Three Hopf algebras from number theory, physics & topology, and their common background II: general categorical formulation

We consider three a priori totally different setups for Hopf algebras from number theory, mathematical physics and algebraic topology. These are the Hopf algebra of Goncharov for multiple zeta values, that of Connes-Kreimer for renormalization, and a Hopf algebra constructed by Baues to study double loop spaces. We show that these examples can be successively unified by considering simplicial objects, co-operads with multiplication and Feynman categories at the ultimate level. These considerations open the door to new constructions and reinterpretations of known constructions in a large common framework which is presented step-by-step with examples throughout. In this second part of two papers, we give the general categorical formulation

Variations and trends in state nursing facility capacity: 1978-93.

The demand for nursing facility (NF) beds has been growing with the aging of the population and many other factors. As the need for nursing home care grows, the Nation's capacity to provide such care is the subject of increasing concern. This article examines licensed NFs and beds, presenting data on trends from 1978-93. Measures of the adequacy of NF beds in States are examined over time, including the ratio of beds per aged population, occupancy rates, and State official's opinions of the adequacy of supply. State and regional variations are shown over time, and we speculate on the factors which may be associated with the variation

Observations on the Overwintering Potential of the Striped Cucumber Beetle (Coleoptera: Chrysomelidae) in Southern Minnesota

The striped cucumber beetle, Acalymma vittatum (Fabricius) (Coleoptera: Chrysomelidae), is an important pest of cucurbit crops. However, the overwinter- ing capacity of this pest in temperate regions is poorly understood. In this study, the in-field survival of A. vittatum was examined during three consecutive winters. In addition, the supercooling points of A. vittatum were determined as an index of cold hardiness for adults. During each winter, the survival of adults decreased significantly through time, with no individuals surviving until spring. By comparing the supercooling points and in-field survival of adults to soil temperatures, it appears that winter temperatures in Minnesota are cold enough to induce freezing of the beetles. Moreover, a considerable amount of mortality occurred before minimum monthly soil temperatures dropped below the supercooling point of overwintering individuals, suggesting the occurrence of prefreeze mortality. An improved understanding of the response of A. vittatum to winter temperatures in temperate regions may aid in early season management of this pest

Estimating the gap between demand and supply of medical appointments by physicians for hypertension care: A pooled analysis in 191 countries

Introduction: With a growing number of people with hypertension, the limited number of physicians could not provide treatment to all patients. We quantified the gap between medical appointments available and needed for hypertension care, overall and in relation to hypertension treatment cascade metrics. Methods: Ecological descriptive analysis. We combined country-year-specific data on hypertension prevalence, awareness, treatment and control (from NCD-RisC) and number of physicians (from WHO). We estimated from 1 to 12 medical appointments per year for hypertensive patients. We assumed that physicians could see 25 patients per day, work 200 days per year, and dedicate 10% of their time to hypertension care. Results: We studied 191 countries. Forty-one countries would not have enough physicians to provide at least 1 medical appointment per year to all the population with hypertension; these countries were low/lower-middle income and in Sub-Saharan Africa or East Asia and Pacific. Regardless of the world region, ≥50% of countries would not have enough physicians to provide ≥8 medical appointments to their population with hypertension. Countries where the demand exceeded the offer of medical appointments for hypertension care had worse hypertension diagnosis, treatment and control rates than countries where the demand did not exceed the offer. There were positive correlations between the physician density and hypertension diagnosis (r=0.70, p<0.001), treatment (r=0.70, p<0.001) and control (r=0.59, p<0.001). Conclusions: Where physicians are the only healthcare professionals allowed to prescribe antihypertensive medications, particularly in low- and middle-income countries, the healthcare system may struggle to deliver antihypertensive treatment to hypertensive patients

Intermediate hyperglycaemia and 10-year mortality in resource-constrained settings: The PERU Migrant Study

Aim To determine whether intermediate hyperglycaemia, defined by fasting plasma glucose and HbA1c criteria, is associated with mortality in a 10‐year cohort of people in a Latin American country. Methods Analysis of the PERU MIGRANT Study was conducted in three different population groups (rural, rural‐to‐urban migrant, and urban). The baseline assessment was conducted in 2007/2008, with follow‐up assessment in 2018. The outcome was all‐cause mortality, and the exposure was intermediate hyperglycaemia, using three definitions: (1) impaired fasting glucose, defined according to American Diabetes Association criteria [fasting plasma glucose 5.6–6.9 mmol/l (100–125 mg/dl)]; (2) prediabetes defined according to American Diabetes Association criteria [HbA1c levels 39–46 mmol/mol (5.7–6.4%)]; and (3) prediabetes defined according to the International Expert Committee criteria [HbA1c levels 42–46 mmol/mol (6.0–6.4%)]. Crude and adjusted hazard ratios and 95% CIs were estimated using Cox proportional hazard models. Results At baseline, the mean (sd) age of the study population was 47.8 (11.9) years and 52.5% of the cohort were women. The study cohort was divided into population groups as follows: 207 people (20.0%) in the rural population group, 583 (59.7%) in the rural‐to‐urban migrant group and 198 (20.3%) in the urban population group. The prevalence of intermediate hyperglycaemia was: 6%, 12.9% and 38.5% according to the American Diabetes Association impaired fasting glucose definition, the International Expert Committee HbA1c‐based definition and the American Diabetes Association HbA1c‐based definition, respectively, and the mortality rate after 10 years was 63/976 (7%). Intermediate hyperglycaemia was associated with all‐cause mortality using the HbA1c‐based definitions in the crude models [hazard ratios 2.82 (95% CI 1.59–4.99) according to the American Diabetes Association and 2.92 (95% CI 1.62–5.28) according to the International Expert Committee], whereas American Diabetes Association‐defined impaired fasting glucose was not [hazard ratio 0.84 (95% CI 0.26–2.68)]. In the adjusted model, however, only the American Diabetes Association HbA1c‐based definition was associated with all‐cause mortality [hazard ratio 1.91 (95% CI 1.03–3.53)], whereas the International Expert Committee HbA1c‐based and American Diabetes Association impaired fasting glucose‐based definitions were not [hazard ratios 1.42 (95% CI 0.75–2.68) and 1.09 (95% CI 0.33–3.63), respectively]. Conclusions Intermediate hyperglycaemia defined using the American Diabetes Association HbA1c criteria was associated with an elevated mortality rate after 10 years in a cohort from Peru. HbA1c appears to be a factor associated with mortality in this Peruvian population

Aggregation and combination of cardiovascular risk factors and their association with 10-year all-cause mortality: The PERU MIGRANT Study

Objective To estimate the association between the aggregation and pair-wise combination of selected cardiovascular risk factors (CVRF) and 10-year all-cause mortality. Methods Secondary data analysis of the PERU MIGRANT study, a prospective population-based cohort. Ten-year all-cause mortality was determined for participants originally enrolled in the PERU MIGRANT Study (baseline in 2007) through the National Registry of Identification and Civil Status. The CVRF included hypertension, type 2 diabetes mellitus, hypercholesterolemia, and overweight/obesity. Exposures were composed of both the aggregation of the selected CVRF (one, two, and three or more CVRF) and pair-wise combinations of CVRF. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI). Findings Of the 989 participants evaluated at baseline, 976 (98.8%) had information about vital status at 10 years of follow-up (9992.63 person-years), and 63 deaths were recorded. In the multivariable model, adjusting for sociodemographic and lifestyle variables, participants with two CVRF (HR: 2.48, 95% CI: 1.03–5.99), and those with three or more CVRF (HR: 3.93, 95% CI: 1.21–12.74) had higher all-cause mortality risk, compared to those without any CVRF. The pair-wise combinations associated with the highest risk of all-cause mortality, compared to those without such comorbidities, were hypertension with type 2 diabetes (HR: 11.67, 95% CI: 3.67–37.10), and hypertension with overweight/obesity (HR: 2.76, 95% CI: 1.18–6.71). Conclusions The aggregation of two or more CVRF and the combination of hypertension with type 2 diabetes or overweight/obesity were associated with an increased risk of 10-year all-cause mortality. These risk profiles will inform primary and secondary prevention strategies to delay mortality from cardiovascular risk factors