Understanding ARFID: clinical characteristics of patients who meet avoidant/restrictive food intake disorder criteria in a multidisciplinary pediatric growth and nutrition clinic

INTRODUCTION: Feeding difficulties are commonly multifactorial in nature, and no uniformly agreed-upon classification system for feeding difficulties currently exists. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-V included a new diagnosis called Avoidant/Restrictive Food Intake Disorder (ARFID), created in order to address the weaknesses of the DSM-IV-text revision (TR) classification system by better capturing the range of feeding difficulties typically found in clinical practice. Little is known about the clinical characteristics associated with meeting the ARFID criteria, and no studies have investigated ARFID prevalence and associated clinical characteristics in patients below the age of 8 years. AIM: To describe the clinical characteristics of a sample of patients referred to Boston Children Hospital’s Growth and Nutrition Program, including the prevalence of ARFID, and identify clinical characteristics associated with meeting the criteria for ARFID. METHODS: We examined prospectively collected data from 69 subjects, age 9 months to 7 years, referred to the Growth and Nutrition Program for feeding difficulties and/or malnutrition between November 2013 and April 2016. Data was collected from caregiver-completed questionnaires, including the Behavioral Pediatrics Assessment Scale (BPFAS), and each patient’s electronic medical record. RESULTS: Premature birth (32.3%), digestive conditions (69.2%), developmental conditions (56.9%), food allergy (20.3%), and meal duration of over 30 minutes (36.2%) were common. Problematic feeding behaviors such as refusing to eat (62.1%) and gagging or vomiting when given new foods (29.2%) were also common. Strategies caregivers used to increase food and liquid consumption included offering only foods the child likes (60.9%) and feeding in front of the television or electronic devices (30.4%). 90.8% had a BPFAS score above threshold. 83.1% of the sample met criteria for ARFID. No statistically significant relationship was found between meeting ARFID criteria and having a BPFAS score above threshold, and there was no statistically significant relationship between meeting ARFID criteria and having a food allergy, having a first-degree relative with a food allergy, or with any of the feeding behaviors or strategies we investigated. CONCLUSION: This study suggests that the majority of patients between the ages of 9 months to 7 years with feeding difficulties referred to the Growth and Nutrition Program meet the criteria for ARFID. While no statistically significant relationship was found between ARFID and the investigated clinical characteristics, further analysis involving a larger sample of patients will be useful for better understanding the clinical characteristics associated with ARFID, and assessing ARFID’s clinical utility.2019-07-11T00:00:00

The Global Macroeconomic Impacts of COVID-19: Seven Scenarios

The outbreak of coronavirus named COVID-19 has disrupted the Chinese economy and is spreading globally. The evolution of the disease and its economic impact is highly uncertain which makes it difficult for policymakers to formulate an appropriate macroeconomic policy response. In order to better understand possible economic outcomes, this paper explores seven different scenarios of how COVID-19 might evolve in the coming year using a modelling technique developed by Lee and McKibbin (2003) and extended by McKibbin and Sidorenko (2006). It examines the impacts of different scenarios on macroeconomic outcomes and financial markets in a global hybrid DSGE/CGE general equilibrium model. The scenarios in this paper demonstrate that even a contained outbreak could significantly impact the global economy in the short run. These scenarios demonstrate the scale of costs that might be avoided by greater investment in public health systems in all economies but particularly in less developed economies where health care systems are less developed and popultion density is high

Coral reef ecosystem - Monitoring and assessment using satellite data sets

Remaining in splendid isolation, the Andaman and Nicobar Islands have a great relevance in the study of marine ecosystems. The islands, though remotely located in an ostensibly pristine environment have born witness to serious issues with regard to their ecosystem health. There are significant changes in the temperature and rain fall pattern in the islands and predictive modelling has forecasted further damage in the near future. The inundation of saline water into inland terrestrial ecosystems has created salinity stress to freshwater species while reducing the water available for domestic consumption. Terrestrial flora and fauna are vulnerable to the intruding saline waters. The marine ecosystem also faces grave challenges. There are issues of anthropogenic pollution resulting in damage of corals, regime shifts in community structure, water quality deterioration and other damage to marine fauna

Using position control to improve the efficiency of wind turbine

Wind energy is one of the renewable energies that can be using to generate electricity. Increasing demand for this type of renewable energy for sustainability and accessibility. Environmentally as it does not cause any pollution in addition to the abundance of required equipment and lessmaintenance and long operation life of its parts despite the high cost of the system at its installation but at long term, become cheaper. Wind power generators depend on their operation on wind speed and direction. Therefore,it should be installing in places where the wind speed is adequate and sufficient to rotate its rotor, it knows that wind speed is variable in its speed and direction they change every hour and every season. In this design, many practical and theoretical (simulation) experiments have been done which will be mentioned and explained in details in this research shows that this mechanism raises the efficiency of wind power generators by 80% when the rotor of the wind turbine directed towards the wind than if they were fixed direction

Paris Climate Agreement Assignment

This assignment can be used for a section on addressing global climate change in a class such as International Political Economy or International Organizations. It requires a student to explain the role of the Paris Climate Agreement by interacting with this treaty’s website

Global macroeconomic scenarios

The COVID-19 global pandemic has caused significant global economic and social disruption. In McKibbin and Fernando (2020), we used data from historical pandemics to explore seven plausible scenarios of the economic consequences if COVID-19 were to become a global pandemic. In this paper, we use currently observed epidemiological outcomes across countries and recent data on sectoral shutdowns and economic shocks to estimate the likely global economic impacts of the pandemic under six new scenarios. The first scenario explores the outcomes if the current course of COVID-19 is successfully controlled, and there is only a mild recurrence in 2021. We then explore scenarios where the opening of economies results in recurrent outbreaks of various magnitudes and countries respond with and without economic shutdowns. We also explore the impact if no vaccine becomes available and the world must adapt to living with COVID-19 in coming decades. The final scenario is the case where a given country is in the most optimistic scenario (Scenario 1), but the rest of the world is in the most pessimistic scenario. The scenarios demonstrate that even a contained outbreak will significantly impact the global economy in the coming years. The economic consequences of the pandemic under plausible scenarios are substantial and the ongoing economic adjustment is far from over.This report was commisioned by Centre for Economic Policy Research. We gratefully acknowledge financial support from the Australia Research Council Centre of Excellence in Population Ageing Research (CE170100005)

Practicing medicine on the high seas: a review of South African doctors’ careers in cruise ship medicine

Background: There has been an increase in the number of South African doctors working in the field of maritime medicine on board cruise ships. Despite this, there is a paucity of literature available addressing the epidemiology, level of expertise and continued medical education (CME) activities of cruise ship medicine. We aim to describe the demographics, qualifications and level of experience of South African doctors embarking on a career as a cruise ship doctor and assess ongoing CME and the future careers of doctors post cruise ship medicine. Materials and methods: A survey was distributed to doctors either currently employed or previously employed as a cruise ship doctor from July 2012 to June 2017. The data obtained was used to describe the characteristics of South African doctors working in the field of cruise ship medicine. Results: Of the 65 respondents, 61.5% were female. The majority of doctors were aged between 25 and 40 years. All South African doctors held a Bachelor of Medicine and Bachelor of Surgery degree, or equivalent, as a primary medical qualification and 46% held a Diploma in Primary Emergency Care prior to working at sea. The majority of doctors obtained certification in Basic Life Support, Advanced Cardiac Life Support, Paediatric Advanced Life Support and Advanced Trauma Life Support prior to joining cruise ship medicine. A wide range of courses and diplomas were undertaken by these doctors whilst working at sea. The majority of doctors opted for short to medium term contracts before returning to South Africa to pursue a land-based career, often by enrolling in postgraduate specialist training programmes. Conclusions: Maritime medicine is an emerging field of emergency medicine in South Africa and requires a high standard of competence. A robust CME programme exists whilst working at sea. Most South African doctors return to South Africa to pursue a land based career, alleviating the potential concern that South Africa is permanently losing doctors to cruise ship medicine