Month: June 2024

Hypertension in diabetes

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Abstract

Diabetes mellitus, a disease that affects hundreds of millions of people worldwide, is increasing in prevalence in all age groups, including children and adolescents. Much of the morbidity and mortality associated with diabetes is closely related to hypertension, often coincident with diabetes. Comorbid hypertension and diabetes often worsen the outcomes of each other, likely rooted in some overlapping pathogenic mechanisms. In this educational review, we will discuss the shared pathophysiology of diabetes and hypertension, particularly in regard to inflammation and oxidative stress, the sympathetic nervous system, vascular remodeling, and the renin–angiotensin–aldosterone system (RAAS). We will also review current hypertension diagnosis and management guidelines from many international jurisdictions for both adult and paediatric populations in the setting of diabetes. Many of these guidelines highlight the use and utility of RAAS blockers in this clinical scenario; however, on review of the evidence for their use, several meta-analyses and systematic reviews fail to demonstrate superiority of RAAS blockers over other anti-hypertensive medications. Finally, we discuss several new anti-hypertensive medications, review their mechanisms of action, and highlight some of the evidence for their use in the setting of hypertension and diabetes.

The Differential Inclusion of Migrant Farmworkers’ and the Landscape of Support in a Migrant-intensive Region in Ontario, Canada

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Abstract

Canada’s national migration regimes, which are witnessing an increase in temporary foreign workers, underscore the contentious nature of inclusion for migrant farmworkers in smaller communities. While migrant farmworkers are entitled to benefits, their access to services and social support is limited. Even though settlement initiatives that welcome and support immigrant newcomers have shifted and intensified toward smaller towns and communities across Canada, support initiatives and the benefits for which temporary migrant farmworkers qualify have received far less attention and resources. Moreover, the COVID-19 pandemic not only highlighted the importance of migrant farmworkers to agricultural industries in Canada, given their designation as “essential” workers, but also catalyzed a significant shift in how communities can support workers. This paper focuses on a migrant-intensive region in southwestern Ontario. It utilizes a qualitative constructivist approach to interviews with 30 migrant farmworkers and 32 service providers to examine the support and services available to workers. Employing the conceptual framework of differential inclusion, this study analyzes the nature of support and highlights how temporary migrant farmworkers are embedded in relations of inclusion and exclusion. This study also explores the potential and capacity of community-based support initiatives to foster inclusion for workers in migrant-intensive communities and the emergence of a support framework during COVID-19. Given the rise in the migrant population in smaller cities and rural communities across Canada, this study aims to address the limited scholarship on the support landscape for migrant farmworkers in these regions.

Interrelation Between Cerebrospinal Fluid Pressure, Intracranial Morphology and Venous Hemodynamics Studied by 4D Flow MRI

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Abstract

Purpose

To quantify the effects of CSF pressure alterations on intracranial venous morphology and hemodynamics in idiopathic intracranial hypertension (IIH) and spontaneous intracranial hypotension (SIH) and assess reversibility when the underlying cause is resolved.

Methods

We prospectively examined venous volume, intracranial venous blood flow and velocity, including optic nerve sheath diameter (ONSD) as a noninvasive surrogate of CSF pressure changes in 11 patients with IIH, 11 age-matched and sex-matched healthy controls and 9 SIH patients, before and after neurosurgical closure of spinal dural leaks. We applied multiparametric MRI including 4D flow MRI, time-of-flight (TOF) and T2-weighted half-Fourier acquisition single-shot turbo-spin echo (HASTE).

Results

Sinus volume overlapped between groups at baseline but decreased after treatment of intracranial hypotension (p = 0.067) along with a significant increase of ONSD (p = 0.003). Blood flow in the middle and dorsal superior sagittal sinus was remarkably lower in patients with higher CSF pressure (i.e., IIH versus controls and SIH after CSF leak closure) but blood flow velocity was comparable cross-sectionally between groups and longitudinally in SIH.

Conclusion

We were able to demonstrate the interaction of CSF pressure, venous volumetry, venous hemodynamics and ONSD using multiparametric brain MRI. Closure of CSF leaks in SIH patients resulted in symptoms suggestive of increased intracranial pressure and caused a subsequent decrease of intracranial venous volume and of blood flow within the superior sagittal sinus while ONSD increased. In contrast, blood flow parameters from 4D flow MRI did not discriminate IIH, SIH and controls as hemodynamics at baseline overlapped at most vessel cross-sections.

Framing uncertainty in water policy discourse: insights from Arizona’s Project ADD Water

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Abstract

Water resource managers contend with and leverage uncertainty in complex decision-making processes. Uncertainty has passive characteristics (context and type), but it is also actively deployed and leveraged by stakeholders via framing and discourse. These passive and active elements of uncertainty interact with each other to shape discourse, which has direct consequences for policy, especially when uncertainty is invoked to delay action in addressing pressing environmental challenges. We explore the interactions of active and passive elements of uncertainty management in a water management decision-making process in the water-limited US state of Arizona. Project ADD Water was intended to engage stakeholders in dialogue about securing water resources under existing state water management policy. Understanding how uncertainty influenced Project ADD Water has only become more important as water management under prolonged drought becomes increasingly complex in Arizona and other similar sites. In the Project ADD Water deliberations, we found examples of both disruptive and productive efforts to frame different types of uncertainty, and we use illustrative examples to explore their relevance to the policy-making process. In addition to our analysis of how stakeholders engage with uncertainty through this process, we also contribute a codebook for holistically examining uncertainty in natural resource decision-making processes beyond ADD Water and materials to structure workshops with stakeholders centered on exploring uncertainty. Our contributions strengthen our understanding of how stakeholders deploy uncertainty in decision-making processes and offer a pathway to facilitate discussions about uncertainty with stakeholders.

Semi-continuous cultivation for enhanced protein production using indigenous green microalgae and synthetic municipal wastewater

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Abstract

Cultivation of microalgae has gained significant interest as an alternative protein source, potentially becoming a target commodity recovered from microalgae-based wastewater treatment. This study examined a semi-continuous cultivation strategy to optimize protein accumulation of the indigenous freshwater chlorophytes, Lobochlamys segnis and Klebsormidium flaccidum, and simultaneously remove nutrients from wastewater efficiently. A strain-specific regime was made based on a fixed biomass concentration at the start of 24-h cultivation cycle, i.e., a constant initial cell density, which regulated harvesting and fresh medium supply volume according to the dilution rate. Six cultivation cycles were conducted in lab-scale 1L reactors with a synthetic municipal wastewater. Lobochlamys segnis and K. flaccidum grew exponentially in all cycles. The biomass productivity was 573 and 580 mg L–1 day–1, in which the total protein consisted of 62 and 45% of dry cell weight (dw), respectively. When a culture medium deficient in nitrogen and phosphorus was used, protein level was significantly reduced. L. segnis consumed all NH4+ and PO43– supplied by the medium replacement, giving the removal rate of 9.2 and 5.2 mg L–1 day–1. Whereas K. flaccidum removed 13.8 mg L–1 day–1 NH4+ without completing PO43– removal. The amino acid profile of both strains was characterized by glutamic acids content (4–5% dw). We concluded that the designed cultivation regime would support a constant biomass production with stable and high protein content, along with an efficient removal of nutrient from the wastewater.

Beyond access: (re)designing archival guides for changing landscapes

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Abstract

In 2013, the authors of this article and their colleague Gavan McCarthy published Stories in Stone: an annotated history and guide to the collections of Ernest Westlake (1855–1922). The guide provided contextual information and digital access to the entire paper archives relating to the three large stone collections formed by Westlake during his lifetime: French and English geological specimens housed in the Oxford University Museum of Natural History from 1924, and a collection of Tasmanian Aboriginal stone tools stored in the Pitt Rivers Museum since 1923. The Tasmanian collections, formed by Westlake from 1908 to 1910, are highly significant to the Palawa (or Pakana or Tasmanian Aboriginal) community because they include objects made by ancestors, and words spoken by ancestors to Westlake and recorded in his field notebooks. Stories in Stone was created to improve access to Westlake’s Tasmanian collections for the Palawa community with whom author Rebe Taylor had worked closely since 1999. Nonetheless, the structural and technical design of Stories in Stone was not Palawa-led. It was driven by Australian and international archiving standards; by stipulations set out by the collecting institutions; and by the stories of collecting and subsequent scholarship on the collections. In 2023, Stories in Stone is offline, and the authors are planning a relaunch. This time they aim to reach beyond their original aim of providing archival access to the Palawa community, and work with Palawa community to co-design how that access is delivered. This consultative work will be done at the University of Tasmania, where Palawa advisors and other Indigenous scholars have been integral to developing international Indigenous data sovereignty principals. This article precedes those formal discussions and thus offers a timely reflection on the original aims and design of Stories in Stone as well as an extensive analysis of broader changes in the management and dissemination of First Nations collections and culture. Such changes include: international human rights frameworks; movements supporting data and archival sovereignty; co-designed archival technologies; and increased focus on archives as process not merely product. These developments will lay the foundations for the next version of Stories in Stone, which aims to go beyond access, scholarship, and standards by helping to facilitate First Nations’ aspirations for dignity, sovereignty, and self-determination.

Returning love to Ancestors captured in the archives: Indigenous wellbeing, sovereignty and archival sovereignty

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Abstract

This paper explores the holistic needs of First Nations people in the archives to control their cultural heritage materials with dignity and respect. It highlights the importance of the archives supporting Indigenous ways of knowing, being and doing. Indigenous people’s spiritual and emotional needs are addressed by considering the support for Indigenous people’s wellbeing in the archives. Models of social, emotional and cultural wellbeing are presented as alternatives to discussing the need for Indigenous cultural safety in the archives. A definition of Indigenous wellbeing, sovereignty and archival sovereignty provides an approach to caring for historical records with dignity and respect and a framework for the local care and protection of Indigenous people’s knowledge into the future. The concept of Returning Love to Ancestors Captured in the Archives (Thorpe 2022), extending the work of (Harkin 2019) and Baker et al. (2020), is offered as a significant reform needed in the approaches to managing historical archives. The paper concludes by sharing a case study of the In Living Memory photographic exhibition, drawn on images created by the former New South Wales Aborigines Welfare Board to demonstrate archival approaches supporting principles of trust, benefit sharing and reciprocal relationships. Combined, they respond to the pressing need for designing respectful archiving approaches for future generations that do not reproduce harm.

The Exclusion of Indigenous Knowledge Systems in Planning Open Spaces in Namibia: The Case of Havana, Windhoek

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Abstract

The lack of accessible and valuable public open spaces for socio-cultural activities is a concern in low-income urban areas. Through an indigenous knowledge systems (IKS) lens, we explored indigenous cultural open spaces (the olupale and omuvanda) of two communities in Namibia and their relevance to urban areas. This qualitative study included interviews, informal discussions, sharing circles (focus groups) storytelling, and participatory observation with the two rural communities. In the Havana low-income area in Windhoek, observations, semi-formal interviews and discussions were used. The study found, on the one hand, that planning practices excluded marginalised urban communities due to reliance on a single modernist rational problem-solving process. On the other hand, and through an indigenous knowledge paradigm, aspects such as community respect, well-being, cooperation, environmental respect, and care being taught, lived, and experienced at cultural open spaces, were mostly excluded. Planning in Windhoek overlooked these vital well-being components, to the detriment of the communities. Existing spatial IKS could help planning in addressing the well-being of low-income residential areas and their residents. This paper is therefore foregrounding IKS in planning and argues that such IKS integration will facilitate the improvement of diverse forms of living spaces, including poor and low-income spaces in urban areas.

Insights from First Nations, Government and Industry Leaders on Criteria for Successful Impact Benefit Agreements

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Abstract

Over the past decade, British Columbia, Canada’s westernmost province, has begun developing liquified natural gas (LNG) mega projects that can transport Canadian resources to foreign markets across the Pacific region. These projects have gained significant profile due to high-level debates over their environmental, social and economic impacts. While LNG projects are required to undergo environmental impact assessment procedures, there is growing recognition of the need to ensure that positive social, economic and environmental impacts are fairly distributed to local communities. Similar to other extractive industries, many corporations leading the development of these projects engage in negotiations over so-called “impact benefit agreements (IBAs)”—legal agreements between a corporation, a government and/or a community that details how projects can benefit the local community and on what timeline so as to build social license to operate and investor confidence. This contribution details the findings of a qualitative study highlighting the perspectives of First Nations, provincial and federal government, and industry leaders to examine what makes an IBA successful and from whose perspective. The paper provides an introduction to IBA structures and processes, a brief review of the legal context, a qualitative methodology co-developed between academic researchers and Indigenous community leaders, and describes key criteria to inform future successful IBA agreements that create equitable multi-party benefits in an era of Indigenous reconciliation.