The Unite for Diabetes campaign: Overcoming constraints to find a global policy solution

Despite the fact that diabetes and other non-communicable diseases represent a significant proportion of the global burden of disease, proportionate global action has not occurred. A 2003 article reported on global constraints to the implementation of effective policies to curb non-communicable disease epidemics. These constraints include a lack of global advocacy, insufficient attention from funding agencies and governments, partnerships and interactions, capacity and resources, and global norms and standards, as well as orientation of health services to acute care. Building on these ideas, this paper will review the progress that has been made with regards to each constraint, focusing on the International Diabetes Federation's Unite for Diabetes campaign and United Nations resolution on diabetes to show how this event – driven by globalization – has helped remove some of these barriers. Additional progress in diabetes and NCD prevention and control is also highlighted. The paper concludes by outlining what still needs to happen for globalization to be an effective solution for diabetes and non-communicable disease prevention and control

"Public sector pricing": Theoretical analysis in a dynamic macroeconomic model.

This thesis examines the role of public policy, with specific reference to public sector pricing, in an economy where all markets do not necessarily clear. The discussion focuses on three non-Walrasian market situations termed, in the nomenclature of Malinvaud and others, as: Keynesian Unemployment, Classical Unemployment and Repressed Inflation. In chapter 1, there is a brief summary of the literature in this area. The framework of the model used, is described in some detail in chapter 2. In chapter 3, the role of the traditional instruments of taxation and public expenditures is analysed in the framework of the present model. The "non-traditional" instrument of public sector pricing throws up some interesting results. Among other things, my results indicate that public sector pricing can be designed to effectively influence the level of aggregate income and employment. The method of financing the government deficit is the subject of chapter 4. My results indicate that the bond-financed multiplier of Blinder and Solow or Tobin and Buiter is simply a special case of the multiplier in my model, when the public sector enterprise prices its output at marginal cost. Equally important, I establish that the Blinder-Solow result "the long-run multiplier for bond-financed deficit spending exceeds that for money-financed deficit spending" is not necessarily true. Furthermore, the stability and convergence properties of the system are shown to rest on the choice of public sector prices. The characterisation of optimal public sector prices is dealt with in chapters 5 and 6, viewed from a different perspective in each of the chapters. In chapter 5, optimal pricing rules are derived which are explicit and readily operational. Finally, in chapter 6, we characterise the dynamic time-path of optimal public sector prices

Soil Moisture as an Indicator of Weather Extremes

In this paper, we investigate floods and droughts in the Upper Mississippi basin over a 50-year period (1950–1999) using a hydrological model (Variable Infiltration Capacity Model – 3 Layer). Simulations have been carried out between January 1950 and December 1999 at daily time-step and 1/8° spatial resolution for the water budget and at hourly time-step and 1° spatial resolution for the energy balance. This paper will provide valuable insights to the slow response components of the hydrological cycle and its diagnostic/predictive value in the case of floods and droughts. The paper compares the use of the Palmer Drought Severity Index against the anomalies of the third layer soil moisture for characterizing droughts and floods. Wavelet and coherency analysis is performed on the soil moisture, river discharge, precipitation and PDSI time series confirm our hypothesis of a strong relationship between droughts and the third layer soil moisture

Use of furosemide stress test for edema control and predicting acute kidney injury in children with nephrotic syndrome

Background: Furosemide stress test (FST) involves measurement of 2‑h urine output after giving 1 mg/kg of furosemide in clinically euvolemic patients and has been shown to identify those with severe and progressive acute kidney injury (AKI). Objectives: To assess whether using FST could help in deciding whether to give diuretics only, or combination of diuretics with albumin infusion, in children with nephrotic syndrome with edema to prevent AKI. Materials and Methods: This prospective, pilot cohort study was conducted on the use of FST to manage edema in children with nephrotic syndrome. Consecutive patients 1–14 years were enrolledfrom October 2016 to April 2017 from the pediatric nephrology outpatient department of a tertiary care center. They were assessed for fluid overload using their present and baseline weight. Patients with fluid overload of ≥10% were screened for AKI by measurement of serum urea and creatinine and monitoring of urine output in the next 24 h. Systemic infections were excluded using clinical and laboratory criteria. AKI was defined using the pediatric RIFLE score. Children with fluid overload of ≥10% were given intravenous furosemide 1 mg/kg provided; they had no clinical signs of intravascular dehydration or shock. Urine output was measured over thenext 2 h. Children with urine output <1 ml/kg/h after FST were presumed to be at risk for progressive AKI. Differences between the average heart rate, serum albumin, and urea/creatinine ratio were analyzed by independent t‑test. Results: A total of 67 children with nephrotic syndrome were reviewed, and 34 with fluid overload of >10% were analyzed for inclusion in the study. Of them, 11 were excluded and 23 were finally analyzed. 19/23 had urine output >1 mg/kg/h in next 2 h and none had serum creatinine increase >0.3 mg/dl or >150% of the baseline value. 4 had urine output < 1 ml/kg/h. Significant difference was found in the post‑FSTheart rate and urea/creatinine ratio between the children who had urine output >1 ml/kg/h and which had < 1 ml/kg/h after furosemide. These children were assumed to be at risk for severe and progressive AKI as per FST and were thereafter given furosemide with albumin to prevent further intravascular dehydration. Conclusion: FST may be used as a bedside test to help identify the children with nephrotic syndrome with intravascular dehydration who are at high risk for AKI and helps rational use of diuretics.&nbsp

Prevalence of vitamin B12 deficiency among individuals with type 2 diabetes mellitus in a South Indian rural community

Background: To estimate the prevalence of vitamin B12 deficiency in a rural south Indian community and to evaluate the association between metformin use and prevalent vitamin B12 deficiency in people with T2DM stratified by oral vitamin B12 supplementation.Methods: Using a cross sectional study design, a random sample of people with T2DM (N=438) was recruited from a rural community. Vitamin B12 deficiency was defined as serum B12 ≤200pg/ml. Data on metformin dose, duration of use, oral vitamin B12 supplementation, and diet were collected. Laboratory measurements included complete blood count, tests for hepatic, renal, and thyroid function, as well as serum vitamin B12 levels and HbA1c.Results: The prevalence of vitamin B12 deficiency in people with T2DM was 11.2% (95% Confidence Interval (CI) 8.2%-14.1%). The odds of vitamin B12 deficiency in patients receiving a metformin dose of 2 grams/day were 4 times higher compared to those receiving ≤1 gram/day, after adjusting for oral B12 supplementation (odds ratio 4.2;95% CI 1.5-11.8). The odds of vitamin B12 deficiency in those taking metformin and receiving oral vitamin B12 supplementation were lower compared to those on metformin and not receiving vitamin B12 supplementation (adjusted odds ratio 0.20; 95% CI 0.06-0.70).Conclusions: Vitamin B12 deficiency affects 1 in 10 people with T2DM, is associated with higher dose metformin use, and oral vitamin B12 supplementation mitigates B12 deficiency in this group

Effect of Irregular Configurations on Seismic Vulnerability of RC Buildings

Abstract Many buildings in the present scenario have irregular configurations both in plan and elevation. This in future may subject to devastating earthquakes. In case, it is necessary to identify the performance of the structures to withstand against disaster for both new and existing one. The present paper made an attempt to study two kinds of irregularities in the building models namely plan irregularity with geometric and diaphragm discontinuity and vertical irregularity with setback and sloping ground. These irregularities are created as per clause 7.1 of IS 1893 (part1)2002 code. In Oder to identify the most vulnerable building among the models considered, the various analytical approaches are performed to identify the seismic demands in both linear and nonlinear way. It is also examined the effect of three different lateral load patterns on the performance of various irregular buildings in pushover analysis. This study creates awareness about seismic vulnerability concept on practicing engineers

Profile and outcomes of children presenting with infection-related glomerulonephritis

Poststreptococcal acute glomerulonephritis (PSGN) was reported as the most common cause of GN in children. There has been, however, a marked shift in epidemiology in recent years with the decline in poststreptococcal cases. Various other bacteria and rarely viral and fungal infections are associated with GN. More cases are now being reported with ongoing infection at the time GN is diagnosed. Therefore, the term infection-related GN (IRGN) is now being used increasingly. We describe the clinical profile and outcomes of children presenting with IRGN at a tertiary care center in the past 1 year. 5 children presented with features of GN. Only 1 of the 5 had the course typically described in PSGN. Two patients also had a post-infectious course but with some unusual features. Another patient had an ongoing systemic infection in the form of pneumonia at the time of onset of features GN, while our fifth patient developed an infection-related GN with dengue illness

Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions

No abstract available