Maintenance of subcategorical information during speech perception: revisiting misunderstood limitations.

Accurate word recognition is facilitated by context. Some relevant context, however, occurs after the word. Rational use of such "right context" would require listeners to have maintained uncertainty or subcategorical information about the word, thus allowing for consideration of possible alternatives when they encounter relevant right context. A classic study continues to be widely cited as evidence that subcategorical information maintenance is limited to highly ambiguous percepts and short time spans (Connine et al., 1991). More recent studies, however, using other phonological contrasts, and sometimes other paradigms, have returned mixed results. We identify procedural and analytical issues that provide an explanation for existing results. We address these issues in two reanalyses of previously published results and two new experiments. In all four cases, we find consistent evidence against both limitations reported in Connine et al.'s seminal work, at least within the classic paradigms. Key to our approach is the introduction of an ideal observer framework to derive normative predictions for human word recognition expected if listeners maintain and integrate subcategorical information about preceding speech input rationally with subsequent context. We test these predictions in Bayesian mixed-effect analyses, including at the level of individual participants. While we find that the ideal observer fits participants' behavior better than models based on previously proposed limitations, we also find one previously unrecognized aspect of listeners' behavior that is unexpected under any existing model, including the ideal observer.

'I don't believe in the neutrality of research. OK?' Mapping researchers' attitudes toward values in science.

Background: Codes of conduct for research integrity provide ambivalent guidance on the role that the values of society as well as political and economic interests can or should play in scientific research. The development of clearer guidance on this matter in the future should consider the attitudes of researchers.Methods: We conducted 24 semi-structured interviews with holders of grants from the European Research Council and performed an inductive thematic analysis thereof.Results: We developed 4 themes reflecting 4 main attitudes of researchers toward the interactions between values and science: awareness, concern, confidence, and embracement. While interviewees recognized that science is not completely value-free (awareness), they still seemed to hold on to the so-called value-free ideal of science as a professional norm to minimize bias (concern, confidence). However, they showed awareness of the beneficial influence that values like diversity can have on research (embracement).Conclusions: Codes such as the European Code of Conduct for Research Integrity tend not to problematize the tensions that emerge from having the value-free ideal of science as a norm and being guided by the values of society. Our findings suggest the time might be ripe for research integrity codes to address more directly the value issues intrinsic to science.

The mediating roles of psychological resilience and psychological well-being of caregivers for the older adults.

Objective: This study aimed to investigate the mediating effects of psychological resilience and psychological well-being for caregivers at nursing homes on the relationship between insomnia and elder maltreatment. As the world is aging quickly and the number of older individuals cared for by formal caregivers has been increasing, this study's results could help create intervention programs to minimize the occurrence of older people's maltreatment. Materials and Methods: A total of 431 care workers who met all criteria, from 21 care service centers for older adults in Fukuoka, Japan, completed the Conditions of Maltreatment Scale, Caregivers' Belief in Ideal Care, Insomnia Severity Index, WHO-5 Well-Being Index, and Connor-Davidson Resilience Scale-10. Results: A multivariate analysis of variance revealed that participants with no insomnia had greater resilience, higher psychological well-being, and greater belief in ideal care and to treated older clients less roughly compared to participants with insomnia. Psychological resilience and well-being were significant mediators in the relationship between insomnia, rough care, and beliefs in ideal care. Conclusion: As formal caregivers are in urgent demand, society should take care of them. The most effective and successful intervention for improving their physical and psychological well-being should be initiated at the individual and organizational levels.

Prevalence and Determinants of Ideal Cardiovascular Health in Kenya: A Cross-Sectional Study Using Data From the 2015 Kenya STEPwise Survey.

Background: Kenya is experiencing a rising burden of cardiovascular diseases (CVDs) due to epidemiological and demographic shifts, along with increasing risk factors. Ideal cardiovascular health (iCVH), defined by the American Heart Association (AHA), encompasses eight metrics to evaluate cardiovascular well-being. This study assessed the prevalence and determinants of iCVH in Kenya. Methods: Data from the 2015 Kenya STEPwise survey on non-communicable disease risk factors, including 4,500 adults aged 18-69, were analysed. iCVH was assessed using 2022 AHA criteria based on seven factors: nicotine exposure, physical activity, diet, BMI, blood pressure, glucose, and lipid levels. A cardiovascular health (CVH) CVH score of ≥80% classified individuals as having iCVH. Multivariable binary and ordinal logistic regression identified factors associated with iCVH. Results: The mean CVH score in Kenya was 78.6% (95% CI: 77.9,79.2%), higher in females (79.3%), rural areas (79.5%), and non-drinkers (79.6%) than in males (77.9%), urban residents (77.0%), and alcohol drinkers (75.4%), respectively. The prevalence of iCVH (CVH score ≥80%) was 45.6%, while 6.4% had poor CVH (CVH score <50%). Only 1.2% achieved the maximum CVH score. iCVH prevalence declined with age and was lower among married individuals (43.7%), alcohol drinkers (32.3%), and urban residents (39.7%). Older adults had 50-80% lower odds of iCVH compared to those under 30 years. Alcohol users (AOR 0.5; p < 0.001) and urban residents (AOR 0.6; p < 0.001) were less likely to have iCVH. Residents of Nairobi and Central regions had 40-60% lower odds of iCVH compared to those in Rift Valley. The Kalenjin (AOR 0.5; p = 0.027) and Turkana (AOR 0.3; p = 0.002) ethnic groups had lower odds of iCVH compared to the Kisii. Conclusion: Less than half of Kenyan adults have iCVH, with poorer CVH status among older adults, urban residents, and alcohol users. Targeted public health interventions could mitigate the CVD burden and enhance health outcomes in Kenya.

Scanning more corresponds to more accuracy in hemodialysis patients: 28-zone protocol's superior findings from an observational study.

AIMS: Hypervolemia remains a problem in hemodialysis patients and is associated with hypertension, cardiovascular events and mortality. Lung Ultrasound (LUS) is a technique that detects hypervolemia via 4 different protocols depending on the number of sites checked on the chest wall. It has not been established which protocol should be preferred in the literature. METHODS: This study included 68 hemodialysis patients from one Dialysis Unit. All the patients underwent LUS with every single protocol 30 min before and after the end of the middle-week dialysis session by a nephrology trainee. Patients' ideal weight was modified based on daily clinical practice rather than ultrasound findings. RESULTS: Seventeen patients (25%) had ultrasound findings compatible with hypervolemia before the dialysis session, while eleven patients (16.2%) had still pulmonary congestion after the end of the session. These findings were similar to the number of patients considered hyperhydrated based on clinical criteria (10 patients). The rest protocols (8-zone, 6-zone and 4-zone protocol) considered fewer patients as hypervolemic. CONCLUSIONS: The 28-zone protocol can effectively detect hypervolemia and even classify the degree of it, although It is a time-consuming method. However, the other protocols can detect the hypervolemia in hemodialysis patients only when severe lung congestion exists. Their usefulness is limited in daily clinical practice in hemodialysis patients. More studies should be carried out for further and more reliable conclusions.

Empirical Bayes Methods, Evidentialism, and the Inferential Roles They Play.

Empirical Bayes-based Methods (EBM) is an increasingly popular form of Objective Bayesianism (OB). It is identified in particular with the statistician Bradley Efron. The main aims of this paper are, first, to describe and illustrate its main features and, second, to locate its role by comparing it with two other statistical paradigms, Subjective Bayesianism (SB) and Evidentialism. EBM's main formal features are illustrated in some detail by schematic examples. The comparison between what Efron calls their underlying "philosophies" is by way of a distinction made between confirmation and evidence. Although this distinction is sometimes made in the statistical literature, it is relatively rare and never to the same point as here. That is, the distinction is invariably spelled out intra- and not inter-paradigmatically solely in terms of one or the other accounts. The distinction made in this paper between confirmation and evidence is illustrated by two well-known statistical paradoxes: the base-rate fallacy and Popper's paradox of ideal evidence. The general conclusion reached is that each of the paradigms has a basic role to play and all are required by an adequate account of statistical inference from a technically informed and fine-grained philosophical perspective.

Quantitative assessment of renal steatosis in patients with type 2 diabetes mellitus using the iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification sequence imaging: repeatability and clinical implications.

Background: Fatty kidney disease is linked to renal function damage, but there is no noninvasive tool for monitoring renal fat accumulation. This study aimed to explore the repeatability of the iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification (IDEAL-IQ) sequence imaging in quantifying renal fat deposition and to assess the differences observed in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 26 healthy participants underwent two IDEAL-IQ scans without repositioning, and the repeatability of the imaging technique was assessed with Bland-Altman analysis. Additionally, 96 patients with T2DM underwent a single IDEAL-IQ scan for the examination of renal fat deposition. The patients with T2DM were classified into three groups based on their estimated glomerular filtration rate (eGFR). One-way analysis of variance was used to analyze the differences of renal fat depositions between the groups. Receiver operating characteristic curve analysis was used to assess the diagnostic performance of IDEAL-IQ. Results: Bland-Altman analyses showed narrower limits of agreement and a significant correlation (r=0.81; P<0.05) between the two IDEAL-IQ scans. Statistically significant differences between the healthy volunteers and patients with T2DM, diabetic kidney disease (DKD) I-II, and or DKD III-IV were found in renal parenchymal proton-density fat fraction (PDFF) values (P<0.001). Renal parenchymal PDFF was negatively correlated with eGFR (r=-0.437; P<0.001) and positive correlated with serum creatinine level (µmol/L) (r=0.421; P<0.001). The area under the curve of IDEAL-IQ in discriminating between the healthy volunteers and patients with T2DM was 0.857. For discriminating T2DM from DKD I-II and DKD III-IV, the IDEAL-IQ had an area under the curve of 0.689 and 0.823, respectively. Conclusions: IDEAL-IQ is a promising and reproducible technique for the assessment of renal fat deposition and identification of risk of DKD in patients with T2DM. Moreover, IDEAL-IQ imaging is expected to improve the sensitivity and specificity of early renal function damage and staging assessment of patients with T2DM.

Delayed Presentation of Concomitant Mid-ileal Mesenteric Tear and Perforation Following Blunt Abdominal Trauma: A Case Report.

The abdomen is involved in most of the trauma cases ranging from a simple to a life-threatening one. Blunt trauma is more dangerous than penetrating trauma to the abdomen. Though blunt abdominal trauma (BAT) is common, its diagnostic difficulties lead to fatal consequences, mainly attributable to the delay in diagnosis owing to the masquerading normalcy in the index presentation of the patient. Morbidity and mortality rates of hollow viscus and mesenteric injuries are quite high per se, with diagnostic delays worsening the scenario. Successful management of the patient lies mainly in early diagnosis and treatment of the underlying bowel pathology. We hereby report a case of a 48-year-old male, who presented with a mid-ileal mesenteric tear and a separate mid-ileal perforation, 96 hours later than trauma and was managed with laparotomy and primary anastomosis.

A prospective cohort study investigating the association between type 2 diabetes and subsequent cardiovascular events in patients with different blood pressure, HbA1c, and lipid levels.

BACKGROUND: Globally, there has been a steady increase in the prevalence of type 2 diabetes, and the risk of cardiovascular disease has increased. The relationship between diabetes and the incidence of cardiovascular disease (CVD) at different blood pressure, glycated haemoglobin A1c (HbA1c), and lipid levels remains uncertain. This study aimed to investigate these associations within a population-based cohort. MATERIAL AND METHODS: We analysed data from the Guiyang subcentre of the China Cardiometabolic Disease and Cancer Cohort Study, which enrolled participants aged 40 years and older between 2011 and 2012. Subsequently, a follow-up visit was conducted during 2014-2016 to assess incident CVD events. RESULTS: The analysis included a cohort of 7197 adults, of whom 590 were diagnosed with diabetes. Among all the participants, the CVD events linked to diabetes had a multivariable adjusted hazard ratio of 2.37 [95% confidence intervals (CI): 1.38-4.08]. Patients with diabetes had a greater risk of experiencing CVD events if they had high blood pressure [hazard ratios (HR): 1.24, 95% CI: 1.39-4.21] and high lipid levels (HR: 2.19, 95% CI: 1.29-3.70) compared to people with normal blood pressure (HR: 1.23, 95% CI: 0.54-2.82) and lipid levels (HR: 1.26, 95% CI: 0.47-3.41). CONCLUSIONS: Our analysis revealed a significant association between diabetes and an increased risk of subsequent CVD events, which can be mitigated through optimal management of the metabolic profile of cardiovascular risk factors.

Simplified approach to retention times of narrow binary pulses in the case of ideal chromatography model and Langmuir isotherm.

Analytical solution to ideal chromatography model has been established for binary Langmuir isotherm and rectangular injections. However, retention time of the less adsorbed species, which is of great theoretical and practical significance, cannot be given in a closed form and is conventionally solved by numerical integration with a floating boundary. A simplified approach is provided in this article. A 4th order algebraic equation was derived and used to solve the maximum concentration that can be further used to explicitly calculate retention time. Under most practical conditions, reliable initial guess can be easily acquired, allowing for the application of Newton-Raphson method for rapid determination of the root of the 4th order equation. In addition, derivatives of retention time with respective to isotherm parameters can be given in analytical forms.

Achieving Ideal Magnetic Light Emission with Electric-Type Emitters.

Optical magnetic dipole (MD) emission predominantly relies on emitters with significant MD transitions, which, however, rarely exist in nature. Here, we propose a strategy to transform electric dipole (ED) emission to a magnetic one by elegantly coupling an ED emitter to a silicon nanoparticle exhibiting a strong MD resonance. This emission mode transformation enables an artificially ideal magnetic dipole source with an MD purity factor of up to 99%. The far-field emission patterns of such artificial MD sources were experimentally measured, which unambiguously resolved their magnetic-type emission origin. This study opens the path to achieving ideal magnetic dipole emission with nonmagnetic emitters, largely extending the availability of magnetic light emitters conventionally limited by nature. Beyond the fundamental significance in science, we anticipate that this study will also facilitate the development of magnetic optical nanosource and enable potential photonic applications relying on magnetic light emission.

Quantitative magnetic resonance imaging of paraspinal muscles for assessing chronic non-specific low back pain in young adults: a prospective case-control study.

PURPOSE: This study aimed to investigate the application of quantitative magnetic resonance imaging of paraspinal muscles in assessing the young CNLBP with unilateral symptom. METHODS: This prospective study enrolled 107 young individuals with unilateral symptomatic CNLBP (56 cases) and a normal cohort (51 cases). All subjects underwent conventional lumbar sequences, T2 mapping, and IDEAL-IQ scans at 3T. T2 values and fat fraction (FF) of bilateral multifidus (mid-levels of L2-L5 vertebrae) and erector spinae (mid-levels of L1-L4 vertebrae) were measured. CNLBP severity, Japanese Orthopedic Association (JOA) score, and Visual Analogue Scale (VAS) score were recorded. Wilcoxon signed-rank tests were used to compare parameter differences between painful and non-painful sides in the case group. Mann-Whitney U tests were employed to evaluate differences between the case and normal group. Logistic regression analysis was conducted to identify predictive factors and to establish a combined model. RESULTS: In the case group, erector spinae FF values (L4 level), erector spinae T2 values (L1, L2, and L4 levels), and multifidus T2 values (L4 and L5 levels) were higher on the painful side (P<0.05). Multifidus T2 values (L5 level) and FF values (L2-L5 levels) were higher in the case group compared to the normal group (P<0.05). The optimal performance in differentiating young CNLBP was the combination of L5 level multifidus T2 value with FF (AUC = 91.81%). Negative correlation existed between T2 values and FF of multifidus at L5 level and JOA scores (r=-0.41, P < 0.05), and positive correlation with VAS scores (r = 0.46, P < 0.05). CONCLUSION: The combination of T2 value and FF may provide deeper insights into the pathological alterations of paraspinal muscles in young CNLBP, providing an important imaging basis for clinical judgment and preventive treatment of non-painful side in unilateral symptomatic patients.

Ideal body image and socioeconomic factors: exploring the perceptions of Kenyan women.

BACKGROUND: Non-communicable diseases are an increasing threat in sub-Saharan Africa (SSA), and overweight and obesity are affecting people across all socioeconomic groups. Some studies suggest that big body sizes may be perceived as desirable among women in SSA and that high prevalence of obesity and overweight are especially present in low socioeconomic societies. This study explores the role of socioeconomic factors in the perception of the ideal body among Kenyan women and whether perceptions and beliefs about the ideal body should be considered relevant when targeting the prevention of obesity and overweight. METHOD: In-depth interviews were conducted with 8 Kenyan women with varying educational backgrounds, aged between 21 and 48, using a qualitative study design. The interviews were conducted in December 2022 and January 2023 in Nairobi, audio-recorded, transcribed and analysed through qualitative content analysis and a coding system using deductive and inductive codes. RESULTS: The participants reported that conclusions about a person's health and wealth status are drawn based on different body sizes. Furthermore, traditional views about the ideal body size, societal pressure, as well as the women's own experience with their body size play a role in the perception of an ideal body. CONCLUSION: Small-sized women desire to gain weight as society may view them as weak and sick. Big-sized women aim to reduce weight primarily due to health complications. Nevertheless, traditionally, a big-sized woman is considered strong and wealthy, creating external pressure on women to fulfil this body image-these findings emphasise traditional aspects in designing culturally sensitive prevention and intervention methods to address overweight and obesity.

Putting patients first: when home-based care staff prioritise loyalty to patients above the system and themselves. An ethnographic study.

BACKGROUND: The growing number of older people worldwide poses challenges for health policy, particularly in the Global North, where policymakers increasingly expect seniors to live and receive care at home. However, healthcare professionals, particularly in home-based care, face dilemmas between adhering to care ideals and meeting external demands. Although they strive to uphold ethical care standards, they must deal with patients' needs, cooperation with colleagues and management guidelines. Home-based care is an essential part of healthcare services in Norway, but staff struggle with high patient numbers and time management. This article focuses on how staff deal with ethical challenges related to contextual and organisational constraints. METHODS: An ethnographic fieldwork in three municipalities in South-East Norway. The first author conducted three to four months of participant observation in each municipality. In addition, she conducted in-depth interviews with key informants in two municipalities and a focus group interview with seven home-based care workers in one municipality. The data was analysed by using a reflexive thematic analysis. RESULTS: Staff in home-based care are frequently more loyal to the patient than to the system and to their own needs. To provide good care, all informants disregarded the patient's formal decision, i.e. they provided more care than the formalised decision stipulated. To prioritise beneficence to patients, informants also disregarded some of the rules applicable in home-based care. In addition, staff accepted risks to their own safety and health to provide care in the patient's home. CONCLUSION: The loyalty of home-based care staff to their patients can go beyond their loyalty to the rules of the system and even their own safety. This commitment might be attributed to a sense of doing meaningful work, to providing relationship-based and individualised care, and to strong moral courage. However, the staff's emphasis on flexibility and individualised care also brings challenges related to unclear boundaries related to patient care.

The quest for optimal ketamine dosing formula in treatment-resistant major depressive disorder.

BACKGROUND: Emerging evidence indicates that intravenous ketamine is effective in managing treatment-resistant unipolar and bipolar depression. Clinical studies highlight its favorable efficacy, safety, and tolerability profile within a dosage range of 0.5-1.0 mg/kg based on actual body weight. However, data on alternative dosage calculation methods, particularly in relation to body mass index (BMI) and therapeutic outcomes, remain limited. METHODS: This retrospective analysis of an open-label study aims to evaluate dose calculation strategies and their impact on treatment response among inpatients with treatment-resistant major depressive disorder (MDD) (n = 28). The study employed the Boer and Devine formulas to determine lean body mass (LBM) and ideal body weight (IBW), and the Mosteller formula to estimate body surface area (BSA). The calculated doses were then compared with the actual doses administered or converted to a dosage per square meter for both responders and non-responders. RESULTS: Regardless of treatment response, defined as a reduction of 50% in the Montgomery-Åsberg Depression Rating Scale, the use of alternative ketamine dosing formulas resulted in underdosing compared to the standardized dose of 0.5 mg/kg. Only two participants received higher doses (102.7% and 113.0%) when the Devine formula was applied. CONCLUSIONS: This study suggests that ketamine dosing formulas, alternative to the standardized 0.5 mg/kg based on body weight, may lead to underdosing and potentially impact outcome interpretation. To enhance dosing accuracy, future studies should consider incorporating body impedance analysis and waist-to-hip ratio measurements, as this study did not account for body composition.

Association of ideal cardiovascular health and history of gestational diabetes mellitus in NHANES 2007-2018.

BACKGROUND: Population-based studies of ideal cardiovascular health (CVH) and gestational diabetes mellitus (GDM) are scarce. METHODS: We conducted a cross-sectional analysis of 2007-2018 National Health Examination and Nutrition Survey women aged ≥ 20 years, who had data on Life's Simple 7 (LS7) metrics and self-reported GDM history. Each LS7 metric was assigned a score of 0 (non-ideal) and 1(ideal) and summed to obtain total ideal CVH scores (0-7). We used logistic regression models to assess associations between LS7 ideal CVH scores (0-7) and GDM history, accounting for socio-demographic factors. RESULTS: Among 9199 women (mean age: 46 years, 8 % with a GDM history), there was a progressive decrease in the odds of past GDM history across increasing ideal CVH scores. Compared to females with 0-1 ideal CVH scores, females with ideal CVH scores of 3, 4 and 5-7 had an associated 39 % lower [odds ratio: 0.61 (95 % CI: 0.41-0.90)], 50 % lower [0.50 (0.33-0.76)] and 66 % lower [0.34 (0.20-0.56)] odds of past GDM history, respectively. There were notable racial/ethnic and citizenship/nativity differences in these associations. CONCLUSIONS: Women with higher ideal CVH scores had lower odds of GDM history. Our findings underscore the importance of optimizing cardiometabolic health among women with GDM history.

Assessment of green development level performance in G20 countries: A dynamic evaluation framework.

To achieve sustainable development goals and foster future prosperity globally, the promotion of green development is essential. Nevertheless, persistent regional disparities in green development among the G20 nations stem from differing economic and environmental conditions in dynamic contexts. In light of these conditions, it is essential for governments to evaluate their country's current green development performance in comparison with higher-performing nations and to learn from their experiences. This study introduces a new dynamic evaluation framework that integrates the importance of evaluation indicators using the dynamic entropy weighting method, a Dynamic Technique for Order Preference by Similarity to Ideal Solution method, and principal component analysis. This framework serves as a tool for G20 countries to assess their green development levels between 2015 and 2021. A key contribution of this study is the facilitation of the G20's ability to implement relevant reform measures and monitor green development progress in a dynamic environment. This framework can serve as a model for similar evaluations in other regions globally. The study's main findings indicate that G20 countries with high levels of green development possess strong economic foundations and prioritise the balanced development of their economies, societies, environments, and innovation.

Is Passynski's Approach to Hydration Numbers Consistent with Thermodynamics?

Hydrophilic and hydrophobic phenomena occur in aqueous solutions. Despite the complex nature of the molecular interactions, the propensity of molecules and ions to hydration is sometimes characterized by a single "hydration number". Passynski's method for determining the hydration numbers in dilute aqueous solutions belongs to the group of methods based on the analysis of the isentropic compressibility of a mixture. Isentropic compressibility is a thermodynamic material constant; thus, the paper deals with Passynski's approach discussed in terms of thermodynamics. First, Passynski's assumptions were applied to the volume of the mixture. Subsequent strict thermodynamic derivation led to a formula for the hydration number which resembled that of Onori rather than the original one. Passynski's number turned out to be inconsistent with the thermodynamics and mechanics of fluids. This is a rather purely empirical measure of the slope of the dependence of isentropic compressibility on the solute mole fraction in a dilute aqueous solution. Being the quotient of the slope and the isentropic compressibility of pure water, Pasynski's numbers are more convenient to analyze and discuss than the slopes themselves. Conclusions about molecular interactions based on these numbers must be treated with considerable caution.

Ideal Family Size and Reproductive Orientations: An Exploration of Change Over Time in the United States.

Drawing on more than 30 years of nationally representative microdata from the General Social Survey, this article comprehensively updates recent trends in ideal family size in the United States. It first documents stability in ideal family sizes between the mid-1980s and 2018, even in the face of a recent fertility decline. Next, the study adopts a latent class approach that identifies typologies of "reproductive orientations," defined as multidimensional mental models of reproduction encompassing ideal family size, attitudes toward reproductive labor, and views on reproduction contexts. The findings indicate three distinct classes of reproductive orientations: Progressive Familialists, Conservative Familialists, and Blended Egalitarians. Further analyses suggest that the prevalence of these classes has changed over time and that class membership is associated with distinct patterns of childbearing and marriage. These findings deepen contemporary understandings of ideal family size in the United States and have broader implications for how demographers conceptualize and measure fertility preferences across diverse contexts.

Small Donors, Big Impact: Optimizing Organ Utilization in Simultaneous Pancreas and Kidney Transplantation From Extra Small Pediatric Donors.

INTRODUCTION: Simultaneous pancreas-kidney transplantation (SPK) is the preferred treatment for individuals with type-1 diabetes and end-stage renal disease. However, a limited supply of "Ideal Pancreas Donors" contributed to a growing disparity between available organs and recipients. Even though SPK outcomes from pediatric donors match those from adult donors, unclear guidelines on minimum age and weight criteria for extra small pediatric pancreas donors lead to hesitancy among several transplant centers to utilize these grafts due to concerns about inadequate islet mass, technical challenges, and increased risk of allograft thrombosis. METHODS: This report details the successful outcomes of SPK transplantations performed at the study center between December 2021 and January 2024, using four extra small pediatric brain-dead donors (ESPDs). Each donor was aged ≤5 years and weighed <20 kg. RESULTS: All SPK recipients achieved immediate posttransplant euglycemia without requiring insulin. None of the recipients experienced graft pancreatitis, graft thrombosis, allograft rejection, or required re-exploration. During a 5-27-month follow-up period, all ESPD recipients maintained optimal graft function, as evidenced by normal glucose tolerance tests and HbA1c (4.9%-5.2%), with 100% graft and patient survival. CONCLUSION: This report examines the usage of ESPDs in SPK transplantation, highlighting their potential to expand the donor pool and reduce wait times in areas with scarce deceased organ donations, thereby increasing the number of available organs for transplantation with acceptable outcomes. Revising donor selection guidelines to reflect the diverse risk-benefit profiles of waitlisted individuals is crucial to addressing geographical disparities and reducing organ discard rates.