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An open question in SN Ia research is where the boundary lies between 'normal' Type Ia supernovae (SNe Ia) that are used in cosmological measurements and those that sit off the Phillips relation. We present the spectroscopic modelling of one such '86G-like' transitional SN Ia, SN 2021rhu, that has recently been employed as a local Hubble Constant calibrator using a tip of the red-giant branch measurement. We detail its modelling from -12 d until maximum brightness using the radiative-transfer spectral-synthesis code tardis. We base our modelling on literature delayed-detonation and deflagration models of Chandrasekhar mass white dwarfs, as well as the double-detonation models of sub-Chandrasekhar mass white dwarfs. We present a new method for 'projecting' abundance profiles to different density profiles for ease of computation. Due to the small velocity extent and low outer densities of the W7 profile, we find it inadequate to reproduce the evolution of SN 2021rhu as it fails to match the high-velocity calcium components. The host extinction of SN 2021rhu is uncertain but we use modelling with and without an extinction correction to set lower and upper limits on the abundances of individual species. Comparing these limits to literature models we conclude that the spectral evolution of SN 2021rhu is also incompatible with double-detonation scenarios, lying more in line with those resulting from the delayed detonation mechanism (although there are some discrepancies, in particular a larger titanium abundance in SN 2021rhu compared to the literature). This suggests that SN 2021rhu is likely a lower luminosity, and hence lower temperature, version of a normal SN Ia., 25 pages, 22 figures, accepted for publication in MNRAS

Introduction Empagliflozin (EMPA) is a selective sodium glucose co-transporter 2 inhibitor (SGLT2i) and an established drug against type 2 diabetes mellitus. Cardiovascular clinical outcome trials on EMPA have shown a reduced mortality rate related to major cardiovascular events, but the precise mechanism of action remains elusive. We have previously proved that chronic EMPA administration reduces infarct size in an in vivo murine model of ischemia / reperfusion injury, irrespective of the diabetic status. The cardioprotective effect of EMPA was attributed to the increase of Signal Transducer and Activator of Transcription 3 (STAT3) phosphorylation. Purpose In this study we aimed to decipher the cell specific effects of EMPA on primary adult ventricular murine cardiomyocytes (pAVMCs) and primary murine cardiac fibroblasts (pMCFs), subjected to hypoxia/reoxygenation (HYP/REO) and to 1) investigate the effect of EMPA on cell death, and 2) reveal the mechanism of cardioprotection. Methods PAVMCs and pMCFs were isolated from adult C57BL/6 murine hearts (n=4–6) and were incubated with EMPA (500nM–100nM) for 24 hours. Cells were then subjected to 3 hours of HYP (99% N2), followed by 1 hour of REO. STATTIC, a selective STAT3 inhibitor was used (500nM–1μM) to determine the contribution of STAT3 on the observed effect. MTT assay was performed at the end of REO to determine cell viability. To unravel the mechanism of cardioprotection, the experimental protocol was repeated, and the cells were either stained with dihydroethidium (DHE) dye to determine relative oxidative stress changes or were harvested for isolation of total protein content. We focused on STAT3 and Akt kinase as key mediators of the cardioprotective survivor activating factor enhancement (SAFE) and the reperfusion injury salvage kinase (RISK) pathways. We also investigated the expression of Cardiotrophin-1 (CT-1), as a potential upstream mediator of STAT3 phosphorylation. Results The evaluation of cell death revealed that pMCFs viability was significantly increased upon EMPA treatment. Added to this, STATTIC co-treatment with EMPA blunted the protective effect on pMCFs, which indicates that EMPA's protection is STAT3-mediated. Oxidative stress remained unaltered by the treatments. Investigation of the molecular pathways that are responsible for the increased viability of pMCFs revealed that EMPA treatment induces an increased phosphorylation of STAT3 and an increase in CT-1 expression, which are both reversed by STATTIC. Akt phosphorylation and expression remained unchanged by EMPA treatment. Notably, the effect of EMPA on pAVMCs' viability was negligible. Conclusion(s) EMPA does not protect pAVMCs, from HYP/REO injury. EMPA rescues the pMCFs in a STAT-3 dependent manner which indicates that EMPA's cardioprotective effect is cell specific and implicates the SAFE pathway. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Boehringer Ingelheim International GmbHGrant title: “Investigation of the distinct effects of Empagliflozin on different cell populations of the healthy myocardium”

Background Empagliflozin (EMPA), Dapagliflozin (DAPA) and Ertugliflozin (ERTU) are selective sodium glucose co-transporter 2 inhibitors (SGLT2i) acting against type 2 diabetes mellitus. Purpose Due to differences in clinical trial outcomes, we aimed to 1) compare the cardioprotective effects of selective SGLT2i in terms of infarct size (IS) reduction and 2) reveal the mechanism of cardioprotection in non-diabetic mice. Methods C57BL/6 mice were randomized and orally received EMPA (10mg/kg/day), DAPA (9.0mg/kg/day), ERTU (9.7mg/kg/day) or vehicle for 7 days. IS was measured after 30' ischemia (I), and 120' reperfusion (R). EMPA, DAPA and ERTU were given at equivalent stoichiometrically doses (ESD). Body weight and fasting blood glucose (FBG) levels were determined at baseline and at the end of the treatment. On the 7th day, mice were housed in metabolic cages for 24 hours. Urine volume (UV), food and water uptake and 24h-glucose levels were determined to examine the extend of SGLT-2 inhibition by the drugs. In a second series, the ischemic myocardium was taken (10'R), shotgun proteomics were performed and several cardioprotective pathways were evaluated. In a third series, the dominant pathways were evaluated through molecular analyses and mitochondrial functionality. The causal relationships in the mechanism of protection, was established by inhibiting the concomitant cardioprotective pathways. Static, the specific STAT-3 inhibitor and wortmannin (a PI3K inhibitor) were administered and IS was measured upon 30'I/120' R. Results EMPA and DAPA but not ERTU reduced IS at this dose. Body weight and FBG levels were not affected by the treatments. EMPA, DAPA and ERTU lead to significant increase in UV and urinary glucose levels compared to the control group independently of the water and food intake. There was no significant difference in the parameters among the different SGLT-2i indicating that the chosen doses are sufficient to produce the same pharmacological SGLT-2 inhibition in mice. Proteomics revealed mitochondrial metabolism and NF-kB signaling as significant. Only EMPA preserved mitochondrial functionality in complex I & II linked oxidative phosphorylation. NF-kB, RISK and STAT-3 activation and the downstream reduction in apoptosis were evident in EMPA and DAPA groups coinciding with IS reduction. Static and wortmannin significantly attenuated IS reduction both in EMPA and DAPA groups indicating that STAT-3 and PI3K activation are the leading mechanisms of cardioprotection. Among several upstream mediators, fibroblast growth factor 2 (FGF-2) and caveolin-3 were increased in EMPA and DAPA groups. Conclusions Short term EMPA, DAPA and ERTU at the chosen ESD inhibit SGLT-2i in a similar extent but only EMPA and DAPA reduce IS. Our study reveals drug specific effects on cardioprotection against I/R injury. Cardioprotection afforded by EMPA and DAPA are STAT-3 and PI3K dependent and associated with increased FGF-2 and Cav-3 expression. Funding Acknowledgement Type of funding sources: None.

Impaired negative feedback and hyperactivation of the hypothalamic–pituitary–adrenal (HPA) axis characterizes type 2 diabetes mellitus (T2DM). The glucocorticoid receptor (GR) is a key mediator of HPA axis negative feedback; however, its role in linking hypercortisolemia and T2DM-associated hyperglycemia, hyperlipidemia and inflammation is not yet known. In peripheral mononuclear cells (PBMC) from 31 T2DM patients and 24 healthy controls, we measured various GR-signaling parameters such as phosphorylated GR (pGR-S211), GRα/GRβ gene expression and GC-sensitivity [using the basal and dexamethasone (DEX)-induced leucine zipper (GILZ) and FK506 binding-protein (FKBP5) mRNA levels as well as the basal interleukin (IL)-1β protein levels]. Diurnal salivary cortisol curve parameters such as the cortisol awaking response (CAR) and area under the curve (AUCtotal and AUCi) as well as inflammatory and metabolic indices were also determined. T2DM patients exhibited diminished pGR-S211 protein content, increased GRβ, decreased basal GILZ and FKBP5 mRNA levels and increased IL-1β levels. Flattened DEX-induced GILZ and FKBP5 response curves and a flattened salivary cortisol profile characterized T2DM patients. Significant associations of GR measures and saliva cortisol curve parameters with biochemical and clinical characteristics were found. Our novel data implicate an insufficient GR signaling in PBMCs in T2DM patients and HPA axis dysfunction. The significant associations of GR-signaling parameters with inflammatory and metabolic indices implicate that GR may be the critical link between HPA axis dysfunction, hypercortisolemia and diabetes-associated metabolic disturbances. Our findings provide significant insights into the contribution of GR-mediated mechanisms in T2DM aetiopathology and therapy.

We present photometric and spectroscopic data on three extragalactic luminous red novae (LRNe): AT 2018bwo, AT 2021afy, and AT 2021blu. AT 2018bwo was discovered in NGC 45 (at about 6.8 Mpc) a few weeks after the outburst onset. During the monitoring period, the transient reached a peak luminosity of 1040 erg s−1. AT 2021afy, hosted by UGC 10043 (∼49.2 Mpc), showed a double-peaked light curve, with the two peaks reaching a similar luminosity of 2.1(±0.6)×1041 erg s−1. Finally, for AT 2021blu in UGC 5829 (∼8.6 Mpc), the pre-outburst phase was well-monitored by several photometric surveys, and the object showed a slow luminosity rise before the outburst. The light curve of AT 2021blu was sampled with an unprecedented cadence until the object disappeared behind the Sun, and it was then recovered at late phases. The light curve of LRN AT 2021blu shows a double peak, with a prominent early maximum reaching a luminosity of 6.5 × 1040 erg s−1, which is half of that of AT 2021afy. The spectra of AT 2021afy and AT 2021blu display the expected evolution for LRNe: a blue continuum dominated by prominent Balmer lines in emission during the first peak, and a redder continuum consistent with that of a K-type star with narrow absorption metal lines during the second, broad maximum. The spectra of AT 2018bwo are markedly different, with a very red continuum dominated by broad molecular features in absorption. As these spectra closely resemble those of LRNe after the second peak, AT 2018bwo was probably discovered at the very late evolutionary stages. This would explain its fast evolution and the spectral properties compatible with that of an M-type star. From the analysis of deep frames of the LRN sites years before the outburst, and considerations of the light curves, the quiescent progenitor systems of the three LRNe were likely massive, with primaries ranging from about 13 M⊙ for AT 2018bwo, to 14−1+4 M⊙ for AT 2021blu, and over 40 M⊙ for AT 2021afy.

The identification of the second-order dependence structure of streamflow has been one of the oldest challenges in hydrological sciences, dating back to the pioneering work of H.E Hurst on the Nile River. Since then, several large-scale studies have investigated the temporal structure of streamflow spanning from the hourly to the climatic scale, covering multiple orders of magni-tude. In this study, we expanded this range to almost eight orders of magnitude by analysing small-scale streamflow time series (in the order of minutes) from ground stations and large-scale streamflow time series (in the order of hundreds of years) acquired from paleocli-matic reconstructions. We aimed to determine the fractal behaviour and the long-range de-pendence behaviour of the streamflow. Additionally, we assessed the behaviour of the first four marginal moments of each time series to test whether they follow similar behaviours as sug-gested in other studies in the literature. The results provide evidence in identifying a common stochastic structure for the streamflow process, based on the Pareto–Burr–Feller marginal dis-tribution and a generalized Hurst–Kolmogorov (HK) dependence structure.

As years progress, we are found more often in a postprandial than a postabsorptive state. Chrononutrition is an integral part of metabolism, pancreatic function, and hormone secretion. Eating most calories and carbohydrates at lunch time and early afternoon, avoiding late evening dinner, and keeping consistent number of daily meals and relative times of eating occasions seem to play a pivotal role for postprandial glycemia and insulin sensitivity. Sequence of meals and nutrients also play a significant role, as foods of low density such as vegetables, salads, or soups consumed first, followed by protein and then by starchy foods lead to ameliorated glycemic and insulin responses. There are several dietary schemes available, such as intermittent fasting regimes, which may improve glycemic and insulin responses. Weight loss is important for the treatment of insulin resistance, and it can be achieved by many approaches, such as low-fat, low-carbohydrate, Mediterranean-style diets, etc. Lifestyle interventions with small weight loss (7–10%), 150 min of weekly moderate intensity exercise and behavioral therapy approach can be highly effective in preventing and treating type 2 diabetes. Similarly, decreasing carbohydrates in meals also improves significantly glycemic and insulin responses, but the extent of this reduction should be individualized, patient-centered, and monitored. Alternative foods or ingredients, such as vinegar, yogurt, whey protein, peanuts and tree nuts should also be considered in ameliorating postprandial hyperglycemia and insulin resistance. This review aims to describe the available evidence about the effects of diet, chrononutrition, alternative dietary interventions and exercise on postprandial glycemia and insulin resistance. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Background Studies in recent years have shown that dulaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), and dapagliflozin, a sodium-glucose cotransporter-2 inhibitor (SGLT-2i), improve or prevent diabetic nephropathy and macrovascular complications in patients with type 2 diabetes mellitus (T2DM). Purpose The aim of this study is to determine whether the combination of dulaglutide and dapagliflozin exerts improves arterial stiffness, endothelial glycocalyx and albuminuria in T2DM compared to dipeptidyl-peptidase 4 inhibitors (DPP-4is). Methods Overall 37 patients with T2DM were included in our study. 21 patients were transitioned from DPP-4is to dulaglutide and dapagliflozin (treatment group) and were followed immediately prior (baseline) and 4 months after the initiation of treatment. 16 patients, matched for sex, age and glycemic control, remained on treatment with DPP-4is (control group). In each visit we measured a) Carotid-femoral PWV b) central systolic blood pressure (cSBP) c) perfused boundary region (PBR) of the sublingual arterial microvessels, d) urinary albumin-to-creatinine ratio (UACR), e) glycosylated hemoglobin (HbA1c). Results There were no statistically significant differences in cardiovascular markers, UACR and HbA1c at baseline (p>0.05). After 4 months, patients on dulaglutide and dapagliflozin combination improved HbA1c (7.9±1.5% vs 6.59±0.6%, p0.05), PWV (10.7±3.4 vs. 12±3.3m/s, p>0.05), cSBP (125.4±21.2 vs. 127±20.1 mmHg, p>0.05) and UACR (240.8±103.6 vs. 204.9±119.6 mg/g), in the control group, despite a statistically significant improvement of HbA1c (8.2±1.9% vs 7.3±1.3%, p Conclusions The combination of dulaglutide and dapagliflozin improves arterial stiffness, endothelial glycocalyx and albuminuria compared to DPP-4is in patients with T2DM. Funding Acknowledgement Type of funding sources: None.

Objectives The objective of this study was to identify and describe different dietary patterns in a nationally representative sample of Greek adults and to assess potential associations with lifestyle characteristics. Study design This was a cross-sectional study. Methods Dietary patterns were derived by principal component analysis using individual dietary data (24-h recall) of 3552 participants of the Hellenic National Nutrition and Health Survey (HNNHS). Analysis of variance and chi-squared test were used to determine the lifestyle characteristics of the participants following each pattern. Results Three dietary patterns were identified explaining 16.5% of variance; a traditional pattern, loading positively on olive oil, non-starchy vegetables, and cheese; a Western pattern, loading positively on refined grains, processed meats, and animal fats; and a prudent pattern, loading positively on fruits, whole grains, and yoghurt and negatively on fast food. A fourth, snack-type pattern, loading positively on sweets, salty snacks, and nuts, was identified in women. Primary crude results revealed an association between dietary patterns and socio-economic status. In multivariate analysis, highest adherence to the prudent pattern was associated with higher protein and unsaturated fat intake and lower energy and saturated fat intake (all P ≤ 0.05); the Western and traditional patterns were associated with higher energy and total and saturated fat intake. The traditional pattern was additionally associated with higher monounsaturated fatty acids intake, whereas the Western pattern, with higher alcohol intake (all P ≤ 0.001). Conclusions These findings are valuable for understanding the dietary behaviors of adults in Greece and enabling more focused public health policies for the promotion of healthier food behaviors in the future.

In the new era of time-domain surveys, Type Ia supernovae are being caught sooner after explosion, which has exposed significant variation in their early light curves. Two driving factors for early-time evolution are the distribution of 56Ni in the ejecta and the presence of flux excesses of various causes. We perform an analysis of the largest young SN Ia sample to date. We compare 115 SN Ia light curves from the Zwicky Transient Facility to the turtls model grid containing light curves of Chandrasekhar mass explosions with a range of 56Ni masses, 56Ni distributions, and explosion energies. We find that the majority of our observed light curves are well reproduced by Chandrasekhar mass explosion models with a preference for highly extended 56Ni distributions. We identify six SNe Ia with an early-time flux excess in our gr-band data (four ‘blue’ and two ‘red’ flux excesses). We find an intrinsic rate of 18 ± 11 per cent of early flux excesses in SNe Ia at z < 0.07, based on three detected flux excesses out of 30 (10 per cent) observed SNe Ia with a simulated efficiency of 57 per cent. This is comparable to rates of flux excesses in the literature but also accounts for detection efficiencies. Two of these events are mostly consistent with circumstellar material interaction, while the other four have longer lifetimes in agreement with companion interaction and 56Ni-clump models. We find a higher frequency of flux excesses in 91T/99aa-like events (44 ± 13 per cent).

Background: Shared risk factors of type 2 diabetes mellitus (T2DM) between parents at risk and their children, such as low physical activity levels, should be addressed to prevent the development of the disease. The aim of this study was to determine the association of objectively measured step counts per day between parents at risk of developing T2DM and their 6- to 10-year-old children. Methods: The baseline data from the Feel4Diabetes study were analyzed. Dyads of children and one parent (n = 250, 54.4% girls and 77.6% mothers) from Belgium were included. Step counts per day during 5 consecutive days from parents and their children were objectively measured with ActiGraph accelerometers. Results: Adjusted linear regression models indicated that parents’ and children’s step counts were significantly associated during all days (β = 0.245), weekdays (β = 0.205), and weekend days (β = 0.316) (P ≤ .002 in all cases). Specifically, mother–daughter associations during all days and weekend days and father–son step counts during weekdays and when considering all days were significant. Conclusion: There is a positive association between step counts from adults at risk of developing T2DM and their children, especially in the mother–daughter and father–son dyads. © 2021 Human Kinetics, Inc.

We present panchromatic observations and modeling of supernova (SN) 2020tlf, the first normal type II-P/L SN with confirmed precursor emission, as detected by the Young Supernova Experiment transient survey with the Pan-STARRS1 telescope. Pre-explosion emission was detected in $riz-$bands at 130 days prior to SN 2020tlf and persisted at relatively constant flux until first light. Soon after discovery, "flash" spectroscopy of SN 2020tlf revealed prominent narrow symmetric emission lines ($v_w < 300$ km s$^{-1}$) that resulted from the photo-ionization of unshocked circumstellar material (CSM) shedded in progenitor mass loss episodes in the final weeks to months before explosion. Surprisingly, this novel display of pre-SN emission and associated mass loss occurred in a RSG progenitor with ZAMS mass of only 10-12 M$_{\odot}$, as inferred from nebular spectra. Modeling of the light curve and multi-epoch spectra with the non-LTE radiative transfer code CMFGEN and radiation-hydrodynamical (RHD) code HERACLES suggests a dense CSM limited to $r \approx 10^{15}$ cm, and mass loss rate of $10^{-2}$ M$_{\odot}$ yr$^{-1}$. The subsequent luminous light-curve plateau and persistent blue excess indicates an extended progenitor, compatible with a RSG model with $R_{\star} = 1100$ R$_{\odot}$. Inferences from the limits on the shock-powered X-ray and radio luminosity are consistent with these conclusions and suggest a CSM density of $��< 2 \times 10^{-16}$ g cm$^{-3}$ for distances of $r \approx 5 \times 10^{15}$ cm, as well as a mass loss rate of $\dot M, 36 pages, 20 figures. Accepted for publication in ApJ

Background: The present study aimed to assess micronutrient intake among Greek adults and to identify the main food sources that contribute to it. Methods: Food consumption data from 2389 participants in the Hellenic National Nutrition and Health Survey (HNNHS), collected with 24-h recalls, was used to calculate micronutrient intakes. Usual nutrient intake was estimated according to the National Cancer Institute method. Nutrient adequacy was estimated using the estimated average requirement (EAR) cut-point method, when available, or adequate intake otherwise. The probability approach was used to determine iron intake adequacy in females of reproductive age. Food group contribution for each nutrient assessed was derived to identify their main food sources. Results: Almost all individuals had vitamin D intake below EAR, whereas vitamins A, E, K and C, as well as potassium intake, were also insufficient in a considerable percentage of the population (>70% in most age groups). Calcium intake was substantially below the EAR for females aged >50 years and males >70 years; the same for magnesium in males >70 years. Furthermore, 50% of females, including those of reproductive age, had intake of folate below EAR. More than 50% of the population (to 79%) exceeded the upper tolerable limit for sodium (2300 mg day−1). Food contribution analysis revealed that most vitamins were derived from low-quality foods (i.e. fast-food). Conclusions: A significant proportion of adults residing in Greece have low nutrient intake and poor food selections. These results provide guidance to public health policy makers for developing strategies to improve the dietary quality in Greece. © 2021 The British Dietetic Association Ltd.

Purpose: This non-randomised controlled trial investigated whether a combined programme of functional physiotherapy and minimally invasive orthopaedic surgery improves the level and degree of capacity and performance of gross motor function in children with spastic cerebral palsy (CP). Methods: Fifty-two children with spastic CP aged 5-7 years, Gross Motor Function Classification System (GMFCS) levels II-IV, were allocated to two equal groups: experimental group (selective percutaneous myofascial lengthening [SPML] procedure and 9-month functional strengthening physiotherapy programme) and control (standard physiotherapy) groups. At baseline and at the end of the 9-month intervention, the capacity and performance of gross motor function were assessed with the Gross Motor Function Measure (GMFM) D and E subcategories and Functional Mobility Scale (FMS), respectively. The level of gross motor function was measured with the GMFCS. Results: There was a statistically significant difference in the post-intervention improvements in the GMFM D (experimental mean difference = 19.63 +/- 10.46; control mean difference = 2.40 +/- 4.62) and E (experimental mean difference = 19.33 +/- 11.82; control mean difference = 4.20 +/- 6.26) between experimental and control group (p < 0.001). There was a significant improvement in the GMFCS level and each FMS distance for the experimental group (p < 0.001), but not for the control group (p > 0.05). Conclusion: SPML procedure combined with functional physiotherapy improves gross motor function in children with spastic CP, by raising the degree and level of motor independence.

Background: Because of the increased burden of cardiovascular disease (CVD), country specific risk prediction models to forecast future CVD events and mortality are recommended, for primary prevention. The aim of this study was to recalibrate the HellenicSCORE, to accurately estimate the 10-year risk CVD mortality of Greek adults. Methods: Data from the Hellenic National Nutrition and Health Survey (HNNHS) were used (N = 1012; 37.9% males). Information on age, smoking, systolic blood pressure (SBP), and total blood cholesterol from adults >40 years of age were derived following validated health survey protocols. Individual scores were calculated using these data and beta-coefficients derived from ESC SCORE. Results: Both updated HellenicSCORE II charts had lower risk estimates compared to the older version and were closer to the ESC SCORE charts, particularly at the extremes. No significant age difference by sex was observed (mean 59.5 (SD 13.1) years in total) in the population. Women had a significant higher mean total cholesterol compared to men [212.9 (39.5) vs 204.6 (41.2) mg/dl, respectively; p = 0.0343], but smoking prevalence and mean SBP was significantly higher in men [p for all

Impaired negative feedback and hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis characterizes type 2 diabetes mellitus (T2DM). The glucocorticoid receptor (GR) is a key mediator of HPA axis negative feedback; however, its role in linking hypercortisolemia and T2DM-associated hyperglycemia, hyperlipidemia and inflammation is not yet known.In peripheral mononuclear cells (PBMC) from 31 T2DM patients and 24 healthy controls, we measured various GR-signaling parameters such as phosphorylated GR (pGR-S211), GRα/GRβ gene expression and GC-sensitivity [using the basal and dexamethasone (DEX)-induced leucine zipper (GILZ) and FK506 binding-protein (FKBP5) mRNA levels as well as the basal interleukin (IL)-1β protein levels]. Diurnal salivary cortisol curve parameters such as the cortisol awaking response (CAR) and area under the curve (AUCT2DM patients exhibited diminished pGR-S211 protein content, increased GRβ, decreased basal GILZ and FKBP5 mRNA levels and increased IL-1β levels. Flattened DEX-induced GILZ and FKBP5 response curves and a flattened salivary cortisol profile characterized T2DM patients. Significant associations of GR measures and saliva cortisol curve parameters with biochemical and clinical characteristics were found.Our novel data implicate an insufficient GR signaling in PBMCs in T2DM patients and HPA axis dysfunction. The significant associations of GR-signaling parameters with inflammatory and metabolic indices implicate that GR may be the critical link between HPA axis dysfunction, hypercortisolemia and diabetes-associated metabolic disturbances. Our findings provide significant insights into the contribution of GR-mediated mechanisms in T2DM aetiopathology and therapy.

Hydropower is the most widely used renewable power source worldwide. The current work presents a methodological tool to determine the hydropower potential of a reservoir based on available hydrological information. A Bayesian analysis of the river flow process and of the reservoir water volume is applied, and the estimated probability density function parameters are integrated for a stochastic analysis and long-term simulation of the river flow process, which is then used as input for the water balance in the reservoir, and thus, for the estimation of the hydropower energy potential. The stochastic approach is employed in terms of the Monte Carlo ensemble technique in order to additionally account for the effect of the intermediate storage retention due to the thresholds of the reservoir. A synthetic river flow timeseries is simulated by preserving the marginal probability distribution function properties of the observed timeseries and also by explicitly preserving the second-order dependence structure of the river flow in the scale domain. The synthetic ensemble is used for the simulation of the reservoir water balance, and the estimation of the hydropower potential is used for covering residential energy needs. For the second-order dependence structure of the river flow, the climacogram metric is used. The proposed methodology has been implemented to assess different reservoir volume scenarios offering the associated hydropower potential for a case study at the island of Crete in Greece. The tool also provides information on the probability of occurrence of the specific volumes based on available hydrological data. Therefore, it constitutes a useful and integrated framework for evaluating the hydropower potential of any given reservoir. The effects of the intermediate storage retention of the reservoir, the marginal and dependence structures of the parent distribution of inflow and the final energy output are also discussed.

Background: The aim of this paper is to present the development of the Feel4Diabetes Healthy Diet Score and to evaluate its clinical validity. Methods: Study population consisted of 3268 adults (63% women) from high diabetes risk families living in 6 European countries. Participants filled in questionnaires at baseline and after 1 year, reflecting the dietary goals of the Feel4Diabetes intervention. Based on these questions the Healthy Diet Score was constructed, consisting of the following components: breakfast, vegetables, fruit and berries, sugary drinks, whole-grain cereals, nuts and seeds, low-fat dairy products, oils and fats, red meat, sweet snacks, salty snacks, and family meals. Maximum score for each component was set based on its estimated relative importance regarding T2DM risk, higher score indicating better quality of diet. Clinical measurements included height, weight, waist circumference, heart rate, blood pressure, and fasting blood sampling, with analyses of glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides. Analysis of (co) variance was used to compare the Healthy Diet Score and its components between countries and sexes using baseline data, and to test differences in clinical characteristics between score categories, adjusted for age, sex and country. Pearson's correlations were used to study the association between changes from baseline to year 1 in the Healthy Diet Score and clinical markers. To estimate reproducibility, Pearson's correlations were studied between baseline and 1 year score, within the control group only. Results: The mean total score was 52.8 ± 12.8 among women and 46.6 ± 12.8 among men (p < 0.001). The total score and its components differed between countries. The change in the Healthy Diet Score was significantly correlated with changes in BMI, waist circumference, and total and LDL cholesterol. The Healthy Diet Score as well as its components at baseline were significantly correlated with the values at year 1, in the control group participants. Conclusion: The Feel4Diabetes Healthy Diet Score is a reproducible method to capture the dietary information collected with the Feel4Diabetes questionnaire and measure the level of and changes in the adherence to the dietary goals of the intervention. It gives a simple parameter that associates with clinical risk factors in a meaningful manner. Trial registration: Clinicaltrials.gov NCT02393872. Registered March 20, 2015. © 2020 The Author(s).

Background and aims: Empirically-derived dietary patterns have been shown to have both positive and adverse associations with cardiovascular disease (CVD). Yet, such associations remain unclear in the Greek population. The aim of this study was to investigate the association between empirically-derived dietary patterns and the presence of CVD and CVD-related medical conditions in a nationally representative sample of Greek adults. Methods and results: Adult participants (≥20 years old) of the Hellenic National Nutrition and Health Survey (HNNHS) were included (N = 3552; 41.2% men; 43.7 years, SD: 18.1). Dietary patterns were derived by principal component analysis using 24-h recall data. The presence of dyslipidemia (elevated cholesterol and/or triglycerides), hypertension, coronary heart disease, and total CVD, was defined according to the International Clinical Diagnosis (ICD)-10 codes. Odds ratios of CVD outcomes were estimated across dietary patterns using multivariable logistic regression analysis. Three dietary patterns -Traditional (proxy Mediterranean), Western, and Prudent-were identified explaining 16.5% of the total variance in consumption. Logistic regression analysis, adjusted for age, sex, total caloric intake, sociodemographic characteristics, and other CVD risk factors, showed an inverse association between the Traditional dietary pattern and CVD presence (OR: 0.53; 95% CI: 0.30–0.95), and a positive association between the Western pattern and dyslipidemia (1.52; 1.02–2.26). No association was found between the Prudent pattern and CVD outcomes. Conclusion: The variability of food intake combinations in the Greek population seem to be associated with the presence of CVD and CVD related conditions. Such findings are imperative for national monitoring and informed priority setting. © 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University

One of the major roles of governments is to create a favorable business environment for fostering entrepreneurial activities, including good infrastructure and a culture that encourages the adoption of technologies. In such a policy context, the Greek National Electronic Public Procurement System (ESIDIS) was developed. The use of ESIDIS is mandatory for the employees, and its success depends on users' satisfaction. The chapter investigates the factors influencing employees' satisfaction when using the system. Perceived usefulness, perceived ease-of-use, perceived risk, and willingness to learn were investigated using empirical research. Structural equation modeling was used for the analysis of the data. Perceived usefulness has the most significant role in determining user satisfaction while risks importance is diminished when users understand the usefulness of the system for their job performance. Managers and policymakers should take these factors into consideration in order to improve users' satisfaction and consequently maximize the added value of the system for the entrepreneurs.

Background: Although there are many interventions targeting childhood obesity prevention, only few have demonstrated positive results. The current review aimed to gather and evaluate available school-based intervention studies with family involvement targeting dietary, physical activity and sedentary behaviors among primary schoolchildren and their families, in order to identify the most effective strategies. Methods: Studies published between 2000 and January 2015 were retrieved from scientific electronic databases and grey literature. The databases used included MEDLINE/PubMed, Web-of-Science, CINAHL and Scopus. Included studies had to be experimental controlled studies and had duration over 1 school year, had family involvement, combined PA and dietary behaviors and were implemented in school setting. A complementary search was executed to update the review to cover the period from February 2015 to January 2019. Results: From the studies examined (n = 425), 27 intervention programs (33 publications) fulfilled the inclusion criteria. Among these, 15 presented significant effect on weight status and/ or overweight/ obesity or clinical indices, 3 presented significant effect on most energy balance-related behaviors (EBRBs) while 9 presented significant effect on some/few EBRBs or determinants. Strategies implemented in effective interventions were: teachers acting as role-models and being actively involved in the delivery of the intervention, school policies supporting the availability of healthy food and beverage choices and limiting unhealthy snacks, changes in the schoolyard, in the recess rules and in the physical education classes to increase physical activity, and involving parents in the intervention via assignments, meetings, informative material and encouraging them to improve the home environment. Use of incentives for children, social marketing techniques, collaboration with local stakeholders were found to increase effectiveness. Programs that focused only on educational sessions and material for parents, without promoting relevant environmental and policy changes, were found to be less effective. Cultural adaptations have been suggested to increase the intervention's acceptance in specific or vulnerable population groups. Conclusions: Several effective strategies were identified in the reviewed programs. Outcomes of the current review were taken into account in developing the Feel4Diabetes-intervention and summed up as recommendations in the current work in order to facilitate other researchers designing similar childhood obesity prevention initiatives. © 2020 The Author(s).

The Greek National Electronic Public Procurement System (ESIDIS) was developed with the aim to provide direct supplies of goods and services for the public administration more effectively and efficiently. The paper aims at investigating the factors that influence users’ satisfaction from ESIDIS. Usefulness, ease-of-use, risk perception and willingness-to-learn were investigated. A structured questionnaire was used for empirical research. The regression model shows the existence of an important prediction model between three independent variables (usefulness, ease-of-use, and willingness-to-learn) and user satisfaction (dependent variable). The resulting regression model can be used to predict user satisfaction when interacting with ESIDIS.

Background. In recent years, pathophysiology of aortic stenosis (AS) has been considered as a possibly active inflammatory process, but its determinants remain unclear. Calcium tissue deposition observed in dilaysis patients have been linked to low level of Fetuin-A, a powerful inhibitor of ectopic calcification. It is thus suspected to play a role in development of aortic stenosis. Purpose. To assess correlation between Fetuin-A level and AS progression in a prospective cohort of AS patients, COFRASA (clinicalTrial.gov_number_NCT00338676) and GENERAC (clinicalTrial.gov_number_NCT00647088). Methods. A comprehensive clinical evaluation and Fetuin-A plasma level measurement was performed at baseline. AS severity was evaluated at baseline and yearly thereafter using echocardiography (mean pressure gradient (MPG)) and computed tomography (degree of aortic valve calcification or AVC). Annual progression was calculated as [(final measurement - baseline measurement)/follow-up duration] for both MPG and AVC measurements. Results. We enrolled 296 patients with at least 1 year of follow-up. Mean age was 74±10 years, 217 (73%) were men. Mean Fetuin-A level was 0.55±0.15 g/L. After a mean follow-up of 3.0±1.7 years, no correlation was found between AS progression and Fetuin-A level, using either MPG (r=0.015, p=0.82) or AVC (r=0.014, p=0.82). This was also true when comparing patients with lower level of Fetuin-A (≤0.53 g/L, the median in our cohort) with patients with higher level(+3±5 mmHg/year (median 2, [0-5] vs +4±4 mmHg/year (median 2, [1-6]) p=0.06, and +205±290 AUC/year (median 122, [32-269]) vs +240±310 AUC/year (median 145, [50-313], p=0.24). This was true also after adjustment for baseline severity and valve antomy. Conclusions. In our prospective cohortot of AS patients we found no impact of Fetuin-A on both hemodynamic and anatomic AS progression. Despite strong capacity to inhibit ectopic calcium deposition, Fetuin-A plasma level seems to have minor influence on AS progression.

Background Arterial stiffness is associated with increased risk for cardiovascular disease. The purpose of this study is to investigate the arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 before and after glycemic control by optimal medication. Methods In 50 patients with uncontrolled type 2 diabetes(age:52±10years)and 25 controls of similar age and sex and no atherosclerotic risk factors we measured at baseline and 6 months after glycemic control a) carotid-femoral pulse wave velocity(PWVc m/sec-Complior SP ALAM),central systolic blood pressure(cSBP -mmHg),augmentation index(AI%), of the aortic pulse wave(ArteriographTensioMed) b)S',E'(m/sec)andE'/A'of mitral annulus by Tissue Doppler c)LV longitudinal strain(GLS-%),systolic(LongSr-l/sec)and diastolic(LongSrE-l/sec)strain rate, twisting(Tw-deg),peak twisting(Tw)and untwisting(unTw-deg/sec)velocity using speckle tracking echocardiography.The degree of LV untwisting was calculated as the percentage difference between peak twisting and untwisting at MVO(%dp PeakTw-UntwMVO)and between peak twisting and untwisting at peak and end of the mitral inflow E wave d)perfusion boundary region(PBR- micrometers)of the sublingual arterial microvessels(ranged from 5-25 micrometers)using Sideview,Darkfield imaging(Microscan,Glycocheck).Increased PBR is considered an accurate index of reduced endothelial glucocalyx thickness because of a deeper RBC penetration in the glucocalyx e) Flow mediated dilatation(FMD) of the brachial artery and percentage difference of FMD (FMD%). Results Compared to controls,diabetics had higher PWVa(10.3±2.2 vs. 8.1±1.9), AI(27.9±15 vs. 19.4±14.7), PWVc(11.8±3.2 vs. 8.8±1.3),cSBP(136±20 vs. 119±18),PBR (2.1±0.2 vs 1.89±0.1)and lower GLS(-15±3 vs. -18±3),LongSr(-0.78±0.1 vs. -0.96±0.2),LongSrE(0.77±0.29 vs. 1.2±0.3),S',E' and E/A(p

Objective: This study examined the correlation between smoking habits and psychopathology status, as well as the impact of confounders such as body mass index and gender. Method: A total of 134 non-smokers and 152 smokers were enrolled in this study. We measured psychopathology features using Symptom Checklist 90-Revised. We ran logistic regression models testing the smoking–psychopathology association, controlling for body mass index and gender. Results: Smoking was positively correlated with depression, interpersonal sensitivity, hostility, somatization, paranoid ideation and psychoticism ( PConclusions: Our data suggest that smoking is a stronger predictor of psychopathology than body mass index and gender.

Background & aims: Serum 25(OH)D deficiency is becoming an epidemic. The aim was to assess vitamin D status of the adult Greek population in relation to intake, sun exposure and other factors, using data from the Hellenic National Nutrition and Health Survey (HNNHS). Methods: Data from 1084 adult participants (37.8% males) were analyzed. Vitamin D intake was assessed using 24-h recalls. Serum 25(OH)D concentration was evaluated and related to anthropometric measurements and other covariates including supplements used, by sex. Variables significantly associated with 25(OH)D < 20 ng/ml were assessed using simple and multiple logistic regression. Results: Median vitamin D intake from food was 1.23 mcg/day (0.60, 2.44), with 9.1% consuming supplements. Median serum 25(OH)D was 16.72 ng/ml, with no sex differences (P = 0.923). The odds of having 25(OH)D < 20 ng/ml significantly decreased with being very active (OR 0.55, 95% CI 0.35, 0.98), increasing length of sun exposure [1–3 h/day (OR 0.59, 95% CI 0.44, 0.80), >3 h/day (OR 0.36, 95% CI 0.24, 0.55)], and skin colour [light to medium skin (OR 0.47, 95% CI 0.24, 0.91), fairly dark skin colour (OR 0.34, 95% CI 0.17, 0.67) and dark or very dark skin colour (OR 0.34, 95% CI 0.15, 0.75)], compared to respective baseline levels. The odds significantly increased with obesity (OR 1.95, 95% CI 1.24, 3.08), and spring season of blood sample collection (OR 1.75, 95% CI 1.22, 2.50). Conclusions: Vitamin D deficiency is highly prevalent in Greek adults. Relevant public health policies are highly recommended, which could include vitamin D fortification. and suggestion for increased but safe sun exposure. © 2019 European Society for Clinical Nutrition and Metabolism