Altered Flow Research Articles

대학생의 셀프리더십과 학습몰입 간의 관계: 자기주도학습능력의 매개효과

Objectives The purposes of this study were to investigate the effect of self-leadership on learning flow of college students and to verify the mediating effect of self-directed learning. Methods Data was collected from 166 college students from nation-wide universities using survey. Mediating effect was verified through stepwise regression analysis using SPSS 29.0 and Process macro v4.0. And also, the significance of indirect effect was verified through bootstrapping test. Results The results of this study are as follows. self-leadership showed positive relationship with self-directed learning and learning flow. And also, self-directed learning showed positive relationship with learning flow. Mediating effect of self-directed learning for the effect of self leadership on learning flow showed partial mediating effect. Conclusions As a result, it was verified that higher self-leadership makes effect on learning flow of college students, self-directed learning can play a role in the alteration of learning flow as a partial mediator, and can serve as initial data of preventive and counseling intervention.

Abstract Su1201: Alteration in cerebrospinal fluid flow in out-of-hospital cardiac arrest patients who underwent target temperature management.

Background: Various parameters of cerebrospinal fluid (CSF) flow measured through magnetic resonance imaging (MRI) flowmetry are utilized to assess the progression of certain diseases. Our study evaluated changes in CSF flow using MRI flowmetry in survivors of out-of-hospital cardiac arrest (OHCA) who underwent target temperature management (TTM). Methods: This prospective observational cohort study was conducted from May 2023 to April 2024 at a single center. We performed Wilcoxon signed-rank tests to compare maximum velocity (V max ), stroke volume (SV), maximum flow (flow max ), and stroke distance measured immediately after return of spontaneous circulation (ROSC) with those measured at 72 h after ROSC. Results: Of the 20 patients enrolled, 7(35.0%), 1(5.0%), 2(10.0%), 5(25.0%) and 5(25.0%) patients had CPC scores of 1, 2, 3, 4, and 5, respectively. V max , SV, flow max , stroke distance measured immediately after ROSC were 3.41 (2.03~4.96), 14.00 (4.00~23.38), 0.09 (0.06~0.22), -0.07 (-0.17~0.05), respectively. V max , SV, flow max , stroke distance measured at 72h after ROSC were 5.26 (2.76~9.28), 24.00 (10.38~42.25), 0.14 (0.08~0.31), -0.07 (-0.18~0.03), respectively. Although V max , SV, and flow max measured at 72 h after ROSC were statistically significantly higher compared to those measured immediately after ROSC (p = 0.002, 0.02, 0.002), there was no significant difference between the stroke distances measured immediately after ROSC and at 72 h after ROSC (p = 0.43). Additionally, the caudocranial direction of CSF flow was observed in 13 (65.0%) patients immediately after ROSC, and in 14 (70.0%) patients 72h after ROSC. Conclusion: This study demonstrated that alterations in cerebrospinal fluid flow were observed in OHCA patients. However, Further studies are needed to determine whether there are differences in alteration in CSF flow based on neurological prognosis.

Blood flow-induced angiocrine signals promote organ growth and regeneration.

Recently, we identified myeloid-derived growth factor (MYDGF) as a blood flow-induced angiocrine signal that promotes human and mouse hepatocyte proliferation and survival. Here, we review literature reporting changes in blood flow after partial organ resection in theliver, lung, and kidney, and we describe the angiocrine signals released by endothelial cells (ECs) upon blood flow alterations in these organs. While hepatocyte growth factor (HGF) and MYDGF are important angiocrine signals for liver regeneration, by now, angiocrine signals have also been reported to stimulate hyperplasia and/or hypertrophy during theregeneration of lungs and kidneys. In addition, angiocrine signals play a critical role in tumor growth. Understanding the mechano-elastic properties and flow-mediated alterations in the organ-specific microvasculature is crucial for therapeutic approaches to maintain organ health and initiate organ renewal.

Two–Stage Detection and Localization of Inter–Frame Tampering in Surveillance Videos Using Texture and Optical Flow

Surveillance cameras provide security and protection through real-time monitoring or through the investigation of recorded videos. The authenticity of surveillance videos cannot be taken for granted, but tampering detection is challenging. Existing techniques face significant limitations, including restricted applicability, poor generalizability, and high computational complexity. This paper presents a robust detection system to meet the challenges of frame duplication (FD) and frame insertion (FI) detection in surveillance videos. The system leverages the alterations in texture patterns and optical flow between consecutive frames and works in two stages; first, suspicious tampered videos are detected using motion residual–based local binary patterns (MR–LBPs) and SVM; second, by eliminating false positives, the precise tampering location is determined using the consistency in the aggregation of optical flow and the variance in MR–LBPs. The system is extensively evaluated on a large COMSATS Structured Video Tampering Evaluation Dataset (CSVTED) comprising challenging videos with varying quality of tampering and complexity levels and cross–validated on benchmark public domain datasets. The system exhibits outstanding performance, achieving 99.5% accuracy in detecting and pinpointing tampered regions. It ensures the generalization and wide applicability of the system while maintaining computational efficiency.

Effects of dietary proteins on cognitive performance and brain vascular function in adults: a systematic review of randomised controlled trials.

The incidence of cognitive decline is rising, leading to increased attention on the preventive role of healthy foods on brain function. Previous reviews including primarily observational studies suggested that dietary proteins may improve cognitive performance, but evidence from individual randomised controlled trials (RCT) is less consistent. Therefore, this systematic review examined the long-term effects of dietary proteins from RCT, considering both their amount and type, on cognitive performance (psychomotor speed and attention, executive function, memory and global cognition). Alterations in cerebral blood flow (CBF) - a validated brain vascular function marker - were also considered. A total of 4747 studies were identified through a systematic search, resulting in twenty-three included papers reporting effects on cognitive performance (n = 23) and CBF (n = 3). Improvements were observed in three out of the nine studies that evaluated psychomotor speed which compared a dietary protein intervention with a non-protein or lower-protein control. Of the six beneficial observations on working memory (n = 12), declarative memory (n = 10) and visuospatial memory (n = 10), five were nut interventions from three different trials. Limited studies focusing on global cognition suggested that specific target populations, namely subacute stroke or dementia, may benefit more than healthy individuals from increased dietary protein intake. From the three studies involving CBF, improvements in regional blood flow were associated with most cognitive performance outcomes. The comparative effects of different protein types warrant further investigation. Overall, this review encourages additional research into protein-rich foods or supplements which could potentially prevent or mitigate cognitive decline.

Altered flow and sediment transport impacts on the ecosystems of Chinese major rivers: An urgent call for eco‐fluvial dynamics

AbstractRiver ecosystems face challenges due to environmental degradation and alterations in flow and sediment transport resulting from climate change and other anthropogenic impacts. These changes may substantially affect river morphology, nutrient dynamics, wetland vegetation, aquatic habitats, and river ecological stability. This highlights the urgent need for systematic and quantitative studies on the interactions and feedback between changes in flow, sediment transport, and river ecology. In this study, we reviewed flow and sediment transport changes in major Chinese rivers, along with their resulting ecological impacts. We propose conducting eco‐fluvial dynamic studies, a potential solution that can guide the evaluation and restoration of ecological health impacted by physical processes. These studies can provide major benefits in balancing human and environmental needs in large river systems, which is crucial for the healthy and sustainable development of rivers.

The Antimicrobial Activity of Zinc Oxide Nanoparticles incorporated into Alginate Impression Material: An In vitro Study.

In dental clinics, disinfecting alginate impression materials is a critical practice to prevent cross-infection. Recently, zinc oxide nanoparticles (ZnO NPs) have been explored for their potential antimicrobial properties, making them promising additives for dental materials. This study investigates the antimicrobial activity of ZnO NPs incorporated into alginate impression materials and assesses the impact on material flow. The objective of this in vitro study was to evaluate the antibacterial and antifungal efficacy of ZnO NPs when incorporated into alginate impression material and to examine its effect on the material's flow properties. Zinc oxide nanoparticles were incorporated into an irreversible hydrocolloid alginate impression material at varying concentrations. The antimicrobial properties were assessed using the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) for antifungal activity against Candida albicans, and the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for antibacterial activity against Staphylococcus aureus. The well-diffusion test was employed to observe zone inhibition. The flow properties of the modified alginate were evaluated using a standardized flow test. Scanning electron microscopy (SEM) was utilized to observe the morphological characteristics and nanoparticle distribution in the alginate matrix. Data were analyzed using one-way analysis of variance (ANOVA) and Duncan's multiple range test, with a significance level set at P ≤ 0.05. The results showed that the MIC for ZnO NPs against Candida albicans was 5% by weight, and the MFC was 10% by weight. For Staphylococcus aureus, the MIC was also 5%, with the MBC at 10%. The incorporation of ZnO NPs resulted in a significant reduction in the flow of the alginate material. SEM images revealed a random distribution of ZnO NPs within the alginate matrix, suggesting uniform incorporation. The incorporation of zinc oxide nanoparticles into alginate impression materials conferred both antibacterial and antifungal properties, with effective antimicrobial activity observed at concentrations as low as 5%. However, the addition of ZnO NPs led to a decrease in the material's flow, which may affect the handling characteristics of the alginate. Clinically, the antimicrobial properties of ZnO NP-enhanced alginate could reduce the risk of cross-contamination in dental settings, but the alteration in flow must be considered when selecting or modifying impression materials for clinical use. Future studies should focus on optimizing the concentration of ZnO NPs to balance antimicrobial efficacy with material performance.

Chronic stress mediates cerebral blood flow alterations via Xanthine Oxidase in an early-onset Alzheimer's Disease model

Chronic stress mediates cerebral blood flow alterations via Xanthine Oxidase in an early-onset Alzheimer's Disease model

Ecosystem services, challenges of water bodies, a problem linked to climate change. A latent issue in Ethiopia

Lakes, rivers, and wetlands support livelihoods by providing numerous ecosystem services. They play crucial roles in human societies in drinking water provisioning, food production (via fisheries, aquaculture, and irrigation of agricultural lands), recreation, energy provision (via hydropower dams), wastewater treatment, and flood and drought control. Therefore, this study aimed to investigate the challenges facing the ecosystem services of Ethiopian water bodies. Freshwater lakes pro-vide diverse consumptive and non-consumptive ecosystem services to people, such as water supply, fisheries, recreation, and natural enjoyment. Wetland systems provide humans with both intermediate and final ecosystem services, such as provisioning services (e.g., freshwater provision), regulating services (e.g., water purification, flood regulation, climatic regulation), supporting services (e.g., habitat for wildlife), and cultural services (e.g., recreation). Challenges include flow alteration, water pollution, destruction or degradation of natural habitats, invasive alien species, and climate change.

Changes in Plasma Clearance of CYP450 Probe Drugs May Not be Specific for Altered In Vivo Enzyme Activity Under (Patho)Physiological Conditions: How to Interpret Findings of Probe Cocktail Studies.

CYP450 (CYP) phenotyping involves quantifying an individual's plasma clearance of CYP-specific probe drugs, as a proxy for in vivo CYP enzyme activity. It is increasingly applied to study alterations in CYP enzyme activity under various (patho)physiological conditions, such as inflammation, obesity, or pregnancy. The phenotyping approach assumes that changes in plasma clearance of probe drugs are driven by changes in CYP enzyme activity. However, plasma clearance is also influenced by protein binding, blood-to-plasma ratio, and hepatic blood flow, all of which may change under (patho)physiological conditions. Using a physiologically based pharmacokinetic (PBPK) workflow, we aimed to evaluate whether the plasma clearance of commonly used CYP probe drugs is indeed directly proportional to alterations in CYP enzyme activity (sensitivity), and to what extent alterations in protein binding, blood-to-plasma ratio, and hepatic blood flow observed under (patho)physiological conditions impact plasma clearance (specificity). Plasma clearance of CYP probe drugs is sensitive to alterations in CYP enzyme activity, since alterations in intrinsic clearance between - 90% and + 150% resulted in near-proportional changes in plasma clearance, except for midazolam in the case of > 50% CYP3A4 induction. However, plasma clearance also changed near-proportionally with alterations in the unbound drug fraction, diminishing probe specificity. This was particularly relevant for high protein-bound probe drugs, as alterations in plasma protein binding resulted in larger relative changes in the unbound drug fraction. Alterations in the blood-to-plasma ratio and hepatic blood flow of ± 50% resulted in plasma clearance changes of less than ± 16%, meaning they limitedly impacted plasma clearance of CYP probe drugs, except for midazolam. In order to correct for the impact of non-metabolic determinants on probe drug plasma clearance, an R script was developed to calculate how much the CYP enzyme activity is actually altered under (patho)physiological conditions, when alterations in the unbound drug fraction, blood-to-plasma ratio, and/or hepatic blood flow also impact probe drug plasma clearance. As plasma protein binding can change under (patho)physiological conditions, alterations in unbound drug fraction should be accounted for when using CYP probe drug plasma clearance as a proxy for CYP enzyme activity in patient populations. The tool developed in this study can support researchers in determining alterations in CYP enzyme activity in patients with (patho)physiological conditions.

Significant individual variation in cardiac-cycle-linked cerebrospinal fluid production following subarachnoid hemorrhage

BackgroundSpontaneous subarachnoid hemorrhage (SAH) often results in altered cerebrospinal fluid (CSF) flow and secondary hydrocephalus, yet the mechanisms behind these phenomena remain poorly understood. This study aimed to elucidate the impact of SAH on individual CSF flow patterns and their association with secondary hydrocephalus.MethodsIn patients who had experienced SAH, changes in CSF flow were assessed using cardiac-gated phase-contrast magnetic resonance imaging (PC-MRI) at the Sylvian aqueduct and cranio-cervical junction (CCJ). Within these regions of interest, volumetric CSF flow was determined for every pixel and net CSF flow volume and direction calculated. The presence of acute or chronic hydrocephalus was deemed from ventriculomegaly and need of CSF diversion. For comparison, we included healthy subjects and patients examined for different CSF diseases.ResultsTwenty-four SAH patients were enrolled, revealing a heterogeneous array of CSF flow alterations at the Sylvian aqueduct. The cardiac-cycle-linked CSF net flow in Sylvian aqueduct differed from the traditional figures of ventricular CSF production about 0.30–0.40 mL/min. In 15 out of 24 patients (62.5%), net CSF flow was retrograde from the fourth to the third and lateral ventricles, while it was upward at the cranio-cervical junction in 2 out of 2 patients (100%). The diverse CSF flow metrics did not distinguish between individuals with acute or chronic secondary hydrocephalus. In comparison, 4/4 healthy subjects showed antegrade net CSF flow in the Sylvian aqueduct and net upward CSF flow in CCJ. These net CSF flow measures also showed interindividual variability among other patients with CSF diseases.ConclusionsThere is considerable inter-individual variation in net CSF flow rates following SAH. Net CSF flow in the Sylvian aqueduct differs markedly from the traditional ventricular CSF production rates of 0.30–0.40 mL/min in SAH patients, but less so in healthy subjects. Furthermore, the cardiac-cycle-linked net CSF flow rates in Sylvian aqueduct and CCJ suggest an important role of extra-ventricular CSF production.

Riparian Vegetated Area in Pre‐Dam, Post‐Dam, and Environmental Flow Periods in Canyonlands National Park From 1940 to 2022

ABSTRACTThe Upper Colorado River Basin is the principal water supply of the western United States and includes a series of canyons that provide habitat for disproportionate numbers of flora and fauna. Following the closing of Flaming Gorge and Blue Mesa dams in 1963 and 1966, decreases in peak flows and elevated base flows allowed extensive vegetation encroachment, channel narrowing, and channel simplification. Since 1992, reservoir releases have been modified to increase the ratio of peak to base flows for environmental reasons, including protection of endangered fish. We used remote imagery from 1940 to 2022 to examine rates of vegetation encroachment along three river reaches in Canyonlands National Park during the pre‐dam (1940–1966), post‐dam (1967–1992), and environmental flows (1993–2022) periods. We found an increase in the vegetated area along the Colorado and Green Rivers upstream of their confluence since 1940. We documented a 6.1% and 4.0% increase in vegetated area in the post‐dam period and a 19.5% and 6.5% increase in vegetated area in the environmental flows period on the Colorado and Green Rivers, respectively. The Cataract Canyon reach (Colorado River below the confluence) has been stable since 1966. All three river reaches showed the slowest period of vegetation encroachment, indicative of channel narrowing, in the last 16 years of environmental flows that included a large peakflow in 2011. Environmental flows that mimic the natural hydrograph have not reversed decreases in peak flow and channel width, due in part to decreasing runoff and increasing flow diversion. Flow alterations that reduce the spring peak could cause further narrowing.

Alteration in cerebrospinal fluid flow based on the neurological prognosis of out-of-hospital cardiac arrest patients.

We evaluated alterations in cerebrospinal fluid (CSF) flow based on the neurological prognosis of out-of-hospital cardiac arrest (OHCA) patients. This prospective observational study was conducted from May 2023 to June 2024. Stroke distance was measured using magnetic resonance imaging flowmetry immediately and at 72h after return of spontaneous circulation (ROSC), with negative values indicating caudocranial direction. The caudocranial direction of CSF flow was observed in 17 (56.7%) patients immediately after ROSC, and in 20 (66.7%) patients at 72h after ROSC. There was no significant difference in the occurrence of caudocranial CSF flow immediately after ROSC between the groups with good and poor neurological prognosis [6 (50.0%) vs. 11 (61.1%); p = 0.55]. However, the occurrence of caudocranial CSF flow at 72h after ROSC was significantly higher in the group with poor neurological prognosis compared to the group with good neurological prognosis [3 (25.0%) vs. 17 (94.4%); p < 0.001]. This study demonstrated that the occurrence of caudocranial CSF flow at 72h after ROSC was significantly higher in the group with poor neurological prognosis compared to the group with good neurological prognosis.

Renal medullary perfusion differs from that in renal cortex in patients with sepsis associated acute kidney injury and correlates with renal function prognosis: A prospective cohort study.

Renal perfusion status remains poorly studied at the bedside during sepsis associated acute kidney injury (AKI). The aim of the study is to examine renal cortical and medullary perfusion using renal contrast enhanced ultrasound (CEUS) in septic patients. In this single-center, prospective longitudinal study, septic patients were enrolled. Renal ultrasonography was performed within 24 hours of ICU admission (D1), then repeated at D3, D5 and D7. Each measurement consisted of three destruction replenishment sequences that were recorded for delayed analysis with dedicated software (Vuebox). Renal cortex and medulla perfusion were quantified by measuring time to peak (TTP). Receiver operating characteristic (ROC) analysis was used to evaluate 28-day renal prognosis. The study included 149 septic patients, including 70 non-AKI patients and 79 AKI patients. Both renal cortical and medullary TTP was longer in the AKI group than in the non-AKI group. The difference of TTP between renal cortex and medulla in AKI group was higher than that in the non-AKI group (p = 0.000). Medullary TTP on day 3 had the best performance in predicting the prognosis of 28-day renal function (AUC 0.673, 95% confidence interval 0.528-0.818, p = 0.024), and its cut-off value was 45 s with a sensitivity 52.2% and a specificity of 82.1%. Cortical TTP on day 3 also had the performance in predicting the prognosis of 28-day renal function (AUC 0.657, 95% confidence interval 0.514-0.800, p = 0.039), and its cut-off value was 33 s with a sensitivity 78.3% and a specificity of 55.0%. Renal medullary perfusion alterations differ from those in cortex, with the medulla is worse. Simultaneous and dynamic assessment of cortical and medullary microcirculatory flow alterations necessary. TTP on day 3, especially medullary TTP, seems to be a relatively stable and useful indicator, which correlates with 28-day renal function prognosis in septic patients. Early correction of renal cortical and medullary perfusion alterations reduces the incidence of adverse renal events.

Dynamic shunt flow alterations through patent foramen ovale during off-pump coronary artery bypass grafting induced by airway pressure changes: a case report.

Interatrial right-to-left shunt flow through a patent foramen ovale (PFO) can be caused by changes in heart position for anastomosis during off-pump coronary artery bypass (OPCAB). We herein present a case in which the direction of PFO shunt flow changed with heart position during OPCAB and the ventilation settings after sternal closure. A 66-year-old man with interstitial pneumonia underwent OPCAB. Preoperative transesophageal echocardiography revealed right-to-left shunt flow through a PFO induced by the Valsalva maneuver. During OPCAB, heart displacement resulted in right-to-left shunting and acute hypoxemia, which quickly improved with increase of inspired oxygen fraction. After chest closure, bidirectional shunt flow developed under increased airway pressure. Vigilant intraoperative monitoring with TEE and postoperative airway pressure management are important to address shunt flow and hypoxemia due to PFO.

Adverse childhood experiences, brain function, and psychiatric diagnoses in a large adult clinical cohort.

Adverse childhood experiences (ACEs) are linked to higher rates of psychiatric disorders in adults. Previous neuroimaging studies with small samples have shown associations between ACEs and alterations in brain volume, connectivity, and blood flow. However, no study has explored these associations in a large clinical population to identify brain regions that may mediate the relationship between ACEs and psychiatric diagnoses. This study aims to evaluate how patient-reported ACEs are associated with brain function in adults, across diagnoses. We analyzed 7,275 adults using HMPAO SPECT scans at rest and during a continuous performance task (CPT). We assessed the impact of ACEs on brain function across psychiatric diagnoses and performed mediation analyses where brain functional regions of interest acted as mediators between patient-reported ACEs and specific psychiatric diagnoses. We further evaluated the risk of being diagnosed with specific classes of mental illnesses as a function of increasing ACEs and identified which specific ACE questions were statistically related to each diagnosis in this cohort. Increased ACEs were associated with higher activity in cognitive control and default mode networks and decreased activity in the dorsal striatum and cerebellum. Higher ACEs increased the risk of anxiety-related disorders, substance abuse, and depression. Several brain regions were identified as potential mediators between ACEs and adult psychiatric diagnoses. This study, utilizing a large clinical cohort, provides new insights into the neurobiological mechanisms linking ACEs to adult psychiatric conditions. The findings suggest that specific brain regions mediate the effects of ACEs on the risk of developing mental health disorders, highlighting potential targets for therapeutic interventions.

Somatosensory migraine auras evoked by bihemispheric cortical spreading depression events in human parietal cortex.

Cortical spreading depression (CSD) is associated with pronounced alterations in cerebral blood flow. These alterations can be captured using high-field functional magnetic resonance imaging (fMRI). While compelling clinical and experimental data suggest that CSD is involved in the pathogenesis of migraine aura, the mechanistic intricacies remain poorly understood. Here, we use visual stimulus-induced blood oxygen level-dependent (BOLD) fMRI responses to characterize spatiotemporal alterations in cerebral blood flow during spontaneous attacks with migraine aura. Six adult participants diagnosed with migraine with aura underwent BOLD fMRI scans with a visual stimulation paradigm, consisting of flickering checkerboard stimulation. Our results revealed that auras with somatosensory symptoms corresponded with bilateral alterations of stimulus-induced BOLD responses in the somatosensory cortex, exhibiting anterior-to-posterior propagation and absence of antecedent occipital abnormalities. These altered stimulus-induced BOLD responses were bilateral, despite a unilateral manifestation of aura symptoms, and had no relationship with positive or negative aura symptoms. The bilateral abnormalities in stimulus-induced BOLD responses completes our current knowledge on migraine aura.

Analysis of the impact of key similarity criteria numbers of TBCC inlet during the mode transition

Abstract A simplified configuration was developed to facilitate the mode transition process within an over-under Turbine-Based Combined Cycle (TBCC) inlet. Leveraging dynamic mesh technology, an unsteady numerical simulation of the mode transition was conducted, emphasising the flow characteristics of the mode transition and the impact of key similarity criteria numbers. The findings indicate that at an incoming Mach number of 2.0, the mode transition is paired with a continuous alteration in the capture mass flow of the high-speed duct. This continual change instigates the inlet unstarting, with subsequent flow characteristics being contingent on the historical effect, exhibiting a degree of hysteresis characteristics. When the scale effect is considered, it is observed that a larger model scale results in higher Reynolds (Re) and Strouhal (St) numbers. This directly contributes to a notable delay in the unstart moment, a decrease in the unstart interval, and an enlargement of the hysteresis loop. An examination of control variables reveals that the Re number marginally influences mode transition characteristics, while the St number’s effect constitutes approximately 90% of the scale effect. This conclusively demonstrates that the St number is the predominant similarity criterion number in the mode transition process.

12417 Atypical Patterns Of Hypoglycemia Post-bariatric Surgery Due To Pancreatic Insulinoma

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 &amp;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

Detection of Hydrological Alteration and soil erosion in a conserved tropical sub-humid ecosystem of Ethiopia

Soil erosion poses a significant challenge in the sub-humid Ethiopian highlands, yet research on the long-term effectiveness of soil and water conservation (SWC) practices in this region using pre- and post-conservation approaches remains limited. This study addresses this knowledge gap by evaluating the impact of SWC practices on water balance and soil erosion in the Debre Mawi watershed. The study covers two-period analyses: pre-conservation (2010–2014) and post-conservation (2015–2022) using the Soil and Water Assessment Tool (SWAT) to simulate hydrological water balance. Hydrological changes were assessed with the Indicators of Hydrological Alteration (IHA) software. Spatial and weekly sediment distribution were also computed. Results showed the SWAT effectively simulated stream flow, though sediment yield estimation was less accurate. The data demonstrated a reduction in surface runoff by 18% and a decrease in sediment yield by 75%. Conversely, evapotranspiration and groundwater storage experienced increases of 13% and 34%, respectively. The decrease in runoff and sediment can be attributed to the implementation of SWC structures with infiltration furrows, which are presently filled with sediment. Moreover, the expansion of eucalyptus tree acreage may deplete soil water during dry periods, thereby prolonging the time needed for the soil to become saturated and produce runoff, but the impact has yet to be quantified. The IHA analysis confirmed a decrease in mean annual flow from 0.06 m3/s to 0.02 m3/s, and sediment concentration decreased from 831.2 mg/l to 285 mg/l between the pre-and post-conservation periods. The study detected that soil erosion is higher than the allowable limits recommended for Ethiopia even after implementing SWCPs. Additionally, sediment transport reduced after the first three weeks due to improved ground cover and soil stability, although significant amounts were recorded until the end of the rainy season, primarily from gullies. The study found significant hydrological alterations in flow and sediment dynamics following the implementation of SWC practices, particularly pronounced in the early years post-conservation (2015–2018). However, the effectiveness of SWC practices diminished over time, with conditions beginning to revert to pre-conservation levels after 10 years. This suggests that these techniques (infiltration furrows) may be unsuitable for sub-humid watersheds, or that they require improved design and major maintenance beyond the third year. This study offers valuable insights into the dynamics of SWC interventions, underscoring the importance of integrating agronomic practices with SWC efforts to sustain long-term soil and water conservation in Ethiopia's sub-humid highlands. Future research should explore the hydrological effects of eucalyptus expansion and refine SWC practices suited to these unique conditions.