Navigating Institutional Challenges: Design to Enable Community Participation in Social Learning for Freshwater Planning.

Social learning is a process suited to developing understanding and concerted action to tackle complex resource dilemmas, such as freshwater management. Research has begun to recognise that in practice social learning encounters a variety of institutional challenges from the shared habits and routines of stakeholders (organised by rules, norms and strategies) that are embedded in organisational structures and norms of professional behaviour. These institutional habits and routines influence the degree of willingness to engage with stakeholders, and expectations of behaviours in social learning processes.

Severe Hypertriglyceridemia Possibly Masked Acute Pancreatitis and Led to a Difficult Diagnosis in an Obese Patient with Ketoacidosis-onset Type 2 Diabetes.

A young obese man with ketoacidosis-onset type 2 diabetes mellitus, associated with severe hypertriglyceridemia, was admitted to a local hospital complaining of abdominal pain. Although the abdominal pain worsened, his serum amylase level remained normal with persistent severe hypertriglyceridemia until the second day of hospitalization. The next day, computed tomography showed severe acute pancreatitis (AP) with serum amylase elevation, while the patient's triglyceride level decreased to 558 mg/dL.