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New Onset Diabetic Retinopathy with Glucagon-like Peptide-1 Receptor Agonists: A Case Report
Get PDFBackground Diabetic retinopathy (DR) is a leading cause of acquired vision loss in middle-aged adults. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are widely used in the management of type 2 diabetes (T2D). Emerging evidence has suggested a possible link between GLP-1 RAs and the acceleration of DR. However, the evidence on the association between GLP-1RA therapies and risk for DR has been mixed, and there is limited guidance on how to manage new onset or worsening DR for patients taking GLP-1RA therapy. The objective of this case report is to describe the clinical decision-making involved in the management of a patient with T2D who developed new-onset and worsening retinopathy following the initiation of several GLP-1RA therapies. Case summary A 43-year-old female with T2D and class II obesity was diagnosed with mild nonproliferative DR after taking various GLP1-RA therapy (ie, exenatide ER and dulaglutide) and maintaining glycemic control for 19 months. The patient was later transitioned to subcutaneous semaglutide for additional weight loss, and diabetic macular edema was detected in the right eye 2 months after. Due to a potentially lower risk of DR complications, treatment was promptly switched to oral semaglutide. The patient\u27s eye exam revealed that her DR improved and diabetic macular edema had significantly resolved 8 months after switching therapy. Practice implications This case highlights a progressive decline in retinal health despite well-controlled T2D and the possible contribution of GLP-1RA therapy to DR progression. Switching to GLP-1RA agents with potentially lower risk for DR, such as oral semaglutide, may be beneficial when patients develop DR on GLP1-RA therapy. Further studies that evaluate the risk of DR while using GLP-1RA therapy, as well as the risk across the GLP1-RA class, are needed. Additional guidance on managing possible new onset or worsening DR on GLP-1RA therapy is especially necessary
Symmetrically Threaded Superconducting Quantum Interference Devices as Next-Generation Kerr-Cat Qubits
No full textKerr-cat qubits are bosonic qubits offering autonomous bit-flip protection, traditionally studied using driven superconducting nonlinear asymmetric inductive element (SNAIL) oscillators. Here, we theoretically explore an alternative circuit for Kerr-cat qubits based on symmetrically threaded superconducting quantum interference devices (SQUIDs). The symmetrically threaded SQUID (STS) architecture employs a simplified flux-pumped design that suppresses two-photon dissipation, a dominant loss mechanism in high-Kerr regimes, by engineering the drive Hamiltonian’s flux operator to generate only even-order harmonics. By fulfilling two critical criteria for practical Kerr-cat qubit operation, the STS emerges as an ideal platform: (1) a static Hamiltonian with diluted Kerr nonlinearity (achieved via the STS’s middle branch) and (2) a drive Hamiltonian restricted to even harmonics, which ensures robust two-photon driving with reduced dissipation. For weak Kerr nonlinearity, we find that the coherent state lifetime (Tα) is similar between STS and SNAIL circuits. However, STS Kerr-cat qubits exhibit enhanced resistance to higher-order photon dissipation, enabling significantly extended Tα even with stronger Kerr nonlinearities (approximately 10 MHz). In contrast to SNAIL, STS Kerr-cat qubits display a Tα dip under weak twophoton driving for a high Kerr coefficient. We demonstrate that this dip can be suppressed by applying drive-dependent detuning, enabling Kerr-cat qubit operation with only eight Josephson junctions (of energies 80 GHz); fewer junctions suffice for higher junction energies. We further validate the robustness of the STS design by studying the impact of strong flux driving and asymmetric Josephson junctions on Tα. With the proposed design and considering a cat size of ten photons, we predict Tα of the order of tens of milliseconds, even in the presence of multiphoton heating and dephasing effects. The robustness of the STS Kerr-cat qubit makes it a promising component for fault-tolerant quantum processors
Institutional Liquidity Costs, Internalized Retail Trade Imbalances, and the Cross Section of Stock Returns
No full textOrder flow segmentation prevents direct interactions between U.S. retail and institutional investors. Using the imbalance in observable internalized retail trades, we show wholesalers use retail flow to provide liquidity to institutional investors, especially when liquidity is scarce. Our institutional liquidity cost () measures average absolute retail trade imbalances, positing that institutions holding stocks with greater such averages more often resort to the expensive wholesaler-provided liquidity. is correlated with expected institutional price impacts. Unlike existing illiquidity measures, has economically meaningful relations with institutional holding horizons and yields annualized liquidity premia of 2.7%–3.2% post-2010, even after excluding microcap stocks
Of Photographs, Souvenirs, and Ticket Stubs: When Do Consumers Desire Mementos During an Experience?
No full textConsumers often desire mementos of their experiential consumption, as reflected in common behaviors such as taking photos during a special event, purchasing souvenirs while on vacation, or keeping ticket stubs from a concert, but when do consumers desire mementos during an experience? This research examines the timing of the desire for mementos during an experience, and the conditions and motivations that prompt those memento timing decisions. We propose that the approaching end of an experience increases feelings of sadness and thus the desire for mementos at that time. However, for experiences that are easily repeatable, the approaching end of an experience does not increase sadness and the desire for mementos. We find support for our hypotheses across laboratory and field studies that encompass different experiences and involve consumers undergoing actual experiences. Together, these studies provide insight into the understudied question of when consumers desire mementos during an experience
Bibliography for Open Access Display
No full textA bibliography created to support a display about Open Access at the Leatherby Libraries during October 2025 at the Leatherby Libraries at Chapman University
Swollen Lymph Node Metastasis in Gastric Cancer: A Forgotten Prognostic Signal in Need of Clinical Action
Get PDFGastric cancer (GC) remains a leading cause of cancer mortality. While the extent of nodal involvement is a well-known prognostic factor, the specific entity of swollen lymph node metastasis (SLNM), bulky nodal tumor deposits detectable radiologically or pathologically, has received little attention in staging. Recent data from a study by Cui et al demonstrated that SLNM is an independent predictor of very poor survival in GC. Through robust data and rigorous propensity-matched analyses, SLNM emerged not merely as an anatomical finding but as an independent predictor of poor prognosis, even among patients undergoing curative resection. As precision oncology advances, the findings by Cui et al urge a fundamental rethinking of how SLNM is incorporated into clinical decision-making for GC management. In this editorial, we critically examine the prognostic significance of SLNM, challenge its omission from traditional staging frameworks, and advocate for its formal integration into preoperative risk stratification and treatment planning. Recognizing SLNM at diagnosis could unlock intensified neoadjuvant therapy strategies and optimize outcomes for a historically high-risk patient subgroup
Twenty Minutes of Corsi Block Tapping Task Training Does Not Improve Mental Rotation in Adults with Stroke
No full textBackground: Visuospatial function is commonly impaired post-stroke and is associated with motor learning and recovery. A single, twenty-minute Corsi Block Tapping Task (CBTT) training session improved visuospatial function in young neurotypical adults; however, it is unclear whether this training would improve visuospatial function in adults with stroke.
Objective: To understand if a single, twenty-minute CBTT training session improved visuospatial function in adults with stroke compared to a no-training control group of adults with stroke.
Methods: Participants post-stroke were assigned to one of two groups. The training group completed twenty minutes of computerized CBTT training. The control group completed a survey and watched a video for twenty minutes. Both groups completed a mental rotation task to assess visuospatial function pre- and post-training. To understand if training impacted mental rotation reaction time, we fit a robust mixed effects model with fixed effects for time, group, and time by group interaction. We also investigated whether lesion side impacted CBTT performance using a robust mixed effects model with fixed effects for log(time), lesion side, and log(time) by lesion side interaction.
Results: Nineteen participants post-stroke were included. Neither the control nor training group improved mental rotation reaction time (time p = 0.61, group p = 0.65; interaction p = 0.52). We also found no effect of lesion side on CBTT performance [log(time) p = 0.001, lesion side p = 0.49, interaction p = 0.89].
Discussion: Twenty minutes of CBTT training did not improve post-stroke mental rotation. Longer training bouts or a different type of visuospatial training may be necessary to improve visuospatial function in adults with stroke
Ready for Takeoff? Exploring United States Health Care Providers’ Pretravel Consultation Priorities, Gaps, Barriers, and Opportunities
No full textPretravel consultation by healthcare providers (HCPs) with travel medicine expertise can mitigate travel-related health risks. This analysis aimed to understand US-based HCPs\u27 pretravel consultation educational gaps, priorities, barriers, and opportunities. An electronic survey was conducted May–June 2024, using a convenience sample of HCPs identified through the Med Learning Group and travel specialists from the International Society of Travel Medicine and American Society of Tropical Medicine and Hygiene. In total, 205 HCPs completed the survey, including physicians (50 %), nurse practitioners (19 %), nurses (12 %), pharmacists (11 %), physician associates (7 %). Most (66 %) provided pretravel consultations and only 21 % held formal travel medicine certification. HCPs not providing pretravel consultation were less comfortable with traveler\u27s diarrhea self-treatment, malaria chemoprophylaxis, altitude illness prevention, yellow fever, Japanese encephalitis, rabies, and typhoid vaccination management. The most desired topics for education were travel vaccinations (94, 46 %), travel medicine insurance (89, 43 %), and altitude illness prevention (86, 42 %). Major barriers to providing pretravel consultation were lack of clarity about reimbursement (110, 54 %), lack of insurance coverage (89, 43 %), and inability to stock travel vaccines (73, 36 %). Top interventions suggested to increase access to and awareness of pretravel consultation included primary care physician education and community outreach. Most HCPs were interested in pretravel educational opportunities, but comfort varied by experience and certification, highlighting need for targeted training, especially for primary care providers. Top barriers were insurance coverage for pretravel consultation and access to travel vaccines, underscoring critical gaps in the US healthcare system
Investing in Innerwork for Peace Leadership: Developing the Educator Innerwork Scale
No full textThis pilot study aimed to develop and validate the Educator Innerwork Scale, an assessment tool designed to measure both individual and organizational aspects of Innerwork within the integral peace leadership framework. A nationwide sample of 167 educators from the U.S. participated in the survey, which included items measuring self-reported practices related to Mindfulness, Empathy, Hope, Cultural Awareness, and Worldview. Item analysis refined the survey to its final form, while internal consistency analyses confirmed the reliability of each subscale. Confirmatory factor analysis (CFA) yielded mixed results for the 5-factor structure of the Innerwork survey, strongly supporting the validity of the Mindfulness, Empathy, and Hope subscales, but indicating weaker validity for the Cultural Awareness and Worldview factors. Furthermore, Analysis of Variance (ANOVA) tests revealed significant relationships between higher levels of institutional support for Innerwork and increased individual Innerwork traits across Mindfulness, Empathy, Hope, and Worldview scales, with effect sizes ranging from medium to strong. While the pilot study’s limited sample size necessitates a cautious interpretation of the results, these findings provide promising support for an Educator Innerwork Scale to inform educator preparation and professional development systems. They also highlight the critical influence of organizational context on the development of peace leadership qualities
Predictive Gene Expression Signatures for Alzheimer\u27s Disease Using Post-Mortem Brain Tissue
No full textBackground: Alzheimer’s Disease (AD) is a progressive neurodegenerative disorder characterized by amyloid-beta (Aβ) plaques and tau protein aggregates in the brain. These pathological features manifest in specific regions, but mechanisms rendering some areas more susceptible to early AD-related changes remain poorly understood. To address this, we developed predictive gene expression signatures to explore molecular mechanisms underlying regional vulnerability to AD pathology.
Methods: Post-mortem brain tissues from participants of the Religious Orders Study and Memory and Aging Project (ROSMAP), Mayo Clinic, and Mount Sinai Brain Bank (MSBB) were used to derive gene expression signatures from six brain regions affected at varying stages of AD progression. Differential gene expression analysis identified genes with altered expression patterns which were used to develop predictive gene signatures using Adaptive Signature Selection and InteGratioN (ASSIGN) to predict pathway activity. Predictions of AD activity were validated against known AD status across clinical markers of AD pathology, including Aβ plaque deposition, tau aggregates, cognitive assessments, and clinical diagnoses. Dysregulation of key biological pathways was then analyzed using g: Profiler and ClueGO. Additionally, genetic and sociodemographic factors impacting AD prediction were assessed, and potential drug repurposing candidates identified using Connectivity Map (CMAP).
Results: Predictive gene expression signatures from six AD-affected brain regions distinguished AD activity in control and AD post-mortem brain tissue, corresponding to clinical markers of disease severity. The signatures revealed common underlying mechanisms of regional vulnerability, including upregulation of extracellular matrix (ECM)-related processes and downregulation of hormonal signaling pathways. Notably, S100A4 was consistently upregulated across all regions, while CRH expression was downregulated except in the cerebellum. Additionally, findings underscored the influence of APOE genotype (e3/e4) and sex on disease progression. Drug repurposing analysis identified FGFR inhibitors, specifically orantinib and bromodomain inhibitors, as promising therapeutic candidates.
Conclusion: Molecular signatures underlying regional vulnerability to AD provide a framework for understanding genetic and systemic factors in disease progression. Findings highlight specific molecular pathways, including ECM-related processes and hormonal regulation, as key drivers of susceptibility. Finally, identified drug repurposing candidates present promising therapeutic avenues for further investigation