Household food insecurity is associated with poor dietary intake in the general population, but little is known about persons with diabetes. We examined dietary intake among youth and young adults ...(YYA) with diabetes in relation to food security (FS) to identify differences in intake quantity and adherence to recommendations. The SEARCH for Diabetes in Youth cross-sectional study includes 1,134 YYA with type 1 diabetes (T1D, mean age: 21 years ± 5) and 274 YYA with type 2 diabetes (T2D, 25 years ± 4.2). Participants (or parents if <18 years) completed the USDA Household FS Survey Module, wherein ≥3 affirmations indicate food insecurity. Diet was assessed via food frequency questionnaire and compared to age- and sex-specific 2020-25 Dietary Guidelines for Americans (DGA) nutritional goals for daily energy, added sugar, saturated fat, calcium, fiber, iron, magnesium, potassium, sodium, vitamins C, D, and E. Associations of FS with daily intake and meeting guidelines were assessed with sex-stratified multivariate linear regression. No intake differences by FS were observed, except females with T1D consumed more sodium (+155 mg, p = .01) and percent of kilocalories from saturated fat (+0.7%, p = .04) when FS was absent. Males with T2D consumed more vitamin E (+1 mg, p = .03) when FS was present. Crude guideline adherence was poor across the board (i.e. below 60%). After multivariate adjustment for demographic, socioeconomic, clinical and diabetes characteristics, females with T1D and T2D, regardless of FS, on average met vitamin C and males met iron guidelines. Males with T2D met percent of kilocalories from saturated fat guidelines in the absence of FS. DGA adherence among YYA with diabetes is of grave concern given that diet is crucial to diabetes management. FS reflects very little enhancement in diet quality. YYA with diabetes consume excessive sodium, added sugars, and inadequate micronutrients except for vitamin C and iron, increasing risk for deficiency, weight gain, heart attack and stroke.
Disclosure
H. D. Bercaw: None. C. Mercado: None. A. D. Liese: None. L. A. Reid: None. J. A. Mendoza: None. E. A. Frongillo: None. K. A. Sauder: None. B. A. Reboussin: None. E. J. Mayer-davis: None. D. Dabelea: None. S. M. Marcovina: None.
Objective
To examine the association between household food insecurity (HFI), glycemic control, severe hypoglycemia and diabetic ketoacidosis (DKA) among youth and young adults (YYA) with youth‐onset ...type 2 diabetes.
Research design and methods
This cross‐sectional study included 395 YYA with type 2 diabetes from the SEARCH for Diabetes in Youth Study (2015–2019). HFI was reported by young adult participants or parents of minor participants via the US Household Food Security Survey Module. Glycemic control was assessed by HbA1c and analyzed as a continuous and categorical variable (optimal: <7.0%, suboptimal: ≥7.0%–9.0%, poor: >9.0%). Acute complications included self‐reported severe hypoglycemia or DKA in the last 12 months. Adjusted logistic and linear regression were used for binary and continuous outcomes, respectively.
Results
Approximately 31% reported HFI in the past 12 months. Mean HbA1c among those with HFI was 9.2% compared to 9.5% without HFI. Of those with HFI, 56% had an HbA1c >9.0% compared to 55% without HFI. Adjusted models showed no associations between HFI and glycemic control. Of those with HFI, 14.4% reported experiencing DKA and 4.7% reported severe hypoglycemia. YYA with HFI had 3.08 times (95% CI: 1.18–8.06) the odds of experiencing DKA as those without HFI. There was no association between HFI and severe hypoglycemia.
Conclusions
HFI was associated with markedly increased odds of DKA but not with glycemic control or severe hypoglycemia. Future research among YYA with type 2 diabetes should evaluate longitudinally whether alleviating HFI reduces DKA.
ABSTRACT
The MLLT10 (formerly AF10) gene is the fourth most common KMT2A fusion partner across all acute leukemias and requires at least 3 breaks to form an in‐frame KMT2A/MLLT10 fusion due to the ...opposite orientation of each gene. A 10‐year retrospective review was performed to identify individuals from all age groups that harbor KMT2A/MLLT10 fusion obtained by our KMT2A/MLLT10 dual‐color dual‐fusion fluorescence in situ hybridization (D‐FISH) assay. Of the 60 unique individuals identified, 31 were male and 29 were female (M:F ratio, 1.1:1) with ages ranging from 3 days to 86 years (mean 21.5 years, median 5.5 years). The diagnoses included acute myeloid leukemia (AML) (49 patients, 82%), B‐ or T‐lymphoblastic leukemia/lymphoma (7 patients, 12%), myeloid sarcoma (3 patients, 5%), and a single case (2%) of undifferentiated leukemia. Twenty‐seven of 49 patients (55%) with AML were in the infant or pediatric age group. Fifty‐three of 60 patients (88%) had KMT2A/MLLT10 D‐FISH signal patterns mostly consisting of single fusions. In addition, 10 (26%) of 38 patients with conventional chromosome studies had “normal” (5 patients) or abnormal (5 patients) chromosome studies that lacked structural or numeric abnormalities involving chromosomes 10 or 11, implying cryptic cytogenetic mechanisms for KMT2A/MLLT10 fusion. Lastly, mate‐pair sequencing was performed on 4 AML cases, 2 of which had “normal” chromosome studies and cryptic KMT2A/MLLT10 fusion as detected by KMT2A/MLLT10 D‐FISH studies, and verified the multiple breaks required to generate KMT2A/MLLT10 fusion.
Physical activity (PA) is essential for optimal diabetes management. Household food insecurity (HFI) may negatively affect diabetes management behaviors. The purpose of this study was to ...cross-sectionally examine the association between HFI and PA in youth and young adults (YYA) with type 1 (N = 1998) and type 2 (N = 391) diabetes from the SEARCH for Diabetes in Youth Study.
HFI was measured with the US Household Food Security Survey Module. PA was measured with the International Physical Activity Questionnaire Short Form. Walking, moderate-intensity PA (excluding walking), vigorous-intensity PA, moderate- to vigorous-intensity PA, and total PA were estimated as minutes per week, while time spent sitting was assessed in minutes per day. All were modeled with median regression. Meeting PA guidelines or not was modeled using logistic regression.
YYA with type 1 diabetes who experienced HFI spent more time walking than those who were food secure. YYA with type 2 diabetes who experienced HFI spent more time sitting than those who were food secure.
Future research should examine walking for leisure versus other domains of walking in relation to HFI and use objective PA measures to corroborate associations between HFI and PA in YYA with diabetes.
Background
Preliminary evidence suggests that non‐lung organ donation from resolved, asymptomatic or mildly symptomatic SARS‐CoV‐2 infected adults may be safe. However, several biological aspects of ...SARS‐CoV‐2 infection differ in children and the risk for transmission and outcomes of recipients from pediatric donors with SARS‐CoV‐2 infection are not well described.
Methods
We report two unvaccinated asymptomatic pediatric non‐lung organ deceased donors who tested positive for SARS‐CoV‐2 RNA by RT‐PCR. Donor One unexpectedly had SARS‐CoV‐2 RNA detected in nasopharyngeal swab and plasma specimens at autopsy despite several negative tests (upper and lower respiratory tract) in the days prior to organ recovery. Donor Two had SARS‐CoV‐ 2 RNA detected in multiple nasopharyngeal swabs but not lower respiratory tract specimens (endotracheal aspirate and bronchoalveolar lavage) during routine surveillance prior to organ recovery and was managed with remdesivir and monoclonal antibodies prior to organ recovery.
Results
Two hearts, two livers and four kidneys were successfully transplanted into seven recipients. No donor to recipient transmission of SARS‐CoV‐2 was observed and graft function of all organs has remained excellent for up to 7 months of followup.
Conclusions
Due to the persistent gap between organ availability and the number of children waiting for transplants, deceased pediatric patients with non‐disseminated SARS‐CoV‐2 infection, isolated to upper and/or lower respiratory tract, should be considered as potential non‐lung organ donors.
We present the discovery of a wide (67 AU) substellar companion to the nearby (21 pc) young solar-metallicity M1 dwarf CD--35 2722, a member of the 100 Myr AB Doradus association. Two epochs of ...astrometry from the NICI Planet-Finding Campaign confirm that CD--35 2722 B is physically associated with the primary star. Near-IR spectra indicate a spectral type of L4?1 with a moderately low surface gravity, making it one of the coolest young companions found to date. The absorption lines and near-IR continuum shape of CD--35 2722 B agree especially well the dusty field L4.5 dwarf 2MASS J22244381--0158521, while the near-IR colors and absolute magnitudes match those of the 5 Myr old L4 planetary-mass companion, 1RXS J160929.1--210524 b. Overall, CD--35 2722 B appears to be an intermediate-age benchmark for L dwarfs, with a less peaked H-band continuum than the youngest objects and near-IR absorption lines comparable to field objects. We fit Ames-Dusty model atmospheres to the near-IR spectra and find T eff= 1700-1900 K and log(g)= 4.5 ? 0.5. The spectra also show that the radial velocities of components A and B agree to within ?10 km s--1, further confirming their physical association. Using the age and bolometric luminosity of CD--35 2722 B, we derive a mass of 31 ? 8 M Jup from the Lyon/Dusty evolutionary models. Altogether, young late-M to mid-L type companions appear to be overluminous for their near-IR spectral type compared with field objects, in contrast to the underluminosity of young late-L and early-T dwarfs.
Hypoglycemia is a common acute complication in diabetes that is often treated with carbohydrate-rich snacks or drinks. For individuals with diabetes and household food insecurity (HFI), uncertain ...availability of food may increase fear of hypoglycemia (FOH). FOH may prevent individuals from optimal diabetes management.
We analyzed data from 1,603 adult (≥18 years, mean 23.7 years, 80% type 1 diabetes T1D, 20% type 2 diabetes T2D) and 592 youth (10.0-17.9 years, mean 15.2 years, 100% T1D) participants in the SEARCH for Diabetes in Youth Study. Adult participants and parents of youth participants completed the U.S. Household Food Security Survey, where ≥3 food insecure conditions or behaviors indicate HFI. Adults, youth, and parents of youth completed the Hypoglycemia Fear Survey that provides a behavior subscale (scores 0-60), worry subscale (scores 0-72), and total score (sum of subscales). We examined the association of HFI with FOH with general linear models, adjusting for socioeconomic, demographic, and clinical covariates.
Approximately 20% of adults and 17% of youth had HFI. Adults with T1D reporting HFI (vs. no HFI) had increased FOH (+3 units for behavior, +11 units for worry, +14 units for total), after adjustment for covariates (all p<0.0001). Parents of youth with T1D reporting HFI had a 3 unit increase in worry FOH (p=0.03). Adults with T2D reporting HFI had increased FOH (+8.9 units for total, +6 units for worry; all p<0.01). Youth with T1D reporting HFI did not differ in FOH than those not reporting HFI.
This research suggests that among adults with diabetes and parents of youth with T1D, those with HFI are more likely to experience FOH than those without HFI. Implementation of common approaches to ameliorate risk of hypoglycemia such as carrying snacks is problematic for people who are food insecure. Providers could consider HFI when discussing hypoglycemia and fear thereof with their patients.
Disclosure
L.A. Reid: None. S. Zheng: None. J.A. Mendoza: None. B.A. Reboussin: None. K.A. Sauder: None. S. Saydah: None. J.M. Lawrence: None. E.T. Jensen: None. L. Henkin: None. K. Flory: None. L.M. Knight: None. C. Pihoker: None. L.M. Dolan: None. A.D. Liese: None.
Funding
National Institutes of Health (1UC4DK108173, 1R01DK117461-01)
We report the discovery of two low-mass companions to the young A0V star HD 1160 at projected separations of 81 + or - 5 AU (HD 1160 B) and 533 + or - 25 AU (HD 1160 C) by the Gemini NICI ...Planet-Finding Campaign. Very Large Telescope images of the system taken over a decade for the purpose of using HD 1160 A as a photometric calibrator confirm that both companions are physically associated. By comparing the system to members of young moving groups and open clusters with well-established ages, we estimate an age of 50 super(+50) sub(-40) Myr for HD 1160 ABC. While the UVW motion of the system does not match any known moving group, the small magnitude of the space velocity is consistent with youth. Near-IR spectroscopy shows HD 1160 C to be an M3.5 + or - 0.5 star with an estimated mass of 0.22 super(+0.03) sub(-0.04) M sub(middot in circle), while NIR photometry of HD 1160 B suggests a brown dwarf with a mass of 33 super(+12) sub(-9) M sub(Jup). The very small mass ratio (0.014) between the A and B components of the system is rare for A star binaries, and would represent a planetary-mass companion were HD 1160 A to be slightly less massive than the Sun.
Modification of the lipid A portion of LPS with cationic monosaccharides provides resistance to polymyxins, which are often employed as a last resort to treat multidrug-resistant bacterial ...infections. Here, we describe the use of fluorescent polyisoprenoids, liquid chromatography-mass spectrometry, and bacterial genetics to probe the activity of membrane-localized proteins that utilize the 55-carbon lipid carrier bactoprenyl phosphate (BP). We have discovered that a substantial background reaction occurs when B-strain E. coli cell membrane fractions are supplemented with exogenous BP. This reaction involves proteins associated with the arn operon, which is necessary for the covalent modification of lipid A with the cationic 4-aminoarabinose (Ara4N). Using a series of arn operon gene deletion mutants, we identified that the modification was dependent on ArnC, which is responsible for forming BP-linked Ara4N, or ArnT, which transfers Ara4N to lipid A. Surprisingly, we found that the majority of the Ara4N-modified isoprenoid was due to the reverse reaction catalyzed by ArnT and demonstrate this using heat-inactivated membrane fractions, isolated lipopolysaccharide fractions, and analyses of a purified ArnT. This work provides methods that will facilitate thorough and rapid investigation of bacterial outer membrane remodeling and the evaluation of polyisoprenoid precursors required for covalent glycan modifications.
Introduction: This article presents some of the results of a year-long project in the Republic of Ireland to review the quality of the hospital inpatient enquiry data for its use in activity-based ...funding (ABF). This is the first of two papers regarding best practice in the management of clinical coding services. Methods: Four methods were used to address this aspect of the project, namely a literature review, a workshop, an assessment of the coding services in 12 Irish hospitals by structured interviews of the clinical coding managers, and a medical record audit of the clinical codes in 10 hospitals. Results: The results included here are those relating to the quality of the medical records, coding work allocation and supervision processes, data quality control measures, communication with clinicians, and the visibility of clinical coders, their managers, and the coding service. Conclusion: The project found instances of best practice in the study hospitals but also found several areas needing improvement. These included improving the structure and content of the medical record, clinician engagement with the clinical coding teams and the ABF process, and the use of data quality control measures.
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