Frequent Encounters Research Articles

Healthcare utilization and clinical characteristics of genetic epilepsy in electronic health records.

Understanding the clinical characteristics and medical treatment of individuals affected by genetic epilepsies is instrumental in guiding selection for genetic testing, defining the phenotype range of these rare disorders, optimizing patient care pathways and pinpointing unaddressed medical need by quantifying healthcare resource utilization. To date, a matched longitudinal cohort study encompassing the entire spectrum of clinical characteristics and medical treatment from childhood through adolescence has not been performed. We identified individuals with genetic and non-genetic epilepsies and onset at ages 0-5 years by linkage across the Cleveland Clinic Health System. We used natural language processing to extract medical terms and procedures from longitudinal electronic health records and tested for cross-sectional and temporal associations with genetic epilepsy. We implemented a two-stage design: in the discovery cohort, individuals were stratified as being 'likely genetic' or 'non-genetic' by a natural language processing algorithm, and controls did not receive genetic testing. The validation cohort consisted of cases with genetic epilepsy confirmed by manual chart review and an independent set of controls who received negative genetic testing. The discovery and validation cohorts consisted of 503 and 344 individuals with genetic epilepsy and matched controls, respectively. The median age at the first encounter was 0.1 years and 7.9 years at the last encounter, and the mean duration of follow-up was 8.2 years. We extracted 188,295 Unified Medical Language System annotations for statistical analysis across 9659 encounters. Individuals with genetic epilepsy received an earlier epilepsy diagnosis and had more frequent and complex encounters with the healthcare system. Notably, the highest enrichment of encounters compared with the non-genetic groups was found during the transition from paediatric to adult care. Our computational approach could validate established comorbidities of genetic epilepsies, such as behavioural abnormality and intellectual disability. We also revealed novel associations for genitourinary abnormalities (odds ratio 1.91, 95% confidence interval: 1.66-2.20, P = 6.16 × 10-19) linked to a spectrum of underrecognized epilepsy-associated genetic disorders. This case-control study leveraged real-world data to identify novel features associated with the likelihood of a genetic aetiology and quantified the healthcare utilization of genetic epilepsies compared with matched controls. Our results strongly recommend early genetic testing to stratify individuals into specialized care paths, thus improving the clinical management of people with genetic epilepsies.

Ethical Awareness and Practices Among Emergency Department Personnel in Riyadh's Tertiary Hospitals: A Cross-Sectional Analysis.

Ethical dilemmas in healthcare, particularly in emergency medical services (EMS), present significant challenges for healthcare workers (HCWs), necessitating a profound understanding of ethics and decision-making. This study assesses the ethical awareness and practices among HCWs in emergency departments of tertiary hospitals in Saudi Arabia, aiming to identify areas of strength and opportunities for improvement. A cross-sectional survey was conducted among 256 HCWs, including physicians, nurses, and administrative staff, in emergency departments across tertiary hospitals in Riyadh, Saudi Arabia. The questionnaire evaluated participants' knowledge of healthcare ethics, their experiences with ethical dilemmas, and the sources from which they derived their ethical understanding. The majority of participants exhibited a commendable level of ethical knowledge and practice, with frequent encounters of ethical or legal issues highlighting the pervasive nature of ethical challenges in emergency healthcare settings. Key sources of ethical knowledge included experiential learning and academic lectures, with a notable emphasis on practical experience. Despite the satisfactory level of ethical awareness, areas requiring further educational focus were identified, emphasizing the need for enhanced ethics training tailored to the emergency medical context. The findings underline the critical importance of incorporating ethics into the core of healthcare education and ongoing professional development for HCWs. Establishing a culture of continuous ethical dialogue and learning is essential for fostering patient-centered care and making informed ethical decisions in the fast-paced environment of emergency services. The study advocates for revising current ethics training programs to ensure they are comprehensive, relevant, and accessible, preparing HCWs to effectively address both current and future ethical challenges.

The Coping Strategies and Cumulative Changes in Intensive Care Unit Nurses after Experiencing Professional Grief: A Hermeneutic Phenomenological Study

Background. Compared to nurses in other hospital departments, intensive care unit (ICU) nurses have more frequent exposure to patient deaths, potentially rendering them more susceptible to experiencing professional grief following patient fatalities. Objective. To explore the coping experiences of ICU nurses following their encounter with professional grief. Methods. This study utilized a qualitative research design based on Heideggerian phenomenology. A purposive sample of 18 ICU nurses was selected from six tertiary hospitals in Guangdong Province, China. Individual semistructured interviews were audio-recorded and transcribed verbatim. The transcribed texts were analyzed using interpretative phenomenological analysis. Results. Two main themes emerged: (1) short-term dual coping with professional grief and (2) long-term cumulative changes from professional grief. These themes reflect the dynamic coping processes experienced by ICU nurses amidst frequent encounters with loss and grief during their clinical work. Conclusions. ICU nurses employ both adaptive and maladaptive coping strategies to address professional grief, significantly impacting their personal and professional well-being. It is advisable to offer targeted education and organizational support systems for ICU nurses to promote positive cumulative growth when they repeatedly encounter patient deaths.

Analyzing tiger interaction and home range shifts using a time-geographic approach

BackgroundInteraction through movement can be used as a marker to understand and model interspecific and intraspecific species dynamics, and the collective behavior of animals sharing the same space. This research leverages the time-geography framework, commonly used in human movement research, to explore the dynamic patterns of interaction between Indochinese tigers (Panthera tigris corbeti) in the western forest complex (WEFCOM) in Thailand.MethodsWe propose and assess ORTEGA, a time-geographic interaction analysis method, to trace spatio-temporal interactions patterns and home range shifts among tigers. Using unique GPS tracking data of tigers in WEFCOM collected over multiple years, concurrent and delayed interaction patterns of tigers are investigated. The outcomes are compared for intraspecific tiger interaction across different genders, relationships, and life stages. Additionally, the performance of ORTEGA is compared to a commonly used proximity-based approach.ResultsAmong the 67 tracked tigers, 42 show concurrent interactions at shared boundaries. Further investigation of five tigers with overlapping home ranges (two adult females, a male, and two young male tigers) suggests that the mother tiger and her two young mostly stay together before their dispersal but interact less post-dispersal. The male tiger increases encounters with the mother tiger while her young shift their home ranges. On another timeline, the neighbor female tiger mostly avoids the mother tiger. Through these home range dynamics and interaction patterns, we identify four types of interaction among these tigers: following, encounter, latency, and avoidance. Compared to the proximity-based approach, ORTEGA demonstrates better detects concurrent mother–young interactions during pre-dispersal, while the proximity-based approach misses many interactions among the dyads. With larger spatial buffers and temporal windows, the proximity-based approach detects more encounters but may overestimate the duration of interaction.ConclusionsThis research demonstrates the applicability and merits of ORTEGA as a time-geographic based approach to animal movement interaction analysis. We show time geography can develop valuable, data-driven insights about animal behavior and interactions. ORTEGA effectively traces frequent encounters and temporally delayed interactions between animals, without relying on specific spatial and temporal buffers. Future research should integrate contextual and behavioral information to better identify and characterize the nature of species interaction.

Optimizing the frequency of physician encounters in follow - up care for patients with type 2 diabetes mellitus: a systematic review

BackgroundDecisions on the frequency of physician encounters for patients with type 2 diabetes mellitus (T2DM) have significant impacts on both patients’ health outcomes and burden on health systems, whereas definitive intervals for physician encounters are still lacking in most clinical guidelines. This study systematically reviewed the existing evidence evaluating different frequencies of physician encounters among T2DM patients.MethodsSystematic search of studies evaluating different visit frequencies for follow - up care in T2DM patients was performed in MEDLINE Ovid, Embase Ovid, and Cochrane library from database inception to 25 March 2022. Studies on the follow - up encounters driven by non - physicians and those on the episodic visits in the acute care settings were excluded in the screening. Citation searching was conducted via Google Scholar on the identified papers after screening. The risk of bias was assessed using Cochrane RoB2 tool for randomized controlled trials and Newcastle - Ottawa Scale for cohort studies. Findings were summarized narratively.ResultsAmong 6363 records from the database search and 231 references from the citation search, 12 articles were eligible for in - depth review. The results showed that for patients who had not achieved cardiometabolic control, intensifying encounter frequency could enhance medication adherence, shorten the time to achieve the treatment target, and improve the patients’ quality of life. However, for the patients who had already achieved the treatment targets, less frequent encounters were equivalent to intensive encounters in maintaining their cardiometabolic control, and could save considerable healthcare costs without substantially lowering the quality of care and patients’ satisfaction.ConclusionExisting evidence suggested that the optimal frequency of physician encounters for patients with T2DM should be individualized, which can be stratified by patients’ risk levels based on the cardiometabolic control to guide the differential scheduling of physician encounters in the follow - up. More research is needed to determine how to optimize the frequency of physician encounters for this large and heterogeneous population.

The agency of urban carnivores in human politics: leopards in Mumbai, India

Across the world, increasing urbanization is leading to more frequent encounters between humans and wildlife. The resulting cohabitation promotes new human–wildlife dynamics in cities and requires innovative approaches for coping with wildlife in habitats that are not conventionally considered as suitable. Here we examined how leopards (Panthera pardus) acclimate to the urban environment in Mumbai, India, and influence human politics through their presence, adaptability, and diverse relationships with humans and nonhumans. Building on perspectives from political ecology and more‐than‐human geography, we show how leopards may thwart the outcomes of wildlife conservation and management and also catalyze transitions toward approaches that foster coexistence. We reveal the political role that leopards play in Mumbai by examining the many ways in which they influence power dynamics among humans. Our analysis illustrates how including considerations about the political agency of wildlife in urban planning can improve nature conservation and social policies.

Echinococcus granulosus comparative genotyping in sheep in Saudi Arabia and Egypt.

Cystic echinococcosis (CE), which is triggered by the parasite Echinococcus granulosus, is a global zoonotic disease that is common in rural regions in which there are frequent encounters between dogs and other domestic animals. The disease can have devastating consequences, impacting the health of people and animals and leading to huge financial losses, especially in the agricultural industry. In the Kingdom of Saudi Arabia (KSA) and Egypt, despite the high incidence of disease, few investigations have been conducted into the genetic variation in species of the genus Echinococcus. This study sought to compare the genetic features of the hydatid cysts carried in sheep in KSA with those found in Egypt. DNA from the protoscolices was used in a PCR targeting the mitochondrial NADH dehydrogenase 1 (NAD1), cytochrome c oxidase subunit 1 (COX1), and nuclear actin II (ACT II) genes, and the resulting amplification products of 30 KSA and Egyptian isolates were sequenced and compared. Among the sheep in KSA, the overall prevalence of CE was 0.51%. Of the sheep cyst DNA samples, 95%, 100%, and 52% were positive for the Cox1, nad1, and act II genes, respectively. Targeting all three genes, all KSA samples belonged to the E. granulosus genotype (G1), whereas all Egyptian isolates belonged to E. granulosus (G1) and E. canadensis (G6). We conclude that isolates of E. granulosus from the two countries shared a common origin in Arabic North Africa, with sheep and camels as common hosts.

Morphology, Phylogeny, and Evolution of the Rarely Known Genus Admetella McIntosh, 1885 (Annelida, Polynoidae) with Recognition of Four New Species from Western Pacific Seamounts

The polynoid genus Admetella constitutes a deep‐sea assemblage of polychaetes, notable for their large bodies adorned with antennal scales positioned dorsally to the bases of lateral antennae. Furthermore, the genus exhibits swimming proficiencies facilitated by elongated parapodia and flattened chaetae. Despite the frequent encounters with Admetella members during various deep‐sea explorations, a substantial gap in our comprehension of their diversity, phylogeny, and evolutionary trajectories still exists. Our thorough morphological and phylogenetic investigations of specimens obtained from three seamounts located in the tropical western Pacific have unveiled six species belonging to the genus Admetella, four of these being newly identified as Admetella multiseta sp. nov., A. levensteini sp. nov., A. nanhaiensis sp. nov., and A. undulata sp. nov. The other two species of Admetella remain unidentifiable at the species level due to the loss of crucial details. Our phylogenetic analysis, grounded on 13 mitochondrial protein‐coding genes and the inclusion of 12S, 16S, 18S, 28S rRNA, and ITS1–ITS2 genes, substantiates the monophyly of Admetella. Admetella is positioned at an intermediate node within the phylogenetic tree, situated between representative shallow‐water and deep‐sea subfamilies. The independent evolution of antennal scales within Admetella among polynoids constitutes a synapomorphy for this genus. Ancestral state reconstruction (ASR) analyses suggest that deep‐sea polynoids evolved from shallow‐water ancestors that possessed lateral antennae, which were subsequently lost in members inhabiting extreme marine environments, such as deep‐sea hydrothermal vents and anchialine caves. The analysis further implicates that swimming ability independently evolved at least four times within the Polynoidae family.

Collaborative methods identify a remote global diversity hotspot of threatened, large‐bodied rhino rays

Abstract North‐western Australia is considered a refuge to several highly threatened elasmobranch species, but there has been little research effort targeting lesser known, large‐bodied rhino rays. This study identified 2,343 records of globally threatened rays of the order Rhinopristiformes from the Pilbara region of Western Australia, with a focus on the Ningaloo Coast World Heritage Area and adjacent Exmouth Gulf. Occurrence data were compiled from various sources including commercial fishing reports (35%), citizen science records (34%), targeted scientific surveys (30%) and published literature (1%). The region was inhabited by all of Australia's Pristidae (four sawfish species), all of Australia's Rhinidae (three wedgefish species) and the sole Australian representative of the Glaucostegidae (giant shovelnose ray). Of the 2,343 records, ~49% were sawfishes, while giant guitarfish and wedgefishes contributed to ~33% and 18% of records, respectively. The Exmouth Gulf appears to be a globally important refuge and pupping area for green sawfish (Pristis zijsron) which was the most commonly encountered pristid. Bottlenose wedgefish (Rhynchobatus australiae) were the most commonly identified rhinid, with less frequent encounters of shark rays (Rhina ancylostoma) and eyebrow wedgefish (Rhynchobatus palpebratus). The Ningaloo Coast World Heritage Area and adjacent Exmouth Gulf host all life stages of giant shovelnose ray (Glaucostegus typus). The combined use of several data sources has highlighted the study region as a ‘lifeboat’ for these globally threatened large‐bodied rays. These data are essential in creating effective conservation and management plans in this globally important refuge, and are highly relevant to global conservation initiatives.

Evaluating Multidisciplinary Bone Marrow Failure Care (EMBRACE) - a Hybrid Implementation-Effectiveness Study

The bone marrow failure syndromes (BMFS) are clinically diverse, with both inherited and acquired etiologies. Patients with BMFS may present unique, complex management issues and frequently experience poor outcomes due to multiple factors, including the rarity of the individual conditions. The Evaluating Multidisciplinary Bone maRrow fAilure CarE (EMBRACE) study is a multi-stage hybrid implementation-effectiveness study that aims to address these challenges by understanding the nature and scale of issues faced by these patients and their physicians, and then developing, implementing, and evaluating a comprehensive 10-component model of care (MoC10). Herein we report the results of the first stage of the EMBRACE study of issue identification and MoC10 development. To identify barriers to optimal care, we performed structured interviews with patients with BMFS and patient advocate groups, followed by a nation-wide physician survey. Thematic analysis of interviews (n = 9) revealed multiple challenges with patient care, including (i) a lack of access to genomic testing to provide a definitive diagnosis, (ii) widespread difficulty in accessing genetic counselling and fertility advice, (iii) a lack of disease-specific patient information at the time of diagnosis, and (iv) perceived failings in care when transitioning from pediatric to adult services. Patients also described anxiety resulting from frequent encounters with health professionals unfamiliar with their disease, leading to significant anxiety and demonstrating a clear need for education both at the time of initial presentation, in considering whether an underlying inherited condition could be present and also following diagnosis, permitting relevant disease specific surveillance and care. As part of this patient-facing analysis, there was a desire on behalf of patients and patient advocates for the opportunity to participate in research and clinical trials. A nation-wide physician survey was then performed targeting clinicians that treat patients with BMFS which received 74 responses across hematologists, oncologists, pediatricians and geneticists who cared for 267 patients with BMFS. The median number of patients cared for per physician was 2 (range 0 - 25), demonstrating a wide range of subspecialty experience and non-centralized care. Responses indicated a desire for affordable access to genomic testing, assistance with result interpretation and genetic counselling/cascade testing of extended kindred, a forum for complex case discussion and advice regarding patient management strategies. Responses from patients, patient advocates and physicians, along with existing evidence-based and best-practice guidelines, were then used to develop a MoC. The MoC10 (Figure 1) incorporates 10 pillars directed at optimising care for patients with BMFS including funded access to genomic testing, access to expert genetic and fertility counselling, standardized hematological and solid organ cancer surveillance, and opportunity for multidisciplinary case discussion including expert opinion regarding allogeneic stem cell transplant. In addition, uncertain and novel germline variants are presented alongside de-identified case presentations at a national forum attended by physicians, scientists, and researchers to promote education, collaboration and information sharing with treating teams. After institutional approval, the MoC10 has been implemented and is undergoing structured evaluation to determine patient and physician acceptability and adherence. Embracing the well-known ‘Plan, Do, Study, Act’ cycle, our implementation approach facilitates iterative learning for continuous improvement. In summary, after extensive stakeholder engagement, we have developed an evidence based comprehensive MoC addressing the current challenges facing patients with BMFS and their care teams. This comprehensive care program continues to undergo evaluation and audit consistent with the principles of an implementation-effectiveness study to determine both patient and physician satisfaction with the model, and iterative refinement in order to provide optimum care.

Exploring the Influencing Factors of Breaking Through the Information Cocoon

In information dissemination, the public often only focuses on the areas of communication they are interested in. Over time, the algorithm recommendation mechanism of online platforms will confine users to information cocoons like cocoon rooms. Information cocoons allow users to continuously obtain homogeneous information, resulting in a narrow field of vision and a negative impact on media dependence. With improving media awareness and self-awareness among users, some users are actively breaking the information cocoon. This paper investigates the behavior of Weibo users, combined with their behavioral characteristics, to study their proactive behavior and explore the factors that affect them to break the information cocoon. This can help users break through the information cocoon and receive more comprehensive and rich information. Simultaneously achieving a balance in user access to information across various platforms is beneficial for long-term retention. Specifically, a quantitative study is conducted using a questionnaire survey method. Then, correlation analysis and result regression analysis were used for the analysis. The conclusion is that the more frequent information encounters and policy interference, the higher the complexity of online information, and the easier it is for users to break through the information cocoon.

Medicine education in a pediatric oncology setting: What can we do better?

BackgroundWhen patients feel more involved in their care, there tends to be a higher rate of adherence and improved health outcomes. This can be more difficult to achieve in pediatric care since children have varying levels of medicine comprehension and parents are an integral component of the child's learning. ObjectivesThis study aimed to determine the satisfaction of children and families being treated for cancer with their medicine education and determine areas for improvement. MethodsSemi-structured interviews were conducted over six months (2016/2017) with families and children with cancer, ages 7 to 19 years, (n = 6) and healthcare providers (n = 9) to assess the current method of medicine education delivery. ResultsFamilies reported increased stress and anxiety levels at the time of diagnosis, negatively impacting their information retention. Patients, families, and healthcare providers reported inconsistent education delivery, including varying amounts of information throughout the treatment and inconsistencies between providers, such as medication names. Parents mentioned a desire for a more consistent and standardized delivery of medicine education, which was found to be helped by a pharmacist-led approach. Receiving supplemental written materials to support verbal education helped with learners' understanding and information retention. Ensuring that the parents are comfortable and familiar with the medicines is a significant component of medicine teaching in pediatric care because they are often responsible for the child's medications and their children see them as a trusted source of information. Ensuring parents' needs are met translates to improved medicine adherence for children with cancer. ConclusionMedicine education should occur sometime post-diagnosis once the patient/family has had time to adjust and the anxiety lessens. Medicine education should be given as consistently as possible by a recurring member of the care team, ideally the pharmacist. The learners' ability to understand and retain information should be individually assessed to determine the delivery of medicine education. Motivating and empowering learners, including children, through frequent medicine encounters could help improve adherence, patient health outcomes, and quality of life and make them more self-managing throughout life.

Development and evaluation of a forensic nursing competency-based hybrid simulation education program: A quasi-experimental design

AimThis study aimed to develop and validate the effectiveness of a hybrid simulation education program designed to enhance the forensic nursing competency of emergency department nurses. BackgroundEmergency nurses often bear the responsibility of conducting forensic nursing assessments and interventions, such as patient recognition and evidence collection, to safeguard patients' legal rights, given their frequent encounters with emergency department patients. Simulation methods have proven effective in training for forensic nursing care. However, there is still a need for the development of forensic nursing education using simulation methods. DesignThis study employed a one-group pre-test/post-test quasi-experimental design. A four-hour simulation education program was developed based on the analysis, design, development, implementation, and evaluation model, with a focus on enhancing forensic nursing competency. MethodsNurses with more than six months of clinical experience in the emergency department in South Korea were divided into an experimental group (n=23) and a baseline comparison group (n=24). Both groups completed self-evaluations of their forensic nursing competency through a survey. The experimental group underwent the simulation education program, and their forensic nursing performance was evaluated before and after the program. Following the training, participants completed a questionnaire to assess their forensic nursing competency and satisfaction with the program. ResultsThe initial forensic nursing competency of the experimental and baseline comparison groups was found to be similar. However, the forensic nursing competency and performance of the experimental group exhibited significant improvement after the training. Regarding program evaluation, the average scores on a 5-point scale were as follows: theoretical lecture (4.79 SD 0.27), simulation education (4.78 SD 0.29), simulation design (4.42 SD 0.45), and satisfaction with the educational program (4.82 SD 0.28). ConclusionsThe forensic nursing competency-based simulation education program herein improved the relevant competency and performance of emergency nurses.

Determination of Knowledge and Attitudes of Nurses About Pain Management: A Cross-Sectional Study

Objective: The aim of this study was to determine the knowledge and attitudes of nurses working in surgical and internal medicine clinics on pain management.
 Methods: This study is descriptive and cross-sectional. A total of 140 nurses working in surgical and internal clinics in a hospital participated in the study. The data were obtained by questionnaire form and Nursing’s Knowledge and Attitudes Survey Regarding Pain (NKASRP). Data were analyzed by using SPSS 22.0 software. In the evaluation of the data; ANOVA, Mann Whitney U, Kruskal Wallis significance test, and logistic regression analysis were used. 
 Results: The mean score of the NKASRP scale of the nurses was 17.72±3.72. It was found that working for more than ten years, receiving graduate education and frequent encounters with painful patients were associated with a high level of knowledge. The probability of having sufficient knowledge of nurses working in surgical clinics was found to be 1.12 times higher (95% CI: 1.02-1.24) than nurses working in internal medicine clinics.
 Conclusions: Effective pain management requires the nurse's correct knowledge, attitude and assessment related to pain. The present study determined that nurses had a lack of knowledge and misconceptions about pain assessment and pain medication use, which are the main obstacles to effective pain management.

THU152 HbA1c Control Of Pediatric Patients With Diabetes In The Urban Community Hospital Representing Underserved, Minority Population: Can The Frequent Encounters With Multi-Disciplinary Diabetes Team Overcome Patient-Related Adverse Variables In Improving Their Glycemic Control?

Abstract Disclosure: S. Velasquez: None. O. Ozcan: None. S. Dave-Sharma: None. Introduction: The American Diabetes association’s established goal for HbA1C across all age groups is as <7%. As the prevalence of diabetes continues to increase, its control in the pediatric population has become more challenging. Studies have shown controlling diabetes is especially challenging in minority ethnic groups of low income neighborhoods. Our hospital, located in the Mott Haven community, serves the minority population of mostly Hispanics and Blacks with an average household income of < $ 20 000 (poverty rate 39%). Objectives: This study aimed to identify different variables among patients with controlled and uncontrolled HbA1c in our unique pediatric population. Our goal was to learn from the group of patients with good diabetes control to improve the control of patients with poor glycemic control by changing the protocols involving our multi-disciplinary care team. Results: We collected data from 86 patients with diabetes (type 1 and 2) from our pediatric endocrinology clinic and divided them into 3 groups based on their HbA1c levels. 1. Good control: HbA1c <7.5 % in 33/86 (38%) patients, 2. Poor control: HbA1C 7.5%-10% with 34/86 (40%), and 3. Very poor control: HbA1C >10% with 19/86 (22%) patients. We studied the data for variables such as gender, age, ethnicity, insurance, type of diabetes, duration of diabetes, BMI, frequency of encounters with the multi-disciplinary team, and more. Of 86 patients, the average age was 15.65 (51% were females, and 49% were males). 43% had type 1 diabetes, and 57% had type 2 diabetes. The type 1 vs. Type 2 diabetes ratio among different groups was 12% Type 1 vs. 88% type 2 in the group with good control, 73.5% Type 1 vs. 26.5% Type 2 in the poor control group, and 42% type 1 vs. 58% type 2 in the group with very poor control. Obesity was found in 50% of our patients; in the good control group, it was 57%. In the poor control group, 38%, and in the very poor control group, 58%. A correlation study run between the HbA1c levels and duration of diabetes found significantly correlated (R 0.38) in the good control group. Other groups were found positively correlated yet found statistically insignificant. Conclusion: We found that Type 2 Diabetes with Obesity was more prevalent than Type 1 in our pediatric population. Patients with poor and very poor diabetes control had a longer duration of diabetes compared to patients with good control. Frequent visits with the diabetes team improved HbA1C in our patients. 84% of patients in the good control group were seen by the diabetes team more frequently (at least every 3-6 months) compared to patients with higher HbA1c. The group with very poor glycemic control patients were more obese with Type 2 Diabetes and were less frequently coming for the scheduled appointments. More efforts must be made to design the protocols to overcome patient-related obstacles to improve diabetes control. Presentation: Thursday, June 15, 2023

Fungsi dan Makna Perapian di Permukiman Desa Kalidesel, Wonosobo, Jawa Tengah

Fireplaces for people in mountainous areas have several functions including those that function for cooking, heating and preserving agricultural products. One of the villages in the mountainous region is Kalidesel Village, Wonosobo, Central Java. The fireplace in the Kalidesel village consists of several elements including a furnace known as a pawon, a small wooden table known as dingklik, a seat known as jengkok, a cupboard for furniture known as an Anjab and a place to put agricultural products known as para. The fireplace is maintained by the community because it has meaning for people's lives. This research will reveal the meaning of a fireplace in the Kalidesel Village Settlement, Wonosobo, Central Java. The method used is descriptive method with observation and interview strategies. Observations were made on several houses in the village of Kalidesel that still maintain a fireplace. Interviews were conducted in several communities in the Kalidesel Village. The results of the study show the functional, social and symbolic meaning of the function of a fireplace in the Kalidesel Village Settlement. Functional meaning that arises in accordance with the function of the fireplace as a cooking tool. The function shows the ecological aspects of the use of wood fuel by using a repek system (how to extract wood without damaging the environment). The social meaning can be seen from the function of warming which is used as a means to strengthen brotherhood. Not only do you come from blood ties, but your neighbors become sedul due to frequent gatherings and encounters with a fireplace. The symbolic meaning of the hearth as a spiritual means. The fireplace is believed to be able to be an intermediary tool that can provide fortune. The meaning of a hearth for people's lives is the creation of comfort and peace in life.

LITHUANIAN HATE SPEECH CLASSIFICATION USING DEEP LEARNING METHODS

The ever-increasing amount of online content and the opportunity for everyone to express their opinions online leads to frequent encounters with social problems: bullying, insults, and hate speech. Some online portals are taking steps to stop this, such as no longer allowing user-generated comments to be made anonymously, removing the possibility to comment under the articles, and some portals employ moderators who identify and eliminate hate speech. However, given the large number of comments, an appropriately large number of people are required to do this work. The rapid development of artificial intelligence in the language technology area may be the solution to this problem. Automated hate speech detection would allow to manage the ever-increasing amount of online content, therefore we report hate speech classification for Lithuanian language by application of deep learning.

Between mundane and extreme: the nature of work on the UK supermarket frontline during a public health crisis

The normally low-risk and routinised nature of supermarket frontline work evolved drastically amid the COVID-19 pandemic. Drawing on a refined conceptual framework of extreme work, this article examines how the public health crisis coupled with maxinisation of organisational flexibility gives rise to extremity in mundane work settings. The findings based on 50 interviews with workers and managers who worked throughout the pandemic on the UK supermarket frontline offer empirical insights into the macro-micro dynamics of extreme-mundane work. These insights reveal a nuanced narrative of supermarket work as both alienating, owing to the frequent encounters of abuse and undervalued responsibilities, and fulfilling as a respite from social isolation induced by the pandemic. This narrative illustrates the complexities of individual motivations to engage with extreme work, while highlighting a need for structural support in coping with elevated exposure to risks and uncertainties. The article argues that the nature of work and workplaces in the face of extreme externalities remains contingent upon human resource management practices on the frontline of a crisis.

Identification of Risk Areas for Gloydius Snakebites in South Korea.

Snakebites can pose a significant threat to human health as the destruction of natural habitats and increased human intrusion into ecosystems result in more frequent encounters with snakes. Mitigation measures for snakebites are particularly crucial for hiking trails where transportation of snakebite victims to medical facilities is challenging due to limited emergency resources and difficult access. This study employed a random forest-based species distribution model approach to investigate the potential habitats of Gloydius spp., specifically Gloydius saxatilis, Gloydius brevicaudus, and Gloydius ussuriensis, in South Korea and to assess the snakebite risk in national parks. Potential habitats of Gloydius spp. were identified and visualized by overlaying binary maps derived from species distribution models (SDMs) of each Gloydius spp. that corresponded to high-risk snakebite areas. In addition, hiking trails with high snakebite risk in the national parks were identified after demonstrating the statistical correlation between the potential habitat distribution of Gloydius spp. and the actual snakebite incidents in major regions of South Korea. The primary environmental variables determining Gloydius spp. habitat were the topographic position index, slope, and the annual average of the maximum and minimum temperatures. The potential habitat of G. saxatilis generally appeared in high-altitude mountainous areas, mostly in the eastern part of the study area. Favorable habitats for G. brevicaudus and G. ussuriensis were predominantly located in mountainous areas throughout the study area, with the exception of some high-altitude mountainous terrain in the east. The number of snakebite incidents per 10,000 people was significantly correlated with the area ratio of Gloydius spp. potential habitat (Spearman's rho = 0.638, p < 0.01). The proportion of snakebite risk areas among national parks in South Korea ranged from 18% to 57%. This study can support practical solutions to prevent injuries and fatalities among hikers due to snakebites by identifying areas with a high risk of snakebite accidents at the hiking-trail level.

RWD36 Healthcare Resource Utilization in Patients with Hidradenitis Suppurativa in Five European Countries and the USA Using Real World Evidence

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a high symptom burden, requiring frequent healthcare encounters. This study describes healthcare resource utilization (HCRU) by disease severity in the EU5 (France, Germany, Italy, Spain, UK) and the USA.