Assessment framework and operational definitions for long-term scenarios

To navigate among the long term challenges for global and national food security, policy makers cannot only rely on qualitative analysis. They also need quantitative tools to measure and rank the different issues that they will face and the policy responses that can be designed. FOODSECURE proposes state-of-the art simulation models that will give both researchers and policy makers the capacity to study these issues in a comprehensive framework. This paper is aimed at providing an overview of the different modeling solutions proposed in the FOODSECURE toolbox and defines a strategy for using the different models in a consistent manner. First, the different models are briefly described and compared. Next, we see how these models tackle key food security indicators and drivers and translate different assumptions about the future within their framework. We then discuss the relative strengths and weaknesses of the different models to address different policy questions. Finally, we discuss how to combine these models and which optimal level of model integration should be used for analysis

Durability and Microstructure of Cement Composites Containing Qatar's Municipal Wastes

Qatar produces more than 2.5 million tons of municipal waste per year with an average waste generation rate of 1.8 kg/day/capita which is one of the highest rates in the world. The rapid growth of municipal solid waste has become one of the serious environmental problem that Qatar is facing with. Qatar's municipal waste is composed of organic and recyclables materials. Municipal solid waste incineration has been performed in Qatar since 2011. By incineration of wastes, not only the volume and weight of wastes are reduced but also energy is generated. Prior to incineration of municipal wastes, recyclables are separated from the waste and the remaining waste is incinerated at a minimum temperature of 850oC. Bottom ash and fly ash are produced as a result of incineration process. These by-products may contain heavy metals and pose a thread to the environment hence needs treatment and/or special disposal. Approximately 60 tonnes of fly ash is generated daily from municipal waste incineration in Qatar and this ash called as municipal solid waste incineration (MSWI) fly ash. This MSWI fly ash is stabilised with cement and then disposed into special landfill. However, cementitious property of MSWI fly ash due to similar mineralogical composition with cement and its finer particle size may favor its potential utilisation in cement based materials. As aforementioned before, 40% of municipal waste of Qatar is composed of recyclables of which 14% is plastic. The major portion of plastic wastes, about 90% of total, are composed of light density polyethylene (LDPE) and high density polyethylene (HDPE) wastes. Therefore, there is a huge potential for recycling of PE wastes in Qatar considering the shortage of raw materials i.e. natural aggregate for construction industry. The scarcity of available land for disposal of municipal wastes and limited natural resources of raw materials for construction industry has opened new research areas for proper disposal and recycling of municipal wastes. Therefore, in this research work, municipal solid waste incineration (MSWI) fly ash and municipal polymeric wastes were used as secondary raw materials for the preparation of cement based composites. MSWI fly ash was utilised as partial replacement of cement by 10% by weight. Polyetyhlene wastes in granular form were utilised as partial replacement of natural aggregate by 10% by volume. Portland cement, silica fume (10% by weight) and MSWI FA (10% by weight) at constant rates were used as binder in all cement-based composites. Three different cement based composites were fabricated by partial substition of natural aggregate with LDPE and HDPE wastes at 0 and 10% by volume. The mixture without PE waste substitution was called as the reference mixture, with LDPE waste was called as Mix 1 and with HDPE waste was called as Mix 2. Besides mechanical performance, durability of fabricated cement composites containing municipal wastes was investigated to determine if their utilisation has positive contribution or adverse impact. The durability properties were examined by performing drying shrinkage and expansion under sulfate exposure tests. Scanning electron microscopy coupled with EDX were used to determine the degradation products of sulfate exposure. In terms of mechanical strength, samples containing PE wastes showed lower strength at early ages due to weaker bonding between LDPE/HDPE and the cement matrix. At later ages, strength improvement was observed and comparable strength values for Mix 1 and Mix 2 were measured with respect to the reference. The effect of utilisation of municipal wastes on the dimensional stability of cement composites was evaluated by measuring the variation of length change at 4, 11, 18, 25, 126 and 168 days of air drying. This test showed that incorporation of PE wastes (Mix 1 and Mix 2) reduced the drying shrinkage and provided better dimensional stability compared to the reference. Sulfate attack is known as one of the most deleterious effects on cement based composites due to the formation of expansive degradation products. To investigate the sulfate resistance of fabricated composites, the length change at 1 week, 2 weeks, 3 weeks, 4 weeks, 8 weeks, 13 weeks, 15 weeks, 4 months and 6 months of sulfate exposure was measured. Both the reference and samples containing PE wastes did not show any visual deterioration except a white and soft layer formed on top of all samples. The length change indicated that composites containing PE wastes experienced reduction in expansion compared to the reference and hence considered as more durable for external sulfate attack. More voids and pores were present in PE incorporated samples, therefore sulfate degradation products probably filled these pores and resulted in lower expansion compared to the reference. There was no significant difference between the mechanical performance and durability of cement composites containing LDPE and HDPE. The microstructure and composition of sulfate degradation products were investigated by SEM-EDX. The decalcification of the C-S-H phase were detected in each sample. Gypsum, calcite and thaumasite were identified as the major deterioration related products, while ettringite was found at trace level. This laboratory study showed that MSWI fly ash and PE wastes can be utilised together to produce durable cement based materials with a lower carbon footprint.qscienc

Novel associations in disorders of sex development: findings from the I-DSD registry

Context: The focus of care in disorders of sex development (DSD) is often directed to issues related to sex and gender development. In addition, the molecular etiology remains unclear in the majority of cases.<p></p> Objective: To report the range of associated conditions identified in the international DSD (I-DSD) Registry.<p></p> Design, Setting, and Patients: Anonymized data were extracted from the I-DSD Registry for diagnosis, karyotype, sex of rearing, genetic investigations, and associated anomalies. If necessary, clarification was sought from the reporting clinician.<p></p> Results: Of 649 accessible cases, associated conditions occurred in 168 (26%); 103 (61%) cases had one condition, 31 (18%) had two conditions, 20 (12%) had three conditions, and 14 (8%) had four or more conditions. Karyotypes with most frequently reported associations included 45,X with 6 of 8 affected cases (75%), 45,X/46,XY with 19 of 42 cases (45%), 46,XY with 112 of 460 cases (24%), and 46,XX with 27 of 121 cases (22%). In the 112 cases of 46,XY DSD, the commonest conditions included small for gestational age in 26 (23%), cardiac anomalies in 22 (20%), and central nervous system disorders in 22 (20%), whereas in the 27 cases of 46,XX DSD, skeletal and renal anomalies were commonest at 12 (44%) and 8 (30%), respectively. Of 170 cases of suspected androgen insensitivity syndrome, 19 (11%) had reported anomalies and 9 of these had confirmed androgen receptor mutations.<p></p> Conclusions: Over a quarter of the cases in the I-DSD Registry have an additional condition. These associations can direct investigators toward novel genetic etiology and also highlight the need for more holistic care of the affected person.<p></p&gt

Efficacy of AZM therapy in patients with gingival overgrowth induced by Cyclosporine A: a systematic review

<p>Abstract</p> <p>Background</p> <p>In daily clinical practice of a dental department it's common to find gingival overgrowth (GO) in periodontal patients under treatment with Cyclosporine A (CsA). The pathogenesis of GO and the mechanism of action of Azithromycin (AZM) are unclear. A systematic review was conducted in order to evaluate the efficacy of Azithromycin in patients with gingival overgrowth induced by assumption of Cyclosporine A.</p> <p>Methods</p> <p>A bibliographic search was performed using the online databases MEDLINE, EMBASE and Cochrane Central of Register Controlled Trials (CENTRAL) in the time period between 1966 and September 2008.</p> <p>Results</p> <p>The literature search retrieved 24 articles; only 5 were Randomised Controlled Trials (RCTs), published in English, fulfilled the inclusion criteria. A great heterogeneity between proposed treatments and outcomes was found, and this did not allow to conduct a quantitative meta-analysis. The systematic review revealed that a 5-day course of Azithromycin with Scaling and Root Planing reduces the degree of gingival overgrowth, while a 7-day course of metronidazole is only effective on concomitant bacterial over-infection.</p> <p>Conclusion</p> <p>Few RCTs on the efficacy of systemic antibiotic therapy in case of GO were found in the literature review. A systemic antibiotic therapy without plaque and calculus removal is not able to reduce gingival overgrowth. The great heterogeneity of diagnostic data and outcomes is due to the lack of precise diagnostic methods and protocols about GO. Future studies need to improve both diagnostic methods and tools and adequate classification aimed to determine a correct prognosis and an appropriate therapy for gingival overgrowth.</p

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: An international case-cohort study

We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts. A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (\u3baw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the Cindex. A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (\u3baw=0.65, IQR 0.53-0.72, p20 years of experience (C-index=0.72, IQR 0.0-0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70-0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72-0.75). Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts

Comprehensive analysis via exome sequencing uncovers genetic etiology in autosomal recessive nonsyndromic deafness in a large multiethnic cohort

Purpose:Autosomal recessive nonsyndromic deafness (ARNSD) is characterized by a high degree of genetic heterogeneity, with reported mutations in 58 different genes. This study was designed to detect deafness-causing variants in a multiethnic cohort with ARNSD by using whole-exome sequencing (WES).Methods:After excluding mutations in the most common gene, GJB2, we performed WES in 160 multiplex families with ARNSD from Turkey, Iran, Mexico, Ecuador, and Puerto Rico to screen for mutations in all known ARNSD genes.Results:We detected ARNSD-causing variants in 90 (56) families, 54 of which had not been previously reported. Identified mutations were located in 31 known ARNSD genes. The most common genes with mutations were MYO15A (13), MYO7A (11), SLC26A4 (10), TMPRSS3 (9), TMC1 (8), ILDR1 (6), and CDH23 (4). Nine mutations were detected in multiple families with shared haplotypes, suggesting founder effects.Conclusion:We report on a large multiethnic cohort with ARNSD in which comprehensive analysis of all known ARNSD genes identifies causative DNA variants in 56 of the families. In the remaining families, WES allows us to search for causative variants in novel genes, thus improving our ability to explain the underlying etiology in more families.Genet Med 18 4, 364-371. © American College of Medical Genetics and Genomics