Northridge Hospital Medical Center

BackgroundDepression and anxiety are highly prevalent in the U.S. and can hinder engagement in preventive health services. Individuals affected by these conditions may have reduced motivation and lower health literacy, increasing their vulnerability to missed preventive-care opportunities such as vaccination. Awareness of human papillomavirus (HPV) and the HPV vaccine is crucial for cancer prevention but remains underexplored among adults with mental-health conditions.MethodsWe analyzed data from the Health Information National Trends Survey (HINTS) 5, Cycles 1-4 (2017-2020), to assess HPV and HPV-vaccine awareness among U.S. adults aged 18-44 with self-reported depression and/or anxiety. Weighted descriptive statistics, chi-square (χ²) tests, and multivariable logistic-regression models were used to assess awareness and associated sociodemographic and health-related factors. The primary aim was to estimate the prevalence of HPV and HPV-vaccine awareness, while the secondary aim was to identify associated sociodemographic and health-related predictors. Awareness was defined using binary (“yes”/“no”) responses to HINTS items, and mental-health exposure was defined as self-reported physician-diagnosed depression and/or anxiety.ResultsThe analytic sample included 1,105 adults, most of whom were female (n = 709; 64.1%), aged 18-34 years (n = 623; 56.4%), White (n = 753; 68.2%), and urban residents (n = 956; 86.5%). Approximately one-third (n = 372; 33.5%) held a college degree, and n = 384 (34.8%) reported annual income ≥ $75,000. Overall, 944 (85.4%) were aware of HPV, and 839 (75.9%) were aware of the HPV vaccine. Higher educational attainment (χ² = 46.7, p < 0.001) and female sex (χ² = 6.88, p = 0.009) were associated with greater awareness, whereas Hispanic ethnicity (χ² = 9.4, p = 0.024) and male sex were linked to lower awareness. Participants with two or more comorbidities showed higher HPV awareness (χ² = 6.11, p = 0.047) but not vaccine awareness (χ² = 2.34, p = 0.311).ConclusionsWhile overall awareness of HPV is high, disparities persist by sex, education, and ethnicity among adults with depression and/or anxiety. Integrating culturally tailored and literacy-appropriate HPV education into mental-health and primary-care settings may promote equitable vaccine awareness and uptake.

INTRODUCTIONThe Health Equity Scholars Program (HESP) addresses the critical need for a diverse, culturally competent workforce to study and treat older adults from underrepresented populations (URPs) with Alzheimer's disease and related dementias (AD/ADRD). The HESP offers tailored mentored training in AD/ADRD research concepts, aiming to develop successful independent researchers. It recruits Scholars from underrepresented backgrounds as well as those passionate about AD/ADRD health equity research.METHODSWe (1) describe the fundamental elements of the HESP, and (2) present preliminary data from the HESP program evaluation results performed by an outside agency, pre–post participation surveys, and Scholar accomplishments.RESULTSThe HESP Scholars reported high rates of proficiency, satisfaction, and competency in nearly all evaluated areas, and have been successful in obtaining grants, promotions, and publications.DISCUSSIONThese initial outcomes data suggest that the HESP is meeting its objective of diversifying the workforce in the field of AD/ADRD research and care.HighlightsThe Health Equity Scholars Program aims to cultivate a diverse and culturally competent workforce, who are well‐prepared to study and treat underrepresented older adults with Alzheimer's disease and related dementias (AD/ADRD).The program provides tailored mentored training in AD/ADRD research concepts, with the goal of nurturing successful independent researchers.Rigorous evaluation processes for applications ensure the selection of highly qualified Scholars.The program includes tailored training activities such as seminars and grant writing workshops, and tracks Scholar achievements while undergoing annual external evaluation to enhance its training program iteratively.

Background: Data from connected insulin pen therapies are revealing both gaps and opportunities to significantly improve care for people on multiple daily insulin injections therapy. This real-world (RW) data analysis reports on the impact of meal-dosing behavior (missed and late) on glycemia in adult and pediatric InPen users with type 1 (T1D) or type 2 diabetes (T2D). Method: The RW data from 5,153 deidentified individuals who used the InPen SIP and CGM for at least 30 days between January 2020 and December 2021, and who had dosing and CGM data between 30 and 59 days since first bolus date, were analyzed using a meal detection algorithm. Users with &amp;lt;14 days of bolus data or inadequate CGM data (&amp;lt;14 days of 70% or more SG data/day) were excluded. Results: The impact of dosing behavior (≤2 versus &amp;gt;3 doses/day) and missed dose frequency (&amp;lt;20% versus ≥20%) on glycemia was analyzed (Table). A dosing frequency of &amp;gt;3 (including correction-only doses) and a missed dose frequency of &amp;lt;20% were associated with improved glycemic metrics. Overall, the frequency of on-time dosing was significantly correlated with user TIR (r=0.59, p&amp;lt;0.001). Conclusion: Real-world InPen with CGM use data provide insights into the impact of meal-dosing behavior on glycemic outcomes, which may inform counseling strategies for care teams and open the door to precision insulin injection management. Disclosure J.Macleod: Employee; Medtronic. M.Smith: Employee; Medtronic. G.Im: Employee; Medtronic. T.L.Cordero: Employee; Medtronic. R.A.Vigersky: Employee; Medtronic.

Objective: The wear duration of insulin infusion sets (IIS) is impacted by initial local trauma caused by cannula insertion and sustained inflammation due mostly to insulin infusion, both of which affect insulin absorption. Efforts have been made to mitigate cannula kinking at insertion and during use, and other site reactions that contribute to IIS failures. This Medtronic preclinical study investigated performance of a novel flexible and kink-free soft cannula. Method: In-vitro tests (included buckling kink test, inflammatory macrophage cell culture, and insulin compatibility test by USP insulin monographic methods) were conducted on the Flexible cannula and commercial Teflon cannulas. In-vivo study of 3-day sets with both cannulas were conducted on diabetic swine by having animals wear one set multiple times (on the abdomen) while receiving Novolog™ insulin subcutaneously via a pump for 7 days or until set failure, determined by (1) blood glucose (BG) value not decreasing by ≥50 mg/dL an hour after a correction bolus for a BG level &amp;gt;350 mg/dL, or (2) evidence of infection at the infusion site. Result: Compared to the control Teflon cannula, kink resistance of the Flexible cannula was significantly improved (Kinked: Teflon 6/6, Flexible 0/6) . In the inflammatory in-vitro cell culture model, the pro-inflammatory cytokines generated by the Flexible cannula trended less (mean MCP-1: Teflon -9.7 ng/mL, Flexible - 7.7 ng/mL; mean MIP-1α: Teflon -24.1 ng/mL, Flexible - 24.0 ng/mL) . Tested by the USP methods, both cannulas were insulin compatible. In the swine diabetes model, the 3-day IIS with the Flexible cannula had a greater 7-day survival rate (50%, n=10) than the corresponding control (36%, n=56) , although not statistically different. No significant increase in total daily dose of insulin was observed. Conclusion: Preliminary in-vitro and in-vivo test results indicate that the novel Flexible cannula is ideally suited for IIS device performance. Further product development is ongoing. Disclosure C.Chiu: Employee; Medtronic. G.Zhang: Employee; Medtronic. S.Chattaraj: Employee; Medtronic. R.Gottlieb: Employee; Medtronic.

Objective: A combination insulin infusion and glucose-sensing device will dramatically improve the ease of use for automated insulin delivery systems. The objective of this preclinical study was to collect safety and efficacy data during 7-day wear of a combined insulin-delivery and glucose-sensing device called the “Duo” set. Method: In a type 1 diabetes (T1D) porcine model, each animal (N=6) wore the Duo set multiple times (on the abdomen) while receiving Novolog® insulin subcutaneously via a pump for one week or until set failure, determined by (1). blood glucose (BG) value not decreasing by at least 50 mg/dL an hour after a correction bolus for a BG level &amp;gt;350 mg/dL, or (2). evidence of infection at the infusion site. Blood glucose was measured five times/day with a BG meter, and pigs also wore a Guardian™ Sensor (3) glucose sensor (GS3) distant from the Duo-set site. Additionally, physical examination and serum panel tests were conducted for safety evaluation. Result: There were 15 wears, with 10 wears lasting more than 7 days. Survival rate (67%) was similar to that of the Medtronic 7-day Extended Wear Infusion Set (EWIS) previously tested in the same porcine model (64%). There was no significant difference in total daily insulin dose (TDD) between the Duo set and the EWIS during the entire 7-day wear. There was no significant difference in glucose values between the Duo-set sensor and the GS3 (p&amp;gt;0.10), which agreed with the measured BG values in the range of 70-300 mg/dL (p&amp;gt;0.10). There was no significant device safety concern identified. Conclusion: The results indicated that no interference of sensor signals was observed from insulin infused though the cannula of the same Duo set in the near proximity or from mechanical inference from the infusion-set movements. These data confirm the feasibility of a combined 7-day set which simultaneously infuses insulin and senses glucose subcutaneously in a T1D porcine model. Disclosure G. Zhang: Employee; Self; Medtronic. E. Anselmo: Employee; Self; Medtronic. L. To: None. S. Chattaraj: Employee; Self; Medtronic.

&lt;div class="section abstract"&gt;&lt;div class="htmlview paragraph"&gt;A key enabler to maximizing the benefits from advanced powertrain technologies is to adopt a systems integration approach and develop optimized controls that consider the propulsion system and vehicle as a whole. This approach becomes essential when incorporating Advanced Driver Assistance Systems (ADAS) and communication technologies, which can provide information on future driving conditions. This may enable the powertrain control system to further improve the vehicle performance and energy efficiency, shifting from an instantaneous optimization of energy consumption to a predictive and “look-ahead” optimization. Benefits from this approach can be realized at all levels of electrification, from conventional combustion engines to hybrid propulsion systems and full electric vehicles, and at all levels of vehicle automation.&lt;/div&gt;&lt;div class="htmlview paragraph"&gt;This paper documents an extensive simulation and experimental campaign that provides a systematic quantification of fuel economy and mobility benefits resulting from leveraging Vehicle-to-Everything (V2X) connectivity, longitudinal (Level 1+) automation, and advanced cylinder deactivation to improve the propulsion system and vehicle efficiency. A Vehicle Dynamics and Powertrain (VD&amp;amp;PT) optimization framework, developed jointly by The Ohio State University and BorgWarner, utilizes advanced route information available from the navigation system and GPS, and Vehicle-to-Infrastructure (V2I) communication when available to minimize the cumulative fuel consumption over a driver-selected route.&lt;/div&gt;&lt;div class="htmlview paragraph"&gt;To assess the benefits of these technologies in real-world conditions, a Monte Carlo simulation framework was developed to quantify the impact of Signal Phase and Timing (SPaT), variability in traffic conditions, and behavior of different drivers on the fuel consumption and vehicle travel time. Further, verification through in-vehicle testing was conducted by reconstructing a subset of these scenarios on a proving ground.&lt;/div&gt;&lt;/div&gt;

Objective: Develop a test methodology for evaluating the reason for infusion set (IS) failure in persons with diabetes using insulin pump therapy (Continuous Sub-cutaneous Insulin Infusion, CSII). Insulin stability (physical, chemical, and microbiological) and/or the loss of preservatives in the infusate are thought to play significant roles in shortening IS wear time. In-vitro and in-vivo methods were used to assess the cause(s) site inflammation and the loss of preservatives. Method: Fast-acting insulin (insulin aspart and lispro) were pumped through different infusion sets (&amp;gt;4) under simulated-use conditions. The pumped insulin and non-pumped insulin controls were characterized for physical, chemical, and microbiological properties. The pumped insulin, combined with fibrinogen (an initiator for material foreign body responses), were tested in murine macrophage cell culture for inflammatory responses. The corresponding infusion sets were tested in vivo in a diabetic porcine model to determine IS wear-time. Result: Pumped insulins in ≥8 insulin/IS combinations met corresponding criteria in USP insulin monographs, indicating no significant chemical changes. Lower preservative content was found to increase insulin aggregates in-vitro/in-vivo. Pro-inflammatory cytokines (MIP-1α, and MCP-1) increased significantly in the inflammatory in-vitro model. The IS wear-time was shortened from 4.9±0.3 days (control) to 1.7±0.3 days (p&amp;lt;0.0001) with lower preservative content (&amp;lt;50% per label claim). Conclusion: Preliminary findings from in-vitro and in-vivo test model development indicate that macrophage number, the inflammatory response, and device wear time were significantly impacted by loss of preservative and trace aggregates/particles. The new test methodology can further our understanding as to how to improve IS wear time. Disclosure S. Chattaraj: Employee; Self; Medtronic. G. Zhang: None. E. Anselmo: Employee; Self; Medtronic. J.C. Fusselman: None.

Abstract: Electronic cigarettes (E-cigarettes/EC’s), also referred to as “vaping”, has become increasingly popular in the United States over the past few years. This rapidly growing epidemic has been recognized as a major public health concern. EC’s are devices that produce an aerosol by heating liquid containing nicotine, tetrahydrocannabinol (THC), cannabinoid (CBD) oils, or other unregulated substances and additives. Vaping may elicit severe respiratory ailments that are suspected to be worse than those caused by cigarette smoking. Several research dissertations illustrate the correlation between short-term inhalation exposure of the nebulized liquid from EC’s and alterations in normal lung function, including inflammation of lung parenchyma. The morbidity and mortality rates seen with vaping associated lung injuries (VAPI) are rising exponentially. As of February 18, 2020, vaping has drawn controversial attention following 68 confirmed deaths, out of 2,807 hospitalized e-cigarette or vaping product use-associated lung injury (EVALI) cases reported by the CDC from all 50 states, the District of Columbia, and two US territories including Puerto Rico and US Virgin Islands. Moreover, there has been a dramatic increase of EC use among adolescents, with the median age being 24 years old 76% of these patients are less than age 35. Literature also suggests that vaping is a form of “harm reduction” as an alternative modality for smoking cessation. Focus has been limited to the unregulated class of these products, which contains the main psychoactive chemical found in cannabis called THC. Thus, the proliferating number of cases pose significant challenges for healthcare professionals. In attempt to mitigate this public health crisis, providers must increase communal awareness and provide education regarding the detrimental health implications exacerbated by vaping.

Background and Aims: Dawn phenomenon (DP) refers to the morning rise in glucose levels observed in individuals with diabetes. While continuous glucose monitoring (CGM) may detect rates of change (ROC) in sensor glucose (SG) levels, ensuring that DP is not due to unannounced carbs can be challenging. Hence, a combination of CGM and activity data were used to identify true DP. Method: MiniMed™ 530G system data were uploaded between 6/2017-10/2017 by 33 individuals. Corresponding heart rate, steps, and metabolic equivalents (METs) were acquired with Fitbit® Charge 2™. Nights without carb or bolus entry from 12-6AM were analyzed. Nights with SG ROC &amp;gt;0.28mg/dL/min (ROC between peak and nadir) and no activity (METs &amp;lt;1.5) ±30min of nadir were identified as true DP; those involving activity (METs &amp;gt;1.5) ±30min of nadir were identified as involving unannounced carb (UC); and those with no nadir were identified as ideal. Results: Individuals had 26 nights with DP, 27 nights with UC, and 39 ideal nights and the Table shows differences in the features related to each. The ROC of SG rise due to DP was lower, took longer time to reach peak, and tended to have a higher SG at nadir when compared with UC. Conclusion: Dawn phenomenon can be identified and characterized in real-world conditions using CGM and fitness tracking. Detecting DP may help improve nocturnal and early morning glycemic management. Disclosure S. Abraham: Employee; Self; Medtronic. D. Kang: None. Y. Zhong: Employee; Self; Medtronic. P. Agrawal: None. T.L. Cordero: Employee; Self; Medtronic. R. Vigersky: Employee; Self; Medtronic.

&lt;p&gt;Se presenta una hoja didáctica para introducir conceptos y modelos químicos relacionados a las baterías en forma de un reto atractivo para los estudiantes de distintos niveles académicos. De forma general se considera el uso de actividades que permita al estudiante explorar su entorno y vincularlo con los temas revisados en clase de química.&lt;/p&gt;