The rising prevalence of metabolic disorders underscores the need for dietary strategies to manage postprandial glucose levels and blood pressure. Protein has been widely recognized for its health benefits, to promote satiety and improve postprandial glucose control (1). Studies have shown that whey protein can significantly lower postprandial glucose and insulin levels in both healthy and diabetic individuals, with greater effectiveness when consumed as a starter before meals (2). However, a recent prospective cohort study indicated that while animal protein consumption may be linked to a higher risk of diabetes onset, incorporating plant-based proteins is advisable. This highlights the need to diversify protein sources in the diet to manage metabolic health and potentially reduce diabetes risk (3).

Therefore, the aim of the current study was to determine whether consuming pea protein isolate before a carbohydrate meal could effectively reduce postprandial glucose levels and blood pressure compared to the simultaneous consumption of protein and carbohydrates.

We examined pea protein isolate as a representative plant-based food source, known for its high protein content and accessibility. Ten healthy adults (2 male and 8 females; mean age: 25.6 ± 1 years; body mass index (BMI): 22.7 ± 1 kg/m2) participated in a crossover trial with three conditions, to consume 30g of pea protein isolate 30 min before (PrePP) or with (PP) a 50g carbohydrate meal, against a carbohydrate meal (control, CHO) provided with water. Continuous glucose monitoring and blood pressure were recorded over 180 minutes after the meal. The effect of the interventions on peak postprandial glucose responses and blood pressure were evaluated using a two-factor repeated measures ANOVA. Comparisons were made using Bonferroni’s test whenever a significant difference was observed. All statistical analyses were performed using GraphPad Prism with a statistical difference of p <0.05 considered as significant.

PrePP significantly delayed and reduced the postprandial glucose peak compared to PP and CHO (0.46 mmol/L at 60 min vs. 1.125 mmol/L for PP, p<0.05 and 1.89 mmol/L for CHO at 30 min, p<0.01). Diastolic blood pressure significantly decreased after both protein drinks compared to CHO, especially between 150 and 180 minutes (9.2 mmHg for PP and 4.2 mmHg for PrePP), while the control showed an increase of 1.6 mmHg from baseline (p < 0.05). Although systolic blood pressure also decreased in PP and PrePP, with reductions of 3.7 and 5.8 mmHg respectively, this change was not significant compared to the control, which decreased by 2 mmHg (p> 0.05).

This study indicates that pea protein preload can effectively reduce postprandial blood glucose levels and may also assist in managing blood pressure, offering a plant-based option for improving metabolic health. Further research is needed to better understand the mechanisms underlying these findings.

Accurate redshift measurements are essential for studying the evolution of quasi-stellar objects (QSOs) and their role in cosmic structure formation. While spectroscopic redshifts provide high precision, they are impractical for the vast number of sources detected in large-scale surveys. Photometric redshifts, derived from broadband fluxes, offer an efficient alternative, particularly when combined with machine learning techniques. In this work, we develop and evaluate a neural network model for predicting the redshifts of QSOs in the Dark Energy Spectroscopic Instrument (DESI) Early Data Release spectroscopic catalogue, using photometry from DESI, the Widefield Infrared Survey Explorer (WISE) and the Galactic Evolution Explorer (GALEX).We compare the performance of the neural network model against a k-Nearest Neighbours approach, these being the most accurate and least resource-intensive of the methods trialled herein, optimising model parameters and assessing accuracy with standard statistical metrics. Our results show that incorporating ultraviolet photometry from GALEX improves photometric redshift estimates, reducing scatter and catastrophic outliers compared to models trained only on near infrared and optical bands. The neural network achieves a correlation coefficient with spectroscopic redshift of 0.9187 with normalised median absolute deviation of 0.197, representing a significant improvement over other methods. Our work combines DESI, WISE and GALEX measurements, providing robust predictions which address the difficulties in predicting photometric redshift of QSOs over a large redshift range.

A wrist-hand exoskeleton designed to assist individuals with wrist and hand limitations is presented in this paper. The novel design is developed based on specific selection criteria, addressing all the Degrees of Freedom (DOF). In the conceptual design phase, design concepts are created and assessed before being screened and scored to determine which concept is the most promising. Performance and possible restrictions are assessed using kinematic and dynamic analysis. Using polylactic acid material, the exoskeleton is prototyped to ensure structural integrity and fit. Manual control, master-slave control, and electroencephalography (EEG) dataset-based control are among the control strategies that have been investigated. Direct manipulation is possible with manual control, nevertheless, master-slave control uses sensors to map user motions. Brain signals for hand opening and closing are interpreted by EEG dataset-based control, which manages the hand open-close of the exoskeleton. This study introduces a novel wrist-hand exoskeleton that improves usefulness, modularity, and mobility. While the numerous control techniques give versatility based on user requirements, the 3D printing process assures personalization and flexibility in design.

Poor iron status is one of the most prevalent problems facing infants worldwide, in both developing and developed countries(1). A complex interplay of both dietary and non-dietary factors affects iron intake, absorption, and requirements, and subsequently iron status(2). We aimed to describe iron status in an ethnically diverse cohort of urban-dwelling infants. Data were collected from 364 infants aged 7.0 to 10.0 months living in two main urban centres in New Zealand (Auckland and Dunedin) between July 2020 and February 2022. Participants were grouped by total ethnicity, with any participants who did not identify as either Māori or Pacific categorised into a single ‘others’ group. Haemoglobin, plasma ferritin, soluble transferrin receptor (sTfR), C-Reactive protein, and alpha-1-acid-glycoprotein were obtained from a non-fasting venous blood sample. Inflammation was adjusted for using the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anaemia (BRINDA) method(3). Body iron concentration (mg/kg body weight) was calculated using the ratio of sTfR and ferritin. A total of 96.3% of Pacific infants were iron sufficient, defined as body iron ≥0 mg/kg body weight and haemoglobin (Hb) ≥105 g/L, compared to 82.3% of Māori and 76.0% of ‘other’ (i.e. neither Māori nor Pacific) infants. ‘Other’ infants had the highest prevalence of iron deficiency overall, with 2.8% categorised with iron-deficiency anaemia (IDA) (body iron <0 mg/kg, haemoglobin <105 g/L), 11.8% with early ‘functional’ iron deficiency (body iron <0 mg/kg, haemoglobin ≥105 g/L), and 9.4% with iron depletion (ferritin <15 µg/L, in the absence of early ‘functional’ iron deficiency and iron deficiency anaemia). For Māori infants, 3.2% and 6.5% had IDA and early ‘functional’ iron deficiency respectively, and 8.1% were iron depleted. One (3.7%) Pacific infant was iron depleted, and the remainder were iron sufficient. Plasma ferritin and body iron concentration were, on average, higher in Pacific compared to non-Pacific infants. These findings give an up-to-date and robust understanding of the iron status of infants by ethnicity, highlighting an unexpected finding that infants who are neither Māori nor Pacific may be at higher risk of poor iron status in NZ.

‘I just don’t know what to eat!’ is a frequent statement from people seeking nutrition support. With a magnitude of information available, confusion and limited confidence is a common complaint. People face myriad challenges in their attempts to have a healthy diet, including cost and time constraints, challenging food environments, and limited knowledge and skills(1). Challenges about eating well are often raised, yet enablers to eating well are not as readily discussed. Intention for healthy behaviours, self-efficacy and social support are examples of favourable elements which support healthy diets(1,2). As such, existing knowledge, skills, and positive influences should also be considered. As part of a wider qualitative study, and using an interpretive description approach, we sought to identify enablers to healthy eating perceived by people engaged with Green Prescription (GRx) and Active Families programmes. Nineteen clients aged 18 years and over, engaged with six GRx services were interviewed between May and October 2023. Eighteen whānau (family) members, (19-53 years) attending Active Families sessions facilitated in the Waitematā area participated in focus group discussions during May-August 2024. Participants were asked in these discussions (kōrero) to share what helps them and their whānau to eat well. Braun and Clarke’s(3) thematic analysis approach was used to analyse responses from these kōrero through data familiarisation, coding, and cyclical review of thematic relationships. Several themes were identified in this analysis: ‘confidence in personal skills,’ ‘supportive environments’, and ‘being open and willing’. Personal skills such as planning meals, managing household budget and efforts to procure ‘good’ food were identified as strengths. These wider food skills have been suggested as potentially more important to enhancing dietary behaviours than cooking skills(4). Participants relayed experiences of developing skills that improved their confidence in eating well including growing, gathering and preserving food, experimenting with recipes, and knowing where to find affordable, nutritious food. Environments where people learned food and cooking skills and household members supported their endeavours to eat well were described as influential to encourage people in their efforts. Participants also expressed that being open to trying new foods and ways of eating led to inspiration and new knowledge. This attitude resulted in increased variety in the diet and further enhanced confidence to seek recipes and food information and spurred on efforts to make changes. People who have sought nutrition advice have often expressed challenges and uncertainty impacting their efforts to eat well. Nevertheless, there are also strengths which have meaningful impact on their eating. In nutrition advice provision, it would be beneficial to thoroughly explore the strengths people exhibit to support healthy eating. Identifying these insights may powerfully effect people’s confidence to eat well and identify more effective support and information provision.

Outbreaks of Rachiplusia nu have occurred on soybean in Brazil as the first species resistant to the Bt soybean expressing only Cry1Ac protein, triggering a significant increase in insecticide use on the crop. This threatens one of the most important benefits of adopting Bt soybean cultivars – the reduction of chemicals. Therefore, this research studied the biology and parasitism capacity of Trichogramma pretiosum at 20, 25, and 30 ± 2 °C on R. nu eggs in order to evaluate the potential of releasing this egg parasitoid in soybean to manage R. nu. Parasitoid exhibited high biological performance on the R. nu eggs as observed in the lifetime parasitism of 24.9, 46.4, and 34.4 R. nu eggs at 20, 25, and 30 °C, respectively, and 100% emergence in both biology and parasitism capacity experiments. The sex ratio was statistically lower at 20 °C (0.4947), but at all studied temperatures, the production of female descendants was equal (sex ratio of 0.4947 at 20 °C) or higher (sex ratio of 0.6666 at 25 °C and 0.6524 at 30 °C). All other evaluated parameters were similar to previously positive recorded observations for T. pretiosum on other soybean pests, such as Anticarsia gemmatalis and Chrysodeixis includens, against which the parasitoid has already been commercially released in the fields as a biocontrol option. Therefore, T. pretiosum might also be released in soybean as an egg parasitoid against R. nu, what needs to be confirmed in future field trials.

During nematode surveys conducted to investigate the biodiversity of plant-parasitic nematodes in Mediterranean olive groves with different management strategies (organic and conventional), a nematode population of the genus Neothada was detected in southern Spain. Application of integrative taxonomical approaches clearly demonstrated that it is a new species described herein as Neothada olearum sp. nov., also representing the first report of the genus in Spain. The new species is amphimictic, characterised by a short body (563–774 μm); cuticle widely annulated (2.5–3.0 μm); total number of body annuli 214–226; 16 longitudinal ridges giving a tessellate body surface; stylet without distinct basal knobs (9.0–11.0 μm); and tail elongate-conoid, with tip bluntly rounded. The results of molecular analysis of D2-D3 28S rRNA, ITS rRNA, partial 18S rRNA, and cytochrome oxidase c subunit 1 (COI) gene sequences support for the new species status and clearly separated from N. major and other species within Neothada. Phylogenetic analyses of ribosomal and mitochondrial markers of this study suggested that Neothada is a monophyletic genus, clearly separated from Thada.

Background: While efgartigimod usage is expected to reduce immunoglobulin (IG) utilization, evidence in clinical practice is limited. Methods: In this retrospective cohort study, patients with gMG treated with efgartigimod for ≥1-year were identified from US medical/pharmacy claims data (April 2016-January 2024) and data from the My VYVGART Path patient support program (PSP). The number of IG courses during 1-year before and after efgartigimod initiation (index date) were evaluated. Patients with ≥6 annual IG courses were considered chronic IG users. Myasthenia Gravis Activities of Daily Living (MG-ADL) scores before and after index were obtained from the PSP where available. Descriptive statistics were used without adjustment for covariates. Results: 167 patients with ≥1 IG claim before index were included. Prior to efgartigimod initiation, the majority of patients (62%) received IG chronically. During the 1-year after index, the number of IG courses fell by 95% (pre: 1531, post: 75). 89% (n=149/167) of patients fully discontinued IG usage. Mean (SD) best-follow up MG-ADL scores were significantly reduced after index (8.0 [4.1] to 2.8 [2.1], P<0.05, n=73/167, 44%). Conclusions: Based on US claims, IG utilization was substantially reduced among patients who continued efgartigimod for ≥1-year, with patients demonstrating a favorable MG-ADL response.

Background: TERT promoter mutation (TPM) is an established biomarker in meningiomas associated with aberrant TERT expression and reduced progression-free survival (PFS). TERT expression, however, has also been observed even in tumours with wildtype TERT promoters (TP-WT). This study aimed to examine TERT expression and clinical outcomes in meningiomas. Methods: TERT expression, TPM status, and TERT promoter methylation of a multi-institutional cohort of meningiomas (n=1241) was assessed through nulk RNA sequencing (n=604), Sanger sequencing of the promoter (n=1095), and methylation profiling (n=1218). 380 Toronto meningiomas were used for discovery, and 861 external institution samples were compiled as a validation cohort. Results: Both TPMs and TERTpromoter methylation were associated with increased TERT expression and may represent independent mechanisms of TERT reactivation. TERT expression was detected in 30.4% of meningiomas that lacked TPMs, was associated with higher WHO grades, and corresponded to shorter PFS, independent of grade and even among TP-WT tumours. TERT expression was associated with a shorter PFS equivalent to those of TERT-negative meningiomas of one higher grade. Conclusions: Our findings highlight the prognostic significance of TERT expression in meningiomas, even in the absence of TPMs. Its presence may identify patients who may progress earlier and should be considered in risk stratification models.

Background: The complement C5 inhibitor (C5IT), ravulizumab, is approved in Canada for the treatment of anti-acetylcholine receptor antibody-positive (AChR-Ab+) generalized myasthenia gravis (gMG). Updated effectiveness and safety results from the ongoing MG SPOTLIGHT Registry (NCT04202341) are reported. Methods: MGFA classification and MG-ADL total scores were assessed in patients who received ravulizumab only (ravu-only) or transitioned from eculizumab to ravulizumab (ecu-to-ravu), with data available prior to C5IT initiation (“pre-C5IT”) and ≥1 assessment post-initiation (“post-ravu”). Results: Of 52 patients with 2 post-ravu assessments, average treatment duration was 10.4 months at last assessment (LA). Mean±SD MG-ADL scores improved (pre-C5IT: 7.6±3.6; LA: 3.4±3.3), as did the proportions of patients with minimal symptom expression (MSE, MG-ADL≤1) (pre-C5IT: 1/52 [2%]; LA: 17/52 [33%]) and MGFA classification 0-II (pre-C5IT: 18/45 [40%]; LA: 40/45 [89%]). In the ravu-only subgroup, outcomes improved (pre-C5IT vs LA): MG-ADL, 6.3±3.0 vs 4.0±3.4; MGFA 0-II, 9/14 [64%] vs 12/14 [86%]. The ecu-to-ravu subgroup sustained continued gradual improvement from last eculizumab assessment to LA: MG-ADL, 4.4±4.2 vs 3.0±2.8; MGFA 0-II, 19/21 [90%] vs 20/21 [95%]. Ravulizumab was well tolerated; no meningococcal infections were reported. Conclusions: These results demonstrate the long-term effectiveness and safety of ravulizumab in routine clinical practice in patients with gMG.

Background: The WHO grade of meningioma was updated in 2021 to include homozygous deletions of CDKN2A/B and TERT promotor mutations. Previous work including the recent cIMPACT-NOW statement have discussed the potential value of including chromosomal copy number alterations to help refine the current grading system. Methods: Chromosomal copy number profiles were inferred from from 1964 meningiomas using DNA methylation. Regularized Cox regresssion was used to identify CNAs independenly associated with post-surgical and post-RT PFS. Outcomes were stratified by WHO grade and novel CNAs to assess their potential value in WHO critiera. Results: Patients with WHO grade 1 tumours and chromosome 1p loss had similar outcomes to those with WHO grade 2 tumours (median PFS 5.83 [95% CI 4.36-Inf] vs 4.48 [4.09-5.18] years). Those with chromosome 1p loss and 1q gain had similar outcomes to those with WHO grade 3 cases regardless of initial grade (median PFS 2.23 [1.28-Inf] years WHO grade 1, 1.90 [1.23-2.25] years WHO grade 2, compared to 2.27 [1.68-3.05] years in WHO grade 3 cases overall). Conclusions: We advocate for chromosome 1p loss being added as a criterion for a CNS WHO grade of 2 meningioma and addition of 1q gain as a criterion for a CNS WHO grade of 3.

Background: Canadian neurosurgery residency programs have an alarming 28.4% attrition rate—seven times higher than the average for most other specialties (1–4%) and double that of US neurosurgery programs. Canadian data for this issue is over 30 years old, highlighting the need for updated research. This study identifies factors contributing to Canadian neurosurgery attrition rates. Methods: Using critical constructivist theory, virtual interviews were conducted with current program directors (PDs) from Canada’s 14 neurosurgery programs and neurosurgery residents who left training between 2013–2023. Interviews were recorded, transcribed, anonymized, and iteratively coded through descriptive thematic analysis to construct an analytical framework. Results: We conducted interviews with 7 PDs and 7 former neurosurgery residents, representing 7 neurosurgery programs across Canada. The average attrition rate was 14.11% (0%–28.6%) from 2013–2023. Contributing factors include poor job prospects in Canada, resource constraints leading to high workloads, poor work-life balance, moral distress due to high levels of patient mortality, and a lack of teaching and support from staff and senior residents. Conclusions: Neurosurgery residents are the future of neurosurgery. Our study uncovers factors contributing to high attrition rates in neurosurgery training, indicating that change must come from provincial governments and within training programs to retain residents.

Background: Trigeminal neuralgia (TN) is more common in multiple sclerosis (MS) patients than in the general population, likely due to demyelination impacting the trigeminal pathways. While brainstem lesions are associated with MS-TN, their precise role remains unclear. Methods: This study investigates the relationship between brainstem MS plaque location, TN symptoms, and treatment response. We retrospectively analyzed brain MRIs of MS-TN patients, segmenting and coregistering brainstem plaques in MNI space. A tractographic atlas of the trigeminal system was generated using high-resolution diffusion imaging from 30 patients. Lesion involvement was determined by intersection with the trigeminal tract, and its association with pain intensity and treatment outcomes was analyzed using linear regression. Results: Our research revealed 83% of MS-TN patients had brainstem lesions near the fourth ventricle. No single lesion hot spot was identified. Lesion volume did not predict symptom recurrence or treatment response. However, 97% of lesions intersected the trigeminal tract, supporting its association with TN symptoms. Conclusions: The strong overlap between lesions and the trigeminal tract suggests a potential pain generator in MS-TN. Further research is needed to determine whether similar lesions exist in asymptomatic MS patients and to confirm this hypothesis. Future studies will explore whether tract involvement better predicts clinical response to treatment.

Background: Neck vessel imaging is often performed in hyperacute stroke to allow neurointerventionalists to estimate access complexity. This study aimed to assess clinician agreement on catheterization strategies based on imaging in these scenarios. Methods: An electronic portfolio of 60 patients with acute ischemic stroke was sent to 53 clinicians. Respondents were asked: (1) the difficulty of catheterization through femoral access with a regular Vertebral catheter, (2) whether to use a Simmons or reverse-curve catheter initially, and (3) whether to consider an alternative access site. Agreement was assessed using Fleiss’ Kappa statistics. Results: Twenty-two respondents (7 neurologists, 15 neuroradiologists) completed the survey. Overall there was slight interrater agreement (κ=0.17, 95% CI: 0.10–0.25). Clinicians with >50 cases annually had better agreement (κ=0.22) for all questions than those with fewer cases (κ=0.07). Agreement did not significantly differ by imaging modality: CTA (κ=0.18) and MRA (κ=0.14). In 40/59 cases (67.80%), at least 25% of clinicians disagreed on whether to use a Simmons or reverse-curve catheter initially. Conclusions: Agreement on catheterization strategies remains fair at best. Our results suggest that visual assessment of pre-procedural vessels imaging is not reliable for the estimation of endovascular access complexity.

Background: Adverse effects and risks associated with glucocorticoid (GC) treatment are frequently encountered in immune-mediated neuromuscular disorders. However, significant variability exists in the management of these complications. Our aim was to establish international consensus guidance on the management of GC-related complications in neuromuscular disorders. Methods: An international task force of 15 experts was assembled to develop clinical recommendations for managing GC-related complications in neuromuscular patients. The RAND/UCLA Appropriateness Method (RAM) was employed to formulate consensus guidance statements. Initial statements were drafted following a comprehensive literature review and were refined based on anonymous expert feedback, with up to three rounds of email voting to achieve consensus. Results: Consensus was reached on statements addressing general patient care, monitoring during GC therapy, osteoporosis prevention, vaccinations, infection screening, and prophylaxis for Pneumocystis jiroveci pneumonia. A multidisciplinary approach to managing GC-related complications was highlighted as a key recommendation. Conclusions: This represents the first consensus guidance in the neurological literature on GC complications, and offer clinicians structured guidance on mitigating and managing common adverse effects associated with both short- and long-term GC use. They also provide a foundation for future debate, quality improvement, research work in this area.

Variation between general practices in the rate of consultations for musculoskeletal pain conditions may signal important differences in access to primary care, perceived usefulness, or available alternative sources of care; however, it might also just reflect differences in underlying ‘need’ between practices’ registered populations. In a study of 30 general practices in Staffordshire, we calculated the proportion of adults consulting for a musculoskeletal pain condition, then examined this in relation to selected practice and population characteristics, including the estimated prevalence of self-reported musculoskeletal problems and chronic pain in each practices’ registered population. Between September 2021 and July 2022, 18,388 adults were consulted for a musculoskeletal pain condition. After controlling for length of recruitment, time of year, and age-sex structure, the proportion consulting varied up to two-fold between practices but was not strongly associated with the prevalence of self-reported long-term musculoskeletal problems, chronic pain, and high-impact chronic pain.