bluuebunny/crossref_metadata_2025 huggingface dataset:
THU361 Diabetic Ketoacidosis As The Initial Presentation Of Pancreatic Adenocarcinoma, A Case Report
Authors: Siddiqui Usman , Ahmad Mobeen , Raza Shaikh Ali , Rosenberg Daniel
Published: October 2023

Disclosure: U. Siddiqui: None. M. Ahmad: None. A. Shaikh: None. D. Rosenberg: None.

Introduction: Signs and symptoms of pancreatic adenocarcinoma may be vague early in its course and is often discovered when it has quite advanced. Type 2 diabetes has been known to be linked with pancreatic adenocarcinoma with proposed mechanisms of hyperglycemia in these patients including increased insulin resistance, rapid beta cell turnover and oxidative stress. Rarely, diabetic ketoacidosis has been reported as an initial presentation of pancreatic carcinoma. We describe the case of a 61-year-old male with no previous diabetic history presenting with diabetic ketoacidosis (DKA) and found to have pancreatic adenocarcinoma. Case description: A 61-year-old male with no significant past medical history presented to the emergency department (ED) for a one week history of vision changes, nausea, abdominal pain and non-bloody vomiting. He reported heavy alcohol use on weekends, drinking 12 beers a day. He was found to be in DKA with his lab work demonstrating: venous pH 7.0, glucose 717 mg/dL, bicarbonate 7 mmol/L, anion gap 34 and positive beta hydroxybutyrate >60 mg/dL. After fluid resuscitation and IV insulin infusion he eventually had resolution of his DKA. Anti-GAD 65 screen was negative and c-peptide level was 5.71 ng/ml. His hemoglobin A1C was found to be 12.6. CT abdomen-pelvis with contrast demonstrated a patchy hypodensity of with dilation of pancreatic duct and a 2.0 cm pancreatic mass, resulting in pancreatic duct dilation with an MRI confirming these findings. Endoscopic Ultrasound fine needle aspiration confirmed pancreatic adenocarcinoma. The patient proceeded to have distal pancreatectomy and splenectomy. Surgical samples did not show lymph node involvement. After pancreatectomy the patient did have significantly decreased insulin requirements. Discussion: Pancreatic cancer is often discovered late in its course due to its subtle signs and symptoms. Evidence shows that type 2 diabetes is strongly linked with pancreatic cancer, with newly diagnosed type 2 diabetes or glucose intolerance being found in 80% of patients. Insulin resistance caused by pancreatic cancer has been proposed as an etiology of this new-onset diabetes and hyperglycemia. DKA as an initial manifestation of pancreatic cancer, however, is rare. Through this case we hope to highlight this association and suggest, in the right clinical setting, pancreatic cancer workup be considered in adults presenting with new onset type 2 diabetes and DKA.

Presentation: Thursday, June 15, 2023
FRI612 Tirzepatide For The Treatment Of Post-bariatric Surgery Hypoglycemia And Early Dumping Syndrome
Authors: Frederick Stortz Ethan , Margaret Lawler Helen
Published: October 2023

Disclosure: E.F. Stortz: None. H.M. Lawler: Research Investigator; Self; VogenX.

Background: Post-bariatric hypoglycemia (PBH) is a challenging condition with limited treatment options. Glucagon-like peptide 1 (GLP-1) receptor agonists have been used with mixed success. To our knowledge, there have been no reported cases of PBH treatment with dual incretin agonist medications. We describe a case in which tirzepatide was successfully used to improve both post-bariatric surgery hypoglycemia as well as symptoms of early dumping syndrome. Clinical Case: A 46-year-old woman with prediabetes presented with labile blood sugars, post-prandial hypoglycemia, and intermittent severe bloating with diarrhea shortly after eating meals. She had a past medical history of gastric banding 16 years ago, resulting in a 70 pound weight loss. Her post-operative course was complicated by post-meal retching and vomiting for many years. She subsequently had gastric band reversal with concurrent sleeve gastrectomy 2 years ago. While her vomiting improved, she experienced intermittent post-meal bloating and diarrhea. About 8 months after this surgery, she developed symptoms of hypoglycemia after meals, with glucometer readings of 30-49 mg/dL. Continuous glucose monitoring (CGM) for 1 week prior to therapy revealed a time in range (70-180 mg/dL) of 90%, 3-4% time above 180 mg/dL, and 6-7% time below 70 mg/dL. Dietary changes did not help improve hypoglycemic episodes or her dumping symptoms. She initially started tirzepatide 2.5mg weekly and noticed improvement in both symptoms. Her dose increased to 5mg weekly, and she had near complete resolution in her post-prandial hypoglycemia. Upon review of 1 week of CGM data, her time in range improved to 96% with 2% time above 180 mg/dL and 0% time below 70 mg/dL. Her glucose peak was 224 with a nadir of 72. Her early dumping symptoms also improved, occurring only with very high-carb meals. Conclusion: Many pharmacotherapies have sought to improve post-bariatric surgery hypoglycemia with limited success often significant side effects. The post-prandial peak of GLP-1 levels tends to be higher in patients after bariatric surgery compared to obese controls, possibly playing a role in the condition’s pathophysiology. Studies of glucose-dependent insulinotropic peptide (GIP) in patients after bariatric surgery exhibit mixed trends. Numerous case reports have shown successful treatment of PBH with GLP-1 receptor agonists, while other have shown no clear benefit. It is possible that dual incretin therapy may attenuate more of the post-prandial hyperinsulinemic-hypoglycemic response in ways that are incompletely understood and requires further investigation. Interestingly, this case showed that tirzepatide administration not only resulted near-resolution of post-prandial hypoglycemia, but it also improved this patients’ early dumping syndrome symptoms.

Presentation: Friday, June 16, 2023
FRI654 Concentrated Regular U-500 Insulin In An Automated Insulin Delivery System: A Case Report
Authors: Aurora John , Saraswat Aruna
Published: October 2023

Disclosure: J. Aurora: None. A. Saraswat: None.

Background: Concentrated regular U-500 (U-500R) insulin is commonly used in patients with T2DM who are highly insulin-resistant, requiring more than 200 units of insulin per day. Utilizing U-500R reduces the number of daily injections, decreases injection volume, and improves cost effectiveness. There have been clinical trials using U-500R for continuous subcutaneous insulin infusion (CSII), particularly in Omnipod which has been shown to improve glycemic control and patient satisfaction without an increase in hypoglycemia (1). In addition, U-500R administration via multiple daily injections (MDI) and an investigational U-500R CSII, have been compared and demonstrated improved glycemic control with both modalities, but an increase in nocturnal hypoglycemia with CSII (2). Automated insulin delivery (AID) systems, or hybrid closed loop systems, have not formally been studied in patients with T2DM using U-500R. We present a case of a patient with T2DM with high insulin resistance using U-500R with Omnipod 5 AID system. Clinical Case: A 54-year-old female with T2DM with high insulin resistance was initially on Omnipod Dash with U-100 insulin lispro with baseline A1c 12.1%. She was transitioned to Omnipod 5 in 2022, and over 4 months A1c improved to 8.8%, GMI 8.8%, TIR 38%, TAR 62%, TBR 0%, CV 35.9%, and automated mode 97%. However, her total daily dose was 134 units leading to pod changes every 1.5 days. She expressed interest in switching to U-500R to reduce pod changes while utilizing her current CSII technology. We switched to U-500R, continued automated mode, increased her 24-hour BG target from 120 mg/dL to 130 mg/dL to reduce hypoglycemia risk, and increased her active insulin time from 3 to 6 hours to reflect U-500R kinetics. After 4 weeks, her GMI improved to 8.0%, TIR 47%, TAR 52%, TBR 1%, CV 45.9%, and automated mode 94%. Although nocturnal BG readings were normal, ranging from 70-130 mg/dL, she was having nightly symptoms of relative hypoglycemia. We then adjusted her BG target overnight to 150 mg/dL, which kept BG between 80-130 mg/dL with resolution of her symptoms. Conclusion: U-500R proved to be safe and effective with Omnipod 5 AID. Despite setting a higher BG target, the algorithm continuously kept BG well below this, particularly overnight. However, the safety mechanisms incorporated with the CSII suspended insulin delivery for predicted hypoglycemia. Further research will be required to adapt the automated dosing algorithm to U-500R to reduce the risk of nocturnal hypoglycemia.

References: 1. Lane WS, et al. A prospective trial of U500 insulin delivered by Omnipod in patients with type 2 diabetes mellitus and severe insulin resistance. Endocr Pract. 2010;16(5):778-784.2.Grunberger G, et al. Human regular U-500 insulin via continuous subcutaneous insulin infusion versus multiple daily injections in adults with type 2 diabetes: The VIVID study. Diabetes Obes Metab. 2020;22(3):434-441.

Presentation: Friday, June 16, 2023
A Type 1 Diabetes Polygenic Score Is Not Associated With Prevalent Type 2 Diabetes in Large Population Studies
Authors: Srinivasan Shylaja , Wu Peitao , Mercader Josep M , Udler Miriam S , Porneala Bianca C , Bartz Traci M , Floyd James S , Sitlani Colleen , Guo Xiquing , Haessler Jeffrey , Kooperberg Charles , Liu Jun , Ahmad Shahzad , van Duijn Cornelia , Liu Ching-Ti , Goodarzi Mark O , Florez Jose C , Meigs James B , Rotter Jerome I , Rich Stephen S , Dupuis Josée , Leong Aaron
Published: October 2023

Context

Both type 1 diabetes (T1D) and type 2 diabetes (T2D) have significant genetic contributions to risk and understanding their overlap can offer clinical insight.

Objective

We examined whether a T1D polygenic score (PS) was associated with a diagnosis of T2D in the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium.

Methods

We constructed a T1D PS using 79 known single nucleotide polymorphisms associated with T1D risk. We analyzed 13 792 T2D cases and 14 169 controls from CHARGE cohorts to determine the association between the T1D PS and T2D prevalence. We validated findings in an independent sample of 2256 T2D cases and 27 052 controls from the Mass General Brigham Biobank (MGB Biobank). As secondary analyses in 5228 T2D cases from CHARGE, we used multivariable regression models to assess the association of the T1D PS with clinical outcomes associated with T1D.

Results

The T1D PS was not associated with T2D both in CHARGE (P = .15) and in the MGB Biobank (P = .87). The partitioned human leukocyte antigens only PS was associated with T2D in CHARGE (OR 1.02 per 1 SD increase in PS, 95% CI 1.01-1.03, P = .006) but not in the MGB Biobank. The T1D PS was weakly associated with insulin use (OR 1.007, 95% CI 1.001-1.012, P = .03) in CHARGE T2D cases but not with other outcomes.

Conclusion

In large biobank samples, a common variant PS for T1D was not consistently associated with prevalent T2D. However, possible heterogeneity in T2D cannot be ruled out and future studies are needed do subphenotyping.
Association of Cerebrovascular Injury and Secondary Vascular Insult With Poor Outcomes After Gunshot Wound to the Head in a Large Civilian Population
Authors: Lamanna Jason J. , Gutierrez Juanmarco , Alawieh Ali , Funk Chadd , Rindler Rima S. , Ahmad Faiz , Howard Brian M. , Gupta Sanjay K. , Gimbel David A. , Smith Randi N. , Pradilla Gustavo , Grossberg Jonathan A.
Published: October 2023

BACKGROUND AND OBJECTIVES:

Cerebrovascular injury (CVI) after civilian gunshot wound to the head (GSWH) likely contributes to poor outcomes, but little supporting evidence exists. The purpose of this study was to determine whether intracranial CVI from GSWH and secondary vascular insult (stroke or rehemorrhage) were associated with poor outcomes in a large civilian population.

METHODS:

This was a single-institution, retrospective cohort study on patients admitted between January 2014 and July 2022 at a large, metropolitan, level-1 trauma center. Multivariate regression models and propensity score matching were used.

RESULTS:

A total of 512 civilian patients presented with GSWH, and a cohort of 172 (33.5%) met inclusion criteria, with 143 (83.1%) males and a mean (SD) age of 34.3 (±14.2) years. The incidence of intracranial CVI was 50.6% (87/172 patients), and that of secondary vascular insult was 32.2% (28/172 patients). Bifrontal trajectories (adjusted odds ratio [aOR] 13.11; 95% CI 2.45-70.25; P = .003) and the number of lobes traversed by the projectile (aOR 3.18; CI 1.77-5.71; P < .001) were associated with increased odds of resultant CVI. Patients with CVI suffered higher rate of mortality (34% vs 20%; odds ratio [OR] 2.1; CI 0.78-5.85; P = .015) and were less likely to achieve a good functional outcome with a Glasgow Outcome Score of 4–5 (34% vs 68%; OR 0.24; CI 0.1-0.6; P = .004) at follow-up. Furthermore, patients with CVI and resultant secondary vascular insult had even worse functional outcomes (Glasgow Outcome Score 4-5, 16.7% vs 39.0%; aOR 0.012; CI 0.001-0.169, P = .001).

CONCLUSION:

Intracranial CVI from GSWH and associated secondary vascular insult are associated with poor outcomes. Given the high prevalence and potentially reversible nature of these secondary injuries, early screening with vascular imaging and treatment of underlying CVI may prove to be critical to improve outcomes by reducing stroke and rehemorrhage incidence.
A high-sugar diet, but not obesity, reduces female fertility in Drosophila melanogaster
Authors: Nunes Rodrigo Dutra , Drummond-Barbosa Daniela
Published: October 2023

Obesity is linked to reduced fertility in various species, from Drosophila to humans. Considering that obesity is often induced by changes in diet or eating behavior, it remains unclear whether obesity, diet, or both reduce fertility. Here, we show that Drosophila females on a high-sugar diet become rapidly obese and less fertile as a result of increased death of early germline cysts and vitellogenic egg chambers (or follicles). They also have high glycogen, glucose and trehalose levels and develop insulin resistance in their fat bodies (but not ovaries). By contrast, females with adipocyte-specific knockdown of the anti-obesity genes brummer or adipose are obese but have normal fertility. Remarkably, females on a high-sugar diet supplemented with a separate source of water have mostly normal fertility and glucose levels, despite persistent obesity, high glycogen and trehalose levels, and fat body insulin resistance. These findings demonstrate that a high-sugar diet affects specific processes in oogenesis independently of insulin resistance, that high glucose levels correlate with reduced fertility on a high-sugar diet, and that obesity alone does not impair fertility.
Synthesis and Biological Evaluation of Siladenoserinol A Analogs Possessing a Diastereomeric 6,8-Dioxabicyclo[3.2.1]octane Skeleton
Authors: Yoshida Masahito , Sasaoka Kohei , Hano Kohei , Sugiyama Yoshiyuki , Hitora Yuki , Doi Takayuki , Tsukamoto Sachiko , Kigoshi Hideo
Published: October 2023

The efficient synthesis of siladenoserinol analogs possessing a diastereomeric 6,8-dioxabicyclo[3.2.1]octane (6,8-DOBCO) skeleton has been achieved from commercially available carbohydrates as a chiral source. In this synthesis, we successfully determined the reaction conditions for the one-pot transformation using AuCl(PPh3)/AgSbF6/2,6-di-tert-butylpyridine (2,6-DTBP), leading to the desired bicycloketal without losing the TBS group. Elongation of two side chains by the Julia–Kocienski olefination and Horner–Wadsworth–Emmons reaction and subsequent chemoselective sulfamation furnished the two desired diastereomers from the corresponding carbohydrates, respectively. The inhibitory activities of the synthetic diastereomeric analogs against the p53–Hdm2 interaction were slightly weaker than that of natural siladenoserinol A, resulting in the fact that the stereochemistry on the 6,8-DOBCO skeleton would be one of the fundamental factors to control the potency of inhibition of the p53–Hdm2 interaction but not an essential one.
No Evidence of Postactivation Performance Enhancement on Endurance Exercises: A Comprehensive Systematic Review and Meta-analysis
Authors: VASCONCELOS GUSTAVO CÉSAR , BRIETZKE CAYQUE , CESARIO JULIO CESAR SILVA , DOUETTS CARLOS DANIEL BENTO , CANESTRI RAUL , VINICIUS ÍTALO , FRANCO-ALVARENGA PAULO ESTEVÃO , PIRES FLÁVIO OLIVEIRA
Published: October 2023

Purpose

Narrative reviews have suggested that postactivation induced by warm-up routines is effective to increase endurance exercise performance in real-world scenarios. However, systematic reviews with meta-analysis rather than narrative ones are required to provide an up-to-date summary of the evidence and provide directions for practical decisions. Therefore, we systematically reviewed peer-reviewed and gray literature to determine the certainty of evidence and the relative effects of postactivation performance enhancement (PAPE) in endurance exercises.

Methods

The effects of PAPE on endurance performance were meta-analyzed as a standardized mean difference (SMD) from control conditions within a random-effects model considering polled data and subgroups (PAPE strategies, endurance test modalities, and V̇O2max-based endurance level).

Results

Eligible studies (n = 35) showed a high risk of bias due to methodological flaws in randomization and blinding procedures. A meta-analysis including 57 comparisons (432 participants) revealed a significant but very small PAPE effect on endurance performance (Z = 2.49, SMD = 0.15—very small, 95% confidence interval = 0.03 to 0.28) due to exceptional effect sizes reported by two studies (SMD of 2.85 and 2.14). We also observed that neither PAPE strategies nor endurance test modalities or V̇O2max-based endurance levels influenced the PAPE effects on endurance performance. Meta-regression showed that PAPE effects were correlated neither with the time interval between conditioning routines and endurance exercise nor with endurance exercise duration. We found a very low certainty of evidence that PAPE potentiates endurance performance.

Conclusions

Based on the analyses of bias and certainty of evidence, we found no support to recommend PAPE strategies to improve endurance exercise performance. Significant but very small PAPE effects on endurance performance were due to two exceptional effect sizes.
Case Report: Complete tomographic resolution of focal choroidal excavation complicated with choroidal neovascularization after anti-VEGF treatment
Authors: Zhioua Braham Imène , Haddar Selim , Boukari Mejdi , Mokrani Manel , Mili Ilhem , Zhioua Raja
Published: October 2023

Purpose: We report a case of focal choroidal excavation (FCE) that resolved after intravitreal injection of anti-vascular endothelial growth factor (VEGF) for choroidal neovascularization (CNV) and we describe its tomographic features.

Case report: A 43-year-old female presented with blurred vision and metamorphopsia in her left eye (LE) evolving for 10 years. The best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/32 in the LE. Fundus examination revealed the presence of a yellowish foveal lesion which corresponded to a conforming FCE associated to a pachychoroid on swept-source optical coherence tomography (OCT). The OCT-Angiography showed a foveal flow void in the choriocapillaris layer corresponding to the FCE area.

Three years later, the patient complained of visual impairment, more metamorphopsia with a BCVA of 20/80 on her LE. The OCT showed intraretinal fluid with a foveal retinal pigment epithelium (RPE) detachment. The OCT-angiography confirmed the presence of CNV. Two months after one intravitreal bevacizumab injection, the OCT documented the complete resolution of macular edema, the regression of the CNV tissue and the restoration of a normal aspect of the fovea without any FCE. Her BCVA improved to 20/32 with resolution of the metamorphopsia. The OCT aspect remained stable during 3 years of follow-up.

Conclusion: CNV can develop in FCE and anti-VEGF therapy is a good option treatment. After treatment, FCE pattern can change et may completely resolve.
Case Report: complete pathological response after chemotherapy for borderline pancreatic cancer
Authors: SAIDANI Ahmed , BELHADJ Anis , Fahd Khefacha , RAKKEH Hichem , BEN OTHMENE Mohamed Raouf , CHEBBI Faouzi
Published: October 2023

Background: Patients with borderline pancreatic cancer have a poor prognosis despite the recent development of multidisciplinary treatments that include chemotherapy. Nowadays induction chemotherapy is developing into a powerful cure to convert borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancers (LAPC) into a resectable cancer. This report supplements published data on the management border line pancreatic cancer and emphasizes the possibility of complete pathological response after chemotherapy in such cases. 

Case presentation:  A 60-year-old man, with a type 2 Diabetes Mellitus, was diagnosed with a 3-centimeter T2N1M0 borderline pancreatic head tumor. Ultrasound endoscopy found a close contact with the superior mesenteric vein (< 180°) and an endoscopically guided biopsy confirmed the diagnosis of ductal adenocarcinoma. The patient underwent systemic chemotherapy with six injections of FOLFIRINOX without radiotherapy. The radiological re-staging revealed a cancer down-sizing of 2cm and tumor became resectable. The patient underwent a Whipple procedure with uneventful follow-up. The pathological examination of the specimen concluded to pathological complete response. The twelve lymph nodes evaluated were negative. Following surgery, adjuvant chemotherapy FOLFIRINOX was given. After three years of follow-up, there is no evidence of recurrence.
Practical Tips for using a Human Library approach In medical education
Authors: Malhi Rebecca , Perez Grace , Shafiq Javeria , Johnston Aaron
Published: October 2023

A Human Library is a structured event that brings people from different groups together. It simulates the format of a customary library, with ‘Readers’ borrowing ‘Books’, who are human volunteers sharing their lived experiences and perspectives. Rooted in principles of social psychology, Human Libraries provide opportunities for Books and Readers to interact in meaningful dialogue. The goal of each interaction is to give the Reader new understanding of the Book’s life.

The Human Library was originally developed as a strategy to challenge prejudice through conversation and personal connection, but the approach is remarkably versatile. We repurposed it for a medical education context in order to provide learners in medical school with information and inspiration, particularly about rural life and rural medicine. We organized and held two Human Library events where pre-medical and undergraduate medical students (Readers) engaged in dialogue with rural physicians (Books). However, the strategy could be used to address a wide variety of challenging subjects where the potential Readers are biased or lack experience.

This article draws upon research literature and our own experiences of running Human Library events to give practical advice for other organizations who might want to use this novel approach in medical education.
Medical education in Bangladesh from Student and Teacher’s Perspective: Impact and challenges of the COVID-19 pandemic
Authors: Rahman M. Wakilur , Hasan Md Mahfuzul , Palash Md. Salauddin , Asaduzzaman Md
Published: October 2023

Background:  

In low- and middle-income countries like Bangladesh, where medical education faces a range of challenges-such as lack of infrastructure, well-trained educators, and advanced technologies, abrupt changes in methodologies without adequate preparation are more challenging than in higher-income countries. This was worsened during the COVID-19 pandemic and these challenges have resulted in a change in medical education methodology. This study assesses the medical education procedure, impacts and adaptation strategies and challenges of the COVID-19 pandemic in the medical education system of Bangladesh from learners' as well as educators' perspectives.  

Methods:  

The study collected data from 22 Medical Colleges/Universities across 18 districts of eight divisions using quantitative and qualitative methods. A total of 408 samples were collected consisting of 316 from students and 92 from medical teachers. Descriptive analysis and probit model were performed for obtaining results. 

Results: 

The efficacy of online learning was questionable, but results showed that it was more effective for theory classes (92.4%) followed by clinical classes (75.63%) and the efficacy rate was low for practical classes (54.11%). All types of classes (theory, practical and clinical) are currently using mixed methods to some extent in medical education in Bangladesh. Regarding impacts and adaptation strategy, approximately 75.3% of the students surveyed expressed their acceptance of online education. Over 80% of the participants acknowledged the advantages of online learning, highlighting the freedom to learn from home, cost and time savings, and avoiding physical closeness with other students as major benefits.  

Conclusions: 

To address future challenges like the COVID-19 pandemic in medical education in Bangladesh, a comprehensive policy approach such as strengthening technological infrastructure, promoting blended learning approaches, enhancing faculty training and support, integrating telemedicine into the curriculum, and continuously evaluating and improving policies and interventions can enhance the resilience of its medical education system, and prepare for future challenges.
Community engagement in maternal and perinatal death surveillance and response (MPDSR): Realist review protocol
Authors: Mbuo Mary , Okello Immaculate , Penn-Kekana Loveday , Willcox Merlin , Portela Anayda , Palestra Francesca , Mathai Matthews
Published: October 2023

Background: While there has been a decline in maternal and perinatal mortality, deaths remain high in sub-Saharan Africa and Asia. With the sustainable development goals (SDGs) targets to reduce maternal and perinatal mortality, more needs to be done to accelerate progress and improve survival. Maternal and perinatal death surveillance and response (MPDSR) is a strategy to identify the clinical and social circumstances that contribute to maternal and perinatal deaths. Through MPDSR, an active surveillance and response cycle is established by bringing together different stakeholders to review and address these social and clinical factors.

Community engagement in MPDSR provides a strong basis for collective action to address social factors and quality of care issues that contribute to maternal and perinatal deaths. Studies have shown that community members can support identification and reporting of maternal and/or perinatal deaths. Skilled care at birth has been increasing globally, but there are still gaps in quality of care. Through MPDSR, community members can collaborate with health workers to improve quality of care. But we do not know how community engagement in MPDSR works in practice; for whom it works and what aspects work (or do not work) and why. This realist review answers the question: which strategies of community engagement in MPDSR produce which outcomes in which contexts?

Methods: For this realist review, we will identify published and grey literature by searching relevant databases for articles. We will include papers published from 2004 in all languages and from all countries.

We have set up an advisory group drawn from academia, international organizations, and practitioners of both MPDSR and community engagement to guide the process.

Conclusion: This protocol and the subsequent realist review will use theoretical approaches from the community engagement literature to generate theory on community engagement in MPDSR.

Prospero registration number:  CRD42022345216
Guardianes de la tierra y la cultura. La agroecología en el Movimiento Campesino de Cajibío
Authors: Marín López Melissa
Published: October 2023

Este texto estudia los movimientos sociales campesinos y la agroecología del modelo alternativo de producción, consumo y distribución alimentaria en el Movimiento Campesino de Cajibío (MCC). La autora hace una reconstrucción histórica del MCC, su configuración política, cultural y organizativa; analiza la dimensión política, sociocultural y económica de la agroecología dentro del mismo, sus prácticas de materialización, aportes y limitaciones colectivas; y el proceso de transición productiva y modificación de los marcos cognoscitivos de las familias campesinas, producto de la adopción de esta práctica como parte de su vida cotidiana. Con una perspectiva cualitativa, mediante dieciocho entrevistas semiestructuradas y observación participante, se evidencia que la agroecología se constituye como apuesta central en el pro yecto político por la creación de un modelo económico alternativo y el reconocimiento legal de los campesinos como sujetos de derechos diferenciados, productores de alimentos sanos y protectores del medio ambiente; contribuye a la reconstrucción progresiva de los tejidos culturales y sociales, propiciando nuevas formas de agricultura, basadas en el respeto a la vida y a la autonomía en el territorio; y la transformación física de las parcelas permite el avance hacia la soberanía alimentaria, el equilibrio funcional del sistema agropecuario y la reduc ción de la dependencia campesina hacia medios externos. Sin embargo, la agroecología en el territorio se trata más de un proceso de que una realidad, pues se tensiona con complejidades económicas, sociales e históricas del contexto que condicionan su desarrollo.
Application of Sediment Fingerprinting to Apportion Sediment Sources: Using Machine Learning Models
Authors: Malhotra Kritika , Zheng Jingyi , Abebe Ash , Lamba Jasmeet
Published: October 2023

Highlights

Relative source contributions to stream bed sediment from construction sites and stream banks were quantified.

Two machine-learning techniques were used to select composite fingerprinting properties.

The MixSIR Bayesian model was employed for source apportionment.

Statistical methods employed for fingerprinting properties selection have the potential to impact source apportionments.

Management strategies to reduce sediment mobilization should be targeted depending on the dominant source of sediment in each sub-watershed.

Abstract. Sediment fingerprinting is an extensively used approach for investigating sediment sources by linking in-stream sediment mixtures with watershed source materials. The overall goal of this research was to estimate the relative source contributions of stream banks and construction sites to the stream bed sediment in an urbanized watershed (Alabama, USA) using a fingerprinting technique established on composite fingerprints selected by two different machine learning techniques at a sub-watershed scale. The two statistical approaches employed to select the subset of fingerprinting properties were: (1) the Random Forest algorithm (RF) with Gini importance ranking of variables; and (2) logistic regression with the least absolute shrinkage and selection operator (LASSO). A Bayesian mixing model was then used to estimate the distribution of mixing proportions along with the associated uncertainty. The models were built based on the composite fingerprints selected using the two machine learning methods. Overall, using the subset of fingerprints selected by RF and LASSO, the relative contribution of stream banks ranged from 14±9% to 97±2% and from 24±18% to 94±5%, respectively, throughout the watershed. The stream bank contributions were compared with a previous study conducted in the watershed that utilized a two-step statistical procedure (which involved a Mann-Whitney U-test as the first step and discriminant function analysis (DFA) as the second step) to select the composite of fingerprinting properties and a frequentist mixing model to calculate the source apportionments. The relative contributions of stream banks to stream bed sediment in the previous study reported ranged from 9±8% to 100±1%. Therefore, the study demonstrated the dependence of source attributions on the statistical procedures used to select the optimum composite fingerprints for sediment fingerprinting applications. Furthermore, the results underscored the importance of using different mixing model structures to obtain reliable estimates of source contributions. Keywords: Least absolute shrinkage and selection operator (LASSO), MixSIR Bayesian model, Random Forest (RF), Statistical techniques.
A Sociological Perspective of Filipino American Immigration
Authors: Pido Antonio J. A.
Published: October 2023

Abstract: With reference to the Filipino immigrants to the United States, how much is the statement, “Kindred Spirit - Waves Apart,” a fact or more of an ideal, is examined from a sociological-historical perspective. Immigrants, among themselves (i.e., between waves) and the host peoples and institutions are the ultimate actors in the process of immigration and integration. However, these may also be influenced by sociological and historical dimensions, over which, the immigrants have little or no control. In addition, there may be sociological cultural factors that the immigrants themselves bring along with them to the new country.
A Filipino Rascal: Denis Rodill 1894–1977
Authors: Rodill Diane
Published: October 2023

Abstract: A Filipino Rascal: Denis Rodill 1894–1977 is the remarkable story of a 14-year-old runaway from Manila, who arrived in Seattle in 1908, preceding the crest of the 1920’s manong wave. His saga links him to Seattle and other American seaport towns and their early 20th century immigration heritage. It highlights his journey across six continents from three oceans through the geopolitical lens of six wars and early 20th century prejudice and discrimination, as it unveils the ships, people, and events along the way. Drawn from seven years of research and much primary data, Denis’ timeline reveals the personal costs of his itinerant life, as well as posthumous recognition, while exploring American attitudes and policies still impacting contemporary Filipinos. The findings reveal a rascal youth whose mariner passion inspired him to overcome enormous challenges to fulfill his American dream.
Fast 2-photon stimulation using holographic patterns
Authors: Brunstein Maia , Lubetzki Jules , Moutoussamy Cédric , Li Wei , Barral Jérémie
Published: October 2023

Two decades after its introduction, optogenetics – a biological technique to control the activity of neurons or other cell types with light – remains a cutting edge and promising tool to study biological processes. Its increasing usage in research varies widely from causally exploring biological mechanisms and neural computations, to neurostimulation and sensory restauration. To stimulate neurons in the brain, a variety of approaches have been developed to generate precise spatiotemporal light patterns. Yet certain constrains still exists in the current optical techniques to activate a neuronal population with both cellular resolution and millisecond precision. Here, we describe an experimental setup allowing to stimulate a few tens of neurons in a plane at sub-millisecond rates using 2-photon activation. A liquid crystal on silicon spatial light modulator (LCoS-SLM) was used to generate spatial patterns in 2 dimensions. The image of the patterns was formed on the plane of a digital micromirror device (DMD) that was used as a fast temporal modulator of each region of interest. Using fluorescent microscopy and patch-clamp recording of neurons in culture expressing the light-gated ion channels, we characterized the temporal and spatial resolution of the microscope. We described the advantages of combining the LCoS-SLM with the DMD to maximize the temporal precision, modulate the illumination amplitude, and reduce background activation. Finally, we showed that this approach can be extended to patterns in 3 dimensions. We concluded that the methodology is well suited to address important questions about the role of temporal information in neuronal coding.
Improving optical sectioning with spinning disk structured illumination microscopy
Authors: Paul Tristan C. , Hagen Guy
Published: October 2023

A new fluorescence microscopy technique for optical sectioning was investigated. This technique combined Spinning Disk microscopy (SD) with Structured Illumination Microscopy (SIM), resulting in more background removal than either method. Spinning Disk Structured Illumination Microscopy (SD-SIM) resulted in higher signal-to-background ratios. The method detected and quantified a dendritic spine neck that was impossible to detect with either SIM or SD alone.
A tuned ocean color algorithm for the Arctic Ocean: a solution for waters with high CDM content
Authors: Li Juan , Matsuoka Atsushi , Hooker Stanford B. , Maritorena Stéphane , Pang Xiaoping , Babin Marcel
Published: October 2023

The Arctic Ocean (AO) is the most river-influenced ocean. Located at the land-sea interface wherein phytoplankton blooms are common, Arctic coastal waterbodies are among the most affected regions by climate change. Given phytoplankton are critical for energy transfer supporting marine food webs, accurate estimation of chlorophyll a concentration (Chl), which is frequently used as a proxy of phytoplankton biomass, is critical for improving our knowledge of the Arctic marine ecosystem and its response to the ongoing climate change. Due to the unique and complex bio-optical properties of the AO, efforts are still needed to obtain more accurate Chl estimates, especially for coastal waters with high colored detrital material (CDM) content. In this study, we optimized the the Garver-Siegel-Maritorena (GSM) algorithm, using an Arctic bio-optical dataset comprised of seven wavelengths (the original GSM wavelengths plus 625 nm). Results suggested that our tuned algorithm, denoted GSMA, outperformed an alternative AO GSM algorithm denoted AO.GSM, but the accuracy of Chl estimates was only improved by 8%. In addition, GSMA showed appreciable robustness when assessed using a satellite image and two non-Arctic coastal datasets.
Switch of orbital angular momentum flux density of partially coherent vortex beams
Authors: Zhang Yongtao , Cai Yangjian , Gbur Greg
Published: October 2023

We investigate the orbital angular momentum (OAM) flux density of beams which are the incoherent superposition of partially coherent vortex (PCV) beams with different topological charges and beam widths. Simulation results show that such beams can exhibit counter-rotating radial regions of the OAM flux density, and that we can “switch” the order of these regions by adjusting the topological charges and beam widths in the source plane. Furthermore, these counter-rotating regions can switch on propagation in free space without any change to the beam parameters. We discuss how these unusual OAM dynamics may find use in OAM-based applications.
Chalcogenide GRIN glasses with high refractive index and large refractive index difference for LWIR imaging
Authors: Gu Zhengxiang , Liang Yachen , Xia Kelun , Guan Yongnian , He Lelu , Wang Xunsi , Dai Shixun , Shen Xiang , Liu Zijun
Published: October 2023

Gradient refractive index (GRIN) materials utilize an internally tailored refractive index in combination with the designed curvature of the optical element surface, providing the optical designer with additional freedom for correcting chromatic and spherical aberrations. In this paper, new GRIN materials suitable for the second (3-5 µm) and third (8-12 µm) atmospheric windows were successfully developed by the thermal diffusion method based on Ge20As20Se60-xTex series high refractive index glasses, where the maximum refractive index difference (Δn) at 4 µm and 10.6 µm were 0.281 and 0.277, respectively. The diffusion characteristics and refractive index distribution of the GRIN glass were analyzed by Raman characterization. Furthermore, the performance of GRIN singlet and homogeneous singlet in the LWIR band (8 µm, 10.6 µm (primary wavelength), 12 µm) was compared, and the results showed that the GRIN singlet had better chromatic aberration correction and unique dispersion characteristics.
Heralded quantum multiplexing entanglement between stationary qubits via distribution of high-dimensional optical entanglement
Authors: Xie Zhihao , Wang Guanyu , Guo Zehui , Li Zhenhua , Li Tao
Published: October 2023

Quantum entanglement between pairs of remote quantum memories (QMs) is a prerequisite for realizing many applications in quantum networks. Here, we present a heralded protocol for the parallel creation of quantum entanglement among multiple pairs of QMs placed in spatially separated nodes, where each QM, encoding a stationary qubit, couples to an optical cavity and deterministically interacts with single photons. Our protocol utilizes an entangled photon pair encoded in the high-dimensional time-bin degree of freedom to simultaneously entangle multiple QM pairs, and is efficient in terms of reducing the time consumption and photon loss during transmission. Furthermore, our approach can be extended to simultaneously support spatial-temporal multiplexing, as its success is heralded by the detection of single photons. These distinguishing features make our protocol particularly useful for long-distance quantum communication and large-scale quantum networks.
Circadian distribution of epileptiform discharges in epilepsy: Candidate mechanisms of variability
Authors: Marinelli Isabella , Walker Jamie J. , Seneviratne Udaya , D’Souza Wendyl , Cook Mark J. , Anderson Clare , Bagshaw Andrew P. , Lightman Stafford L. , Woldman Wessel , Terry John R.
Published: October 2023

Epilepsy is a serious neurological disorder characterised by a tendency to have recurrent, spontaneous, seizures. Classically, seizures are assumed to occur at random. However, recent research has uncovered underlying rhythms both in seizures and in key signatures of epilepsy—so-called interictal epileptiform activity—with timescales that vary from hours and days through to months. Understanding the physiological mechanisms that determine these rhythmic patterns of epileptiform discharges remains an open question. Many people with epilepsy identify precipitants of their seizures, the most common of which include stress, sleep deprivation and fatigue. To quantify the impact of these physiological factors, we analysed 24-hour EEG recordings from a cohort of 107 people with idiopathic generalized epilepsy. We found two subgroups with distinct distributions of epileptiform discharges: one with highest incidence during sleep and the other during day-time. We interrogated these data using a mathematical model that describes the transitions between background and epileptiform activity in large-scale brain networks. This model was extended to include a time-dependent forcing term, where the excitability of nodes within the network could be modulated by other factors. We calibrated this forcing term using independently-collected human cortisol (the primary stress-responsive hormone characterised by circadian and ultradian patterns of secretion) data and sleep-staged EEG from healthy human participants. We found that either the dynamics of cortisol or sleep stage transition, or a combination of both, could explain most of the observed distributions of epileptiform discharges. Our findings provide conceptual evidence for the existence of underlying physiological drivers of rhythms of epileptiform discharges. These findings should motivate future research to explore these mechanisms in carefully designed experiments using animal models or people with epilepsy.
Impact of individual, household, and area characteristics on health and social care outcomes for people with multimorbidity: Protocol for a multilevel analysis
Authors: MacRae Clare , Mercer Stewart W. , Lawson Andrew , Marshall Alan , Pearce Jamie , Abubakar Eleojo , Zheng Chunyu , van den Akker Marjan , Williams Thomas , Swann Olivia , Pollock Louisa , Rawlings Anna , Fry Rich , Lyons Ronan A. , Lyons Jane , Mizen Amy , Dibben Chris , Guthrie Bruce
Published: October 2023

Background

Multimorbidity is one of the greatest challenges facing health and social care systems globally. It is associated with high rates of health service use, adverse healthcare events, and premature death. Despite its importance, little is known about the effects of contextual determinants such as household and area characteristics on health and care outcomes for people with multimorbidity. This study protocol presents a plan for the examination of associations between individual, household, and area characteristics with important health and social care outcomes.

Methods

The study will use a cross-section of data from the SAIL Databank on 01 January 2019 and include all people alive and registered with a Welsh GP. The cohort will be stratified according to the presence or absence of multimorbidity, defined as two or more long-term conditions. Multilevel models will be used to examine covariates measured for individuals, households, and areas to account for social processes operating at different levels. The intra-class correlation coefficient will be calculated to determine the strength of association at each level of the hierarchy. Model outcomes will be any emergency department attendance, emergency hospital or care home admission, or mortality, within the study follow-up period.

Discussion

Household and area characteristics might act as protective or risk factors for health and care outcomes for people with multimorbidity, in which case results of the analyses can be used to guide clinical and policy responses for effective targeting of limited resources.
Long term survival and abnormal liver fat accumulation in mice with specific thymidine kinase 2 deficiency in liver tissue
Authors: Zhao Qian , Zhou Xiaoshan , Yan Jingyi , Kuiper Raoul , Curbo Sophie , Karlsson Anna
Published: October 2023

Deficiency in thymidine kinase 2 (TK2) causes mitochondrial DNA depletion. Liver mitochondria are severely affected inTk2complete knockout models and have been suggested to play a role in the pathogenesis of theTk2knockout phenotype, characterized by loss of hypodermal fat tissue, growth retardation and reduced life span. Here we report a liver specificTk2knockout (KO) model to further study mechanisms contributing to the phenotypic changes associated withTk2deficiency. Interestingly, the liver specificTk2KO mice had a normal life span despite a much lower mtDNA level in liver tissue. Mitochondrial DNA encoded peptide COXI did not differ between theTk2KO and control mice. However, the relative liver weight was significantly increased in the maleTk2KO mouse model. Histology analysis indicated an increased lipid accumulation. We conclude that other enzyme activities can partly compensateTk2deficiency to maintain mtDNA at a low but stable level throughout the life span of the liver specificTk2KO mice. The lower level of mtDNA was sufficient for survival but led to an abnormal lipid accumulation in liver tissue.