Introduction and Objective: Celiac disease (CD) and Type 1 Diabetes Mellitus (T1DM) often co-occur due to shared autoimmune mechanisms. While a gluten-free diet is the only treatment for CD, its impact on glycemic control and Hemoglobin A1c (HbA1c) remains unclear. This study examines the association between CD and uncontrolled HbA1c levels in a pediatric T1DM population. Methods: The study is a retrospective chart review of patients less than 18 years old with T1DM ICD-10 codes across Corewell Health East in metropolitan Detroit area spanning 01/01/2012 to 12/31/2023. We analyzed data from 2203 pediatric patients with T1DM, stratified by CD status (Yes: n=101; No: n=2,102) and glycemic control (Controlled HbA1c <7: n=561; Uncontrolled HbA1c ≥7: n=1642). HbA1c values of less than 3.5 or greater than 20 were excluded. Statistical analysis included Chi-square, t-test, and logistic regression. Results: Of the 2203 pediatric patients with T1DM, 4.6% had concurrent CD diagnosis. The majority of the T1DM patients were male (54.2%), White (70.3%) with a median age of 12 [range 0-17]. T1DM patients with CD had a significantly higher number of HbA1c measurements (Mean [SD]: 16.90 [12.17] vs. 10.54 [9.93], p<0.0001). In addition, a higher proportion of T1DM patients with CD had an average HbA1c ≥ 7 (uncontrolled) compared to those without (89.1% vs. 73.8%, p<0.0006). Using regression analysis, T1DM patients with CD had significantly higher odds of having uncontrolled HbA1c levels (adj OR: 2.60, 95% CI: 1.37-4.90) after adjusting for age, race and gender. Conclusion: This study found that pediatric patients with both T1DM and CD had higher risk of uncontrolled DM. Also, T1DM patients with CD had more frequent HbA1c measurements, suggesting increased glycemic variability or challenges in control. These findings emphasize the need for close monitoring and individualized management for pediatric patients with both conditions. A. Lin: None. M.A. Jankowski: None. L. Qu: None. V. Uhley: None. R. Homayouni: Board Member; Quire Inc. M.R. Brennan: Speaker's Bureau; Boehringer-Ingelheim, Bayer Pharmaceuticals, Inc, Novo Nordisk.
Background and Objectives:Middle age is a pivotal developmental life stage marked by health transitions, including the onset of major chronic diseases and functional limitations. Social determinants of health, particularly race/ethnicity, can play a significant role in accentuating the effects of comorbidity and functional limitations. This study examines how comorbidity, functional limitations, and race/ethnicity influence patterns of health services use and spending among middle-aged adults. Research Design and Methods:We used pooled yearly cross-sectional data (Medical Expenditure Panel Survey, 2008-2022; excluding 2020) from middle-aged adults (ages 50-64). We derived comorbidity phenotypes using latent class analyses (LCA) and generalized linear regression to examine their associations with health services outcomes, considering the vulnerabilities introduced by functional limitations and race/ethnicity. Results:LCA supported a 3-class solution: low prevalence of chronic conditions (63.4%), hypertensive/arthritis/joint pain (29.3%), and complex cardiovascular (C-CVD, 7.3%). Individuals with C-CVD had elevated levels of healthcare spending and use, including problematically high levels of emergency department and inpatient hospitalizations, despite higher use of office-based visits (OBVs). We found that Non-Hispanic Black adults (NHBs) and Hispanic adults had lower health spending compared to Non-Hispanic White adults (NHWs) and were less likely to use OBVs. NHBs had a higher propensity for ED use, whereas Hispanic adults were less likely to be hospitalized. Physical and instrumental/activities of daily living (I/ADL) limitations increased OBVs for both NHBs and NHWs, while I/ADLs increased hospitalizations among Hispanic adults. Discussion and Implications:These findings underscore the importance of targeted healthcare for high-risk patient populations for mitigating excess health burdens.
Geothermal heating and cooling of commercial and residential buildings is a critical component of buildings decarbonization and consequently reducing emitted greenhouse gases. In this paper we examine the state-of-the-art modelling of ground heat exchangers and their utilization in modern geothermal design software packages. Using this modern methodology for modelling, we have examined the effects of several key parameters for the design of geothermal plants. We argue for the necessity for deeper geothermal boreholes and show that bore-fields with deeper, but a smaller number of boreholes perform superiorly over bore-fields with the same total depth but shallower and greater number of boreholes. Moreover, the improvements due to groundwater flow and u-loop placement in the boreholes are discussed. The role of volumetric heat capacity of grouts that is ignored in most traditional geothermal models but included in the modern modelling methodologies are emphasized. Considerations for coiled tubing drilling for geothermal applications are reviewed and maximum achievable drilling depth for coiled tubing drilling are predicted for a sample coiled turning drilling operation. It is shown that increasing torque per pressure differential of positive displacement motors, although enhances drilling mechanical efficiency, could reduce the maximum drillable depth.
Understanding the preoperative risk factors for successful rotator cuff repair (RCR) and ways to optimize these factors is an evolving area of study. The Rotator Cuff Healing Index and other proxy risk factors for failed rotator cuff healing have implicated significant fatty infiltration, muscular atrophy, advanced chronological age, tear size and retraction, and ultimately, osteoporosis. Although structural (or biological) augmentation and tendon transfer have been proposed as solutions for the alarmingly high rate of failure after primary RCR, other options may preferentially focus on the enthesis and underlying osseous footprint. Currently, bisphosphonates are frequently used in the treatment of osteoporosis and prevention of fragility fractures. However, burgeoning evidence suggests that postoperative zoledronic acid may have clinical utility after rotator cuff and other tendon repairs. In the cost-conscious world of evidence-based medicine, the added economic burden of additional medications and office visits may or may not improve patient outcomes-much less confer added value. Our advice to fellow shoulder surgeons: Wait for further information, but continue to holistically consider and optimize risk factors for poor soft-tissue healing. Although the addition of postoperative bisphosphonates may improve suture anchor fixation and promote a better foundation for healing, it will not immediately transform your RCR success rates.
