COVID-19 outbreak and pediatric diabetes: perceptions of health care professionals worldwide

This is the peer reviewed version of the following article: "COVID-19 outbreak and pediatric diabetes: perceptions of health care professionals worldwide". Pediatric Diabetes (2020): 20 July, which has been published in final form at 10.1111/pedi.13084. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsCoronavirus diasease (COVID-19) is an infectious disease that startedin Wuhan, China in late 2019 and later spread around the world. Diabetes has beenrecognized as a possible risk factor for COVID-19 complications.Objective: International Society for Pediatric and Adolescent Diabetes (ISPAD) investi-gated perceptions, challenges and experience of health care professionals (HCP) takingcare of children and young people with diabetes worldwide during COVID-19 pandemic.Methods: From 21st April to 17th May 2020, during COVID-19 pandemic, a web-based survey was sent to ISPAD members and former participants of ISPAD confer-ences by email.Results: Responders from 215 diabetes centers from 75 countries completed the sur-vey. Majority were from UK (35; 16.3%), USA (20; 9.3%), and India (15; 7%). HCPwere mostly pediatric endocrinologists (64%). During COVID-19 pandemic, 16.5% ofresponders continued face-to-face consultation while most changed to telephone(32%) or video (18%) consultations. 19% reported a shortage of medical supplies.22% reported a delay in diagnosis of patients with new-onset diabetes, while 15%reported a higher incidence of DKA. 12% reported having one or more patients withCOVID-19. Most of the 86 children and adolescents with diabetes and COVID-19had only mild/moderate symptoms, while 5 required admission to an intensive careunit. No deaths were reported.Conclusions: This large global survey during COVID-19 pandemic showed that manyHCP adapted to the pandemic by resorting to telemedicine. One fourth of HCPreported delays in diagnosis and an increased rate of DKA. The emergence ofCOVID-19 pandemic had an important impact on family's behavior that might haveled to increase in diabetic ketoacidosis presentatio

The incidence, mortality and timing of Pneumocystis jiroveci pneumonia after hematopoietic cell transplantation: a CIBMTR analysis

Pneumocystis jiroveci pneumonia (PJP) is associated with high morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Little is known about PJP infections after HSCT because of the rarity of disease given routine prophylaxis. We report the results of a CIBMTR study evaluating the incidence, timing, prophylaxis agents, risk factors, and mortality of PJP after autologous (auto) and allogeneic (allo) HSCT. Between 1995 and 2005, 0.63% allo recipients and 0.28% auto recipients of first HSCT developed PJP. Cases occurred as early as 30 days to beyond a year after allo HSCT. A nested case cohort analysis with supplemental data (n=68 allo cases, n=111 allo controls) revealed that risk factors for PJP infection included lymphopenia and mismatch after HSCT. After allo or auto HSCT, overall survival was significantly poorer among cases vs. controls (p=0.0004). After controlling for significant variables, proportional hazards model revealed that PJP cases were 6.87 times more likely to die vs. matched controls (p<0.0001). We conclude PJP infection is rare after HSCT but is associated with high mortality. Factors associated with GVHD and with poor immune reconstitution are among the risk factors for PJP and suggest that protracted prophylaxis for PJP in high-risk HSCT recipients may improve outcomes

Oil-Based Mud Cutting as an Additional Raw Material in Clinker Production

Oil-Based Mud (OBM) cutting is a hazardous by-product generated during oil-well drilling. Its chemical composition suggests that it might be suitable as a raw material in cement manufacturing. It is rich in calcium oxide, silica, and aluminium oxide, which are the major oxides in raw materials for cement manufacturing. In this research, OBM cutting is used as a constituent of the raw meal for cement clinker production. Raw meal mixtures were prepared by mixing different ratios of raw materials increasing OBM content. The impact of the addition of OBM cutting on the resulting clinker has been investigated. The results demonstrate that OBM cutting could be recycled in the manufacturing of Portland cement clinker. Clinker prepared using OBM cutting had very similar properties to that prepared from limestone. This result could represent an opportunity for solving an environmental problem. The addition of OBM cutting lowers the calcination temperature, and increases the rate of carbonate dissociation. However, it also leads to a higher free lime in clinker, which is a result of the presence of trace elements, such as barium. Overall, its use as a raw material in cement production could provide a cost-effective, environment-friendly route for the management of OBM cutting

Adrenal suppression: A practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapy

Inhaled corticosteroids (ICSs) are the most effective anti-inflammatory agents available for the treatment of asthma and represent the mainstay of therapy for most patients with the disease. Although these medications are considered safe at low-to-moderate doses, safety concerns with prolonged use of high ICS doses remain; among these concerns is the risk of adrenal suppression (AS). AS is a condition characterized by the inability to produce adequate amounts of the glucocorticoid, cortisol, which is critical during periods of physiological stress. It is a proven, yet under-recognized, complication of most forms of glucocorticoid therapy that can persist for up to 1 year after cessation of corticosteroid treatment. If left unnoticed, AS can lead to significant morbidity and even mortality. More than 60 recent cases of AS have been described in the literature and almost all cases have involved children being treated with ≥500 μg/day of fluticasone

Systems approaches to innovation in crop protection. A systematic literature review

The objective of this paper is to explore the extent to which systems approaches to innovation are reflected in the crop protection literature and how such approaches are used. A systematic literature review is conducted to study the relation between crop protection and systems approaches to innovation in 107 publications. The analysis of the crop protection literature demonstrates that only a small fraction is systems-oriented as compared to the bulk of publications with a technology-oriented approach. The analysis of agricultural innovations systems literature shows that, although crop protection is addressed, the potential of this systems approach remains largely unexplored for crop protection innovation. A large share of the publications included in this review focus on cropping or farming ‘systems’ while ‘innovation’ often equals the development, transfer, adoption and diffusion of crop protection technologies at farm level. There is relatively little attention for the institutional and political dimensions of crop protection and the interactions between farm, regional and national levels in crop protection systems. The traditional division of roles and responsibilities of researchers as innovators, extension personnel as disseminators, and farmers as end-users, is challenged only to a limited extent. The majority of publications discusses ways to optimise existing features of crop protection systems, without exploring more structural transformations that may be required to enhance the resilience of crop protection systems

Asymmetric response of forest and grassy biomes to climate variability across the African Humid Period : influenced by anthropogenic disturbance?

A comprehensive understanding of the relationship between land cover, climate change and disturbance dynamics is needed to inform scenarios of vegetation change on the African continent. Although significant advances have been made, large uncertainties exist in projections of future biodiversity and ecosystem change for the world's largest tropical landmass. To better illustrate the effects of climate–disturbance–ecosystem interactions on continental‐scale vegetation change, we apply a novel statistical multivariate envelope approach to subfossil pollen data and climate model outputs (TraCE‐21ka). We target paleoenvironmental records across continental Africa, from the African Humid Period (AHP: ca 14 700–5500 yr BP) – an interval of spatially and temporally variable hydroclimatic conditions – until recent times, to improve our understanding of overarching vegetation trends and to compare changes between forest and grassy biomes (savanna and grassland). Our results suggest that although climate variability was the dominant driver of change, forest and grassy biomes responded asymmetrically: 1) the climatic envelope of grassy biomes expanded, or persisted in increasingly diverse climatic conditions, during the second half of the AHP whilst that of forest did not; 2) forest retreat occurred much more slowly during the mid to late Holocene compared to the early AHP forest expansion; and 3) as forest and grassy biomes diverged during the second half of the AHP, their ecological relationship (envelope overlap) fundamentally changed. Based on these asymmetries and associated changes in human land use, we propose and discuss three hypotheses about the influence of anthropogenic disturbance on continental‐scale vegetation change

Conflict-induced displacement as a catalyst for agricultural innovation: findings from South Sudan

This article explores how conflict-induced displacement influences agricultural innovation processes and systems, and its implications after the return home or permanent resettlement of smallholder farmers. Results show that high rates of agricultural innovation occurred during displacement in the Sudanese Civil War (1983-2005), many of which were maintained afterwards. Respondents cited the need for adaptation to new social and physical circumstances, changed gender roles, and enhanced inter-household communication as contributing to increased opportunities for knowledge exchange, trade, and importantly, the development of new networks, modes of organisation and social norms. Furthermore, returnees to South Sudan have embodied these changes together with new values, habits and expectations. New linkages continued across borders between returnees and non-returnees, facilitating knowledge exchange and access to resources, markets and sources of ideas. A high degree of autonomous innovation capacity was also evident. Further research is required on the dynamics and processes associated with innovation in conflict-induced displacement. It is important for policy makers to encourage approaches that seek to actively tap into and build on the institutional, human and social capital built during displacement

Farmers’ perceptions of climate variability and its adverse impacts on crop and livestock production in Ethiopia

© 2017 Elsevier. Ltd This article explores farmers’ perceptions of the manifestations of global change as a whole and of climate variability in particular, and its effects on the agricultural production in selected highland areas of Ethiopia. Primary data was collected using group and individual interviews, complemented by observations and a survey. The study shows that more that eighty percent of farmers felt the various manifestations and effects of climate variability. The study reveals that sex, age, income and educational level are determinant factors of farmers’ perceptions on the manifestations and effects of climate variability on crop and livestock production. Farmers’ perceptions of change in temperature are cognate with meteorological data analysis. However, their perceptions were found to be in disagreement with meteorological rainfall trends. This research concludes by suggesting realistic and achievable recommendations to enhance the adaptive capacity of farmers to climate extremes and the existing and future physical, biological and epidemiological challenges on crop and livestock production, so that shortfalls on farmers adaptive capacity can be addressed

El desafío de la administración adecuada de antimicrobianos en pediatría.

Background: Antibiotics are among the drugs most commonly prescribed to children in hospitals and communities. Unfortunately, a great number of these prescriptions are unnecessary or inappropriate. Antibiotic abuse and misuse have several negative consequences, including drug-related adverse events, the emergence of multidrug resistant bacterial pathogens, the development of Clostridium difficile infection, the negative impact on microbiota, and undertreatment risks. In this paper, the principle of and strategies for paediatric antimicrobial stewardship (AS) programs, the effects of AS interventions and the common barriers to development and implementation of AS programs are discussed. Discussion: Over the last few years, there have been significant shortages in the development and availability of new antibiotics; therefore, the implementation of strategies to preserve the activity of existing antimicrobial agents has become an urgent public health priority. AS is one such approach. The need for formal AS programs in paediatrics was officially recognized only recently, considering the widespread use of antibiotics in children and the different antimicrobial resistance patterns that these subjects exhibit in comparison to adult and elderly patients. However, not all problems related to the implementation of AS programs among paediatric patients are solved. The most important remaining problems involve educating paediatricians, creating a multidisciplinary interprofessional AS team able to prepare guidelines, monitoring antibiotic prescriptions and defining corrective measures, and the availability of administrative consensuses with adequate financial support. Additionally, the problem of optimizing the duration of AS programs remains unsolved. Further studies are needed to solve the above mentioned problems. Conclusions: In paediatric patients, as in adults, the successful implementation of AS strategies has had a significant impact on reducing targeted- and nontargeted-antimicrobial use by improving the quality of care for hospitalized patients and preventing the emergence of resistance. Considering that rationalization of antibiotic misuse and abuse is the basis for reducing emergence of bacterial resistance and several clinical problems, all efforts must be made to develop multidisciplinary paediatric AS programs in hospital and community settings

Pseudoacromegaly

© 2018 Elsevier Inc. Individuals with acromegaloid physical appearance or tall stature may be referred to endocrinologists to exclude growth hormone (GH) excess. While some of these subjects could be healthy individuals with normal variants of growth or physical traits, others will have acromegaly or pituitary gigantism, which are, in general, straightforward diagnoses upon assessment of the GH/IGF-1 axis. However, some patients with physical features resembling acromegaly – usually affecting the face and extremities –, or gigantism – accelerated growth/tall stature – will have no abnormalities in the GH axis. This scenario is termed pseudoacromegaly, and its correct diagnosis can be challenging due to the rarity and variability of these conditions, as well as due to significant overlap in their characteristics. In this review we aim to provide a comprehensive overview of pseudoacromegaly conditions, highlighting their similarities and differences with acromegaly and pituitary gigantism, to aid physicians with the diagnosis of patients with pseudoacromegaly.PM is supported by a clinical fellowship by Barts and the London Charity. Our studies on pituitary adenomas and related conditions received support from the Medical Research Council, Rosetrees Trust and the Wellcome Trust