Previous studies have demonstrated racial and ethnic differences in glycemic control even after adjustment for variables such as insulin dosage, diabetes duration, and socioeconomic status. It is controversial whether genetic, physiologic, cultural, socioeconomic, and/or provider-related factors underlie these disparities.

This study in a large, racially/ethnically diverse sample of children with type 1 diabetes demonstrates that racial disparities in insulin treatment methods and diabetes outcomes remain even after adjustment for socioeconomic status. (Read the full article)

Increasing data suggest that neonatal pain has long-term consequences. Pharmacologic interventions for minor pain are ineffective, and nonpharmacologic techniques (sucrose taste, pacifier suckling, breastfeeding) are effective and now widely used.

The taste of sucrose has been shown to be an effective and widely used analgesic for infants, and this study demonstrates that combining brief exposure to natural radiant warmth with the taste of sucrose improves the analgesic effect for the infant. (Read the full article)

An increasing number of children are unvaccinated at entry into public schools, potentially endangering children who cannot be vaccinated for medical reasons and threatening herd immunity. Voluntary exemptions from immunizations vary geographically and by parental characteristics.

We find that exemption behavior is highest in peripheral areas of cities and that specific types of student populations are associated with high exemption rates. Additionally, there is spatial overlap between clusters of high personal exemption and medical exemption populations. (Read the full article)

Biotinidase deficiency (BD) might cause severe and permanent consequences. Cases detected through newborn screening and under treatment are shown to remain asymptomatic. However, some countries, including Spain, do not provide universal BD screening within their national newborn screening programs.

It provides a first estimate of the lifetime costs and health outcomes of a Spanish birth cohort with and without neonatal screening for BD. It shows that newborn screening for BD is likely to be a cost-effective use of resources. (Read the full article)

The value of ultrasound imaging for the diagnosis, prognosis, and surgical planning of cryptorchidism is limited at best.

Ultrasound remains grossly overused by referring physicians throughout Ontario, Canada, which resulted in a 3-month delay to definitive surgery and unnecessary expenditures. (Read the full article)

Increasing percentages of youth are living with chronic medical conditions. Although adolescents face peak risks for onset and intensification of alcohol and marijuana use, we know little about these behaviors and their associations with treatment adherence among chronically ill youth.

This study quantifies alcohol and marijuana use behaviors among a heterogeneous sample of chronically ill youth in aggregate and by condition, and measures associations between alcohol use/binge drinking and knowledge about alcohol interactions with medications/laboratory tests and also treatment nonadherence. (Read the full article)

Every time an education institution loses a funding source, rethinks program delivery, revises positions, incorporates technology, or changes curriculum, it is making an investment in change. These are sizable, important investments, so why not protect them?

So, how do we manage? What do we do when consistently engaging in the difficult discussion about rape culture is hard on our hearts, but helpful for our students?

Source: www.thestar.com - Saturday, May 09, 2020
Canada approved a verbal demarche to two senior WHO executives that urged them to allow Taiwan to be admitted as an observer to an upcoming meeting because its input would be “meaningful and important.”

The Valencia CF starlet gives you his formula for finishing when running in on goal.

The new analysis significantly increases the annual estimate of undocumented high school students earning diplomas that has long been used in debates about immigration and special protections for immigrant youth who were illegally brought to the U.S. as children.

As editor Wilhelm Crous puts it, "We haven't seen this movie before."

Strategic partnerships could be used to create win-win outcomes, says Sifiso Skenjana.

Government went to war against Covid-19 with very low supplies in citizen trust and financial reserves, says Solly Moeng.

Even before the recent news of the season’s first confirmed spotted lanternfly hatches in the Philadelphia region, homeowners in many parts of Pennsylvania were gearing up for their annual battle with the destructive pest.

A $450,000 grant from the U.S. Agency for International Development’s Feed the Future Innovation Lab for Peanut Research will aid researchers in Penn State’s College of Agricultural Sciences as they explore the potential to empower women farmers in northern Ghana through peanut production.

Since the March 24 coup by the Seleka, a loose coalition of Muslim rebels, the Central African Republic has been in free fall. There are about 400,000 internally displaced people, 64,000 refugees, and burned villages, largely in the western part of the country. Banditry, the rise of self-defense militias and clashes between Christian and Muslim communities are now part of daily life for this mineral-rich country in the heart of Africa. The expanding insecurity makes the delivery of humanitarian assistance difficult, and the United Nations has even warned of the risk of genocide.

Los conflictos en los países pequeños suelen agravarse debido a la indiferencia internacional. Sin embargo, en el caso de la República Centroafricana (RCA), el problema es ligeramente distinto. Hay una importante presencia internacional en este Estado, pero los actores principales han decidido mantenerse al margen y esperar en vez de intervenir activamente en la crisis.

Le 1er juin dernier à Mugamba (province de Bururi), Pierre Nkurunziza a lancé un ultimatum. « Du haut d’une camionnette, micro à la main, sous très haute protection de l’armée et de la police », rapporte l’AFP, le président burundais a ordonné aux insurgés de cette commune du Sud du pays de déposer les armes dans les quinze jours : « Téléphonez à vos frères qui ont pris les armes, dites-leur que nous leur donnons quinze jours pour qu’ils y renoncent […] Quinze jours, pas plus. Dites-leur cela ». Hasard ou préméditation, la fin de cet ultimatum devrait coïncider avec la reprise prévue des discussions à Arusha, en Tanzanie, entre le gouvernement et l’opposition.

Continuous spread of antimalarial drug resistance is a threat to current chemotherapy efficacy. Therefore, characterizing the genetic diversity of drug resistance markers is needed to follow treatment effectiveness and further update control strategies. Here, we genotyped Plasmodium falciparum resistance gene markers associated with sulfadoxine-pyrimethamine (SP) and artemisinin-based combination therapy (ACT) in isolates from pregnant women in Ghana. The prevalence of the septuple IRNI-A/FGKGS/T pfdhfr/pfdhps haplotypes including the pfdhps A581G and A613S/T mutations was high at delivery among post-SP treatment isolates (18.2%) compared to those of first-antenatal care (before initiation of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP); 6.1%; p = 0.03). Regarding the pfk13 marker gene, two non-synonymous mutations (N458D and A481C) were detected at positions previously related to artemisinin resistance in isolates from Southeast-Asia. These mutations were predicted in silico to alter the stability of the pfk13 propeller-encoding domain. Overall, these findings highlight the need for intensified monitoring and surveillance on additional mutations associated with increased SP resistance as well as emergence of resistance against artemesinin derivatives.

Resistance to amoxicillin-clavulanate, a widely used beta-lactam/beta-lactamase inhibitor combination antibiotic, is rising globally, yet susceptibility testing remains challenging. To test whether whole-genome sequencing (WGS) could provide a more reliable assessment of susceptibility than traditional methods, we predicted resistance from WGS for 976 E. coli bloodstream infection isolates from Oxfordshire, UK, comparing against phenotypes from the BD Phoenix (calibrated against EUCAST guidelines). 339/976 (35%) isolates were amoxicillin-clavulanate resistant. Predictions based solely on beta-lactamase presence/absence performed poorly (sensitivity 23% (78/339)) but improved when genetic features associated with penicillinase hyper-production (e.g. promoter mutations, copy number estimates) were considered (sensitivity 82% (277/339); p<0.0001). Most discrepancies occurred in isolates with peri-breakpoint MICs. We investigated two potential causes; the phenotypic reference and the binary resistant/susceptible classification. We performed reference standard, replicated phenotyping in a random stratified subsample of 261/976 (27%) isolates using agar dilution, following both EUCAST and CLSI guidelines, which use different clavulanate concentrations. As well as disagreeing with each other, neither agar dilution phenotype aligned perfectly with genetic features. A random-effects model investigating associations between genetic features and MICs showed that some genetic features had small, variable and additive effects, resulting in variable resistance classification. Using model fixed-effects to predict MICs for the non-agar dilution isolates, predicted MICs were in essential agreement (±1 doubling dilution) with observed (BD Phoenix) MICs for 691/715 (97%) isolates. This suggests amoxicillin-clavulanate resistance in E. coli is quantitative, rather than qualitative, explaining the poorly reproducible binary (resistant/susceptible) phenotypes and suboptimal concordance between different phenotypic methods and with WGS-based predictions.

Dihydroartemisinin-piperaquine has shown excellent efficacy and tolerability in malaria treatment. However, concerns have been raised of potentially harmful cardiotoxic effects associated with piperaquine. The population pharmacokinetics and cardiac effects of piperaquine were evaluated in 1,000 patients, mostly children enrolled in a multicentre trial from 10 sites in Africa. A linear relationship described the QTc-prolonging effect of piperaquine, estimating a 5.90ms mean QTc-prolongation per 100ng/mL increase in piperaquine concentration. The effect of piperaquine on absolute QTc-interval estimated a mean maximum QTc-interval of 456ms (EC₅₀=209ng/mL). Simulations from the pharmacokinetic-pharmacodynamic models predicted 1.98-2.46% risk of having QTc-prolongation > 60ms in all treatment settings. Although piperaquine administration resulted in QTc-prolongation, no cardiovascular adverse events were found in these patients. Thus, the use of dihydroartemisinin-piperaquine should not be limited by this concern.

Introduction: This study was performed to evaluate the impacts of vanA-positivity of Enterococcus faecium (EFM) exhibiting diverse susceptibility phenotypes to glycopeptides on clinical outcomes in patients with a bloodstream infection (BSI) through a prospective, multicenter, observational study.

Methods: A total of 509 patients with an EFM BSI from eight sentinel hospitals in South Korea during a two-year period were enrolled in this study. Risk factors of the hosts and causative EFM isolates were assessed to determine associations with the 30-day mortality of EFM BSI patients via multivariable logistic regression analyses.

Results: The vanA gene was detected in 35.2% (179/509) of EFM isolates; 131 EFM isolates exhibited typical VanA phenotypes (group vanA-VanA), while the remaining 48 EFM isolates exhibited atypical phenotypes (group vanA-Atypical), including VanD (n = 43) and vancomycin-variable phenotypes (n = 5). A multivariable logistic regression indicated that vanA-positivity of causative pathogens was independently associated with the increased 30-day mortality rate in the patients with an EFM BSI; however, there was no significant difference in the survival rates between the patients of the vanA-VanA and vanA-Atypical groups (log-rank test, P = 0.904).

Conclusions: A high 30-day mortality rate was observed in patients with vanA-positive EFM BSIs, and vanA-positivity of causative EFM was an independent risk factor for early mortality irrespective of the susceptibility phenotypes to glycopeptides; thus, intensified antimicrobial stewardship is needed to improve clinical outcome of patients with vanA-positive EFM BSI.

Omadacycline, a novel aminomethylcycline antibiotic with activity against Gram-positive and -negative organisms, including tetracycline-resistant pathogens, received FDA approval in October, 2018 for the treatment of patients with acute bacterial skin and skin structure infections (ABSSSI) and community-acquired bacterial pneumonia (CABP). A previously-developed population pharmacokinetic (PK) model based on Phase 1 intravenous and oral PK data was refined using data from infected patients. Data from 10 Phase 1 studies used to develop the previous model were pooled with data from three additional Phase 1 studies, a Phase 1b uncomplicated urinary tract infection study, one Phase 3 CABP study, and two Phase 3 ABSSSI studies. The final population PK model was a three-compartment model with first-order absorption using transit compartments to account for absorption delay following oral dosing and first-order elimination. Epithelial lining fluid (ELF) concentrations were modeled as a sub-compartment of the first peripheral compartment. A food effect on oral bioavailability was included in the model. Sex was the only significant covariate identified, with 15.6% lower clearance for females relative to males. Goodness-of-fit diagnostics indicated a precise and unbiased fit to the data. The final model, which was robust in its ability to predict plasma and ELF exposures following omadacycline administration, was also able to predict the central tendency and variability in concentration-time profiles using an external Phase 3 ABSSSI dataset. A population PK model, which described omadacycline PK in healthy subjects and infected patients, was developed and subsequently used to support pharmacokinetic-pharmacodynamic (PK-PD) and PK-PD target attainment assessments.

The off-label use of third generation cephalosporin (3GC) during in ovo vaccination or vaccination of newly hatched chicks, was a common practice worldwide. CMY-2-producing Escherichia coli have been disseminated among broiler production. The objectives of this study were to determine the epidemiological linkage of bla_CMY-2-positive plasmids among broilers both within and outside Japan because grandparent stock and parent stock were imported in Japan. We examined the whole genome sequences of 132 3GC-resistant E. coli isolates collected from healthy broilers during 2002-2014. The predominant 3GC-resistance gene was bla_CMY-2, which was detected in the plasmids of 87 (65.9%) isolates. The main plasmid replicon types were IncI1-I (n=21; 24.1%), IncI (n=12; 13.8%), IncB/O/K/Z (n=28; 32.2%), and IncC (n=22; 25.3%). Those plasmids were subjected to gene clustering and network analyses and plasmid multi-locus sequence typing (pMLST). The chromosomal DNA of isolates was subjected to MLST and single nucleotide variant (SNV)-based phylogenetic analysis.

MLST and SNV-based phylogenetic analysis revealed high diversity of E. coli isolates. ST429 harboring bla_CMY-2-positive IncB/O/K/Z was closely related to isolates from broiler in Germany harboring bla_CMY-2-positive IncB/O/K/Z. pST55-IncI and pST12-IncI1-I and pST3-IncC were prevalent in western Japan. pST12-IncI1-I and pST3-IncC were closely related to those detected in E. coli isolates from chicken in American continent, whereas 26 IncB/O/K/Z were related to those in Europe. These data will be useful to reveal the whole picture of transmission of CMY-2-producing bacteria in and out of Japan.

BACKGROUND AND OBJECTIVES:

Children with medical complexity (CMC) comprise only 6% of the pediatric population, account for ~40% of pediatric health care spending, and provide an important opportunity for cost saving. Savings in this group can have an important impact on pediatric health care costs. The objective of this study was to assess the impact of a multicenter care management program on spending and use in CMC.

This list looks at seven top South African products disrupting the traditional way of doing finance.

CONTEXT:

Several antiemetics have been used in children with acute gastroenteritis. However, there is still controversy over their use.

Shoo K. Lee
Nov 1, 2000; 106:1070-1079
ARTICLES

Graham A. Colditz
Jul 1, 1995; 96:29-35
ARTICLES

Wolfgang Lindner
May 1, 1999; 103:961-967
ARTICLES

Julie A. Jaskiewicz
Sep 1, 1994; 94:390-396
COMMENTARY

CNA Staff, Apr 21, 2020 / 11:00 am (CNA).- The Archbishop of Halifax-Yarmouth in Canada has offered prayers for the victims of a weekend shooting rampage in a small town in Nova Scotia, including a member of the country’s Royal Canadian Mounted Police. 

In a letter addressed to the commissioner of the Royal Canadian Mounted Police (RCMP) dated April 20, Archbishop Anthony Mancini of Halifax-Yarmouth expressed condolences for the death of Constable Heidi Stevenson, a 23-year veteran of the force. 

“I wish to express on my behalf, as Archbishop of Halifax-Yarmouth, and in the name of Catholic faithful, our sincere condolences on the loss of life of Constable Heidi Stevenson,” said Mancini. 

“Her death in the line of duty indicates the highest sacrifice that one can make on behalf of the citizens she served,” he added. The archbishop said that he would be praying for her family, and for the officers of the RCMP who are mourning her life. 

In a video message posted on Tuesday, April 21, Mancini offered condolences, prayers, and assurances to the people of his archdiocese after, according to police, denture-fitter Gabriel Wortman went on a 14-hour shooting attack which spread across Saturday and Sunday.

“These last few days have been a shock, as we have all been affected by the useless and premature death of so many of our fellow citizens,” he said. “Try as we will to understand this tragedy, it remains incomprehensible. We are experiencing a great sense of loss, frustration, and even anger,” he added. 

As of Monday morning, 18 people have been confirmed to have been killed by the shooter, making it the deadliest mass shooting in Canadian history, stunning a province which typically sees fewer than 15 homicides total per year. 

Authorities have not yet determined a motive for why the 51-year-old denture fitter committed the attack. The suspect is now deceased, although it has not yet been determined how he died. 

Mancini acknowledged that the existing circumstances related to the ongoing COVID-19 pandemic has made the grieving process more complicated.

“This loss of life comes upon us at a time when we are already weighed down by the threat of the coronavirus. In this time of mourning, we ought to be able to come together to experience the comfort of community care and its support. Yet here we are, in isolation in order to stay safe, making the present circumstances even more tragic,” he said. 

The archbishop encouraged people to use “technological means” to offer support to each other throughout the grieving process, and reminded Nova Scotians that “love is greater than tragedy and death.”

“I wish to extend to all the families and friends of those who have died our prayers and our expression of solidarity,” he said. “In this time, when we celebrate the resurrection, it is good to recall that death is not the last word.”

Mancini also suggested that his flock pray for “the growing number of COVID-19 victims” and “for those on the front lines doing all they can to protect us--the doctors, the nurses, and of course, the police.”

Asana is a top-notch collaboration tool that helps teams manage all kinds of tasks. Although it may be confusing at first, its flexibility and vast capabilities are well worth the initial effort it takes to get started.

Still using your kid's birthday as your universal password? You're heading toward trouble. With a password manager, you can have a unique and strong password for every secure website. We've evaluated two dozen of the best password managers to help you choose.

Source: www.thestar.com - Friday, May 08, 2020
The unemployment rate jumped 5.2 points in April to 13 per cent in the first full month of economic restrictions.

‘Offering a complicated range of highly specialised funds defeats the aim of simplicity’.

In this blended, mix-and-match, do-it-yourself world of education, what is curriculum, and who develops it? How do we know if it works?

In a sprawling but nuanced examination, comedian John Oliver explained why the U.S. standardized testing system exists and the harms it creates.

Watch our live studio analysis as Fin24's Moeshfieka Botha unpacks the 2018 Budget Speech with a number of prominent political commentators and analysts.

Inventory management is more than simply knowing what's left in the warehouse. Today these systems track the warehouse, a product's shelf life, and even your customers' experience. We test top players to help you choose.

Document management solutions have evolved from simple file storage engines to sophisticated workflow and data classification systems. We review and rank the top 10 players in this field.

Managing identity across an ever-widening array of software services and other network boundaries has become one of the most challenging aspects of the IT profession.. We test 10 end-to-end identity management solutions that can help.

Grace McStravock, who will graduate Saturday, May 9 with a 3.98 GPA in actuarial science and minors in mathematics and statistics, has been selected as Smeal’s spring 2020 risk management student marshal.

In this episode of the Getting Smart Podcast, Tom sits down with Daniel to learn more about his life as an international educator, the American School of Paris, Daniel's goals and challenges in international education, and what he thinks all American educators should know about international educat

The Weather Risk Management Club has continued meeting via Zoom during the remote learning period, carrying on their work examining the impacts of severe weather events on the economy.

The cockpit glasses promise to give you a bird's eye view from the Anafi drone's 180-degree camera. The Anafi FPV bundle will go on sale early this month.