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Abstract Elevated numbers of atherogenic lipoproteins (apoB) predict the incidence of type 2 diabetes (T2D). We reported that this may be mediated via the activation of the NLRP3 inflammasome, as low-density lipoproteins (LDL) induce interleukin-1 beta (IL-1β) secretion from human white adipose tissue (WAT) and macrophages. However, mitigating nutritional approaches remained unknown. We tested whether omega-3 eicosapentaenoic and docosahexaenoic acids (EPA and DHA) treat LDL-induced upregulation of WAT IL-1β-secretion and its relation to T2D risk factors. Twelve-week intervention with EPA and DHA (2.7 g/day, Webber Naturals) abolished baseline group-differences in WAT IL-1β-secretion between subjects with high-apoB (N = 17) and low-apoB (N = 16) separated around median plasma apoB. Post-intervention LDL failed to trigger IL-1β-secretion and inhibited it in lipopolysaccharide-stimulated WAT. Omega-3 supplementation also improved β-cell function and postprandial fat metabolism in association with higher blood EPA and mostly DHA. It also blunted the association of WAT NLRP3 and IL1B expression and IL-1β-secretion with multiple cardiometabolic risk factors including adiposity. Ex vivo, EPA and DHA inhibited WAT IL-1β-secretion in a dose-dependent manner. In conclusion, EPA and DHA treat LDL-induced upregulation of WAT NLRP3 inflammasome/IL-1β pathway and related T2D risk factors. This may aid in the prevention of T2D and related morbidities in subjects with high-apoB. Clinical Trail Registration ClinicalTrials.gov (NCT04496154): Omega-3 to Reduce Diabetes Risk in Subjects with High Number of Particles That Carry “Bad Cholesterol” in the Blood – Full Text View - ClinicalTrials.gov.

Tropical glaciers in the central Andes are vital water resources and crucial climate indicators, currently undergoing rapid retreat. However, understanding their vulnerability to the combined effects of persistent warming, the El Niño and La Niña climate phenomena, and interannual fluctuations remains limited. Here, we automate the mapping of key mass balance parameters on the Quelccaya Ice Cap (QIC) in Peru, one of the largest tropical ice caps. Using Landsat's near-infrared (NIR) band, we analyze snow cover area (SCA) and total area (TA) and calculate the accumulation area ratio (AAR) and equilibrium-line altitude (ELA) over nearly 40 years (1985–2023). Between 1985 and 2022, the QIC lost ∼58 % and ∼37 % of its SCA and TA, respectively. We show that the QIC's reduction in SCA and rise in ELA are exacerbated by El Niño events, which are strongly correlated with the preceding wet season's Oceanic Niño Index (ONI). Further, expansion in the QIC's SCA is observed during all La Niña years, except during the 2021–2022 La Niña. Although this is a singular event, it could indicate a weakened ability for SCA recovery and an accelerated decline in the future, primarily driven by anthropogenic warming.

The number of Arctic glaciers with direct, long-term measurements of mass balance is limited. Here we used satellite-based observations of the glacier snowline altitude (SLA), the location of the transition between snow cover and ice late in the summer, to approximate the position of the equilibrium-line altitude (ELA), a variable important for mass balance assessment and for understanding the response of glaciers to climate change. We mapped the snowline (SL) on a subset of 269 land-terminating glaciers above 60° N latitude in the latest available summer, clear-sky Landsat satellite image between 1984 and 2022. The mean SLA was extracted using the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) Global Digital Elevation Model (GDEM). We compared the remotely observed SLA observations with available long-term field-based measurements of ELA and with ERA5-Land reanalysis climate data. Over the last 4 decades, Arctic glacier SLAs have risen an average of ∼152 m (3.9±0.4 m yr−1; R2=0.74, p), with a corresponding summer (June, July, August) temperature shift of +1.2 °C at the glacier locations. This equates to a 127±5 m shift per 1 °C of summer warming. However, we note that the effect of glacier surface thinning could bias our estimates of SLA rise by up to ∼1 m yr−1, a significant fraction (∼25 %) of the overall rate of change, and thus should be interpreted as a maximum constraint. Along with warming, we observe an overall decrease in snowfall, an increase in rainfall, and a decrease in the total number of days in which the mean daily temperature is less than or equal to 0 °C. Glacier SLA is most strongly correlated with the number of freezing days, emphasizing the dual effect of multi-decadal trends in mean annual temperature on both ablation (increasing melt) and accumulation processes (reducing the number of days in which snow can fall). Although we find evidence for a negative morpho-topographic feedback that occurs as glaciers retreat to higher elevations, we show that more than 50 % of the glaciers studied here could be entirely below the late-summer SLA by 2100, assuming the pace of global warming and the mean rate of SLA rise are maintained.

Abstract Elevated plasma numbers of atherogenic apoB-lipoproteins (apoB), mostly as low-density lipoproteins (LDL), predict diabetes risk by unclear mechanisms. Upregulation of the NLRP3 inflammasome/interleukin-1 beta (IL-1β) system in white adipose tissue (WAT) is implicated in type 2 diabetes (T2D); however, metabolic signals that stimulate it remain unexplored. We hypothesized that (1) subjects with high-apoB have higher WAT IL-1β-secretion than subjects with low-apoB, (2) WAT IL-1β-secretion is associated with T2D risk factors, and (3) LDL prime and/or activate the WAT NLRP3 inflammasome. Forty non-diabetic subjects were assessed for T2D risk factors related to systemic and WAT glucose and fat metabolism. Regulation of the NLRP3 inflammasome was explored using LDL without/with the inflammasome’s priming and activation controls (LPS and ATP). LDL induced IL1B-expression and IL-1β-secretion in the presence of ATP in WAT and macrophages. Subjects with high-apoB had higher WAT IL-1β-secretion independently of covariates. The direction of association of LDL-induced WAT IL-1β-secretion to T2D risk factors was consistently pathological in high-apoB subjects only. Adjustment for IL-1β-secretion eliminated the association of plasma apoB with T2D risk factors. In conclusion, subjects with high-apoB have higher WAT IL-1β-secretion that may explain their risk for T2D and may be related to LDL-induced priming of the NLRP3 inflammasome. ClinicalTrials.gov (NCT04496154): Omega-3 to Reduce Diabetes Risk in Subjects With High Number of Particles That Carry "Bad Cholesterol" in the Blood—Full Text View—ClinicalTrials.gov.

Abstract Unique identification of optical devices is important for anti-counterfeiting. Physical unclonable functions (PUFs), which use random physical characteristics for authentication, are advantageous over existing optical solutions, such as holograms, due to the inherent asymmetry in their fabrication and reproduction complexity. However, whilst unique, PUFs are potentially vulnerable to replication and simulation. Here we introduce an additional benefit of a small modification to an established model of nanoparticle PUFs by using a second measurement parameter to verify their authenticity. A randomly deposited array of quantum dots is encapsulated in a transparent polymer, forming a tag. Photoluminescence is measured as a function of excitation power to assess uniqueness as well as the intrinsic nonlinear response of the quantum material. This captures a fingerprint, which is non-trivial to clone or simulate. To demonstrate this concept practically, we show that these tags can be read using an unmodified smartphone, with its built-in flash for excitation. This development over constellation-style optical PUFs paves the way for more secure, facile authentication of devices without requiring complex fabrication or characterisation techniques.

Tropical glaciers in the central Andes are vital water resources and crucial climate indicators, currently undergoing rapid retreat. However, understanding their vulnerability to the combined effects of persistent warming, the El Niño and La Niña climate phenomena, and interannual fluctuations remains limited. Here, we automate the mapping of key mass balance parameters on the Quelccaya Ice Cap (QIC) in Peru, one of the largest tropical ice caps. Using Landsat's near-infrared (NIR) band, we analyze snow cover area (SCA) and total area (TA) and calculate the accumulation area ratio (AAR) and equilibrium-line altitude (ELA) over nearly 40 years (1985–2023). Between 1985 and 2022, the QIC lost ∼58 % and ∼37 % of its SCA and TA, respectively. We show that the QIC's reduction in SCA and rise in ELA are exacerbated by El Niño events, which are strongly correlated with the preceding wet season's Oceanic Niño Index (ONI). Further, expansion in the QIC's SCA is observed during all La Niña years, except during the 2021–2022 La Niña. Although this is a singular event, it could indicate a weakened ability for SCA recovery and an accelerated decline in the future, primarily driven by anthropogenic warming. [ABSTRACT FROM AUTHOR]

Introduction: Geriatric emergency department (ED) guidelines emphasize timely identification of delirium. This article updates previous diagnostic accuracy systematic reviews of history, physical examination, laboratory testing, and ED screening instruments for the diagnosis of delirium as well as test–treatment thresholds for ED delirium screening. Methods: We conducted a systematic review to quantify the diagnostic accuracy of approaches to identify delirium. Studies were included if they described adults aged 60 or older evaluated in the ED setting with an index test for delirium compared with an acceptable criterion standard for delirium. Data were extracted and studies were reviewed for risk of bias. When appropriate, we conducted a meta‐analysis and estimated delirium screening thresholds. Results: Full‐text review was performed on 55 studies and 27 were included in the current analysis. No studies were identified exploring the accuracy of findings on history or laboratory analysis. While two studies reported clinicians accurately rule in delirium, clinician gestalt is inadequate to rule out delirium. We report meta‐analysis on three studies that quantified the accuracy of the 4 A's Test (4AT) to rule in (pooled positive likelihood ratio [LR+] 7.5, 95% confidence interval [CI] 2.7–20.7) and rule out (pooled negative likelihood ratio [LR−] 0.18, 95% CI 0.09–0.34) delirium. We also conducted meta‐analysis of two studies that quantified the accuracy of the Abbreviated Mental Test‐4 (AMT‐4) and found that the pooled LR+ (4.3, 95% CI 2.4–7.8) was lower than that observed for the 4AT, but the pooled LR− (0.22, 95% CI 0.05–1) was similar. Based on one study the Confusion Assessment Method for the Intensive Care Unit (CAM‐ICU) is the superior instrument to rule in delirium. The calculated test threshold is 2% and the treatment threshold is 11%. Conclusions: The quantitative accuracy of history and physical examination to identify ED delirium is virtually unexplored. The 4AT has the largest quantity of ED‐based research. Other screening instruments may more accurately rule in or rule out delirium. If the goal is to rule in delirium then the CAM‐ICU or brief CAM or modified CAM for the ED are superior instruments, although the accuracy of these screening tools are based on single‐center studies. To rule out delirium, the Delirium Triage Screen is superior based on one single‐center study. [ABSTRACT FROM AUTHOR]

ObjectiveSpecialty care may improve diabetic foot ulcer outcomes. Medically underserved populations receive less specialty care. We aimed to determine the association between specialty care and ulcer progression, major amputation, or death. If a beneficial association is found, increasing access to specialty care might help advance health equity.Research design and methodsWe retrospectively analyzed a cohort of Wisconsin and Illinois Medicare patients with diabetic foot ulcers (n = 55,409), stratified by ulcer severity (i.e., early stage, osteomyelitis, or gangrene). Within each stratum, we constructed Kaplan-Meier curves for event-free survival, defining events as: ulcer progression, major amputation, or death. Patients were grouped based on whether they received specialty care from at least one of six disciplines: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, and vascular surgery. Multivariate Cox proportional hazard models estimated the association between specialty care and event-free survival, adjusting for sociodemographic factors and comorbidities, and stratifying on ulcer severity.ResultsPatients who received specialty care had longer event-free survival compared to those who did not (log-rank pConclusionsSpecialty care was associated with longer event-free survivals for patients with diabetic foot ulcers. Increased, equitable access to specialty care might improve diabetic foot ulcer outcomes and disparities.

Prior studies in younger adults showed that reducing the normally high intake of the saturated fatty acid, palmitic acid (PA), in the North American diet by replacing it with the monounsaturated fatty acid, oleic acid (OA), decreased blood concentrations and secretion by peripheral blood mononuclear cells (PBMCs) of interleukin (IL)-1β and IL-6 and changed brain activation in regions of the working memory network. We examined the effects of these fatty acid manipulations in the diet of older adults. Ten subjects, aged 65–75 years, participated in a randomized, cross-over trial comparing 1-week high PA versus low PA/high OA diets. We evaluated functional magnetic resonance imaging (fMRI) using an N-back test of working memory and a resting state scan, cytokine secretion by lipopolysaccharide (LPS)-stimulated PBMCs, and plasma cytokine concentrations. During the low PA compared to the high PA diet, we observed increased activation for the 2-back minus 0-back conditions in the right dorsolateral prefrontal cortex (Broadman Area (BA) 9; p

This exploratory study examined the impact of three process groups for first-year, first-semester master's degree students (N = 20, total). The Group Environment Scale (GES; Moos 1994, 2002), Forms I (Ideal) and R (Real), were utilized to measure the participants' ideal perceptions and real perceptions of the small group environment. The overall results show that cohesion, leader support, task orientation, order/organization, and leader control were critical aspects of the experience. A group facilitator impact was found when comparing the results from the three different groups. Implications for group work training and future research are presented.

The Council of Emergency Medicine Residency Directors’ (CORD) Academy for Scholarship in Education in Emergency Medicine was founded in 2010 to support emergency medicine educators, advance educational methods and scholarship in Emergency Medicine, and foster collaboration among members. As one of the first academies housed in a specialty organization, the CORD Academy concept has been successfully implemented, and has now grown to thirty members in the categories of Distinguished Educator, Academy Scholar, and Academy Member in four focus areas (Teaching and Evaluation; Enduring Educational Materials, Educational Leadership, and Education Research). In this update, the Academy leadership describes the revised academy structure, evolution of the application, and reports the activities of the three Academy pillars – membership/awards/recognition; faculty development and structured programs; and education research and scholarship – in the first five years of the Academy.

Sex-specific differences exist in insulin secretion (ISec) and sensitivity (IS) in humans. However, current fasting indices used to estimate them, such as HOMA and QUICKI, are not sex-specific. We aimed to develop sex-specific models to improve the prediction of ISec and IS by fasting measures in adults with overweight/obesity. A post hoc analysis was conducted on baseline data of two clinical trials completed between 2010 and 2020 (37 men and 61 postmenopausal women, 45–73 years, BMI > 25 kg/m2, without chronic disease). Glucose-induced insulin or C-peptide secretions and IS were measured using gold-standard Botnia-clamps, which is a 1 h intravenous glucose tolerance test followed by a 3 h hyperinsulinemic–euglycemic clamp. Stepwise regression analysis using anthropometric and fasting plasma glucose, insulin, and lipoprotein-related measures was used to predict ISec and IS. First-phase, second-phase and total glucose-induced ISec were predicted by a combination of fasting plasma insulin and apoB without or with plasma glucose, triglyceride, and waist circumference in women (R2 = 0.58–0.69), and by plasma insulin and glucose without or with BMI and cholesterol in men (R2 = 0.41–0.83). Plasma C-peptide, alone in men or followed by glucose in women, predicted C-peptide secretion. IS was predicted by plasma insulin and waist circumference, followed by HDL-C in women (R2 = 0.57) or by glucose in men (R2 = 0.67). The sex-specific models agreed with the Botnia-clamp measurements of ISec and IS more than with HOMA or QUICKI. Sex-specific models incorporating anthropometric and lipoprotein-related parameters allowed better prediction of ISec and IS in subjects with overweight or obesity than current indices that rely on glucose and insulin alone.

The number of Arctic glaciers with direct, long-term measurements of mass balance is limited. Here we used satellite-based observations of the glacier snowline altitude (SLA), the location of the transition between snow cover and ice late in the summer, to approximate the position of the equilibrium-line altitude (ELA), a variable important for mass balance assessment and for understanding the response of glaciers to climate change. We mapped the snowline (SL) on a subset of 269 land-terminating glaciers above 60° N latitude in the latest available summer, clear-sky Landsat satellite image between 1984 and 2022. The mean SLA was extracted using the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) Global Digital Elevation Model (GDEM). We compared the remotely observed SLA observations with available long-term field-based measurements of ELA and with ERA5-Land reanalysis climate data. Over the last 4 decades, Arctic glacier SLAs have risen an average of ∼152 m (3.9±0.4 m yr -1 ; R2=0.74 , p<0.001), with a corresponding summer (June, July, August) temperature shift of +1.2 °C at the glacier locations. This equates to a 127±5 m shift per 1 °C of summer warming. However, we note that the effect of glacier surface thinning could bias our estimates of SLA rise by up to ∼1 m yr -1 , a significant fraction (∼25 %) of the overall rate of change, and thus should be interpreted as a maximum constraint. Along with warming, we observe an overall decrease in snowfall, an increase in rainfall, and a decrease in the total number of days in which the mean daily temperature is less than or equal to 0 °C. Glacier SLA is most strongly correlated with the number of freezing days, emphasizing the dual effect of multi-decadal trends in mean annual temperature on both ablation (increasing melt) and accumulation processes (reducing the number of days in which snow can fall). Although we find evidence for a negative morpho-topographic feedback that occurs as glaciers retreat to higher elevations, we show that more than 50 % of the glaciers studied here could be entirely below the late-summer SLA by 2100, assuming the pace of global warming and the mean rate of SLA rise are maintained. [ABSTRACT FROM AUTHOR]