Aquaculture and biodiversity to 2050

This article presents an analysis of aquaculture at the global level, stressing the extent to which the sector faces a range of challenges, among them a rising demand for seafood products in response to demographic growth, a global biodiversity crisis and planet-wide changes that include the effects of climate disruption. At the same time, it does not seem that we are currently on course to meet the international biodiversity objectives we have set ourselves: wide-ranging changes are needed in many sectors of production to achieve this. And the COVID crisis has revealed the low resilience of globalized production systems and shown why it might be advantageous to repatriate some production. Though aquaculture still has important environmental problems to resolve before it is sustainable, it has some competitive advantages by comparison with other animal products that ought to enable it to confront the food security challenge in the period to 2050. Various scenarios are proposed, including an increase, on a trend basis, of 44% in global aquaculture production. All these scenarios will require political choices (given that conservation and sustainable-farming approaches can rarely be fully reconciled) and the public will need to be provided with honest information, while biodiversity is prioritized as both a universal common good and a source of future solutions.

The multi-disciplinary team approach to screening for bone health in children with cystic fibrosis

Background: It is important to identify and treat lowbone mineral density (BMD) to prevent fractures and secondary complications. Individuals with cystic fibrosis (CF) are at risk of low BMD because of medication-related side effects, low body mass index, delayed puberty, and the effects of abnormal CF transmembrane conductance regulator. According to 2018 registry data, only 4% of patients aged 8 and older had completed a dualenergy X-ray absorptiometry (DEXA) scan at the Yale Pediatric CF Center. Our aim was to improve assessment of bone health by using a multidisciplinary team (MDT) to identify those at risk. Method(s): The MDT worked to identify patients at our center who were aged 8 and older and should undergo BMD screening based on the following risk factors: less than 90% of ideal body weight (our nurse coordinator queried from PortCF, and our dietician screened as part of regular nutritional assessment), percentage predicted forced expiratory volume in 1 second less than 50% (our nurse coordinator queried from PortCF, and our respiratory therapist screened as part of regular assessment), history of glucocorticoid use of 5 mg/d or more for more than 90 days per year or repeated antibiotic courses (our pharmacists queried medication history), history of fracture (our physical therapist added fracture screening to the regular musculoskeletal screen), history of delayed puberty or aged 18 and older (identified during weekly clinic conference). COVID delayed introduction of our plan. All members of the MDT were able to help explain the process and importance of DEXA scanning. The clinic nurse coordinator and PT monitored for scan completion and communicated with the team when results were available so that follow-up education and counseling could be provided. Dates of completed scan and recommended follow-up were added to the weekly clinic log for tracking. Result(s): Thirty-nine of 57 patients in our pediatric clinic met criteria for BMD assessment. The percentage of eligible patients completing screening rose from 4% in 2018 to 19.2% in 2019 and 33.3% in 2020 using a multidisciplinary approach to patient identification and education. As of March 2022, 51% of eligible patients had completed an initial assessment. Five of the 20 completed (20%) had results indicating low BMD for age. Three received referrals for additional physical therapy because of overall low physical activity levels and moderate postural deviations. The remaining two were already involved in regular physical activity. Education on safe bone-loading activity and protective education was provided. The team continues to provide dietary counseling and referrals to endocrine clinic as appropriate. One of the five patients with initial low BMD has undergone a 2-year follow-up scan and demonstrated significant improvement in BMD. Conclusion(s): A multidisciplinary approach to BMD screening was helpful. The percentage of eligible patients completing screening rose from 4% in 2018 to 19.2% in 2019 and 33.3% in 2020. We encountered challenges in getting all appropriate patients to complete their scans, largely because of COVID. Twenty-five percent of those scanned had low BMD for age. Standardizing multidisciplinary education and counseling will be an important next step, as will following the repeat scans of those whose initial scans were abnormal. Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Improving cystic fibrosis-related diabetes annual screening in adults with cystic fibrosis

Background: Cystic fibrosis (CF)-related diabetes (CFRD) is associated with decline in lung function and nutritional status. Cystic Fibrosis Foundation (CFF) guidelines recommend annual CFRD screening in patients starting at age 10. A review of our adult program data showed a decline in screening during 2020. We identified barriers, in addition to the COVID pandemic, that contributed to a decline in adherence. In July 2020, our clinic moved to a new location and began offering morning visits. After a quality improvement review, we began offering annual oral glucose tolerance testing (OGTT) within a routine clinic visit along with annual routine labs. Our objective was to use this multidisciplinary approach to increase OGTT screening to 50% within the first year of moving to our new location. Method(s): The CFF Patient Registry was used to compile a list of our nondiabetic patients overdue for annual OGTT. The list was reviewed during our multidisciplinary preclinic conference to identify patients who needed testing. Each patient was re-educated during clinic, and barriers to testing identified through patient interview and questionnaires. Common barriers to testing adherencewere length of testing time, time missed from work, COVID concerns, and needle phobia. The nurse and nurse coordinators made follow-up appointments, incorporating OGTT into next clinic appointment to increase adherence. Patients received phone call reminders for these appointments and the fasting criteria for testing. Result(s): CFF Registry Report data showed a decline in OGTT screening from 26% in 2019 to 21% in 2020.We identified 76 eligible patients who needed OGTT in 2021. Patient interviews were conducted during clinic visits and barriers identified. We offered routine clinic appointments in conjunction with lab appointments to increase screening adherence. We were able to capture seven patients in the first 6 months and 14 in the second 6 months, increasing our OGTT screening rate to 28%. Conclusion(s): Using a multimodal approach in a multidisciplinary team,we increased our OGTT annual screening rate by 7 percentage points. The ability to incorporate recommended screening into routine clinic visits supported adherence and patient satisfaction. Limitations to OGTT screening include continued COVID concerns and transportation to clinic.We plan to continue this quality improvement approach to increase adherence to 50% within this next year by continued consolidation of lab work and OGTT with visits and assisting patients with scheduling lab appointments and transportation to the clinic Copyright © 2022, European Cystic Fibrosis Society. All rights reserved