Development Of Guidelines For Management Research Articles

Genetic disease amongst the Plain community.

The purpose of this review is to highlight recent genetic studies of the Amish and Mennonite (Plain) communities. For decades, the study of genetically isolated populations has improved our understanding and management of genetic diseases that affect all populations. Major themes of current genetic research of the Amish and Mennonites include new causative gene and new candidate gene discovery, phenotype expansion of previously identified genetic disease, and a target for AAV9-mediated gene therapy. Additionally, several genome-wide association studies (GWAS) examining complex traits such as dementia, cardiometabolic disease, and age-related macular degeneration have been conducted. Finally, clinically relevant studies of attitudes of the Plain community towards genetic testing and telemedicine, as well as reviews of and management suggestions for the Amish variants of propionic acidemia and APOB-associated familial hypercholesterolemia have been recently published. Recent genetic studies of the Plain community continue to highlight the value of studying isolated populations to propel genetic disease discovery and treatment. Additionally, population-specific polygenic risk scores are needed for underrepresented and minority populations, to avoid exacerbating disparities in medical genetics care. Finally, it is important for clinicians to develop management guidelines for variants common in this rapidly growing population, such as propionic acidemia.

Development of Management Guidelines of Inclusive Education in Special Education Center, Petchabun Province

Development of Management Guidelines of Inclusive Education in Special Education Center, Petchabun Province

Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) syndrome: a single-institution case series with a focus on management

BackgroundPyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) syndrome is a rare condition characterized by clinical features of all three dermatologic conditions. The management of PASH syndrome is difficult, with no consensus on treatment guidelines. Since PASH syndrome can increase morbidity and adversely impact quality of life, better characterization of effective therapies is needed.MethodsA retrospective cohort study was conducted to identify all patients with pyoderma gangrenosum (PG) treated at The Ohio State University Wexner Medical Center between 2015 and 2021. PG diagnosis was confirmed via PARACELSUS score. Subsequent chart review identified eight patients with concomitant hidradenitis suppurativa (HS) and acne who were clinically diagnosed with PASH syndrome.ResultsEight patients were clinically diagnosed with PASH syndrome based on their clinical presentation at our institution. Seven patients had failed some type of medical therapy prior to presentation, including topical corticosteroids, oral corticosteroids, oral antibiotics, and biologics. One patient had also tried surgical drainage at an outside institution. Six patients were effectively treated with biologics, usually in combination with other therapies. One patient experienced improvement of her skin lesions after diagnosis and treatment of her underlying hematologic malignancy.ConclusionsMedical management with biologics in combination with corticosteroids and/or antibiotics was effective in the management of most patients. Diagnosis and treatment of an underlying condition should be prioritized in refractory cases. If workup is negative, surgical management may be considered. Further investigation with a greater number of patients is required to develop management guidelines for PASH syndrome.

Local climate, air quality and leaf litter cover shape foliar fungal communities on an urban tree.

Foliar fungi on urban trees are important for tree health, biodiversity and ecosystem functioning. Yet, we lack insights into how urbanization influences foliar fungal communities. We created detailed maps of Stockholm region's climate and air quality and characterized foliar fungi from mature oaks (Quercus robur) across climatic, air quality and local habitat gradients. Fungal richness was higher in locations with high growing season relative humidity, and fungal community composition was structured by growing season maximum temperature, NO2 concentration and leaf litter cover. The relative abundance of mycoparasites and endophytes increased with temperature. The relative abundance of pathogens was lowest with high concentrations of NO2 and particulate matter (PM2.5), while saprotrophs increased with leaf litter cover. Our findings show that urbanization influences foliar fungi, providing insights for developing management guidelines to promote tree health, prevent disease outbreaks and maintain biodiversity within urban landscapes.

Advanced stage melanoma during pregnancy: Real-world management.

9540 Background: Treatment (tx) of advanced melanoma during pregnancy represents a major challenge. While management of early-stage melanoma is similar to non-pregnant patients (pts), very little data is available on outcome or tx guidelines for pregnant pts with advanced stage. Therefore, we collected real world management data, to ultimately develop management guidelines for these pts. Methods: This retrospective, international, multicenter database, included pts who either were diagnosed with advanced melanoma (newly diagnosed or recurrent) during pregnancy (group 1) or conceived while on systemic tx for melanoma (group 2) between 01/2011–06/2023. Patient, primary tumor and advanced melanoma characteristics, intervention/tx during pregnancy, and outcomes of mother and fetus were collected using a standardized, de-identified form. Results: 68 pts from 7 countries were included, with a total of 72 pregnancies: 60 pregnancies in group 1 and 12 in group 2, including 5 twin pregnancies. Median age at time of pregnancy was 32 (19-42). In group 1, advanced melanoma diagnosis occurred during the 1st trimester in 38%, followed by 3rd (32%), 2nd (22%) and unknown (8%) trimester. 2% had stage II melanoma, 48% stage III, and 50% stage IV. 76% were cutaneous melanoma, 7% mucosal, and 17% other subtypes. BRAF mutations were seen in 70%. Pregnancy was terminated in 15% of cases, and miscarriage occurred in 1 case. Of the 50 live births, 68% were induced and 56% were preterm (38% vaginal, 54% C-section). Median gestational age (MGA) was 34 wks (27-40). Systemic tx was initiated during pregnancy in 8 pts (targeted therapy [TT, 63%], immunotherapy [IT, 37%]). 90% switched or initiated new systemic tx after pregnancy (median time to start of therapy: 28 days; IT 65%, TT 27%, chemo 8%). 5-year overall survival (OS) was 49% (95%CI 34-69), with a median follow-up (MFU) of 26m. In group 2, 82% had cutaneous melanoma and 18% an unknown primary. 91% had a BRAF mutation. 42% of pts received systemic tx for stage III melanoma and 58% for stage IV (IT 75%, TT 25%). 33% of pregnancies were terminated, 8% ended in miscarriage. Of the 8 live births, 43% were preterm, 29% were induced (43% vaginal, 29% C-section). MGA was 35 wks (32-39). Half the pts initiated new or continued tx after pregnancy (IT 50%, TT 50%). 5-year OS was 78% (95%CI 55-100), with MFU of 48m. Of the 57 live births, 1 child born at 26w died after 3 days. No children developed melanoma, despite 5 placentas with melanoma involvement. 4 unexposed children had congenital deficits: prematurity-related (n=3) and congenital hypothyroidism (n=1). 1 child with 3rd trimester Vemurafenib exposure had heart malformations, and 2 experienced toxicity after in uteroIT exposure. Conclusions: This is the largest contemporary dataset of pts diagnosed with advanced melanoma during pregnancy and pts who became pregnant on systemic melanoma therapy, and provides a basis for developing clinical guidelines for this challenging population.

Etiological spectrum and diagnostic challenges of short-duration fever in West Bengal (India). A cross-sectional tertiary care study

IntroductionThe scarcity of epidemiological data on acute febrile illnesses from South Asia impairs evidence-based clinical decision-making. Our study aimed to explore the etiological spectrum of short-duration fever in patients admitted to a tertiary care hospital in West Bengal, India. MethodsWe conducted a cross-sectional study from May 2021 to April 2022 involving 150 adult patients presenting with a fever lasting less than two weeks at Burdwan Medical College and Hospital (West Bengal, India). We performed comprehensive clinical assessments, including microbiological, serological, and other specific investigations, to identify the causes of the fever. ResultsThe demographic profile predominantly included individuals aged 21–40 years, with a male-to-female ratio of 1.9:1; 60.7% of participants were from rural areas. The primary etiological agents identified were scrub typhus (25.3%), dengue (15.3%), and enteric fever (13.3%). Notably, 80% of patients presented with non-localizing symptoms, while 14.7% had respiratory symptoms. Blood cultures pinpointed Salmonella typhi and Staphylococcus aureus in a minority of cases (3.3%); malaria, primarily Plasmodium vivax, was diagnosed in 12% of the cases. ConclusionOur findings highlight the complexity of diagnosing short-duration fevers, dominated by a wide range of etiological agents, with a notable prevalence of scrub typhus. These results underscore the urgent need for enhanced diagnostic facilities, including the availability of scrub typhus testing at primary healthcare centers. We recommend empirical doxycycline therapy for suspected cases and emphasize the need for further research to develop management guidelines for acute febrile illnesses. This study also highlights the importance of raising both community and clinician awareness to prevent irrational antibiotic use.

Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update.

The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2023, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to American College of Chest Physicians methodology. Key recommendations include the concept that interventions should be goal-oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique-oriented (immobilization). An evidence-based, goal-oriented approach excludes the immobilization of suspected spinal injuries via rigid collars or backboards.

Thermal tolerance in Pacific salmon: A systematic review of species, populations, life stages and methodologies

AbstractAquatic systems are warming and exceeding upper thermal limits (UTLs) for many fish species, yet understanding how they inform resilience to climate change is challenging. Using Pacific salmon (Oncorhynchus spp.) as a model, we conducted a systematic review involving 168 papers investigating UTL in five species. We found considerable variation in UTL among species, within species and across life stages; largely attributed to methodological approaches (e.g. CTmax/UILT, Aerobic/Cardiac Scope, Thermal Migration Barriers, Rearing Mortality, Thermal Preference/Avoidance). Given that each method has strengths and weaknesses owing to logistics, time scale and ecological realism, we offer a new framework for assessing vulnerability to warming that stresses the importance of considering UTL metrics in the context of intended use (i.e. the development of management guidelines, projections of future persistence and survival) and what aspect (physiological or behavioural) of thermal response a metric investigates. Comparing studies with identical UTL approaches revealed that within species, UTL was higher for populations historically encountering higher temperatures—suggesting local thermal adaptation. Within populations, UTL differed across the lifecycle, being highest in fry and lowest in embryo and migrating adults, but this was not universal. For spawning Pacific salmon, UTL has not been assessed and few studies have examined estuarine and marine stages. Ultimately, this data gap limits the life‐history thermal perspectives that can be drawn and may indicate a broader gap for all fishes, given that Pacific salmon are among the most well‐studied species. Our framework illustrates the inherent and methodological inconsistencies in UTL and offers a guide for how thermal limits can best be used to assess the warming tolerance and vulnerability of fishes.

The Management of Intussusception: A Systematic Review.

Intussusception (ISN) is adangerous condition where a portion of the intestine slides into an adjacent area of the intestine. This telescoping motion frequently prevents liquids or food from flowing through. Developing management guidelines for ileocolic (IC) intussusception was the aim of this systematic study.Data sources were PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, and Embase databases. Our review investigated English-language articles (from 2010 to 2023) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Overall, there were 15 articles. Surveys and analyses of national databases were the most widely used methods (n=15). The search identified 561 studies; 15 were eligible for inclusion in the analysis. Further understanding of the management of intussusception may help improve evaluation and management in the future. The use of preventive antibiotics does not reduce problems following radiologic reduction. When clinically appropriate, repeated attempts at enema reduction may be made. After the enema reduction of ileocolic intussusception, patients can be safely watched in the emergency room (ER), thereby avoiding hospitalization. Success rates for laparoscopic reduction are high. When it comes to intussusception in children who are hemodynamically stable and do not have a serious illness, there is no need for pre-reduction antibiotics. Prioritizing nonoperative outpatient (OP) therapy is recommended as the primary approach, with the utilization of minimally invasive procedures to avoid the necessity for laparotomy. The management of colonic intussusception involves complete removal in one piece, while enteric intussusception can be addressed through reduction followed by resection. A targeted approach is recommended, recognizing the intermediate forms of intussusception that may exist between the colonic and enteric types. It is essential to note that the prevailing treatment for adult intussusception remains to be surgical intervention.

Critical quality appraisal and algorithm development of clinical practice guidelines for management of poststroke sensory loss: a systematic review

ObjectivesThis study aimed to assess the methodological quality of clinical practice guidelines (CPGs) associated with the management of poststroke sensory loss and develop an algorithm for health professionals.MethodsWe conducted a...

Patient Reported Outcome Measures in the Foot and Ankle Literature: A Systematic Review

Category: Other Introduction/Purpose: Optimising clinical practice requires emphasis on patient-orientated care and therefore patient reported outcome measures (PROMs) play a key role in shaping evidence-based clinical guidelines. As such, it is crucial that we use appropriate, valid and reliable PROMs to quantify outcomes in orthopaedic research. A previous systematic review evaluating evidence published between 2002-2011 identified 139 different PROMs used in the foot and ankle literature and found the most common PROM was The American Orthopaedic Foot and Ankle Society (AOFAS) score. However, in 2011, AOFAS issued a position statement outlining the lack of reliability and validity of the AOFAS score, describing it as a ‘less than ideal’ measure. This systematic review aims to provide an updated analysis of the PROMS used in the foot and ankle literature. Methods: This systematic review was performed according to PRIMSA guidelines. An electronic title/abstract screen of every article published between January 2012- December 2022 in Foot and ankle international, Clinical Orthopaedics and Related Research, Knee Surgery Sports Traumatology and Arthroscopy, The Bone and Joint Journal and The American Journal of Sports Medicine was performed by two reviewers. Articles with a foot and ankle focus were selected for full text screening and papers reporting at least one PROM were included in the final review. The following data was extracted from each article: journal of publication, month/year of publication, pathology/intervention described, PROMS reported and use of the minimally clinically important difference (MCID) to evaluate post intervention changes in PROMs. The number of studies using each individual PROM was calculated and a subgroup analysis was performed to investigate variation in PROM selection according to year of publication, journal of publication and the condition being investigated. Results: A total of 3,174 foot and ankle articles were identified, of which 1,168 (36.8%) articles reporting at least one PROM were included. The most common PROM was the AOFAS score, reported in 50.3% of studies, followed by visual analogue scale (VAS) pain score (44.4%) and 36-item short form survey (SF-36) (15.3%). Use of the AOFAS score declined across the review period. Between 2012-2016 AOFAS was the most common PROM, whilst VAS pain was most common in four of the last six years. Although some variation in PROMs according to clinical pathology exists, AOFAS score is featured in the top 3 most common PROMs for every analysed condition. Only 8/1,168 (0.7%) articles reported the number of patients achieving a minimally clinically important difference (MCID) post-intervention. Conclusion: Whilst use of the AOFAS score declined over the review period, it remains the most common PROM overall across all included journals and many conditions. There exists a lack of consensus regarding the most suitable alternative PROMs, with multiple validated instruments including FAOS, FAAM and FFI used inconsistently with relatively low frequency. There is a heavy reliance on statistical significance to evaluate and compare post-intervention PROM changes. However, it is important to quantify PROMs according to the patient perspective. Reporting the proportion of patients achieving MCID will allow clinicians to interpret PROMs and develop management guidelines in a patient-focused manner.

White spill: Life cycle assessment approach to managing marine EPS litter from flood-released pontoons

Expanded polystyrene (EPS) pollution in the marine environment is a pressing issue in Queensland, Australia due to a recent flood that scattered hundreds of EPS-containing pontoons along the coastline, causing severe ecological damage. To assist in the clean-up effort and provide crucial data for developing management guidelines, this study investigates the environmental performance of different end-of-life (EoL) disposal/recycling methods, including (i) landfill; (ii) on-site mechanical re-processing using a thermal densifier (MR); and (iii) on-site dissolution/precipitation using d-limonene (DP). Applying the life cycle assessment framework, the results showed that DP was the most environmentally favourable option. Its impacts in climate change (GWP), acidification (TAP), and fossil fuel depletion (FFD) were 612 kg CO2 eq, 4.3 kg SO2 eq, and 184.7 kg oil eq, respectively. For comparison, the impacts of landfilling EPS in these categories were found to be 700 kg CO2 eq, 3.5 kg SO2 eq, and 282 kg oil eq, respectively. Landfill also contributed considerably to eutrophication potential (MEP), at 3.77 kg N eq. Impacts from MR were most significant due to the need to transport the densifier unit to the site. The analysis also revealed that the transportation of personnel and heavy machinery to the site, was the biggest contributor to impacts in the EoL stage. Its impacts in GWP, TAP, MEP, and FFD were 1369.8 kg CO2 eq, 6.5 kg SO2 eq, 0.2189 kg N eq, and 497.7 kg oil eq, respectively. Monte Carlo analysis showed that the conclusions made from these results were stable and reliable. Limitations of this model and recommendations for future investigations were also discussed in this work.

Effects of single tree selection cutting on vascular plant species diversity components in temperate forests of Hyrcanian region

Temperate forests in northern Iran are one of the most important natural ecosystems with the highest economic value and a key role in the conservation of forest biodiversity in Iran. We studied vascular plant species diversity components (alpha, beta and gamma) of herb and tree layers on 120 plots at six sites in forests managed by single tree selection and forests that have been left unmanaged for more than 30 years in the Hyrcanian forest zone in northern Iran. Generalized linear mixed models (GLMM) were used to analyse the effect of management on stand properties, tree and herb layer local diversity and soil characteristics. Despite the differences in herb layer local α-diversity, forest management did affect neither community composition of the herb layer nor regional γ-diversity. Also, species richness as well as α- and γ-diversity of the tree layer was significantly higher in managed forests, while β-diversity showed no directional response across herb and tree layers. According to constrained ordination analysis, main drivers for explaining variance in plant species composition were soil organic matter, total nitrogen, potassium, phosphorous, pH and forest structural variables (basal area, number of trees per hectare and canopy cover) in herb and tree layers. We found that in Hyrcanian forests single tree selection management promotes environmental conditions that effectively contribute to increased diversity of the herb and tree layers at the local and regional scale compared to unmanaged forests. The higher diversity of herb and tree layers is likely being driven by higher within-stand heterogeneity, improved light availability in managed forests due to lower stocking density and larger canopy gaps, or also results from topsoil disturbances through wood extraction. This study indicated that single tree selection system has the potential to be used in order to improve biodiversity conservation, and these results can be useful for development of management guidelines and decision-making processes.Because it may not be specific enough to dismiss or prioritize forest management regimes, based only on their impact on plant diversity, further assessments of forest management effects on other crucial factors (such as fauna diversity, structural diversity and forest ecosystems services) are needed.

Participant Heterogeneity of Systemic Scleroderma Interventional Trials Worldwide

Objective: Heterogeneity of participants in clinical trials distorts intervention efficacy. However, factors associated with participant heterogeneity in randomized clinical trials (RCTs) focusing on systemic sclerosis (SSc) are not clear. We conducted this systematic review to establish normative standards for future research and help develop management guidelines. Methods: Three databases and 4 registries were searched to identify characteristics of SSc RCTs across different countries. Risk of bias was assessed by the Cochrane Collaboration’s tool and logistic regression was performed to calculate crude and adjusted odds ratios. Results: In total, 261 trials met our inclusion criteria. The quality of SSc RCTs worldwide was relatively poor, with no trend of improvement in recent years, and only 12.2% were ranked as having a low risk of bias. Trials with a low risk of bias as well as single-center, single-country, or open-label trials tended to have better participant adherence than trials with a high risk of bias and multiple-center, multiple-country, or double-blind trials. Interestingly, trial registration and primary outcome definition contributed to high withdrawal. National income was also relevant; participant adherence in high-income countries, but not in upper- and lower-middle-income countries, was significantly altered by different variables. Conclusion: Overall, the risk of bias, national income, and trial design may lead to participant heterogeneity of SSc RCTs and ultimately confound the general clinical utility of the results. Trials with a rigorous design and transparent conduction protocol are crucial for obtaining unbiased data that can serve as a reference and for maintaining the fundamental repeatability of SSc RCTs.

Metaplastic breast cancer: an all-round multidisciplinary consensus.

Metaplastic breast cancer (MpBC) is a rare and aggressive histologic subtype of breast cancer (BC) characterized by the presence of at least two cellular types, commonly epithelial and mesenchymal components. Despite growing evidence that MpBC is a unique entity, it has long been treated as a variant of nonspecial type (NST) BC. MpBC typically shows the phenotype of triple-negative breast cancer (TNBC), but compared to NST-TNBC, it is a relatively chemorefractory tumor associated with worse outcomes. Therefore, there is an urgent need to develop management guidelines specifically for MpBC to improve the prognosis of patients with early MpBC. This expert consensus aims to guide diagnosis and standardize clinical management of early MpBC among treating physicians. We provide guidance on the challenging radiological and pathological diagnosis of MpBC. Evidence on the involvement of genetic predisposition in the development of MpBC is also explored. We emphasize the importance of a multidisciplinary approach for the treatment of patients with early MpBC. The optimal surgery and radiotherapy approach is presented, as well as the opportunity offered by novel therapeutic approaches to increase treatment response in this chemoresistant subtype. Appropriate management of patients with MpBC is critical to reduce the high risk of local and distant recurrence that characterizes this disease.

Key terms and definitions in acute porphyrias: Results of an international Delphi consensus led by the European porphyria network.

Acute porphyrias are a group of rare inherited disorders causing acute neurovisceral attacks. Many terms used frequently in the literature and clinical practice are ambiguous, which can lead to confusion in the way patients are managed, studied, and reported in clinical studies. Agreed definitions are a necessary first step in developing management guidelines and will facilitate communication of results of future clinical research. The Delphi method was used to generate consensus on key terms and definitions in acute porphyria. The process started with a brainstorming phase offered to all members of the European Porphyria Network followed by two Delphi rounds among international experts in the field of porphyria (the Acute Porphyria Expert Panel). A consensus of 75% or more was defined as the agreement threshold. A total of 63 respondents from 26 countries participated in the brainstorming phase, leading to the choice of nine terms and definitions. A total of 34 experts were invited to take part in the Delphi rounds. Seven of the initial nine terms and definitions which entered the first Delphi round achieved the threshold for agreement. Following a second Delphi round, all nine definitions achieved agreement.Agreement on the definitions for nine important terms describing acute porphyrias represents a significant step forward for the porphyria community. It will facilitate more accurate comparison of outcomes among porphyria centres and in clinical trials and provide a strong framework for developing evidence-based clinical guidelines.

The introduction to air pollution on pregnancy outcome (APPO) study: a multicenter cohort study.

The air pollution on pregnancy outcome (APPO) study is a prospective hospital-based cohort study designed to investigate the maternal and fetal effects of a particulate matter with an aerodynamic below 10 μm (PM10) and PM2.5 (below 2.5 μm) exposure. This study aims to analyze a relationship between particulate matter and adverse pregnancy outcomes and to find related biomarkers and develop management guidelines. About 1,200 pregnant women are recruited for 3 years (from January 2021 to December 2023) from seven university hospitals to investigate the effects of particulate matter on pregnancy complications and adverse pregnancy outcomes. We collect biological samples by 5 mL of maternal venous blood and 15 mL of urine in each trimester of pregnancy, and 5 mL of umbilical cord blood and 2×2×2 cm of placental tissue are collected after delivery. In addition, by applying PM10 and PM2.5 concentration values and time-activity patterns from the time weighted average model, the individual predicted exposure of air pollution for the pregnant women are obtained. The average exposure of PM10 and PM2.5 of the participants in the entire period of pregnancy, was exceeded the World Health Organization air quality guidelines (an annual level, PM10 >15 μg/m3, PM2.5 >5 μg/m3). Moreover, it was revealed that the PM concentration was increasing toward the 3rd trimester of pregnancy. The APPO study will be able to identify the degree of exposure to air pollution in pregnant women and use it as basic data for estimating individual exposure to particulate matter. And the results of the APPO study will facilitate in the development of health management for pregnant women against air pollution.

Eating disorders in children and adolescents with type 1 diabetes mellitus

Introduction and purpose: Eating disorders are an ever-growing problem, both in the general population and also in the population of pediatric patients with type 1 diabetes mellitus. However, for this specific group of patients, there is a twofold higher risk of developing eating disorders, the occurrence of additional distinct forms of these disorders, the so-called diabulimia - consisting of deliberate restriction of insulin delivery or skipping insulin doses, which can consequently lead to poor metabolic control of diabetes , and even threaten the lives of patients. The purpose of this work is to present the current state of knowledge on the diagnosis, prevention and treatment of eating disorders in children and adolescents with type 1 diabetes.
 The state of knowladge: The background of the onset of eating disorders in pediatric patients with type 1 diabetes mellitus includes the lowered self-esteem accompanying early adolescence, stress, excessive focus on external appearance, as well as difficulties in accepting the diagnosis and a rather strict dietary regime. Since the treatment of eating disorders is long and difficult, the most important goal becomes effective prevention and rapid selection of patients with a predisposition to develop such disorders. The first screening tools - SEEDS, m-SCOFF and DEPS-R questionnaires - have already been developed, and the effectiveness of therapy sessions aimed at this group of patients is also being studied. 
 Summary: Therapy of eating disorders in patients with type 1 diabetes should be targeted at this specific patient population. It requires cooperation and communication of teams dealing separately with these diseases, education of the staff and their thorough knowledge of the background of the problem, prompt action and, above all, the development of specific guidelines for management, methods of prevention and the earliest possible start of treatment, which will also include the patient's caregivers.

Pre-agricultural soil erosion rates in the midwestern United States

Abstract Erosion degrades soils and undermines agricultural productivity. For agriculture to be sustainable, soil erosion rates must be low enough to maintain fertile soil. Hence, quantifying both pre-agricultural and agricultural erosion rates is vital for determining whether farming practices are sustainable. However, there have been few measurements of pre-agricultural erosion rates in major farming areas where soils form from Pleistocene deposits. We quantified pre-agricultural erosion rates in the midwestern United States, one of the world's most productive agricultural regions. We sampled soil profiles from 14 native prairies and used in situ–produced 10Be and geochemical mass balance to calculate physical erosion rates. The median pre-agricultural erosion rate of 0.04 mm yr–1 is orders of magnitude lower than agricultural values previously measured in adjacent fields, as is a site-averaged diffusion coefficient (0.005 m2 yr–1) calculated from erosion rate and topographic curvature data. The long-term erosion rates are also one to four orders of magnitude lower than the assumed 1 mm yr–1 soil loss tolerance value assigned to these locations by the U.S. Department of Agriculture. Hence, quantifying long-term erosion rates using cosmogenic nuclides provides a means for more robustly defining rates of tolerable erosion and for developing management guidelines that promote soil sustainability.

A Participatory Framework for Plain Language Clinical Management Guideline Development.

Background: Clinical management guidelines (CMGs) are decision support tools for patient care used by professionals, patients, and family caregivers. Since clinical experts develop numerous CMGs, their technical language hinders comprehension and access by nonmedical stakeholders. Additionally, the views of affected individuals and their families are often not incorporated into treatment guidelines. We developed an adequate methodology for addressing the needs and preferences of family and professional stakeholders regarding CMGs, a recently developed protocol for managing congenital disorders of glycosylation (CDG), a family of rare metabolic diseases. We used the CDG community and phosphomannomutase 2 (PMM2)-CDG CMGs as a pilot to test and implement our methodology. Results: We listened to 89 PMM2-CDG families and 35 professional stakeholders and quantified their CMG-related needs and preferences through an electronic questionnaire. Most families and professionals rated CMGs as relevant (86.5% and 94.3%, respectively), and valuable (84.3% and 94.3%, respectively) in CDG management. The most identified challenges were the lack of CMG awareness (50.6% of families) and the lack of plain language CMG (39.3% of professionals). Concordantly, among families, the most suggested solution was involving them in CMG development (55.1%), while professionals proposed adapting CMGs to include plain language (71.4%). Based on these results, a participatory framework built upon health literacy principles was created to improve CMG comprehension and accessibility. The outputs are six complementary CMG-related resources differentially adapted to the CDG community’s needs and preferences, with a plain language PMM2-CDG CMG as the primary outcome. Additionally, the participants established a distribution plan to ensure wider access to all resources. Conclusions: This empowering, people-centric methodology accelerates CMG development and accessibility to all stakeholders, ultimately improving the quality of life of individuals living with a specific condition and raising the possibility of application to other clinical guidelines.