bluuebunny/crossref_metadata_2025_split huggingface dataset:
12417 Atypical Patterns Of Hypoglycemia Post-bariatric Surgery Due To Pancreatic Insulinoma
Authors: Chopra Karishma A 
Published: October 2024

Abstract
Disclosure: K.A. Chopra: None.
Accurately diagnosing an insulinoma in patients who have had bariatric surgery can be challenging because the autonomic symptoms of palpitations, tremors, anxiety and neuroglycopenic hypoglycemia symptoms of confusion and loss of consciousness may overlap with dumping syndrome or be attributed to non-insulinoma pancreatogenous hypoglycemia. When evaluating hypoglycemia, it is crucial to obtain a detailed history of the pattern and timing of hypoglycemia episodes and collect a critical sample of insulin, proinsulin, c-peptide levels during an episode of low glucose to prevent misdiagnosis. 58-year-old woman with hypertension, obesity, and history of laparoscopic sleeve gastrectomy presented for evaluation of hypoglycemia. The patient lost 100 pounds after her sleeve gastrectomy. Within the past year, the patient had two hospitalizations for severe symptomatic hypoglycemia with associated loss of consciousness. Imaging showed atrophic pancreas and she was discharged with a prescription for daily prednisone without critical sample testing for insulin or c-peptide levels. She sought a second opinion for her hypoglycemia at UCM. Since she was taking prednisone for 10 months prior to initial evaluation at UCM, evaluation for adrenal insufficiency could not be completed initially. She started continuous glucose monitoring which showed multiple daily episodes of hypoglycemia, fasting and at other various timepoints. Fasting labs showed low glucose of 20 mg/dL (RR 60-99 mg/dL), elevated proinsulin 120 pmol/L (RR 3.6- 22 pmol/L), inappropriately normal insulin 16.4 uIU/mL (RR &lt;28.5 uIU/mL), and inappropriately normal c-peptide 0.82 pmol/mL (RR 0.30-2.35 pmol/mL), consistent with insulinoma. CT abdomen showed 1.4 cm arterially enhancing round lesion in the pancreatic body. Endoscopic ultrasound showed 13 mm mass in the pancreatic body with fine needle aspiration with pathology showing a well-differentiated neuroendocrine tumor. She received stress dose hydrocortisone preceding surgery and underwent successful enucleation of 1.6 cm pancreatic neuroendocrine tumor. A few weeks after her surgery, her HPA axis was re-evaluated, and steroids were discontinued. She has had no episodes of hypoglycemia since. Although hypoglycemia can be associated post-bariatric surgery, most patients develop postprandial hypoglycemia due to surgical alterations in alimentary flow leading to increased incretin and insulin secretion (Mulla et al 2016). Therefore, it is important to consider insulinoma in the differential diagnosis of post-bariatric surgery patients presenting without typical postprandial patterns of hypoglycemia. Reference: Mulla CM, Storino A, Yee EU, Lautz D, Sawnhey MS, Moser AJ, Patti ME, Insulinoma After Bariatric Surgery: Diagnostic Dilemma and Therapeutic Approaches. Obes Surg. 2016 Apr;26(4):874-81.
Presentation: 6/1/2024
Linkage between Fuz and Gpr161 genes regulates sonic hedgehog signaling during mouse neural tube development
Authors: Kim Sung-Eun , Kim Hyun-Yi , Wlodarczyk Bogdan J. , Finnell Richard H. 
Published: October 2024

ABSTRACT
Sonic hedgehog (Shh) signaling regulates embryonic morphogenesis utilizing the primary cilium, the cell's antenna, which acts as a signaling hub. Fuz, an effector of planar cell polarity signaling, regulates Shh signaling by facilitating cilia formation, and the G protein-coupled receptor 161 (Gpr161) is a negative regulator of Shh signaling. The range of phenotypic malformations observed in mice bearing mutations in either of the genes encoding these proteins is similar; however, their functional relationship has not been previously explored. This study identified the genetic and biochemical linkage between Fuz and Gpr161 in mouse neural tube development. Fuz was found to be genetically epistatic to Gpr161 with respect to regulation of Shh signaling in mouse neural tube development. The Fuz protein biochemically interacts with Gpr161, and Fuz regulates Gpr161-mediated ciliary localization, a process that might utilize β-arrestin 2. Our study characterizes a previously unappreciated Gpr161-Fuz axis that regulates Shh signaling during mouse neural tube development.
The importance of muscle activation on the interpretation of muscle mechanical performance
Authors: Kissane Roger W. P. , Askew Graham N. 
Published: October 2024

ABSTRACT
The work loop technique was developed to assess muscle performance during cyclical length changes with phasic activation, simulating the in vivo conditions of many muscles, particularly during locomotion. To estimate muscle function in vivo, the standard approach involves subjecting a muscle to length trajectories and activation timings derived from in vivo measurements, whilst simultaneously measuring force. However, the stimulation paradigm typically used, supramaximal, ‘square-wave’ stimulation, does not accurately reflect the graded intensity of activation observed in vivo. While the importance of the timing and duration of stimulation within the cycle on estimates of muscle performance has long been established, the importance of graded muscle activation has not been investigated. In this study, we investigated how the activation pattern affects muscle performance by comparing square-wave, supramaximal activation with a graded in vivo activation pattern. First, we used in vivo electromyography-derived activation patterns and fibre strains from the rabbit digastric muscle during mastication and replayed them in situ. Second, we used Hill-type musculoskeletal model-derived activation patterns and fibre strains in a trotting mouse, replayed ex vivo in the soleus (SOL) and extensor digitorum longus (EDL) muscles. In the rabbit digastric muscle, square-wave activation led to an 8-fold higher estimate of net power, compared with the in vivo graded activation pattern. Similarly, in the mouse SOL and EDL, supramaximal, square-wave activation resulted in significantly greater positive and negative muscle work. These findings highlight that realistic interpretations of in vivo muscle function rely upon more accurate representations of muscle activation intensity.
New sightings of southern elephant seals (Mirounga leonina) in México: Citizen science and wildlife dispersion
Authors: Barba-Acuña Isai David , Gallo-Reynoso Juan Pablo , Ortega-Borchardt José Ángel , Muñoz-Espinoza Manuel , Hernández-Camacho Claudia J. , Eder Elena B. , Dobbin-Turner Lynda , Casillas-Angón Christian 
Published: October 2024

El elefante marino del sur (Mirounga leonina) tiene una distribución circumpolar en el hemisferio sur. Sin embargo, observaciones recientes han documentado esta especie en varios lugares del hemisferio norte. Con la integración de la ciencia ciudadana, se reportan 3 nuevos registros de esta especie en México. Se recopilaron fotografías, videos e información de elefantes marinos con la colaboración de ciudadanos (pescadores y fotógrafas) en el Golfo de California y la costa sur del Pacífico mexicano. De los avistamientos se obtuvo información sobre la fecha, hora, ubicación geográfica y comportamiento general del elefante marino. La especie, sexo y categoría de edad de los pinnípedos se identificaron con base en características morfológicas externas. Se registraron 3 avistamientos de individuos diferentes de elefante marino del sur en las costas del océano Pacifico de México. En febrero de 2021 se observó un macho juvenil en Bahías de Huatulco, Oaxaca. En mayo de 2022 se avistó un macho subadulto en la Bahía de San Jorge, Sonora. En febrero de 2023 se observó otro macho subadulto en el Golfo de Santa Clara, Sonora. Documentamos 3 avistamientos extralimitales del elefante marino del sur, uno de los cuales es el registro más septentrional de esta especie en el Océano Pacífico. Estos registros contribuyen a la comprensión de los patrones de dispersión de los elefantes marinos del sur y resaltan la importancia de la ciencia ciudadana para avanzar en el conocimiento de las distribuciones de los mamíferos marinos.
Optimizing range of motion in reverse shoulder arthroplasty
Authors: Mouchantaf Mark , Parisi Marco , Secci Gregorio , Biegun Manon , Chelli Mikael , Schippers Philipp , Boileau Pascal 
Published: October 2024

AimsOptimal glenoid positioning in reverse shoulder arthroplasty (RSA) is crucial to provide impingement-free range of motion (ROM). Lateralization and inclination correction are not yet systematically used. Using planning software, we simulated the most used glenoid implant positions. The primary goal was to determine the configuration that delivers the best theoretical impingement-free ROM.MethodsWith the use of a 3D planning software (Blueprint) for RSA, 41 shoulders in 41 consecutive patients (17 males and 24 females; means age 73 years (SD 7)) undergoing RSA were planned. For the same anteroposterior positioning and retroversion of the glenoid implant, four different glenoid baseplate configurations were used on each shoulder to compare ROM: 1) no correction of the RSA angle and no lateralization (C-L-); 2) correction of the RSA angle with medialization by inferior reaming (C+M+); 3) correction of the RSA angle without lateralization by superior compensation (C+L-); and 4) correction of the RSA angle and additional lateralization (C+L+). The same humeral inlay implant and positioning were used on the humeral side for the four different glenoid configurations with a 3 mm symmetric 135° inclined polyethylene liner.ResultsThe configuration with lateralization and correction of the RSA angle (C+L+) led to better ROM in flexion, extension, adduction, and external rotation (p ≤ 0.001). Only internal rotation was not significantly different between groups (p = 0.388). The configuration where correction of the inclination was done by medialization (C+M+) led to the worst ROM in adduction, extension, abduction, flexion, and external rotation of the shoulder.ConclusionOur software study shows that, when using a 135° inlay reversed humeral implant, correcting glenoid inclination (RSA angle 0°) and lateralizing the glenoid component by using an angled bony or metallic augment of 8 to 10 mm provides optimal impingement-free ROM.Cite this article: Bone Jt Open 2024;5(10):851–857.
Direct patient costs for drugs and consumables at fifteen health facilities in Southern Madagascar, a secondary analysis of patient invoices
Authors: Franke Mara Anna , Neumann Anne , Nordmann Kim , Suleymanova Daniela , Ravololohanitra Onja Gabrielle , Knauss Samuel , Emmrich Julius Valentin 
Published: October 2024

Background
Financial risk protection in health is a key objective of the Sustainable Development Goals. However, financial risk protection mechanisms are limited, especially in low-income countries, such as Madagascar. To design effective financial risk protection mechanisms, solid and reliable data on the costs patients incur when seeking care are essential. With this study, we therefore aim to describe medical costs for drugs and consumables for patients as well as model the likelihood of catastrophic health expenditure at fifteen health facilities in Southern Madagascar.

Methods
We conducted a costing analysis of patient invoices from fifteen health facilities (four primary and eleven secondary facilities) in Southern Madagascar, including public, private, and faith-based facilities. We included invoices from patients accessing care for life-threatening conditions, accidents and injuries, paediatric, or maternity care between February 2021 and July 2022. Costing data were limited to costs for drugs and consumables. We used regional household expenditure data from a representative household survey to calculate the incidence of catastrophic health expenditure in our sample.

Results
We analysed data from 9,855 cases, including 4,980 outpatient cases, 3,447 inpatient cases without surgical intervention, and 1,419 surgical cases. The average patient cost for drugs and medical consumables across all cases was USD 39.52 (range: USD 0.13–1,381.18, IQR: USD 9.07–46.91). Average costs for surgical treatment were USD 119.33 (range: USD 8.10–522.88, IQR: USD 73.81–160.49), for inpatient treatment USD 47.07 (range: USD 1.82–1,381.19, IQR: USD 22.38–58.91), and for outpatient treatment USD 11.73 (range: USD 0.15–207.79, IQR USD: 6.00–15.53). On average patients at faith-based facilities paid USD 47.20 (range: USD 0.49–530.33, IQR: 10.74–58.54), USD19.47 (range: USD 0.40–1,381.23, IQR: 6.77–24.07) at private facilities, and USD 34.65 (range: USD 0.58–245.24, IQR: USD 6.08–60.11) at public facilities. Patients requiring surgical care were most likely to experience catastrophic health expenditure and average costs for maternity care were significantly higher than for other patient groups.

Conclusions
Financial risk protection schemes in Madagascar, such as the national UHC policy, and the national solidarity fund, as well as interventions by non-governmental and multilateral organisations, need to focus on surgical cases and maternity care to protect vulnerable populations from catastrophic health expenditures for life-threatening conditions, accidents and injuries, and maternity and paediatric care.
Developing lifestyle intervention program for pre-hypertensive patients; consensus building using a modified Delphi approach
Authors: Hassan Danish , Shakil Ur Rehman Syed , Khalid Saira , Tipu Imran , Husnain Muhammad 
Published: October 2024

Background
Prehypertension is a preclinical state of hypertension which leads to an increased likelihood of coronary heart disease, myocardial infarction, cerebrovascular disease as well as target organ damage. Addressing pre-hypertension through early lifestyle interventions is crucial to mitigating these detrimental effects and improving long-term health outcomes. So, the main objective of this study is to develop a lifestyle intervention program (LSIP) for the management of prehypertension using consensus building approach.

Methods
It was a three round online modified Delphi study with 70 members panellists. All panellists had an experience of prehypertension either as patients (n = 30) or professionals (n = 40). Round 1 included initial recommendations developed from a previous systematic review and metanalysis, which were rated by panellists for their importance on a 5-point Likert scale. Panellists could also suggest additional items in the Round 1. Round 2 and 3 included all items from the Round 1 with new items suggested by the panellists. Data was analysed descriptively using SPSS version 29. All items receiving at least 70% of all respondents combined rating of ‘Important’ and ‘Very Important’ in Round 3 were included in the final set of recommendations.

Results
Fifty-one panellists (80.9%) (patients = 25, professionals = 26) completed Round 3. Twenty-six recommendation items were included in the Round 1. Twenty new items were added in Round 2 with 46 total items in Round 2 and 3. Thirty-five of these items reached consensus in Round 3. The final set of recommendation comprised of 15 educational. 10 dietary, and 10 exercise recommendations.

Conclusion
This modified Delphi study developed a comprehensive LSIP for the prevention of prehypertension, incorporating a holistic approach with educational, dietary, and exercise components aimed at the general population. Previously established standards of care (SOC) for managing prehypertension varied significantly and often provided fragmented guidance particularly on physical activity and education. This preventive model offers a novel and scalable approach for early intervention in prehypertension, potentially reducing reliance on medications and improving long-term health outcomes.
Enhanced Agricultural Parcel Segmentation Through Multi-Modal Satellite Image Time Series Prediction
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Authors: Vasilescu Vlad , Datcu Mihai , Faur Daniela 
Published: October 2024

Land monitoring plays a vital role in modern farming practices and agricultural management. An accurate tracking of status and conditions for agricultural parcels could help farmers and landowners make informed decisions about irrigation, fertilisation, pest control and crop rotation choices. Moreover, it enables early detection of potential problems such as soil erosion, plant disease or invasive species infestations, allowing for timely intervention and mitigation measures. Consequently, this leads to promoting sustainable farming practices, improving crop yields and supporting the long-term health of both farmland and ecosystems.
One-off acquisitions of satellite images may not be sufficient to accurately identify land crop categories due to temporal variations in agricultural activities and other natural phenomena. Satellite image time series (SITS) data provide a comprehensive view over time, capturing seasonal changes, crop growth cycles and land dynamics, enabling the development of robust classification models and for a more informed decision-making process in agriculture and land management.
In this paper, we tackled the task of semantic segmentation of agricultural fields, using both optical and radar modalities. Our experiments made use of the PASTIS dataset, containing over 2.4k 128 x 128 time series, each acquisition encapsulating 10 relevant Sentinel-2 (S2) bands (out of the 13 bands provided by Sentinel-2, bands B1, B9 and B10 were excluded). We have also experimented with it's multimodal counterpart, namely PASTIS-R, containing corresponding Sentinel-1 (S1) time-series, in both ascending and descending orbit. The versatility of these datasets, acquired over the French metropolitan area, motivates their usage in training algorithms which could be further applied on a variety of environments. While S2-based SITS segmentation has been the most attempted approach in recent years, very few works succesfully address the multimodal fusion of optical and radar data (S1 + S2). In our study, we experimented with both trajectories, aiming to find a good trade-off between accuracy and inference speed. We tested multiple fusion techniques for S1 + S2 prediction, drawing conclusions regarding the best approach, while also proposing a technique to retrieve the most influential/non-influential timestamps, through a cross-attention module encapsulated in a mid-fusion strategy. Our experiments reveal that we can achieve comparable accuracy to state-of-the-art (SOA) methods, albeit with improved computational speed.
The development of fast and accurate automatic systems for crop segmentation is mostly driven by the need of rapid climate change adaptation, lowering the risk of future unpredictable losses, while also increasing resilience through the pre-emptive adoption of climate-smart agricultural techniques.
Analisis Peran Swasta dan Pemerintah terhadap Kesempatan Kerja di Jawa Tengah Tahun 2019-2022
Authors: Handayani Suci Ningtyas , Suharto Umayatu Suiroh 
Published: October 2024

This research was carried out to analyze the influence of Manufacture, Wage, and Government Expenditure on Employment in Central Java province in 2019 – 2023. The analysis method in this research uses the Panel Data Method. Based on the result of the analysis it was concluded that the best analysis model was the Random Effect Model (REM). The results of the partial analysis are that manufacturing and government expenditure do not influence employment. Meanwhile, there is an influence of wages on employment.
International Commodity Governance: Softwood Timber Trade 1870–1970
Authors: Kuorelahti Elina , Jensen-Eriksen Niklas 
Published: October 2024

Abstract
This article explores the history of international softwood timber trade from the late 19th century until the 1970s, focusing on governance and the interplay between public and private sectors. By examining the roles of business associations and international networks, it highlights how these entities have influenced market regulation, standardization, and resource distribution, thus representing significant forms of commodity governance. The study contextualizes the evolution of timber trade governance through periods of geopolitical challenges, world wars, and economic shifts, paying particular attention to the power dynamics between governments, trade associations, and international organizations such as the League of Nations and UN. This research reveals the continuity of governance practices pre- and post-1945, challenging the traditional periodization that separates pre-UNCTAD activities from subsequent developments in global commodity governance.
Performance signature for angular misalignment measurement of fiber to fiber connectors with minimum insertion loss and low distortion in optical fiber transceiver systems
Authors: Prabu Ramachandran Thandaiah , Mallan Srinivasan , Prasanth Kulandai Glory , Ravindra Gajji , Chitra Muthappa Perumal , Rajalakshmi Pitchai , Fathi Samir Hossam 
Published: October 2024

Abstract
This paper has demonstrated the performance signature of fiber to fiber connectors with minimum insertion loss and low distortion in optical fiber transceiver systems. Insertion loss is clarified against the lateral and longitudinal misalignment for single mode graded index fiber for various fiber core diameter. Insertion loss is clarified in relation to angular misalignment for joints in multimode step index silica doped optical fibers with numerical apertures variations. Total coupling signal loss efficiency is demonstrated versus the lateral and longitudinal misalignment for single mode graded index fiber for different fiber core diameter. As well as the coupling loss efficiency is studied versus angular misalignment for joints in multimode step index silica doped optical fibers with numerical apertures variations. Insertion loss is demonstrated versus numerical aperture variations for joints in multimode step index silica doped/germanium doped/plastic optical fibers with various degree angular misalignment variations.
Fairness optimized based DBA for long reach XGPON networks
Authors: Patel Mehul C. , Mandloi A.S. 
Published: October 2024

Abstract
The evaluation of the next-generation XGPON network involves assessing parameters like bandwidth utilization, packet loss, and queuing delays, all of which impact on efficient upstream bandwidth allocation. In a condition of heavy traffic load, one ONU trying to monopolizing bandwidth utilization for itself, and lead to disadvantaging others. This issue is exacerbated by long distances in extended-reach XGPON networks, causing redundant bandwidth requests, lead to higher queuing delays at others ONUs. To address this, a proposed game-theoretic model is introduce, to ensure fair bandwidth distribution while maintaining Quality of Service parameters, load fairness, delay fairness. The performance of the proposed DBA, tested alongside the XGIANT DBA using the NS3 simulator, and demonstrates improved fairness that validates the proposed DBA’s effectiveness.