Reading Tutors’ Interpretation of Curriculum-Based Measurement Graphs

A societal “lockdown” began in early 2020 in response to the coronavirus disease (COVID-19) pandemic to slow the rate of transmission. Many states adopted social distancing and social isolation practices. Loneliness has been shown to be a significant burden on society during the COVID-19 pandemic and has been associated with poor mental health outcomes. Loneliness and poor mental health have been shown to increase behaviors that promote sedentary behavior and decrease physical activity. PURPOSE: To examine changes in psychological health and physical activity over 8 weeks during “lockdown” in response to COVID-19. METHODS: 90 individuals answered questions regarding their loneliness, depression, mood state, and physical activity over four time points each lasting two weeks. RESULTS: Time point (TP) 2, approximately 1 month into “lockdown”, showed the most significant effects on depression (26.33 ± 3.86) compared to TP 1 (17.31 ± 10.53, p < 0.001), TP 3 (16.11 ± 11.94, p < 0.001), and TP 4 (14.27 ± 10.86, p < 0.001), and TP 4 had the lowest total mood disturbance (35.92 ± 19.8) compared to TP 1 (41.05 ± 18.24, p < 0.05), TP 2 (43.26 ± 18.31, p < 0.01), and TP 3 (39.70 ± 19.71, p < 0.05). Self-reported symptoms of depression were seen in 100% of the sample population during TP 2. There were no significant changes in physical activity over 8 weeks (p > 0.05). Loneliness, depression, and mood state were negatively associated with participation in physical activity. Total mood disturbance was negatively associated with total physical activity at TP 1 (r = -0.24, p < 0.05), TP 2 (r = -0.28, p < 0.05) and TP 3 (r = -0.25, p < 0.05). Depression was negatively associated with total physical activity during TP 3 (r = -0.25, p < 0.05), TP 4 (r = -0.24, p < 0.05). CONCLUSION: Social isolation and social distancing practices had a negative effect on depression, and mood. Depressive symptoms were much higher than average compared to previous epidemiological data. Depression and total mood disturbance were highest during TP two possibly due to ambiguity and loneliness from social distancing. While physical activity was unchanged throughout the study, less people participated in the recommended physical activity guidelines. This study supports the connection between mental health and physical activity.

BACKGROUND AND AIMS Kidney transplantation is recognized as the treatment of choice for patients with End Stage Kidney Disease (ESKD). Improvement in short term patient and graft survival of kidney transplant recipients (KTRs), has shifted interest to the long-term outcomes and Health-Related Quality of Life (HRQoL) estimation is closely related. Thus, reliable evaluation of HRQoL with disease-specific questionnaires is of great importance. The aim of our study was to assess prospectively possible changes in HRQoL during follow up period and to identify associated factors that might affect these changes. METHOD We used the Greek version of the translated and adapted by our team disease-specific instrument Kidney Transplant Questionnaire 25 (KTQ-25) and the Greek SF-36 were administered in a cohort of KTRs during their routine visit in the transplant outpatient clinic twice, at study entry and after one year. Sociodemographic and medical information were also collected at both time points. Inclusion criteria were, aged ≥18-year-old, time since transplant ≥1 year, functioning transplant. All participants provided written informed consent. RESULTS A total of 84 KTRs (59 males; mean age 53.5 ± 10.7; mean e-GFR 47.7 ± 15.1 mL/min/1.73 m2; average time since transplantation 55.7 ± 48.3 months) included in the study at the first time point, while 74 KTRs (88.1%) remained for the second assessment (3 died, 4 denied and 4 changed transplant unit). The majority of KTRs were married (73.8%), with children (77.4%), non-smokers (81.6%) and retired (60.7%). The 45.8% had family monthly income ≤ 1000€. In 62%, hemodialysis was the modality before transplantation and 59.52% had received graft from deceased donor. Immunosuppressive treatment was 84.34% corticosteroids, 54.22% Tacrolimus, 40.96% Cyclosporine, 91.75% MMF and 3.61% Azathioprine. The observed SF-36 scores in all dimensions both time-points were similar without significant changes. Also, no significant changes found between the two time-points at all 5 dimensions and total score of the KTQ-25. A multivariate regression analysis for the 5 dimensions of the KTQ-25 at the second time-point was done. Showed that variables significantly associated with Physical Symptoms dimension was age (P = 0.021) directly and Osteoporosis (P = 0.025) inversely. In regression analysis of Fatigue dimension, variables that remained significant were female sex (P = 0.046) and higher serum cholesterols’ levels (P = 0.012). Uncertainty/Fear dimension was significantly worse in KTRs with history of cardiovascular disease (P = 0.032). Appearance dimension was significantly and positively correlated with female sex and negative with age and history of cardiovascular disease (P = 0.018, P = 0.043 and P = 0.041, respectively). No significantly correlation found for Emotions dimension. Total KTQ-25 score was significantly correlated with female sex (P = 0.024), while history of cardiovascular disease had a negative impact on the score (P = 0.013). CONCLUSION In this one-year prospective study of the HRQoL of KTRs, no statistically significant changes were found in the scores of KTQ-25 and SF-36 instruments. Age, sex, osteoporosis, serum cholesterols’ levels and history of cardiovascular disease are some of the factors that might affect prospectively HRQoL of KTRs.

Alternative methods of exposure are needed for minimally invasive surgery to avoid hypercarbia and acidosis associated with carbon dioxide (CO2) abdominal insufflation. The goals of this study were to determine the pulmonary and hemodynamic effects of both helium (HE) abdominal insufflation and placement of a mechanical abdominal wall-lifting device (lifter) during laparoscopy. Sixteen adult domestic pigs under general endotracheal anesthesia underwent baseline measurements of pulmonary capillary wedge pressure (PCWP), cardiac output (CO), and arterial blood gas. Six pigs underwent standard CO2 abdominal insufflation, five pigs underwent abdominal insufflation with HE, and a lifter was used for exposure in five other animals. Sequential readings of PCWP, CO, and arterial blood gas were recorded at 20-min intervals for 60 min in all 16 animals. No significant changes from baseline values were noted in arterial pCO2 or pH in animals who underwent placement of the lifter at any time point. After undergoing HE insufflation, animals experienced modest but significant acidosis and little change in pCO2. There was a significant rise in arterial pCO2 and decrease in pH from baseline values at all time points in animals undergoing CO2 insufflation. This study shows that neither HE abdominal insufflation or the lifter have significant deleterious pulmonary or hemodynamic effects on experimental animals during laparoscopy. Gasless laparoscopy or HE insufflation may provide a safer alternative method of exposure for minimally invasive surgery in patients with pre-existing pulmonary or cardiac dysfunction. By minimizing risk in these patients, costly invasive monitoring may be avoided.

Impairment of <i>FOS</i> mRNA induction by a translation inhibitor puromycin in granulocytes from myelodysplastic syndrome patients

BackgroundThe objective of this study was to investigate neurological short-term effects of craniosacral therapy as an ideal form of osteopathic manipulative treatment (OMT) due to the soft kinaesthetic stimulation.MethodsIncluded were 30 preterm infants, with a gestational age between 25 and 33 weeks, who were admitted to the neonatal intensive care unit of the University Hospital of Graz, Austria. The infants were randomized either into the intervention group (IG) which received standardised craniosacral therapy, or the control group (CG) which received standard care. To guarantee that only preterm infants with subsequent normal neurodevelopment were included, follow up was done regularly at the corrected age (= actual age in weeks minus weeks premature) of 12 and 24 months. After 2 years 5 infants had to be excluded (IG; n = 12; CG: n = 13).General Movements (GMs) are part of the spontaneous movement repertoire and are present from early fetal life onwards until the end of the first half year of life. To evaluate the immediate result of such an intervention, we selected the General Movement Assessment (GMA) as an appropriate tool. Besides the global GMA (primary outcome) we used as detailed GMA, the General Movement Optimality Score (GMOS- secondary outcome), based on Prechtl’s optimality concept. To analyse GMOS (secondary outcome) a linear mixed model with fixed effects for session, time point (time point refers to the comparisons of the measurements before vs. after each session) and intervention (IG vs. CG), random effect for individual children and a first order autoregressive covariance structure was used for calculation of significant differences between groups and interactions. Following interaction terms were included in the model: session*time point, session*intervention, time point*intervention and session*time point*intervention. Exploratory post hoc analyses (interaction: session*time point*intervention) were performed to determine group differences for all twelve measurement (before and after all 6 sessions) separately.ResultsBetween groups no difference in the global GMA (primary outcome) could be observed.The GMOS (secondary outcome) did not change from session to session (main effect session: p = 0.262) in the IG or the CG. Furthermore no differences between IG and CG (main effect group: p = 0.361) and no interaction of time*session could be observed (p = 0.658). Post hoc analysis showed a trend toward higher values before (p = 0.085) and after (p = 0.075) the first session in CG compared to IG. At all other time points GMOS were not significantly different between groups.ConclusionWe were able to indicate that a group of “healthy” preterm infants undergoing an intervention with craniosacral therapy (IG) showed no significant changes in GMs compared to preterm infants without intervention (CG). In view of the fact that the global GMA (primary outcome) showed no difference between groups and the GMOS (detailed GMA-secondary outcome) did not deteriorate in the IG, craniosacral therapy seems to be safe in preterm infants.Trial registrationGerman Clinical Trials Register DRKS00004258.

Objective To investigate the relationship between microvascular permeability, contents of adipose and fatty acids as shown by quantitative permeability parameters of dynamic contrast- enhanced MRI (DCE-MRI) and ex vivo 1H high-resolution magic angle spinning nuclear magnetic resonance spectroscopy (1H HRMAS NMRS) in femoral bone marrow of rats after total body irradiation (TBI) by X- ray. Methods Thirty-six 6-to- 8-week-old SD rats were randomly divided into the TBI group and control group (n=18 each). The TBI group rats received 6.0 Gy high energy X-ray TBI, whereas the control rats did not receive any irradiation. Before irradiation and on days 4 and 7 after irradiation, femur DCE - MRI perfusion imaging was used to measure the volume transfer constant (Ktrans) , reflux rate constant (kep) , plasma volume fraction (vp) and extravascular extracellular volume fraction (ve) of microvessels in femoral region of interest (ROI). The rat bone marrow tissue was frozen with liquid nitrogen and then examined with 1H HRMAS NMRS. The adipose content and microvessel density (MVD) in the bone marrow were studied pathologically. Results Across all time points before and after X- ray irradiation, the TBI group showed significant changes in DCE- MRI perfusion parameters Ktrans, kep, vp and ve, the Ktrans value was increasing until peaking on day 7 after irradiation; the vp value appeared serially decreasing (all P<0.01) ; the kep value was reduced to 0.360 ±0.049/min (P<0.01) on day 4 and to 0.689 ± 0.138/min on day 7 (P<0.01) after irradiation; the ve value increased to 3.331±0.817 on day 7 (P<0.01) , and remained unchanged on day 7 after irradiation (P=0.355). Across all time points before and after X- ray irradiation, the TBI group also showed significant changes in proportions of (n-3) poly-unsaturated fatty acids (PUFA) , (n-6) PUFA and saturated fatty acids (SAFA) in femoral bone marrow. After irradiation, the proportion of bone marrow (n-6) PUFA gradually increased until reaching the maximum on day 7, while the proportion of bone marrow (n-3) PUFA gradually decreased (all P<0.01). At all time points in the TBI rats, the Ktrans value was negatively correlated with (n-3) PUFA (r=-0.639 3, P<0.01) , and positively correlated with (n-6) PUFA (r=0.684 1, P<0.05) of the bone marrow. Conclusion Bone marrow microcirculation and microvascular permeability may be correlated with adipose content after TBI. The changes in bone marrow microcirculation may be underlain by a pathophysiology mechanism based on fat-vascular permeability. Key words: Dose-response relationship, radiation; Bone marrow; Fat; Magnetic resonance imaging; Magnetic resonance spectroscopy

To investigate the feasibility of establishing an anterior cruciate ligament (ACL) reconstruction model using hamstring tendon autograft in cynomolgus monkeys. Twelve healthy adult male cynomolgus monkeys, weighing 8-13 kg, were randomly divided into two groups ( n=6). In the experimental group, the ACL reconstruction model of the right lower limb was prepared by using a single bundle of hamstring tendon, and the ACL of the right lower limb was only cut off in the control group. The survival of animals in the two groups was observed after operation. Before operation and at 3, 6, and 12 months after operation, the knee range of motion, thigh circumference, and calf circumference of the two groups were measured; the anterior tibial translation D-value (ATTD) was measured by Ligs joint ligament digital body examination instrument under the loads of 13-20 N, respectively. At the same time, the experimental group underwent MRI examination to observe the graft morphology and the signal/ noise quotient (SNQ) was caculated. All animals survived to the end of the experiment. In the experimental group, the knee range of motion, thigh circumference, and calf circumference decreased first and then gradually increased after operation; the above indexes were significantly lower at 3 and 6 months after operation than before operation ( P<0.05), and no significant difference was found between pre-operation and 12 months after operation ( P>0.05). In the control group, there was no significant change in knee range of motion after operation, showing no significant difference between pre- and post-operation ( P>0.05), but the thigh circumference and calf circumference gradually significantly decreased with time ( P<0.05), and the difference was significant when compared with those before operation ( P<0.05). At 6 and 12 months after operation, the thigh circumference and calf circumference were significantly larger in the experimental group than in the control group ( P<0.05). At 3 and 6 months after operation, the knee range of motion was significantly smaller in the experimental group than in the control group ( P<0.05). Under the loading condition of 13-20 N, the ATTD in the experimental group increased first and then decreased after operation; and the ATTD significantly increased at 3, 6 months after operation when compared with the value before operation ( P<0.05). But there was no significant difference between the pre-operation and 12 months after operation ( P>0.05). There was no significant change in ATTD in the control group at 3, 6, and 12 months after operation ( P>0.05), and which were significantly higher than those before operation ( P<0.05). At each time point after operation, the ATTD was significantly smaller in the experimental group than in the control group under the same load ( P<0.05). The MRI examination of the experimental group showed that the ACL boundary gradually became clear after reconstruction and was covered by the synovial membrane. The SNQ at each time point after operation was significantly higher than that before operation, but gradually decreased with time, and the differences between time points were significant ( P<0.05). The ACL reconstruction model in cynomolgus monkey with autogenous hamstring tendon transplantation was successfully established.

Delivery of siRNA to the Mouse Lung via a Functionalized Lipopolyamine

This study investigated the dynamics of ubiquitinated proteins after the inflammatory stimulation of RAW 264.7 macrophage-like cells with bacterial lipopolysaccharide. Ubiquitination is a common protein post-translational modification that regulates many key cellular functions. We demonstrated that levels of global ubiquitination and K48 and K63 polyubiquitin chains change after lipopolysaccharide stimulation. Quantitative proteomic analysis identified 1199 ubiquitinated proteins, 78 of which exhibited significant changes in ubiquitination levels following stimulation. Integrating the ubiquitinome data with global proteomic and transcriptomic results allowed us to identify a subset of 88 proteins that were targeted for degradation after lipopolysaccharide stimulation. Using cellular assays and Western blot analyses, we biochemically validated DBC1 (a histone deacetylase inhibitor) as a degradation substrate that is targeted via an orchestrated mechanism utilizing caspases and the proteasome. The degradation of DBC1 releases histone deacetylase activity, linking lipopolysaccharide activation to chromatin remodeling in caspase- and proteasome-mediated signaling.

Background: Effective muscular recruitment during cycling is crucial to optimising performance.  As such, much research has examined when muscles are active during the pedal revolution and how muscle co-activation may influence pedalling technique but little evidence associated with the effect of fatigue on lower limb joint angles and its subsequent effect on power output and muscle recruitment.  Purpose: Are changes in muscular recruitment patterns and changes in lower limb kinematics detrimental to performance?  Methods: A preliminary case study of a well-trained veteran cyclist (V I‡O2peak  49.9 ml . kg-1 . min-1 and PPO of 400W) conducted a 16.1km simulated cycling time trial on a Wattbike Pro at 80% PPO with a cadence of 98 rpm.  Bilateral surface EMG were employed using pairs of Ag/AgCl electrodes adhered to both right and left vastus medialis (VM), biceps femoris (BF), tibialis anterior (TA) and gastrocnemius (GM).  Intervals of sixty seconds in duration, of 3D kinematic and electromyography (EMG) data were synchronised using a Vicon motion capture system throughout the time trial.  Ten consecutive pedal revolutions per 60 s interval were processed for subsequent analysis.    Kinematic and EMG data signals were imported into Visual 3D v.5 and Matlab for processing.  Results: There were statistically significant changes (p<0.05) in all kinematic data across nine time points.  Fundamental changes occurred between minute 10-12 with a decrease in flexion angle for the left hip (z = -9.56, p<0.05, r = 0.55), and the right hip, (z = -7.67, p<0.05, r = 0.44).  The left ankle starts to have a greater planter flexion (z = -9.69, p<0.05, r = 0.56) between minutes 10-12 and this continues to have a significant change between time points for the remainder of the trial.  The magnitude of EMG data revealed that there were statistically significant changes (p<0.05) in all muscles across seven time points.  Decreases in the magnitude of activation were observed between minutes 8-10 for both the left (z = -9.17, p<0.05, r = 0.53) and right (z = -8.21, p<0.0005, r = 0.48) TA.  The frequency domain EMG analysis indicated a trend towards lower frequencies being recorded for the left and right TA and GM with a trend towards higher frequencies being recorded for the left and right VM.  Analysis of the Wattbike data indicated that there were statistically significant differences from minutes 1 to 20 between left and right angle to peak force applied to the crank (t(19) = 20.89, p<0.05) with no statistical significance between left and right limb percentage use (95% CI 2.81, 3.31%).  Indications showed that there was a higher magnitude of activation for the left leg across all muscles tested and the Wattbike data indicates greater power generation on the left side of the pedal revolution.  Discussion: Based on the results from this study there were decreases in the ankles range of motion (ROM) with increases in hip flexion from minute 10-12 with changes in neuromuscular activity between minutes 8-10 then there were smaller effect changes for the remainder of the time trial.  The alterations in the EMG median frequency indicated a trend towards muscular fatigue for TA and GM with increases in neuromuscular activity in both VM’s possibly counteracting fatigue.  The ankle’s decrease in ROM may be a product of fatigue associated with the TA and GM but by becoming stiffer it may optimise the foot/pedal interface.  Even with these changes in kinematic and EMG data the power output remained constant.  Conclusion: As this was a case study further work in this area needs to be considered in establishing variability in joint angles and how they may be beneficial/detrimental in generating the same level of power output when fatigued.  An association of muscular fatigue in cycling and changes to lower limb joint angle variability requires further investigation examining joint coupling patterns, independent pedal power analysis and cross reference to physiological parameters for fatigue to establish strategies that may be beneficial in improving cycling performance.

Expression profiles of toll-like receptors in channel catfish (Ictalurus punctatus) after infection with Ichthyophthirius multifiliis

Flowering process governs seed set and thus affects agricultural productivity. Soybean, a major legume crop, requires short-day photoperiod conditions for flowering. While leaf-derived signal(s) are essential for the photoperiod-induced floral initiation process at the shoot apical meristem, molecular events associated with early floral transition stages in either leaves or shoot apical meristems are not well understood. To provide novel insights into the molecular basis of floral initiation, RNA-Seq was used to characterize the soybean transcriptome of leaf and micro-dissected shoot apical meristem at different time points after short-day treatment. Shoot apical meristem expressed a higher number of transcripts in comparison to that of leaf highlighting greater diversity and abundance of transcripts expressed in the shoot apical meristem. A total of 2951 shoot apical meristem and 13,609 leaf sequences with significant profile changes during the time course examined were identified. Most changes in mRNA level occurred after 1short-day treatment. Transcripts involved in mediating responses to stimulus including hormones or in various metabolic processes represent the top enriched GO functional category for the SAM and leaf dataset, respectively. Transcripts associated with protein degradation were also significantly changing in leaf and SAM implicating their involvement in triggering the developmental switch. RNA-Seq analysis of shoot apical meristem and leaf from soybean undergoing floral transition reveal major reprogramming events in leaves and the SAM that point toward hormones gibberellins (GA) and cytokinin as key regulators in the production of systemic flowering signal(s) in leaves. These hormones may form part of the systemic signals in addition to the established florigen, FLOWERING LOCUS T (FT). Further, evidence is emerging that the conversion of shoot apical meristem to inflorescence meristem is linked with the interplay of auxin, cytokinin and GA creating a low cytokinin and high GA environment.

Introduction: Diet and dietary interventions have drawn considerable attention in the literature as etiopathogenic factors and therapeutic approaches to Autism Spectrum Disorders (ASD), respectively. The objective of this study was to determine the influence of a gluten-free, casein-free (GFCF) diet on the alterations of behavior in children and adolescents diagnosed with ASD. We also aim to explore the possible association between ASD symptoms and urinary concentrations of beta-casomorphin. Methods: A total of 28 patients were recruited for this crossover clinical trial. Patients followed a normal diet (including gluten and casein) for three months and a GFCF diet for another three months. The order of the intervention —i.e., beginning with normal diet or with GFCF diet— was determined at random. The subjects were evaluated at three time points: at the onset of the study, after the first diet, and after the second diet. Each evaluation entailed three questionnaires on behavior and autism, a food frequency questionnaire (to determine adherence to the diet) and a determination of concentrations of beta-casomorphin in urine using chromatographic techniques. Results: No significant behavioral changes were found after a GFCF diet. No association was found between ASD symptoms and urinary concentrations of beta-casomorphin. Conclusion: A GFCF diet followed for three months do neither show significant changes in behavioral symptoms of autism nor in urine concentrations of beta-casomorphin using chromatographic detection. However, we need further studies including elements of placebo and double-blindness and more sophisticated beta-casomorphin detection techniques to better define subjects who might benefit from these diets.

BackgroundInsecticide-treated bed nets (ITNs) reduce malaria transmission and are an important prevention tool. However, there are still information gaps on how the reduction in malaria transmission by ITNs affects parasite genetics population structure. This study examined the relationship between transmission reduction from ITN use and the population genetic diversity of Plasmodium falciparum in an area of high ITN coverage in western Kenya.MethodsParasite genetic diversity was assessed by scoring eight single copy neutral multilocus microsatellite (MS) markers in samples collected from P. falciparum-infected children (< five years) before introduction of ITNs (1996, baseline, n = 69) and five years after intervention (2001, follow-up, n = 74).ResultsThere were no significant changes in overall high mixed infections and unbiased expected heterozygosity between baseline (%MA = 94% and He = 0.75) and follow up (%MA = 95% and He = 0.79) years. However, locus specific analysis detected significant differences for some individual loci between the two time points. Pfg377 loci, a gametocyte-specific MS marker showed significant increase in mixed infections and He in the follow up survey (%MA = 53% and He = 0.57) compared to the baseline (%MA = 30% and He = 0.29). An opposite trend was observed in the erythrocyte binding protein (EBP) MS marker. There was moderate genetic differentiation at the Pfg377 and TAA60 loci (FST = 0.117 and 0.137 respectively) between the baseline and post-ITN parasite populations. Further analysis revealed linkage disequilibrium (LD) of the microsatellites in the baseline (14 significant pair-wise tests and ISA = 0.016) that was broken in the follow up parasite population (6 significant pairs and ISA = 0.0003). The locus specific change in He, the moderate population differentiation and break in LD between the baseline and follow up years suggest an underlying change in population sub-structure despite the stability in the overall genetic diversity and multiple infection levels.ConclusionsThe results from this study suggest that although P. falciparum population maintained an overall stability in genetic diversity after five years of high ITN coverage, there was significant locus specific change associated with gametocytes, marking these for further investigation.

The T1DX-QI is a type 1 diabetes learning health system including over 10 diabetes centers across the U.S. The program is coordinated by the T1D Exchange in Boston, MA. Several research studies have demonstrated the impact of insulin pump use and frequent insulin bolusing on diabetes-related clinical outcomes. Five centers in the T1DX-QI used QI methodology including Plan - Do- Study - Act (PDSA) cycles to test and expand insulin pump use initiatives among patients aged 12 - 26 years at their centers. Successful interventions include developing mobile technology classes, redesigning workflow, coaching patients to bolus for meals and corrections, and removing barriers to adoption. The centers shared data monthly with the coordinating office. These data were used for ongoing QI coaching and to promote the cross-sharing of best practices. Statistical Process Control charts with the relevant rules for fundamental improvements were used to evaluate project effectiveness. Two examples appear in Figure 1. Three of five participating centers had substantial improvement in this process, ranging from 6% - 17%. There was a 10% significant change among the collaborative cohort in 20 months. Successful QI interventions improved pump use. Further expansion is needed to increase the percentages of patients meeting bolusing goals. Disclosure O. Ebekozien: None. N. Rioles: None. J.A. Indyk: None. S. Lyons: Other Relationship; Self; Springer Publishing Company. S. Majidi: Advisory Panel; Self; Companion Medical. T. Proffitt: None. J.M. Lee: Advisory Panel; Self; Goodrx. Consultant; Self; T1D Exchange. Research Support; Self; Lenovo. Funding The Leona M. and Harry B. Helmsley Charitable Trust