. Insured Population Using a Large Administrative Claims Database.

Objective: A 2021 international consensus statement defined type 2 diabetes remission as A1C <6.5% measured at least 3 months after cessation of glucose-lowering therapy. We aimed to investigate whether retrospective claims-based data can assess remission based on this definition, whether three increasingly strict alternative definitions affect the prevalence of remission and characteristics of remission cohorts, and how cohorts with and without sufficient data to assess for remission differ. Research design and methods: We used de-identified administrative claims from commercially insured and Medicare Advantage members, enriched with laboratory values, to assess diabetes remission. We used alternative glycemic, temporal, and pharmacologic criteria to assess the sensitivity of remission definitions to changes in claims-based logic. Results: Among 524,076 adults with type 2 diabetes, 185,285 (35.4%) had insufficient additional laboratory and/or enrollment data to assess for remission. While more likely to be younger, these individuals had similar initial A1C values and geographical distribution as the 338,791 (64.6%) assessed for remission. Of those assessed for remission, 10,694 (3.2%) met the 2021 consensus statement definition. The proportion of individuals meeting the three alternative definitions ranged from 0.8 to 2.3%. Across all criteria, those meeting the remission definition were more likely to be female, had a lower initially observed A1C, and had a higher prevalence of bariatric surgery. Conclusion: This study demonstrates the feasibility of laboratory-value enriched claims-based assessments of type 2 diabetes remission. Establishing stable claims-based markers of remission can enable population assessments of diabetes remission and evaluate the association between remission and clinical outcomes.

Characterizing Diabetes Empowerment and Motivation for Changing Health Behaviors Among People with Type 2 Diabetes: A Cross-Sectional Survey.

INTRODUCTION: Effectively engaging people with type 2 diabetes (T2D) earlier in their health journeys is critical to prevent downstream complications. Digitally based diabetes programs are a growing component of care delivery that have the potential to engage individuals outside of traditional clinic-based settings and use personalized data to pair people to tailored diabetes self-management interventions. Knowing an individuals' diabetes empowerment and health-related motivation can help drive appropriate recommendations for personalized interventions. We aimed to characterize diabetes empowerment and motivation towards changing health behaviors among participants in Level2, a T2D specialty care organization in the USA that combines wearable technology with personalized clinical support. METHODS: A cross-sectional online survey was conducted among people enrolled in Level2 (February-March 2021). Distributions of respondent-reported diabetes empowerment and health motivation were analyzed using Motivation and Attitudes Toward Changing Health (MATCH) and Diabetes Empowerment Scale Short Form (DES-SF) scales, respectively. Associations between MATCH and DES-SF scores with Level2 engagement measures and glycemic control were analyzed. RESULTS: The final analysis included 1258 respondents with T2D (mean age 55.7 ± 8.4 years). Respondents had high average MATCH (4.19/5) and DES-SF (4.02/5) scores. The average MATCH subscores for willingness (4.43/5) and worthwhileness (4.39/5) were higher than the average ability subscore (3.73/5). Both MATCH and DES-SF scores showed very weak correlations with Level2 engagement measures and glycemic control (ρ = - 0.18-0.19). CONCLUSIONS: Level2 survey respondents had high average motivation and diabetes empowerment scores. Further research is needed to validate sensitivity of these scales to detect changes in motivation and empowerment over time and to determine whether differences in scores can be used to pair people to personalized interventions.

Direct Mass Measurements to Inform the Behavior of

Nuclear isomer effects are pivotal in understanding nuclear astrophysics, particularly in the rapid neutron-capture process where the population of metastable isomers can alter the radioactive decay paths of nuclei produced during astrophysical events. The ß-decaying isomer ^{128m}Sb was identified as potentially impactful since the ß-decay pathway along the A=128 isobar funnels into this state bypassing the ground state. We report the first direct mass measurements of the ^{128}Sb isomer and ground state using the Canadian Penning Trap mass spectrometer at Argonne National Laboratory. We find mass excesses of -84564.8(25) keV and -84608.8(21) keV, respectively, resulting in an excitation energy for the isomer of 43.9(33) keV. These results provide the first key nuclear data input for understanding the role of ^{128m}Sb in nucleosynthesis, and we show that it will influence the flow of the rapid neutron-capture process.

Improved Time in Range During 28 Days of Meal Delivery for People With Type 2 Diabetes.

Objective: Nutrition therapy is a cornerstone of care for people with type 2 diabetes, yet starting new, healthy eating behaviors and sustaining them can be challenging. This decentralized, single-arm study assessed the impact of 28 days of home-delivered, pre-portioned meals (three meals per day) on continuous glucose monitoring (CGM)-derived glycemic control and quality of life. Research design and methods: We enrolled 154 people with type 2 diabetes from across the United States. All participants were enrolled in a digital-first type 2 diabetes care center of excellence and had a time in range (TIR) <70% or a glucose management index (GMI) >7%. A total of 102 participants received another set of meals for a household member. Forty-four participants were excluded from CGM-based analysis because of sparse data in the baseline or intervention period. Results: From the baseline through the intervention period, average TIR improved by 6.8% (95% CI 4.0-9.7, P <0.001), average GMI improved by 0.21% (95% CI 0.11-0.32, P <0.001), and participants' odds of achieving ≥70% TIR increased (odds ratio 2.55 [95% CI 0.93-7.80, P = 0.051]). Although average TIR increased rapidly upon initiation of meal delivery, it regressed when the delivery period ended. Conclusion: Home-delivered meals were associated with modest TIR and GMI improvements, but only in the short term. More research is needed to determine whether the effects of nutrition therapy can be extended by providing ongoing meal delivery or additional support such as behavioral intervention.

Improved Neutron Lifetime Measurement with UCNτ.

We report an improved measurement of the free neutron lifetime τ_{n} using the UCNτ apparatus at the Los Alamos Neutron Science Center. We count a total of approximately 38×10^{6} surviving ultracold neutrons (UCNs) after storing in UCNτ's magnetogravitational trap over two data acquisition campaigns in 2017 and 2018. We extract τ_{n} from three blinded, independent analyses by both pairing long and short storage time runs to find a set of replicate τ_{n} measurements and by performing a global likelihood fit to all data while self-consistently incorporating the ß-decay lifetime. Both techniques achieve consistent results and find a value τ_{n}=877.75±0.28_{stat}+0.22/-0.16_{syst} s. With this sensitivity, neutron lifetime experiments now directly address the impact of recent refinements in our understanding of the standard model for neutron decay.

Posterior occipital gunshot wound causing orbital roof blow-in fracture with encephalocele.

Isolated orbital roof fractures are rare fractures that usually occur in conjunction with other facial bone fractures during high velocity trauma. This report concerns a patient with an isolated orbital roof fracture with encephalocele, including its diagnosis, surgical management, and clinical follow-up. This case required a multidisciplinary approach to safely repair the fracture, reduce the encephalocele, restore the orbital volume, and restore the patient's form and function.

Measurement of the neutron lifetime using a magneto-gravitational trap and in situ detection.

The precise value of the mean neutron lifetime, τn, plays an important role in nuclear and particle physics and cosmology. It is used to predict the ratio of protons to helium atoms in the primordial universe and to search for physics beyond the Standard Model of particle physics. We eliminated loss mechanisms present in previous trap experiments by levitating polarized ultracold neutrons above the surface of an asymmetric storage trap using a repulsive magnetic field gradient so that the stored neutrons do not interact with material trap walls. As a result of this approach and the use of an in situ neutron detector, the lifetime reported here [877.7 ± 0.7 (stat) +0.4/-0.2 (sys) seconds] does not require corrections larger than the quoted uncertainties.

A new method for measuring the neutron lifetime using an in situ neutron detector.

In this paper, we describe a new method for measuring surviving neutrons in neutron lifetime measurements using bottled ultracold neutrons (UCN), which provides better characterization of systematic uncertainties and enables higher precision than previous measurement techniques. An active detector that can be lowered into the trap has been used to measure the neutron distribution as a function of height and measure the influence of marginally trapped UCN on the neutron lifetime measurement. In addition, measurements have demonstrated phase-space evolution and its effect on the lifetime measurement.

Axis inhibition protein 2 (AXIN2) polymorphisms and tooth agenesis.

Tooth agenesis is a common congenital disorder that affects almost 20% of the world's population. A number of different genes have been shown to be associated with cases of tooth agenesis including AXIN2, IRF6, FGFR1, MSX1, PAX9, and TGFA. Of particular interest is AXIN2, which was linked to two families segregating oligodontia and colorectal cancer. We studied two collections of families affected with tooth agenesis and tested them for association with AXIN2. Significant association between tooth agenesis and AXIN2 was found (p=0.02) in cases with at least one missing incisor. Our work further supports a role of AXIN2 in human tooth agenesis and for the first time suggests AXIN2 is involved in sporadic forms of common incisor agenesis. Future studies should identify which specific tooth agenesis sub-phenotypes are consequence of AXIN2 genetic variations. A sub-set of these cases could have an increased susceptibility for colon cancer or other types of tumours and this knowledge would have significant clinical implications.

Effects of problem-based scheduling on patient waiting and staff utilization of time in a pediatric clinic.

The patient scheduling system in a pediatric outpatient clinic was changed from time-based to problem-based in an A-B-A-B reversal design. During baseline, time-based scheduling was in effect with patients being scheduled in 15-min periods regardless of presenting problem. During intervention, a receptionist matched client problems with time slots so that a more extensive treatment was allocated more time. Problem-based scheduling resulted in a substantial decrease in mean number of minutes spent in clinic across all presenting problems. Waiting time increased to baseline levels when problem-based scheduling was removed and decreased again on reintroduction of the program. A follow-up check conducted 1 month after the end of the second intervention phase revealed that the effects were maintained. The problem-based schedule also resulted in an increase in the proportion of extra time that medical staff had available and produced a positive consumer response.

Residential magnetic and electric fields.

A magnetic flux density (MFD) and electric-field (E-field) data-acquisition system was built for characterizing extremely low-frequency fields in residences. Every 2 min during 24-h periods, MFD and E-field measurements were made in 43 homes in King, Pierce, and Snohomish counties of Washington State. The total electrical energy used in each residence during the 24-h measurement period was also recorded, and maps were drawn to scale of the distribution wiring within 43 m (140 ft) of these homes. Finally, on a separate date, field measurements were made in each home during an epidemiological interview. The results of this study can be summarized as follows: 1) 24-h-average MFD measured at two separate points in the family room were correlated, as were a 24-h-average bedroom measurement and the mean of the two family-room measurements. 2) The 24-h-average family-room MFD and E-field measurements were uncorrelated. 3) The 24-h-average total harmonic distortions of family-room MFD and E-fields were less than about 24% and 7%, respectively. 4) Residential MFD exhibited a definite 24-h (diurnal) cycle. 5) The 24-h-average and interviewer-measured MFD were correlated. 6) Residential 24-h-average MFD were correlated with the wiring code developed by Wertheimer and Leeper. 7) An improved prediction of 24-h-average residential MFD was obtained using the total number of service drops, the distance to neighboring transmission lines, and the number of primary phase conductors.