Metabolic Effects Associated with ICS in Patients with COPD and Comorbid Type 2 Diabetes: A Historical Matched Cohort Study

Background Management guidelines for chronic obstructive pulmonary disease (COPD) recommend that inhaled corticosteroids (ICS) are prescribed to patients with the most severe symptoms. However, these guidelines have not been widely implemented by physicians, leading to widespread use of ICS in patients with mild-to-moderate COPD. Of particular concern is the potential risk of worsening diabetic control associated with ICS use. Here we investigate whether ICS therapy in patients with COPD and comorbid type 2 diabetes mellitus (T2DM) has a negative impact on diabetic control, and whether these negative effects are dose-dependent. Methods and Findings This was a historical matched cohort study utilising primary care medical record data from two large UK databases. We selected patients aged >= 40 years with COPD and T2DM, prescribed ICS (n = 1360) or non-ICS therapy (n = 2642) between 2008 and 2012. The primary endpoint was change in HbA(1c) between the baseline and outcome periods. After 1:1 matching, each cohort consisted of 682 patients. Over the 12-18-month outcome period, patients prescribed ICS had significantly greater increases in HbA1c values compared with those prescribed non-ICS therapies; adjusted difference 0.16% (95% confidence interval [Cl]: 0.05-0.27%) in all COPD patients, and 0.25% (95% Cl: 0.10-0.40%) in mild-to-moderate COPD patients. Patients in the ICS cohort also had significantly more diabetes-related general practice visits per year and received more frequent glucose strip prescriptions, compared with those prescribed non-ICS therapies. Patients prescribed higher cumulative doses of ICS (> 250 mg) had greater odds of increased HbA(1c) and/or receiving additional antidiabetic medication, and increased odds of being above the Quality and Outcomes Framework (QOF) target for HbA1c levels, compared with those prescribed lower cumulative doses ( Conclusion For patients with COPD and comorbid T2DM, ICS therapy may have a negative impact on diabetes control. Patients prescribed higher cumulative doses of ICS may be at greater risk of diabetes progression

Maternal colonization with Streptococcus agalactiae and associated stillbirth and neonatal disease in coastal Kenya

Streptococcus agalactiae (group B streptococcus, GBS) causes neonatal disease and stillbirth, but its burden in sub-Saharan Africa is uncertain. We assessed maternal recto-vaginal GBS colonization (7,967 women), stillbirth and neonatal disease. Whole-genome sequencing was used to determine serotypes, sequence types and phylogeny. We found low maternal GBS colonization prevalence (934/7,967, 12%), but comparatively high incidence of GBS-associated stillbirth and early onset neonatal disease (EOD) in hospital (0.91 (0.25-2.3)/1,000 births and 0.76 (0.25-1.77)/1,000 live births, respectively). However, using a population denominator, EOD incidence was considerably reduced (0.13 (0.07-0.21)/1,000 live births). Treated cases of EOD had very high case fatality (17/36, 47%), especially within 24 h of birth, making under-ascertainment of community-born cases highly likely, both here and in similar facility-based studies. Maternal GBS colonization was less common in women with low socio-economic status, HIV infection and undernutrition, but when GBS-colonized, they were more probably colonized by the most virulent clone, CC17. CC17 accounted for 267/915 (29%) of maternal colonizing (265/267 (99%) serotype III; 2/267 (0.7%) serotype IV) and 51/73 (70%) of neonatal disease cases (all serotype III). Trivalent (Ia/II/III) and pentavalent (Ia/Ib/II/III/V) vaccines would cover 71/73 (97%) and 72/73 (99%) of disease-causing serotypes, respectively. Serotype IV should be considered for inclusion, with evidence of capsular switching in CC17 strains

Shelter Projects 2015-2016

Spanning humanitarian responses from all over the world, Shelter Projects 2015-2016 is the sixth in a series of compilations of shelter case studies, overviews of emergencies and opinion pieces. The projects represent responses to conflict, natural disasters and complex or multiple crises, demonstrating some of the implementation and response options available. The book is intended to support learning by highlighting the strengths, weaknesses and some of the lessons that can be learned from different projects, which try to maximize emergency funds to safeguard the health, security and dignity of affected people, whilst – wherever possible – supporting longer-term shelter needs and sustainable recovery. The target audience is humanitarian managers and shelter programme staff from local, national and international organizations at all levels of experience. Shelter Projects is also a useful resource for advocacy purposes, showcasing the work done by the sector, as well as for research and capacity-building activities

Interferenze digitali. Un'estetica delle pratiche digitali a supporto del discorso di design

'Desis in The Mirror’ è un progetto di ricerca nato nell’estate del 2013 per riflettere sulle pratiche di produzione audiovisiva realizzate dai membri del DESIS Network, quasi tutti non film maker. Le esperienze dei membri dei DESIS Lab sono state messe in relazione con altre raccolte di video-interviste a film maker e artisti che, da prospettive e formazioni diverse, raccontano progetti legati all'innovazione sociale e alla sostenibilità. Il progetto rappresenta, dunque, un processo di riflessione sulle pratiche del design che includono artefatti multimediali digitali. La piattaforma digitale utilizzata per i collegamenti e le registrazioni ha facilitato e reso possibile video interviste impossibili da realizzare in presenza, ma ha comportato altri limiti connessi alla tecnologia stessa, introducendo elementi fortemente connotanti quali disturbi sonori e rumori visivi, nonché il punto di vista unico della ripresa video da webcam. Dunque, un’estetica delle pratiche digitali fondata su una nuova materialità. Il progetto nato in seguito all’indagine è un format multimediale per la disseminazione della ricerca, rivolto sia ai membri del DESIS Network, sia a un pubblico più esteso di ricercatori. Partendo dalle registrazioni delle interviste vengono elaborati testi, immagini, brevi montaggi, video che moltiplicano le modalità di fruizione, fornendo percorsi di lettura via via differenti. Nella costruzione del format non si è solo tenuto conto della discontinuità e spesso cattiva qualità delle video-interviste: le interferenze della connessione digitale sono diventate cifra stilistica del progetto e spesso elementi di transizione, funzionali al montaggio dei contenuti

Electrodeposition of NiO/YSZ from hydroalcoholic solutions containing Chitosan

NiO–YSZ films – of thicknesses in the range ca. 1–15μm– have been fabricated by multi-step galvanostatic deposition from acidic hydroalcoholic solutions of NiCl2, ZrOCl2 and YCl3, containing Chitosan. The crystallographic structure of the electrodeposits has been studied by XRD, their chemical composition has been evaluated by EDX analysis, their morphology has been observed by SEM and optical microscopy and their adhesion has been quantified by the scratch-test method. Deposition-rate measurements have pinpointed some kinetic factors, relevant to process optimisation and bath management. As-plated samples exhibit an X-ray amorphous structure, that can be converted to crystalline fcc-NiO/cubic-fluorite YSZ by heat treatment. The YSZ composition is Y/Zr ca. 0.2 (molar ratio) and does not depend appreciably on processing conditions; the NiO content can be tuned in the range Ni/(Zr+Y) ca. 0.2–2 (molar ratio) by adjusting the electrodeposition parameters