A combined risk score enhances prediction of type 1 diabetes among susceptible children

This is the author accepted manuscript. The final version is available from Nature Research via the DOI in this recordType 1 diabetes (T1D)-an autoimmune disease that destroys the pancreatic islets, resulting in insulin deficiency-often begins early in life when islet autoantibody appearance signals high risk1. However, clinical diabetes can follow in weeks or only after decades, and is very difficult to predict. Ketoacidosis at onset remains common2,3 and is most severe in the very young4,5, in whom it can be life threatening and difficult to treat6-9. Autoantibody surveillance programs effectively prevent most ketoacidosis10-12 but require frequent evaluations whose expense limits public health adoption13. Prevention therapies applied before onset, when greater islet mass remains, have rarely been feasible14 because individuals at greatest risk of impending T1D are difficult to identify. To remedy this, we sought accurate, cost-effective estimation of future T1D risk by developing a combined risk score incorporating both fixed and variable factors (genetic, clinical and immunological) in 7,798 high-risk children followed closely from birth for 9.3 years. Compared with autoantibodies alone, the combined model dramatically improves T1D prediction at ≥2 years of age over horizons up to 8 years of age (area under the receiver operating characteristic curve ≥ 0.9), doubles the estimated efficiency of population-based newborn screening to prevent ketoacidosis, and enables individualized risk estimates for better prevention trial selection.National Institutes of Health/National Center for Advancing Translational Sciences Clinical and Translational ScienceDiabetes Research CenterDiabetes UKWellcome TrustJDR

Value of hospital antimicrobial stewardship programs [ASPs]:a systematic review

Abstract Background Hospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs. Methods An update to the Dik et al. systematic review (2000–2014) was conducted on EMBASE and Medline using PRISMA guidelines. The updated search was limited to primary research studies in English (30 September 2014–31 December 2017) that evaluated patient and/or economic outcomes after implementation of hospital ASPs including length of stay (LOS), antimicrobial use, and total (including operational and implementation) costs. Results One hundred forty-six studies meeting inclusion criteria were included. The majority of these studies were conducted within the last 5 years in North America (49%), Europe (25%), and Asia (14%), with few studies conducted in Africa (3%), South America (3%), and Australia (3%). Most studies were conducted in hospitals with 500–1000 beds and evaluated LOS and change in antibiotic expenditure, the majority of which showed a decrease in LOS (85%) and antibiotic expenditure (92%). The mean cost-savings varied by hospital size and region after implementation of ASPs. Average cost savings in US studies were $732 per patient (range:$2.50 to $2640), with similar trends exhibited in European studies. The key driver of cost savings was from reduction in LOS. Savings were higher among hospitals with comprehensive ASPs which included therapy review and antibiotic restrictions. Conclusions Our data indicates that hospital ASPs have significant value with beneficial clinical and economic impacts. More robust published data is required in terms of implementation, LOS, and overall costs so that decision-makers can make a stronger case for investing in ASPs, considering competing priorities. Such data on ASPs in lower- and middle-income countries is limited and requires urgent attention

The History, Relevance, and Applications of the Periodic System in Geochemistry

Geochemistry is a discipline in the earth sciences concerned with understanding the chemistry of the Earth and what that chemistry tells us about the processes that control the formation and evolution of Earth materials and the planet itself. The periodic table and the periodic system, as developed by Mendeleev and others in the nineteenth century, are as important in geochemistry as in other areas of chemistry. In fact, systemisation of the myriad of observations that geochemists make is perhaps even more important in this branch of chemistry, given the huge variability in the nature of Earth materials – from the Fe-rich core, through the silicate-dominated mantle and crust, to the volatile-rich ocean and atmosphere. This systemisation started in the eighteenth century, when geochemistry did not yet exist as a separate pursuit in itself. Mineralogy, one of the disciplines that eventually became geochemistry, was central to the discovery of the elements, and nineteenth-century mineralogists played a key role in this endeavour. Early “geochemists” continued this systemisation effort into the twentieth century, particularly highlighted in the career of V.M. Goldschmidt. The focus of the modern discipline of geochemistry has moved well beyond classification, in order to invert the information held in the properties of elements across the periodic table and their distribution across Earth and planetary materials, to learn about the physicochemical processes that shaped the Earth and other planets, on all scales. We illustrate this approach with key examples, those rooted in the patterns inherent in the periodic law as well as those that exploit concepts that only became familiar after Mendeleev, such as stable and radiogenic isotopes

A study of sounds produced by Algerian esophageal speakers

Background: Total Laryngectomy is a mode of treatment of patients with advanced laryngeal cancer. It affects the voice and the speech communication.Objective: To present an acoustic analysis of the new voice after total laryngectomy in Algerian hospital environment.Methods: A corpus of sounds was collected from October 2008 to September 2009 and pronounced by eight male speakers who have undergone total laryngectomy. Minimum age of patients was 47 years and maximum age was 59 years with mean age 54.87 years. Recordings were made before the beginning of reeducation and after three, six, and eleven months using esophageal voice. The acoustic analysis includes the Pitch F0 (Hz), Formants, intensity, Jitter (%), Shimmer (dB), harmonic to noise ratio HNR (dB), and degree of unvoiced frames DUF (%).Results: We note a restriction in F0, increasing of Jitter and Shimmer, decreasing of HNR values, and reduced intensity compared to the voice of normal laryngeal speakers. In addition, we note a higher percentage of DUF during the pronunciation of sustained vowels.Conclusion: Some deficiencies were reported in the taking care of patients. Therefore, the acoustic analysis may be used in evaluating the reliability of the technique of reeducation.Key words: Total laryngectomy, pathological voice, acoustic analysis, Jitter, Shimmer

An Experimental Study of the Gemination in Arabic Language

In this paper, we report the results of an experimental study of the acoustic and articulatory features of the gemination in Modern Arabic language, pronounced by Algerian speakers. To extract the feature characteristics, we have carried out an acoustic analysis by computing the values of frequency formants, energy and durations of the consonants and subsequent vowels in the various [VCV] and [VCgV] utterances (Cg: geminate consonant). For the articulatory analysis, a range of kinematics parameters were analyzed from the phoneme productions including movement trajectories, distance, velocity, and duration of tongue movements. Among the most important results, we note a longer duration of the vowel following a geminate consonant, a decreasing in levels of F1 and F2 formants and a rising in level of F3 formant of this vowel

A study of sounds produced by Algerian esophageal speakers

Background: Total Laryngectomy is a mode of treatment of patients with advanced laryngeal cancer. It affects the voice and the speech communication. Objective: To present an acoustic analysis of the new voice after total laryngectomy in Algerian hospital environment. Methods: A corpus of sounds was collected from October 2008 to September 2009 and pronounced by eight male speakers who have undergone total laryngectomy. Minimum age of patients was 47 years and maximum age was 59 years with mean age 54.87 years. Recordings were made before the beginning of reeducation and after three, six, and eleven months using esophageal voice. The acoustic analysis includes the Pitch F0 (Hz), Formants, intensity, Jitter (%), Shimmer (dB), harmonic to noise ratio HNR (dB), and degree of unvoiced frames DUF (%). Results: We note a restriction in F0, increasing of Jitter and Shimmer, decreasing of HNR values, and reduced intensity compared to the voice of normal laryngeal speakers. In addition, we note a higher percentage of DUF during the pronunciation of sustained vowels. Conclusion: Some deficiencies were reported in the taking care of patients. Therefore, the acoustic analysis may be used in evaluating the reliability of the technique of reeducation

An Experimental Study of the Gemination in Arabic Language

In this paper, we report the results of an experimental study of the acoustic and articulatory features of the gemination in Modern Arabic language, pronounced by Algerian speakers. To extract the feature characteristics, we have carried out an acoustic analysis by computing the values of frequency formants, energy and durations of the consonants and subsequent vowels in the various [VCV] and [VCgV] utterances (Cg: geminate consonant). For the articulatory analysis, a range of kinematics parameters were analyzed from the phoneme productions including movement trajectories, distance, velocity, and duration of tongue movements. Among the most important results, we note a longer duration of the vowel following a geminate consonant, a decreasing in levels of F1 and F2 formants and a rising in level of F3 formant of this vowel