Safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes

WSTĘP. Celem pracy była ocena bezpieczeństwa skuteczności stosowania pompy insulinowej u dzieci młodzieży chorych na cukrzycę typu 1. MATERIAŁ I METODY. Do badania włączono 95 dzieci, które rozpoczęły stosowanie pompy insulinowej w Johns Hopkins Hospital w okresie od stycznia 1990 do grudnia 2000 roku. Średni wiek badanych wynosił 12,0 lat (przedział 4&#8211;18 lat); 29% badanych było poniżej 10 roku życia. Dane zebrano z dokumentacji medycznej, począwszy od okresu 6&#8211;12 miesięcy przed zastosowaniem terapii pompą insulinową. Średni czas obserwacji wynosił 28 miesięcy. WYNIKI. Zaobserwowano niewielkie, lecz znamienne statystycznie obniżenie stężenia HbA1c w 3.&#8211;6. miesiącu terapii (7,7% vs. 7,5%, p = 0,03). W czasie dalszej obserwacji stężenie to stopniowo zwiększało się i pozostało podwyższone po roku, jednak na to zjawisko wpływał wiek badanych i czas trwania cukrzycy. Obie wymienione zmienne wiązały się z wyższym stężeniem HbA1c. Po uwzględnieniu wieku i czasu trwania cukrzycy średnie stężenie HbA1c po rozpoczęciu terapii pompą insulinową było znamiennie niższe niż przed jej zastosowaniem (7,7% vs. 8,1%, p < 0,001). Częstość powikłań (kwasica ketonowa, interwencje w izbie przyjęć) była podobna przed i po rozpoczęciu leczenia. Zaobserwowano mniej incydentów hipoglikemii po rozpoczęciu terapii (12 vs. 17, współczynnik częstości = 0,46; 95% CI 0,21&#8211;1,01). WNIOSKI. Badanie to sugeruje, że stosowanie pompy insulinowej jest bezpieczną i skuteczną metodą leczenia u wybranych dzieci chorych na cukrzycę typu 1.INTRODUCTION. To evaluate the safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes. MATERIAL AND METHODS. All 95 patients who began insulin pump therapy at Johns Hopkins Hospital between January 1990 and December 2000 were included in the study. The mean age was 12.0 years (range 4&#8211;18), and 29% of the patients were < 10 years old. Data were obtained by chart review beginning 6&#8211;12 months before pump start. The median duration of follow-up was 28 months. RESULTS. There was a small but significant decrease in HbA1c at 3&#8211;6 months after pump start (7.7% vs. 7.5%; P = 0.03). HbA1c levels then gradually increased and remained elevated after 1 year of followup; however, this association was confounded by age and diabetes duration, both of which were associated with higher HbA1c levels. After adjusting for duration and age, mean HbA1c after pump start was significantly lower than before pump start (7.7% vs. 8.1%; P < 0.001). The number of medical complications (diabetic ketoacidosis, emergency department visits) was similar before and after pump start. There were fewer hypoglycemic events after pump start (12 vs. 17, rate ratio 0.46, 95% CI 0.21&#8211;1.01). CONCLUSIONS. This study suggests that pump therapy is safe and effective in selected children and adolescents with type 1 diabetes

Using dust, gas and stellar mass selected samples to probe dust sources and sinks in low metallicity galaxies

We combine samples of nearby galaxies with Herschel photometry selected on their dust, metal, H I and stellar mass content, and compare these to chemical evolution models in order to discriminate between different dust sources. In a companion paper, we used an H I-selected sample of nearby galaxies to reveal a subsample of very gas-rich (gas fraction >80 per cent) sources with dust masses significantly below predictions from simple chemical evolution models, and well below Md/M* and Md/Mgas scaling relations seen in dust and stellar-selected samples of local galaxies. We use a chemical evolution model to explain these dust-poor, but gas-rich, sources as well as the observed star formation rates (SFRs) and dust-to-gas ratios. We find that (i) a delayed star formation history is required to model the observed SFRs; (ii) inflows and outflows are required to model the observed metallicities at low gas fractions; (iii) a reduced contribution of dust from supernovae (SNe) is needed to explain the dust-poor sources with high gas fractions. These dust-poor, low stellar mass galaxies require a typical core-collapse SN to produce 0.01-0.16 M⊙ of dust. To match the observed dust masses at lower gas fractions, significant grain growth is required to counteract the reduced contribution from dust in SNe and dust destruction from SN shocks. These findings are statistically robust, though due to intrinsic scatter it is not always possible to find one single model that successfully describes all the data. We also show that the dust-to-metal ratio decreases towards lower metallicity

Childhood in Sociology and Society: The US Perspective

The field of childhood studies in the US is comprised of cross-disciplinary researchers who theorize and conduct research on both children and youth. US sociologists who study childhood largely draw on the childhood literature published in English. This article focuses on American sociological contributions, but notes relevant contributions from non-American scholars published in English that have shaped and fueled American research. This article also profiles the institutional support of childhood research in the US, specifically outlining the activities of the ‘Children and Youth’ Section of the American Sociological Association (ASA), and assesses the contributions of this area of study for sociology as well as the implications for an interdisciplinary field.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

H-ATLAS/GAMA: quantifying the morphological evolution of the galaxy population using cosmic calorimetry

Using results from the Herschel Astrophysical Terrahertz Large-Area Survey (H-ATLAS) and the Galaxy and Mass Assembly (GAMA) project, we show that, for galaxy masses above ≃ 108 M⊙, 51 per cent of the stellar mass-density in the local Universe is in early-type galaxies (ETGs; Sérsic n > 2.5) while 89 per cent of the rate of production of stellar mass-density is occurring in late-type galaxies (LTGs; Sérsic n < 2.5). From this zero-redshift benchmark, we have used a calorimetric technique to quantify the importance of the morphological transformation of galaxies over the history of the Universe. The extragalactic background radiation contains all the energy generated by nuclear fusion in stars since the big bang. By resolving this background radiation into individual galaxies using the deepest far-infrared survey with the Herschel Space Observatory and a deep near-infrared/optical survey with the Hubble Space Telescope (HST), and using measurements of the Sérsic index of these galaxies derived from the HST images, we estimate that ≃83 per cent of the stellar mass-density formed over the history of the Universe occurred in LTGs. The difference between this value and the fraction of the stellar mass-density that is in LTGs today implies there must have been a major transformation of LTGs into ETGs after the formation of most of the stars

The Public Repository of Xenografts enables discovery and randomized phase II-like trials in mice

More than 90% of drugs with preclinical activity fail in human trials, largely due to insufficient efficacy. We hypothesized that adequately powered trials of patient-derived xenografts (PDX) in mice could efficiently define therapeutic activity across heterogeneous tumors. To address this hypothesis, we established a large, publicly available repository of well-characterized leukemia and lymphoma PDXs that undergo orthotopic engraftment, called the Public Repository of Xenografts (PRoXe). PRoXe includes all de-identified information relevant to the primary specimens and the PDXs derived from them. Using this repository, we demonstrate that large studies of acute leukemia PDXs that mimic human randomized clinical trials can characterize drug efficacy and generate transcriptional, functional, and proteomic biomarkers in both treatment-naive and relapsed/refractory disease

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Analyses of pig genomes provide insight into porcine demography and evolution

For 10,000 years pigs and humans have shared a close and complex relationship. From domestication to modern breeding practices, humans have shaped the genomes of domestic pigs. Here we present the assembly and analysis of the genome sequence of a female domestic Duroc pig (Sus scrofa) and a comparison with the genomes of wild and domestic pigs from Europe and Asia. Wild pigs emerged in South East Asia and subsequently spread across Eurasia. Our results reveal a deep phylogenetic split between European and Asian wild boars ∼1 million years ago, and a selective sweep analysis indicates selection on genes involved in RNA processing and regulation. Genes associated with immune response and olfaction exhibit fast evolution. Pigs have the largest repertoire of functional olfactory receptor genes, reflecting the importance of smell in this scavenging animal. The pig genome sequence provides an important resource for further improvements of this important livestock species, and our identification of many putative disease-causing variants extends the potential of the pig as a biomedical model

Age Expansion of the Thirty-Second Walk Test Norms for Children

Purpose: The purposes of this study were to expand age ranges for a previously published normative database (n = 227) on the 30-second walk test, describe changes with age, explore contributions of subject characteristics, and verify previous data. Methods: Children (n = 302; age, 5–17 years) from 4 urban schools were tested for distance walked in 30 seconds. Age, height, right lower extremity length, weight, sex, and race/ethnicity were recorded. Results: Distance walked increased from 5 to 10 years of age, decreased slightly at age 11 years, followed by a more gradual decrease from 12 to 17 years. A significant difference in distance walked was found across ages. Right leg length, age, and weight explained 11.5% of the variance in walk distance. Conclusion: A percentile chart of the pooled data (previous and current, n = 529) should facilitate the use of the 30-second walk test when examining children for mobility limitations

Using the MDASI-Adolescent for Early Symptom Identification and Mitigation of Symptom Impact on Daily Living in Adolescent and Young Adult Stem Cell Transplant Patients

Hematopoietic stem cell transplantation (HSCT) requires an intensive pre- and post-procedure course that leads to symptoms including fatigue, nausea/vomiting, and pain, all of which interfere significantly with activities of daily living. These symptoms place a substantial burden on patients during the time period surrounding transplant as well as during long-term recovery. The MD Anderson Symptom Inventory (MDASI) is a symptom-reporting survey that has been successfully used in adult patients with cancer and may have utility in the adolescent and young adult (AYA) population. At the Children&rsquo;s Cancer Hospital at MD Anderson Cancer Center, we adopted a modified version of the MDASI, the MDASI-adolescent (MDASI-Adol), as a standard of care for clinical practice in assessing the symptom burden of patients in the peri-transplant period. We then conducted a retrospective chart review to describe the clinical utility of implementing this symptom-screening tool in AYA patients admitted to our pediatric stem cell transplant service. Here, we report our findings on the symptom burden experienced by pediatric and AYA patients undergoing stem cell transplantation as reported on the MDASI-Adol. Our study confirmed that the MDASI-Adol was able to identify a high symptom burden related to HSCT in the AYA population and that it can be used to guide symptom-specific interventions prior to transplant and during recovery. Implementing a standard symptom-screening survey proved informative to our clinical practice and could mitigate treatment complications and alleviate symptom burden