Honeymoon Period Research Articles

Insights in Nutrition to Optimize Type 1 Diabetes Therapy.

Nutrition is an essential part of therapy for type 1 diabetes and is constantly evolving, offering growing opportunities to prevent this disease, slow down its evolution, and mitigate it. An attempt was made to bring together the current state of knowledge. In the path from the preclinical phase of the disease to its clinical onset, there is a phase known as the "honeymoon period" or partial remission, where different possible dietary options for combatting this disease have been presented. The most commonly used dietary models were compared, and the most frequent co-existing pathologies, such as overweight, non-alcoholic fatty liver disease, dyslipidemia, celiac disease, and metabolic instability, were addressed from their nutritional and dietary perspectives to provide clinicians with an updated framework of knowledge and support researchers in further investigations into the topic. Finally, a glimpse into the possible interplay between nutrition and the gut microbiome, food security, and ultra-processed food is provided. It is hoped that clinicians treating people with type 1 diabetes will be provided with further opportunities for the daily management of their patients through personalized nutrition.

Intrathecal baclofen therapy as treatment for spasticity and dystonia: Review of cases in a pediatric palliative care unit

IntroductionPatients managed in the Pediatric Palliative Care Integral Unit (PPCIU) have serious neurological conditions that involve significant damage at central nervous system level. The movement disorder is a very common clinical problem and for the patients where an adequate control of muscle tone is not achieved with usual techniques or drugs, intrathecal baclofen therapy (IBT) should be considered. Materials and methodsDescriptive retrospective study based on the review of clinical records of patients who received IBT being followed by the PPCIU of Madrid Autonomous Region in the timeframe between September 2012 and February 2021. ResultsIBT was implanted in 8 patients affected by infantile cerebral palsy (ICP) with a Gross Motor Function Scale (GMFCS) IV–V, 3 patients was a Pantothenate kinase deficit-associated neurodegeneration (PKAN), 2 had Acquired Brain Damage, and the remaining 3 had, respectively, 2 glutaric aciduria type I (GA-1), and poly-malformative syndrome. In all patients we observed a period of clinical stability after IBT, we call this period “honeymoon”. Two patients died while in the honeymoon period, at 24.9 and 19.6 months from implantation of the pump; the median of duration of the honeymoon period in the remaining 14 was 14.4 months (IQ: 8.3–25.8). ConclusionsIBT was not only used in patients with non-progressive diseases, but also in the group of patients with neurodegenerative or progressive diseases. In all of them, after implantation of the device, we have objectified a period of clinical stability and a better control of muscle tone disorders.

The “India exception”: An echo of the “China human rights exception” in the 1970s–1980s

Recent Canadian allegations of a link between Indian agents and the murder of a Sikh Canadian leader have sunk the Canada-India relationship. Diplomatically speaking, the US is balancing between supporting its traditional ally Canada and its newfound strategic partner India in its struggle against Chinese hegemony. India's seemingly exceptional treatment at present reminds us of the “China human rights exception” in the 1970s and early 1980s, when the US government chose not to call out China's problems with human rights, even as America was itself adopting a foreign policy centring on human rights. Despite the many differences between China and India, the China exception and its related historical process helps us understand the evolving “India exception,” which indeed exists and likely represents the beginning of the end of the honeymoon period between India and the West, although it may take at least two decades for that process to culminate.

Rebound Pain After Peripheral Nerve Blocks: End of the Honeymoon Period

Rebound Pain After Peripheral Nerve Blocks: End of the Honeymoon Period

Adoptive parents’ perspectives on adoption adjustment and post-adoption support

ABSTRACT This study investigated adoption adjustment and the honeymoon period through the perspective of adoptive parents. Parents who had adopted a child from a public child welfare system participated in interviews seeking information on their post-adoption experience. Parents’ voices are critical to understanding adoption adjustment and post-adoption needs due to their firsthand experience. The findings in this study build on the understanding of when challenges arise for children and families after adoption and how adoptive parents perceive these experiences. Implications for practice include guidance for pre-adoption training and expansion of post-adoption support through public child welfare agencies.

Sino-Soviet Relations in the Early 1950s - Late 1960s

From 1950 to 1960, Sino-Soviet relations transitioned from a close alliance to an eventual split. This change was influenced by various factors, including the Sino-Soviet Treaty of Friendship, Alliance, and Mutual Assistance, as well as the Korean War. Despite sharing communist ideologies, the two countries had fundamental differences in their developmental objectives, which led to irreparable divisions and an ultimate severance of ties. Additionally, the personal characteristics of the leaders further exacerbated suspicions and military tensions between the two nations. In the early 1950s, the Chinese Communist Partys (CCP) policies were primarily focused on safeguarding its domestic interests. Despite underlying suspicions and compromises, China and the Soviet Union formalized their alliance through the Sino-Soviet Treaty of Friendship, Alliance, and Mutual Assistance. Chinas military involvement in Korea in 1953 further strengthened the relationship, ushering in a honeymoon period for the alliance. However, the CCP harbored a long-term objective of establishing itself as an independent entity free from external control. The underlying motives and imbalances inherent in Soviet aid began to erode the CCPs trust in the USSR. In 1956, the 20th Congress of the Communist Party of the Soviet Union (CPSU) marked the onset of ideological divergences between the two nations. Subsequent internal conflicts within the socialist bloc and disagreements on how to resolve them prompted China to scrutinize the Soviet Unions true intentions and its great power chauvinism. These evolving dynamics progressively widened the divide between China and the Soviet Union, accentuating pre-existing tensions and eventually culminating in the dissolution of their alliance.

Prolonged Honeymoon Period in Type I Diabetes (T1D) Patients on Low-Carbohydrate Diet (LCD)

The presented case is a 68-year-old female with Type 1 diabetes (T1D). She was admitted for an emergency case with acute distress in January 2018 and was diagnosed with T1D with a blood glucose (BG) level of 459 mg/dL, HbA1c of 13.7%, glutamic acid decarboxylase autoantibody (GADA) level >2000 U/mL (<5 U/mL), and C-reactive protein (CRP) level of 1.10 ng/mL. She received Multiple Daily Injections (MDI) of insulin for 3 months, and then her HbA1c decreased to 7.3%. After that, she has been on a super-low carbohydrate diet (LCD) and received only Lantus XR and ipragliflozin. Serum CRP showed 0.2 ng/mL, suggesting a prolonged honeymoon period for years through continuous LCD.

SAT102 Natural History Of Type 1 Diabetes In Humanized Mouse Model

Abstract Disclosure: A. Aldasouqi: None. S. Rafiqi: None. J.C. Jaume: None. S. Imam: None. Type 1 diabetes (T1D) is an autoimmune disease caused by an imbalance in T-regulatory and T-effector cells characterized by the destruction of insulin-producing beta cells by T-effector cells, leading to insulin deficiency and complexities like diabetic nephropathy, retinopathy, and neuropathy. Researchers at The University of Toledo have developed a humanized mice model which spontaneously develops T1D at 3-5 weeks of age and mimics human T1D. This study aims to monitor blood glucose levels before the onset of T1D (preweaning stage mice) and track the dynamics of immune cells using flow cytometry throughout the progression of the disease. Our results show that T-regulatory cells constitute 4.773% ± 0.81% cells at preweaning which drops to 2.60± 0.35 (%) in males and 1.78 ± 0.58 (%) in females at the 10th week while CD8+ T cells producing interferon-gamma (cytotoxic lymphocytes, CTLs) constitute 3.32 ± 0.60 (%) at preweaning, which increased to 27.625± 1.43 (%) in males and 21.13± 2.87 (%) in females as the disease progresses. This reduction in T-regulatory cells and enrichment of CD8s and CTLs leads to the destruction of beta cells as seen in humans as well. Dysregulation of immune responses can be correlated with the progression of diabetes in terms of blood glucose levels which increased from 147mg/dl (preweaning), peaked to 373mg/dl in 5th week, and was observed in partial remission stage around the 8th week as observed in human T1D ‘honeymoon period’. This study will help us to understand the immune dynamics in the progression of T1D as it helps us to present a better picture of the status of immune cells in a human-like immune system and provides benchmark data of the interplay of the immune system. Presentation: Saturday, June 17, 2023

THU367 Hyperosmolar Hyperglycemic State In A Middle-old Male With Primary Hyperparathyroidism

Abstract Disclosure: D.M. Dimayuga: None. M.C. Isidro: None. A 79-year-old male was brought to our hospital for drowsiness. He had low-grade fever with associated cough and anorexia 1 week prior. He had a previous history of hypertension and primary hyperparathyroidism (PHPT) maintained on cinacalcet. He did not have a history of diabetes and a family history of diabetes, and his HbA1c was 5.4% three months before. On admission, the results of his physical examination and vital signs were as follows: height, 152cm; weight, 56.0 kg; BMI, 24.2 kg/m2; temperature, 36.5C; heart rate, 85 beats/min; SpO2, 98% (on room air); respiratory rate, 22 breaths/min; and blood pressure, 115/60 mm Hg. His blood glucose level was 966 mg/dL, HbA1c 13.4%, and serum osmolality 324 mOsm/kg. Serum ketones were 15 mg/dL and blood gas analysis was normal. He was diagnosed with hyperglycemic hyperosmolar state (HHS) and infusion of insulin and saline was subsequently initiated. With clinical suspicion of chronic pancreatitis given the patient’s history of PHPT, serum lipase was checked, 105 U/L (NV: 12-53 U/L). Ionized calcium was 1.36 mmol/L. On CT scan of abdomen, there was no evidence of duct dilatation and calcification, and instead, “features of diffuse fatty atrophy of the pancreas” were seen. His endogenous insulin secretory capacity was sufficient (serum C-peptide: 2.76 ng/mL, NV: 0.78-5.19 ng/mL). Eventually, the patient’s level of consciousness improved and glycemic control was achieved. Soon after, insulin was shifted to basal-bolus regimen. On the 7th day of hospitalization, patient was discharged with minimal insulin requirements. Two weeks later, on follow up, his blood glucose levels were found to be stable. It was not clear whether our patient had new-onset autoimmune or type 2 diabetes. Although autoimmune diabetes generally occurs when about 90% of the pancreatic beta cells have been destroyed, the patient could have been in the honeymoon period wherein beta cell activity was transiently regained after commencement of insulin therapy. Our plan is to monitor his C-peptide titers and test his insulin antibodies. Evidence suggests that PHPT may cause insulin resistance and glucose intolerance. The rise in free intracellular calcium may reduce glucose transport in insulin-stimulated glucose transporters, increasing the need for insulin. This could be the case in our patient hence we diagnosed him with type 2 diabetes. To the best of our knowledge, this is the first case demonstrating the co-occurrence of HHS and PHPT. Presentation: Thursday, June 15, 2023

Body mass index and partial remission in 119 children with type 1 diabetes-a 6-year observational study.

This long-term study aimed to analyze the associations between BMI Z-score, HbA1c, and daily insulin requirement (DIR) and the prevalence and duration of partial remission (PR) in children and adolescents with type 1 diabetes (T1D). After retrieving retrospective data for 195 patients from their health records at 24, 48, and 72 months after T1D diagnosis, the study group was comprised of 119 (57 girls) children with a complete dataset for all 6 years. PR was defined according to the ISPAD guidelines. Analyses were carried out in the whole group and subgroups according to PR duration: no PR at all (NPR), PR lasting less than 2 years (PR < 2), and PR at least 2 years (PR ≥ 2). PR was observed in 63% of the patients (78.9% of overweight and 100% of obese patients). NPR patients showed the lowest mean initial BMI Z-score [-0.65 ± 1.29 vs. 0.02 ± 1.42, (PR < 2), p = 0.01 and vs. 0.64 ± 1.43 (PR ≥ 2), p = 0.17]. The dissimilarity in BMI across patients declined over time. Within the NPR group, the initial mean BMI Z-score significantly increased within the first 2 years (unadjusted p < 0.001) and remained constant afterward. In the PR <2 group, the highest increase in BMI Z-score occurred after 4 years (p < 0.001) and then decreased (p = 0.04). In the PR ≥2, the BMI Z-score slightly decreased within the first 2 years (p = 0.02), then increased (p = 0.03) and remained unchanged for the last 2 years. Six years after T1D started, the mean DIRs do not differ among the patient groups (ANOVA p = 0.272). During 6 years of follow-up, PR occurred in almost two-thirds of the studied children including almost all overweight and obese children. We observed a gradual normalization of the BMI Z-score at the end of the follow-up. BMI Z-score increased slightly in children with no remission initially but remained later constant until the end of observation. In both remitter groups, the increase in BMI Z-score appeared later when the protective honeymoon period ended. Regardless of BMI Z-score, the β-cell destruction process progresses, and after 6 years, the DIR is similar for all patients.

Can Classical Athens Offer Lessons for a Large, Pluralistic Society?

Abstract Recoiling from the power that Athenian democracy placed in the hands of the poor, the founding fathers of the United States took Athens as primarily an anti-model, whereas nineteenth-century defenders of slavery found Athens a very congenial model indeed, seeming as it did to lend a mantle of legitimacy to an unspeakable practice. After a “honeymoon period” in which democracy was idealized as the only legitimate form of government, now at the outset of the twenty-first century the alliance of democracy with a capitalism that often proves heartless to the less fortunate has raised some troubling questions about democracy itself. Despite its small size, classical Athens offers valuable guidance for tempering current difficulties in both the United States and elsewhere by adopting and adapting the selection of some officials by sortition, direct election by popular vote of elected officials, a rigorous system of accountability, and the fostering of civic and community values.

The development of arable cultivation in the south-east of England and its relationship with vegetation cover: A honeymoon period for biodiversity?

The onset of prehistoric farming brought unprecedented changes to landscapes and their biodiversity. Past biodiversity patterns are broadly understood for different parts of Europe, and demonstrate trajectories that have been linked to prehistoric and historic demographic transitions, and associated land-use practices. To our knowledge, this paper is the first attempt to directly link evidence of agricultural practice from the archaeological record to biodiversity patterns. Records of fossil pollen are used to estimate plant and landscape diversity patterns, and novel approaches are employed to analyse 1194 harmonised archaeobotanical samples (plant macrofossil remains) spanning the prehistoric and Roman periods, from southern England. We demonstrate changes in the use of crops and gathered edible plants and non-linear trends in cultivation practices. Whilst, overall, cereal production is characterised by ever larger and extensive regimes, different trajectories are evident for most of early prehistory, the Middle Iron Age and the Late Roman period. Comparisons with the Shannon diversity of fossil pollen records from the same region suggest a positive relationship between developing agricultural regimes and landscape scale biodiversity during the prehistoric period. The Roman period represents a tipping point in the relationship between expanding agriculture and pollen diversity, with declining pollen diversity evident in the records from the region.

The graduate nurse experience: A New Zealand perspective

Introduction: The move from senior student to novice/advanced beginner registered nurse has been noted to be a stressful period. This longitudinal study follows the experiences of five cohorts of graduate New Zealand registered nurses throughout their first year of practice (n = 530). Methods: Data were collected via self-report survey using the Casey-Fink Graduate Nurse Experience Survey© at three points throughout the first year of practice. Results: Exploratory factor analysis (EFA) resulted in a 5-factor solution for 24 items from section two of the survey: professional support, professional role, professional concerns, professional communication and personal stress. Most respondents (93%) were female, New Zealand Europeans (80%) working in either surgical or medical clinical areas. Professional support from preceptors and exposure to positive role models contributed to a sense of being supported for 81% of the respondents. Satisfaction with choosing the professional role of nursing remained constant with over 90% agreeing or strongly agreeing they had made the right career choice. Across time, respondents reported few professional concerns and few concerns about professional communication. Concerns about personal stress were consistent, with 50% reporting stress related to issues such as finances, childcare and job performance. Conclusion: Contrary to other research, a honeymoon period was not evident (other than the initial high satisfaction with salary), rather the nurses’ satisfaction with nursing remained high throughout the year.

Recovery of intracellular glucose uptake in T cells during partial remission of type 1 diabetes.

Notwithstanding the irreversible beta cell failure seen in type 1 diabetes, some individuals may experience a special phase named 'partial remission' or 'the honeymoon period', in which there is a transient recovery of beta cell function. Importantly, this stage of partial remission shows spontaneous immune downregulation, although the exact mechanisms are unclear. Intracellular energy metabolism is crucial for the differentiation and function of T cells, and provides promising targets for immunometabolic intervention strategies, but its role during partial remission is unknown. In this study, we aim to investigate the association between T cell intracellular glucose and fatty acid metabolism and the partial remission phase. This is a cross-sectional study with a follow-up component. Intracellular uptake of glucose and fatty acids by T cells was detected in participants with either new-onset type 1 diabetes or type 1 diabetes that was already in partial remission, and compared with heathy individuals and participants with type 2 diabetes. Subsequently, the participants with new-onset type 1 diabetes were followed up to determine whether they experienced a partial remission (remitters) or not (non-remitters). The trajectory of changes in T cell glucose metabolism was observed in remitters and non-remitters. Expression of programmed cell death-1 (PD-1) was also analysed to investigate possible mechanisms driving altered glucose metabolism. Partial remission was defined when patients had convalescent fasting or 2 h postprandial C-peptide >300 pmol/l after insulin treatment. Compared with participants with new-onset type 1 diabetes, intracellular glucose uptake by T cells decreased significantly in individuals with partial remission. The trajectory of these changes during follow-up showed that intracelluar glucose uptake in T cells fluctuated during different disease stages, with a decreased uptake during partial remission that rebounded after remission. This dynamic in T cell glucose uptake was only detected in remitters and not in non-remitters. Further analysis demonstrated that changes of intracellular glucose uptake were found in subsets of CD4+ and CD8+ T cells, including Th17, Th1, CD8+ naive T cells (Tn) and CD8+ terminally differentiated effector memory T cells (Temra). Moreover, glucose uptake in CD8+ T cells was negatively related to PD-1 expression. The intracellular metabolism of fatty acids was not found to be different between new-onset participants and those in partial remission. Intracellular glucose uptake in T cells was specifically decreased during partial remission in type 1 diabetes and may be related to PD-1 upregulation, which may be involved in the down-modulation of immune responses during partial remission. This study suggests that altered immune metabolism could be a target for interventions at the point of diagnosis of type 1 diabetes.

The Early Treatment Phase in Parkinson's Disease: Not a Honeymoon for All, Not a Honeymoon at All?

The discovery of levodopa in the late 60 s of twentieth century was a 'golden moment' for people with Parkinson's disease (PD). Unfortunately, clinical experience showed that some symptoms escaped from symptomatic control, and long-term complications developed. Back then, neurologists coined the term "honeymoon period" for the early phase of uncomplicated response to levodopa, and it continues to be used in scientific literature. However, medical terms are no longer restricted to professionals, and few people with PD relate to the notion of a "honeymoon". We examine the reasons why this term, once helpful, but inaccurate and inappropriate, should be abandoned.

Idiopathic remitting type 1 diabetes: a case report

AbstractWe describe a case of diabetes remission in a 17‐year‐old male initially diagnosed and treated as having type 1 diabetes, who has since stopped insulin and remained off all diabetes treatments since December 2017.This individual, a Caucasian male, presented aged 17 years with symptoms of polyuria and polydipsia in 2015. His BMI was 23kg/m2. Type 1 diabetes was diagnosed based on a formal laboratory glucose of 32.7mmol/L and an HbA1c of 86mmol/mol (10%). Blood ketones were 2.4mmol/L with a normal venous blood gas and a bicarbonate of 27nmol/L. A positive family history of type 1 diabetes in a maternal aunt was noted.The insulin requirements consistently fell from 21 months post‐diagnosis, with persistent normal range HbA1c (30mmol/mol, 4.9%). At 28 months, insulin was stopped due to increasing frequency of hypoglycaemic events. Initially, a honeymoon period was suspected; however, he has remained off all treatment, for almost five years.To our knowledge this is the first case report meeting the diagnostic criteria for idiopathic remitting diabetes first published in 2014. Further reports of individuals meeting these criteria are essential to provide information about the natural history of idiopathic remitting diabetes and answer questions about rates of relapse and possible underlying aetiology. Copyright © 2023 John Wiley &amp; Sons.

진로단절 위기를 경험한 중도장애 중년 남성의 외상 후 성장에 관한 생애사연구

The purpose of this study is to discover growth factors by analyzing the process of life changes before and after trauma events through the career history of a man with walking disability who has experienced post-traumatic growth. For this purpose, the data collected through two in-depth interview were analyzed into categories of ‘dimension of life’, ‘turning point’, and ‘adaptation’ based on life-history analysis framework by Mandelbaum(1973). The results of this study are as follows: first, ‘dimension of life’ of the study participant was &lt;the wanted urethane expert&gt;, &lt;‘workholic’: honeymoon period and life of nothing but work&gt;, &lt;a lone warrior on the scene of survival&gt;, &lt;the only Sun in the sky&gt; and &lt;another ‘heart’: passion and intrepidity&gt;. Second, ‘turning point’ was &lt;the collapsed vertebra: the precarious pivot of life&gt;, &lt;missing ‘myself’: ‘swing’ between hope and despair&gt; and &lt;being in the world: What is the meaning of ‘walking disability’ like&gt;. Third, ‘adaptation’ was &lt;another ‘cane’ as support that sustains me&gt;, &lt;the factory manager that has the disabled father&gt; and &lt;also ‘myself’: the photographer carrying two canes with walking disability&gt;. This participant experienced crises by walking disability in his life as an irreplaceable talent in the automobile seat manufacture, but he got over the crisis of career interruption finding out the meaning of his life through ‘self-understanding’ by putting his ‘family’ at the center of his life, and above all, being supported by the factory manager that had the disabled father. The results showed the importance of ‘discovering the meaning of life through sufficient self-understanding and self-awareness’ for post-traumatic growth, and the importance of ‘awareness of disabled people at work’ for maintaining employment of the severely disabled. This result can provide important implications for counseling for disabilities in the mid-life and supporting for their employment promotion.

The initial survival of the Unicorns: a behavioral perspective of Snapchat

Purpose Unicorn companies, such as Facebook, Uber, and Airbnb, significantly impact our economies. This happens although they had a dramatic initial start – at least in terms of financial performance – that would have let any other “conventional” business close. In other words, Unicorns challenge the start-ups’ problems traditionally associated with early failure (liability of newness). This paper aims to understand what helps Unicorn firms initially survive despite huge losses. Design/methodology/approach By adopting a behavioral lens, this historical case study article focuses on key strategic decisions regarding the famous social media Unicorn Snapchat from 2011 to 2022. The case combines secondary data and a thematic analysis of Snapchat founders’ and investors’ interviews/comments to identify the behavioral antecedents leading to Snapchat’s honeymoon. Findings Snapchat network effect triggered cognitive biases of Snapchat founders’ and investors’ decisions, leading them to provide initial assets (i.e. beliefs/goodwill, trust, financial resources and psychological commitment) to the nascent Unicorn. Therefore, the network effect and biases resulted in significant antecedents for Snapchat’s honeymoon. Originality/value The authors propose a general, theoretical framework advancing the possible impact of biases on Unicorns’ initial survival. The authors argue that some biases of the Unicorns’ founders and investors can positively support a honeymoon period for these new ventures. This is one of the first case studies drawing on a behavioral approach in general and on biases in particular to investigate the liability of newness in the Unicorns’ context.

Birth pangs or a honeymoon from hell? The long annus horribilis for Welsh devolution, 1998–2000

ABSTRACT 2024 marks twenty-five years since the first elections to, and meeting of, the National Assembly for Wales. The Assembly had been established by the narrowest of margins at a referendum in 1997. However, supporters of devolution would have no honeymoon period. Instead, the period from Autumn 1998 to February 2000 marked what might almost be seen as a long annus horribilis for Welsh devolution. This was a period of political instability, weak leadership and partisan infighting, all of which threatened the credibility of an already vulnerable devolution project. This article outlines how this saga began with the resignation of Ron Davies as Secretary of State for Wales in 1998 and only ended when Alun Michael, Davies’s successor as Welsh Labour leader and the first First Secretary of Wales, was forced out of office. This paper uses recently released archival materials to add new detail to this story, demonstrating the extent to which the UK Government orchestrated Michael’s rise to power, the clear sense of buyer’s remorse Michael’s backers would go on to experience and the frenzied discussions that went on within Whitehall during his beleaguered tenure as First Secretary.

A framework for long-lasting, slowly varying transient dynamics.

Much of the focus of applied dynamical systems is on asymptotic dynamics such as equilibria and periodic solutions. However, in many systems there are transient phenomena, such as temporary population collapses and the honeymoon period after the start of mass vaccination, that can last for a very long time and play an important role in ecological and epidemiological applications. In previous work we defined transient centers which are points in state space that give rise to arbitrarily long and arbitrarily slow transient dynamics. Here we present the mathematical properties of transient centers and provide further insight into these special points. We show that under certain conditions, the entire forward and backward trajectory of a transient center, as well as all its limit points must also be transient centers. We also derive conditions that can be used to verify which points are transient centers and whether those are reachable transient centers. Finally we present examples to demonstrate the utility of the theory, including applications to predatory-prey systems and disease transmission models, and show that the long transience noted in these models are generated by transient centers.