Dynamic associations between glucose and ecological momentary cognition in Type 1 Diabetes

Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations prevented researchers from understanding how naturally-occurring glucose fluctuations impact cognitive fluctuations. This study leveraged advances in continuous glucose monitoring (CGM) and cognitive ecological momentary assessment (EMA) to characterize dynamic, within-person associations between glucose and cognition in naturalistic environments. Using CGM and EMA, we obtained intensive longitudinal measurements of glucose and cognition (processing speed, sustained attention) in 200 adults with T1D. First, we used hierarchical Bayesian modeling to estimate dynamic, within-person associations between glucose and cognition. Consistent with laboratory studies, we hypothesized that cognitive performance would be reduced at low and high glucose, reflecting cognitive vulnerability to glucose fluctuations. Second, we used data-driven lasso regression to identify clinical characteristics that predicted individual differences in cognitive vulnerability to glucose fluctuations. Large glucose fluctuations were associated with slower and less accurate processing speed, although slight glucose elevations (relative to person-level means) were associated with faster processing speed. Glucose fluctuations were not related to sustained attention. Seven clinical characteristics predicted individual differences in cognitive vulnerability to glucose fluctuations: age, time in hypoglycemia, lifetime severe hypoglycemic events, microvascular complications, glucose variability, fatigue, and neck circumference. Results establish the impact of glucose on processing speed in naturalistic environments, suggest that minimizing glucose fluctuations is important for optimizing processing speed, and identify several clinical characteristics that may exacerbate cognitive vulnerability to glucose fluctuations.

Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

BACKGROUND

Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months.

METHODS

We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed.

RESULTS

We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05).

CONCLUSION

While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.

Opportunities to increase the attractiveness of the German Public Health Service as an employer

 

For decades, the public health service in Germany (PHS) experienced shortages of young professionals and challenges in recruiting qualified personnel. To sustainably counteract this challenge, it is necessary to understand the reasons of the perceived low attractiveness of PHS as a potential employer among students and young professionals. Two cross-sectional online surveys were conducted to assess the attitudes of medical, public health, and health science students towards the PHS as a potential employer. Wave 1, conducted from 2019-12 to 2020-04, focused on factors associated with high and with low interest in working for the PHS. Wave 2 was conducted from 2020-06 to 2020-09 to capture changes that may have resulted from the newfound attention of the PHS during the SARS-CoV-2 pandemic. Participants in both waves were asked about opportunities to increase the attractiveness of the PHS, which were analyzed using qualitative content analysis. In total 3040 students participated. Low interest in the PHS was associated with limited knowledge about public health, primary interest in clinical medicine, and a negative image of the public service. The qualitative analysis indicated as major obstacles: low visibility of and low awareness about the PHS, a perception of hierarchical and bureaucratic workplaces, and perceptions of repetitive occupations, among others. The participants suggested: improving awareness about the PHS in the population, including PHS in curriculum, and reducing entry barriers for non-medical students. The results of the largest survey of students on the attractiveness of the ÖGD in Germany provide valuable insights for ongoing reform processes. In addition to approaches to increase external visibility, existing processes and procedures within the ÖGD should be considered.

Key messages

• To counteract the shortage of skilled workers, the PHS must become more attractive to young professionals. This requires both, greater external visibility and modernization of internal structures.

• Successful inclusion of the perspective of young professionals in the current modernization processes introduces opportunities to increase the attractiveness of the PHS in the long-term.

Global health from home - results from a German student-led online lecture series during COVID-19

Background

The COVID-19 pandemic calls for a skilled health workforce, yet global health is largely missing in the medical curriculum in Germany. The interdisciplinary national student “Global Health Network” therefore initiated an online lecture series. “Global Health - perspectives, opportunities and challenges” included 14 lectures on a range of topics held by German and international academics from October 2020 to January 2021.

Methods

Evaluations were performed prior to, at midterm and after the series, including 5-point likert scales and open questions. Using quantitative and qualitative approaches, participants' motivation and learning outcomes of global health education were analysed.

Results

A total of 1393 students registered for the series. Individual lectures attracted on average 400 participants, mainly female medical students between 20-25 years, but also a variety of ages, genders and disciplines. Main reasons for participation included interest in COVID-19-related developments, learning about global health-specific topics, and professional development. More than 40% of participants reported to know little about global health before attending; after the lecture series, only 10% made this statement. In addition, 90% of participants perceived an increase of motivation to learn more about the topics, while about 40% gained motivation to become practically involved in the field. The lecture series was accredited in the curriculum at some universities, thus innovating the curriculum and enabling formal credits.

Conclusions

The new model of student-led online teaching proved to be feasible and demonstrated students' interest and positive impact on global health knowledge. Further institutional change and inclusion of global health in the curricula have to follow.

Key messages

Students need global health education to respond to global health-related challenges. Volunteer student-led initiatives can increase knowledge and interest and be an important driver for change towards improving global health education.

Fast-ion Dα spectroscopy diagnostic at KSTAR

A fast-ion Dα (FIDA) diagnostics system was installed for core and edge measurements on KSTAR. This system has two tangential FIDA arrays that cover both blue- and redshifted Dα lines (cold: 656.09 nm) in active views along the neutral beam 1 A centerline. The spectral band is 647-662.5 nm, and it covers the Doppler shift of the emission from the maximum energy of the neutral beam (100 keV). A curved filter strip with a motorized stage adequately prevents saturation of the electron multiplying charge-coupled device signal by the cold Dα line from the plasma edge. From comparisons of the measured spectra and FIDASIM modeling code, the FIDA spectra are well matched quantitatively. Moreover, the first measurements show that the FIDA radiance agrees with the neutron rate in the time trace during external heating and perturbation. In addition, responses are observed in the core FIDA radiance during the edge-localized mode cycle.