Performance of HbA1c for classifying diabetes and diagnostic threshold for diabetes among the Mexican American border community

Objective. In 2009, the International Expert Committee recommended the use of HbA1c test for diagnosis of diabetes. Although it has been recommended for the diagnosis of diabetes, its precise test performance among Mexican Americans is uncertain. A strong “gold standard” would rely on repeated blood glucose measurement on different days, which is the recommended method for diagnosing diabetes in clinical practice. Our objective was to assess test performance of HbA1c in detecting diabetes and pre-diabetes against repeated fasting blood glucose measurement for the Mexican American population living in United States-Mexico border. Moreover, we wanted to find out a specific and precise threshold value of HbA1c for Diabetes Mellitus (DM) and pre-diabetes for this high-risk population which might assist in better diagnosis and better management of patient diabetes. ^ Research design and methods. We used CCHC dataset for our study. In 2004, the Cameron County Hispanic Cohort (CCHC), now numbering 2,574, was established drawn from randomly selected households on the basis of 2000 Census tract data. The CCHC study randomly selected a subset of people (aged 18-64 years) in CCHC cohort households to determine the influence of SES on diabetes and obesity. Among the participants in Cohort-2000, 67.15% are female; all are Hispanic. ^ Individuals were defined as having diabetes mellitus (Fasting plasma glucose [FPG] ≥ 126 mg/dL or pre-diabetes (100 ≤ FPG < 126 mg/dL). HbA1c test performance was evaluated using receiver operator characteristic (ROC) curves. Moreover, change-point models were used to determine HbA1c thresholds compatible with FPG thresholds for diabetes and pre-diabetes. ^ Results. When assessing Fasting Plasma Glucose (FPG) is used to detect diabetes, the sensitivity and specificity of HbA1c≥ 6.5% was 75% and 87% respectively (area under the curve 0.895). Additionally, when assessing FPG to detect pre-diabetes, the sensitivity and specificity of HbA1c≥ 6.0% (ADA recommended threshold) was 18% and 90% respectively. The sensitivity and specificity of HbA1c≥ 5.7% (International Expert Committee recommended threshold) for detecting pre-diabetes was 31% and 78% respectively. ROC analyses suggest HbA1c as a sound predictor of diabetes mellitus (area under the curve 0.895) but a poorer predictor for pre-diabetes (area under the curve 0.632). ^ Conclusions. Our data support the current recommendations for use of HbA1c in the diagnosis of diabetes for the Mexican American population as it has shown reasonable sensitivity, specificity and accuracy against repeated FPG measures. However, use of HbA1c may be premature for detecting pre-diabetes in this specific population because of the poor sensitivity with FPG. It might be the case that HbA1c is differentiating the cases more effectively who are at risk of developing diabetes. Following these pre-diabetic individuals for a longer-term for the detection of incident diabetes may lead to more confirmatory result.^

Design, Synthesis and Development of Transporter Targeting Agents for Image-guided Therapy and Drug Delivery

The purpose of this study was to design, synthesize and develop novel transporter targeting agents for image-guided therapy and drug delivery. Two novel agents, N4-guanine (N4amG) and glycopeptide (GP) were synthesized for tumor cell proliferation assessment and cancer theranostic platform, respectively. N4amG and GP were synthesized and radiolabeled with 99mTc and 68Ga. The chemical and radiochemical purities as well as radiochemical stabilities of radiolabeled N4amG and GP were tested. In vitro stability assessment showed both 99mTc-N4amG and 99mTc-GP were stable up to 6 hours, whereas 68Ga-GP was stable up to 2 hours. Cell culture studies confirmed radiolabeled N4amG and GP could penetrate the cell membrane through nucleoside transporters and amino acid transporters, respectively. Up to 40% of intracellular 99mTc-N4amG and 99mTc-GP was found within cell nucleus following 2 hours of incubation. Flow cytometry analysis revealed 99mTc-N4amG was a cell cycle S phase-specific agent. There was a significant difference of the uptake of 99mTc-GP between pre- and post- paclitaxel-treated cells, which suggests that 99mTc-GP may be useful in chemotherapy treatment monitoring. Moreover, radiolabeled N4amG and GP were tested in vivo using tumor-bearing animal models. 99mTc-N4amG showed an increase in tumor-to-muscle count density ratios up to 5 at 4 hour imaging. Both 99mTc-labeled agents showed decreased tumor uptake after paclitaxel treatment. Immunohistochemistry analysis demonstrated that the uptake of 99mTc-N4amG was correlated with Ki-67 expression. Both 99mTc-N4amG and 99mTc-GP could differentiate between tumor and inflammation in animal studies. Furthermore, 68Ga-GP was compared to 18F-FDG in rabbit PET imaging studies. 68Ga-GP had lower tumor standardized uptake values (SUV), but similar uptake dynamics, and different biodistribution compared with 18F-FDG. Finally, to demonstrate that GP can be a potential drug carrier for cancer theranostics, several drugs, including doxorubicin, were selected to be conjugated to GP. Imaging studies demonstrated that tumor uptake of GP-drug conjugates was increased as a function of time. GP-doxorubicin (GP-DOX) showed a slow-release pattern in in vitro cytotoxicity assay and exhibited anti-cancer efficacy with reduced toxicity in in vivo tumor growth delay study. In conclusion, both N4amG and GP are transporter-based targeting agents. Radiolabeled N4amG can be used for tumor cell proliferation assessment. GP is a potential agent for image-guided therapy and drug delivery.

Selected age-diagnostic datums of ODP Site 184-1148

The 853 m thick sediment sequence recovered at ODP Site 1148 provides an unprecedented record of tectonic and paleoceanographic evolution in the South China Sea over the past 33 Ma. Litho-, bio-, and chemo-stratigraphic studies helped identify six periods of changes marking the major steps of the South China Sea geohistory. Rapid deposition with sedimentation rates of 60 m/Ma or more characterized the early Oligocene rifting. Several unconformities from the slumped unit between 457 and 495 mcd together erased about 3 Ma late Oligocene record, providing solid evidence of tectonic transition from rifting/slow spreading to rapid spreading in the South China Sea. Slow sedimentation of ~20-30 m/Ma signifies stable seafloor spreading in the early Miocene. Dissolution may have affected the completeness of Miocene-Pleistocene succession with short-term hiatuses beyond current biostratigraphical resolution. Five major dissolution events, D-1 to D-5, characterize the stepwise development of deep water masses in close association to post-Oligocene South China Sea basin transformation. The concurrence of local and global dissolution events in the Miocene and Pliocene suggests climatic forcing as the main mechanism causing deep water circulation changes concomitantly in world oceans and in marginal seas. A return of high sedimentation rate of 60 m/Ma to the late Pliocene and Pleistocene South China Sea was caused by intensified down-slope transport due to frequent sea level fluctuations and exposure of a large shelf area during sea level low-stands. The six paleoceanographic stages, respectively corresponding to rifting (~33-28.5 Ma), changing spreading southward (28.5-23 Ma), stable spreading to end of spreading (23-15 Ma), post-spreading balance (15-9 Ma), further modification and monsoon influence (9-5 Ma), and glacial prevalence (5-0 Ma), had transformed the South China Sea from a series of deep grabens to a rapidly expanding open gulf and finally to a semi-enclosed marginal sea in the past 33 Ma.

(Table 1) Diagnostic characters of specimens of Marenzelleria bastropi sp. n., M. arctia, M. neglecta, M. viridis and M. wireni

Marenzelleria bastropi, a new species of Spionidae (Polychaeta) from the brackish water Currituck Sound, North Carolina, is described. The new species is characterized by the great number of chaetigers between the first neuro- and notopodial hooded hooks, the extension of the nuchal organ up to the end of chaetiger 2/middle of chaetiger 3 and the presence of about 60-90 branchiate chaetigers. Marenzelleria bastropi sp. nov. is closely related to M. neglecta (Sikorski and Bick, 2004) and Marenzelleria viridis (Verrill, 1873). Marenzelleria wireni Augener, 1913 is described here for the first time from western Spitsbergen. Adult specimens are investigated and compared with specimens from other areas of distribution. A key for subadult and adult specimens of all Marenzelleria species is provided.

Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loos of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study

Aims: To assess the clinical presentation and acute management of patients with transient loss of consciousness (T-LOC) in the emergency department (ED). Methods and results: A multi-centre prospective observational study was carried out in 19 Spanish hospitals over 1 month. The patients included were 14 years old and were admitted to the ED because of an episode of T-LOC. Questionnaires and corresponding electrocardiograms (ECGs) were reviewed by a Steering Committee (SC) to unify diagnostic criteria, evaluate adherence to guidelines, and diagnose correctly the ECGs. We included 1419 patients (prevalence, 1.14%).ECG was performed in 1335 patients (94%) in the ED: 498 (37.3%) ECGs were classified as abnormal. The positive diagnostic yield ranged from 0% for the chest X-ray to 12% for the orthostatic test. In the ED, 1217 (86%) patients received a final diagnosis of syncope, whereas the remaining 202 (14%) were diagnosed of non-syncopal transient lossof consciousness (NST-LOC). After final review by the SC, 1080 patients (76%) were diagnosed of syncope, whereas 339 (24%) were diagnosed of NST-LOC (P , 0.001). Syncope was diagnosed correctly in 84% of patients. Only 25% of patients with T-LOC were admitted to hospitals. Conclusion Adherence to clinical guidelines for syncope management was low; many diagnostic tests were performed with low diagnostic yield. Important differences were observed between syncope diagnoses at the ED and by SC decision.

New diagnostic and therapeutic approaches to treat ventricular tachycardias originating at the summit of the left ventricle role of merged hemodynamic-MRI and alternative ablation sources

The left ventricular (LV) summit is the most common site of idiopathic epicardial LV arrhythmias and frequently represents a diagnostic and a therapeutic challenge.1 We present a case of sustained monomorphic ventricular tachycardia (SMVT) originating at the LV summit that underwent failed cryosurgical epicardial ablation and was successfully treated with the aid of merged hemodynamic and contrast-enhanced MRI (CE-MRI).

Drifting plasma collection by a positive biased tether wire in LEO-like plasma conditions: current measurement and plasma diagnostic

BETs is a three-year project financed by the Space Program of the European Commission, aimed at developing an efficient deorbit system that could be carried on board any future satellite launched into Low Earth Orbit (LEO). The operational system involves a conductive tape-tether left bare to establish anodic contact with the ambient plasma as a giant Langmuir probe. As a part of this project, we are carrying out both numerical and experimental approaches to estimate the collected current by the positive part of the tether. This paper deals with experimental measurements performed in the IONospheric Atmosphere Simulator (JONAS) plasma chamber of the Onera-Space Environment Department. The JONAS facility is a 9- m3 vacuum chamber equipped with a plasma source providing drifting plasma simulating LEO conditions in terms of density and temperature. A thin metallic cylinder, simulating the tether, is set inside the chamber and polarized up to 1000 V. The Earth's magnetic field is neutralized inside the chamber. In a first time, tether collected current versus tether polarization is measured for different plasma source energies and densities. In complement, several types of Langmuir probes are used at the same location to allow the extraction of both ion densities and electron parameters by computer modeling (classical Langmuir probe characteristics are not accurate enough in the present situation). These two measurements permit estimation of the discrepancies between the theoretical collection laws, orbital motion limited law in particular, and the experimental data in LEO-like conditions without magnetic fields. In a second time, the spatial variations and the time evolutions of the plasma properties around the tether are investigated. Spherical and emissive Langmuir probes are also used for a more extensive characterization of the plasma in space and time dependent analysis. Results show the ion depletion because of the wake effect and the accumulation of- ions upstream of the tether. In some regimes (at large positive potential), oscillations are observed on the tether collected current and on Langmuir probe collected current in specific sites.

Advanced data acquisition system implementation for the ITER Neutron Diagnostic use case using EPICS and FlexRIO technology on a PXIe platform

In the framework of the ITER Control Breakdown Structure (CBS), Plant System Instrumentation & Control (I&C) defines the hardware and software required to control one or more plant systems [1]. For diagnostics, most of the complex Plant System I&C are to be delivered by ITER Domestic Agencies (DAs). As an example for the DAs, ITER Organization (IO) has developed several use cases for diagnostics Plant System I&C that fully comply with guidelines presented in the Plant Control Design Handbook (PCDH) [2]. One such use case is for neutron diagnostics, specifically the Fission Chamber (FC), which is responsible for delivering time-resolved measurements of neutron source strength and fusion power to aid in assessing the functional performance of ITER [3]. ITER will deploy four Fission Chamber units, each consisting of three individual FC detectors. Two of these detectors contain Uranium 235 for Neutron detection, while a third "dummy" detector will provide gamma and noise detection. The neutron flux from each MFC is measured by the three methods: . Counting Mode: measures the number of individual pulses and their location in the record. Pulse parameters (threshold and width) are user configurable. . Campbelling Mode (Mean Square Voltage): measures the RMS deviation in signal amplitude from its average value. .Current Mode: integrates the signal amplitude over the measurement period

Design and integration of lower ports for ITER diagnostic systems

All around the ITER vacuum vessel, forty-four ports will provide access to the vacuum vessel for remotehandling operations, diagnostic systems, heating, and vacuum systems: 18 upper ports, 17 equatorialports, and 9 lower ports. Among the lower ports, three of them will be used for the remote handlinginstallation of the ITER divertor. Once the divertor is in place, these ports will host various diagnosticsystems mounted in the so-called diagnostic racks. The diagnostic racks must allow the support andcooling of the diagnostics, extraction of the required diagnostic signals, and providing access and main-tainability while minimizing the leakage of radiation toward the back of the port where the humans areallowed to enter. A fully integrated inner rack, carrying the near plasma diagnostic components, will bean stainless steel structure, 4.2 m long, with a maximum weight of 10 t. This structure brings water forcooling and baking at maximum temperature of 240?C and provides connection with gas, vacuum andelectric services. Additional racks (placed away from plasma and not requiring cooling) may be requiredfor the support of some particular diagnostic components. The diagnostics racks and its associated exvessel structures, which are in its conceptual design phase, are being designed to survive the lifetimeof ITER of 20 years. This paper presents the current state of development including interfaces, diagnos-tic integration, operation and maintenance, shielding requirements, remote handling, loads cases anddiscussion of the main challenges coming from the severe environment and engineering requirements.