Latent Autoimmune Diabetes in Adults in the United Arab Emirates: Clinical Features and Factors Related to Insulin-Requirement

AIMS: To describe and to characterize clinical features of latent autoimmune diabetes in adults (LADA) compared to type 1 and type 2 diabetes in the UAE. METHODS: In this cross-sectional study a dataset including 18,101 subjects with adult-onset (>30 years) diabetes was accessed. 17,072 subjects fulfilled the inclusion/exclusion criteria. Data about anthropometrics, demographics, autoantibodies to Glutamic Acid Decarboxylase (GADA) and to Islet Antigen 2 (anti-IA2), HbA1c, cholesterol and blood pressure were extracted. LADA was diagnosed according to GADA and/or anti-IA2 positivity and time to insulin therapy. RESULTS: 437 (2.6%) patients were identified as LADA and 34 (0.2%) as classical type 1 diabetes in adults. Mean age at diagnosis, BMI, waist circumference, systolic blood pressure and HbA1c significantly differed between, LADA, type 2 and type 1 diabetes, LADA showing halfway features between type 2 and type 1 diabetes. A decreasing trend for age at diagnosis and waist circumference was found among LADA subjects when subdivided by positivity for anti-IA2, GADA or for both antibodies (p=0.013 and p=0.011 for trend, respectively). There was a gradual downward trend in autoantibody titre in LADA subjects requiring insulin within the first year from diagnosis to subjects not requiring insulin after 10 years of follow-up (p<0.001). CONCLUSIONS: This is the first study describing the clinical features of LADA in the UAE, which appear to be different from both type 1 and type 2 diabetes. Furthermore, we showed that the clinical phenotype of LADA is dependent on different patterns of antibody positivity, influencing the time to insulin requirement

Design and Analysis of Mobility Permit-based Traffic Management Schemes

High demand for mobility has undeniably been causing numerous negative impacts on the economy, the society and the environment. As a potential solution to address this challenge, a rapid transition is taking place in the transportation sector with emerging concepts of mobility marketplace. The basic premise is to treat the transportation system and its use as a collection of commodities or services that can be bought from the transportation market. This concept is increasingly becoming a reality with the technological developments in automotive industry such as connected and autonomous vehicles (CAVs). However, there are many policy, design and operation related issues that must be addressed before these traffic management schemes become reality. This thesis research aims at addressing some of these challenges and issues with a specific focus on the two most promising market-driven instruments, namely, mobility permits (MP)- and mobility credits (MC)-based traffic management schemes, which have been proposed to manage travel demand and mitigate traffic congestion by controlling roadway-use right. This research has made several distinctive contributions into the literature. We first conduct a critical review of the state-of-the-art methodological advances on MP- and MC-based travel demand management schemes. We synthesize the relevant body of literature with an in-depth discussion on related studies to provide an improved understanding of the fundamental constructs of these problems, including problem variants, methodologies, and modeling attributes. We also discuss the research gaps and challenges and suggest some possible perspectives and directions for future research. Based on the gaps identified in the literature review, an integrated framework is proposed for implementing various roadway-use right-based traffic management programs such as MP and MC-based schemes. This framework entails a unique construct for integrating the needs of multiple stakeholders (e.g., road users and authorities), diverse network conditions, and traffic control methods. It allows easy incorporation of different components required for implementing a coordinative mobility scheme, taking into account the influence of the participating players and the underlying issues. The framework can be served as a road-map to future studies on different roadway-use right-based solutions for traffic congestion management. With our proposed framework, we then focus on addressing various specific challenges arising in designing and implementing MP-based and MC-based schemes, such as, representation of realistic user characteristics (e.g., utility function, user priorities and cooperation), availability of information on users and traffic conditions, uncertainty in system conditions and user behaviors, and circulation of mobility rights in market place. For the MP-based scheme, we focus specifically on designing a mobility scheme for single-bottleneck roadways. Roads with bridges, tunnels and business districts with limited parking spaces are the most obvious examples of a simple roadway with a single-bottleneck in a transportation network. We deal with observing operational objectives, specifically, balancing efficiency, equity (users priorities), and revenue outcome of distributing mobility permits under the “fairness” constraint. We explore the theoretical properties of the proposed scheme and show that the proposed scheme can achieve an optimal traffic pattern. Particularly, we show that the proposed scheme is a Pareto-improving and strategy-proof scheme capable of achieving efficient and effective market prices suitable for travelers. Our computational results indicate the effectiveness of the proposed scheme as an alternative solution for MP-based traffic management on single-bottleneck roadways. We then investigate the case of traffic congestion management in a general road network through a MC-based scheme. Specifically, we propose a MC-based traffic management scheme in a road network consisting of a mixed-fleet traffic with connected and autonomous vehicles (CAVs) and conventional vehicles (non-CAVs). The basic premise of the proposed scheme is to regulate or influence travel demand and congestion with regards to the supply (capacity) of road networks, implementing a market-driven traffic management paradigm. A set of revenue-neutral, Pareto-improving MC-based charge and reward policies applicable to stochastic traffic environments are developed, considering different characteristics of users such as cooperative versus selfish routing behaviors, human-associated factors (e.g., level of uncertainty) and interactions due to a shared infrastructure setting. Path-free mathematical programming models are formulated, obviating computationally intractable path enumeration process pertinent to the existing studies. This makes the proposed scheme suitable for examining the theoretical characteristics of large-scale realistic transport networks. We examine several theoretical properties related to the proposed MC-based scheme, including the existence and uniqueness of the equilibrium price, and existence of Pareto-improving credit charges and rewards rates that can promote travel decision behaviors of individual travelers towards a network-wide optimal state. Our comprehensive computational results indicate that the proposed MC-based scheme can be an effective tool for managing travel demand and routing decisions in mixed-vehicle traffic settings

Perspektif Kinerja Pengembangan Produksi Komoditi Kelapa Sawit di PTPN III

Penelitian "Perspektif Kinerja Pengembangan Produksi Komoditi Kelapa Sawit di PTPN III" merupakan penelitian yang mendeskripsikan manajemen perusahaan dalam mengembangkan produksi komoditi kelapa sawit di PTPN III, Mengkaji perspektif pengembangan komoditi kelapa sawit di PTPN Ill serta mengetahui hambatan-hambatan pengembangan produksi komoditi kelapa sawit di PTPN III. Hasil penelitian menyimpulkan bahwa dengan Kinerja yang prima di Unit Produksi maka Keunggulan Kinerja yang saat ini telah dicapai PT. Perkebunan Nusantara Ill (Persero) khususnya di kebun dan pabrik dapat dipertahankan dan berkelanjutan sehingga tetap berkontribusi secara maksimal terhadap kekuatan Daya Saing Perusahaan. Kebijakan yang tepat, cepat dan konsisten sangat diperlukan untuk mengantisipasi persaingan bisnis, terutama terhadap perubahan bisnis global, fluktuasi harga jual komoditas, perubahan nilai kurs dan rencana investasi pengembangan usaha baru. Hal ini terkait dengan "Apakah kondisi perkembangan bisnis perusahaan sudah mengalami tingkat kejenuhan dengan hanya mengandalkan bisnis konvensional di sektor hulu". Upaya strategis perusahaan dalam rangka meningkatkan produktivitas, nilai tambah dan daya saing adalah melakukan pengembangan areal baru dan pengembangan industry hilir berbasis perkebunan yang terintegrasi dalam satu kawasan industry. Keberhasilan pembangunan kawasan industry dalam pengembangan industry hilir berbasis perkebunan sangat bergantung dari efektifitas hubungan kerjasama antara pemegang saham, manajemen, dunia usaha (Public-Private partnership), dan keterkaitan dengan mitra strategis. Untuk mengefektifkan kerjasama dan koordinasi tersebut diperlukan adanya peran serta dari masing-masing pemangku kepentingan untuk menangani secara professional dan berkesinambungan

Diagnosing ileal atresia: the role of clinical correlation and plain radiography

Ileal atresia is a subset of congenital gastrointestinal malformations that result in neonatal bowel obstruction. We report a case of a 7-day old male neonate who presented with failure to pass meconium, abdominal distension and late onset bilious vomiting. A plain abdominal radiograph revealed dilated bowel loops with fluid levels of different sizes, the largest appearing as a fluid filled mass with an abrupt cut off. These findings were consistent with ileal atresia and the diagnosis was confirmed intra-operatively. This case description is aimed at emphasizing the role of clinical correlation and a plain abdominal radiograph in the diagnosis of ileal atresia which are two important modalities that have imaging modalities which delay management. The  diagnosis of ileal atresia can be suspected in the neonate who presents with failure to pass meconium, abdominal distension, late onset bilious vomiting and a plain abdominal radiograph with fluid levels of different sizes, the largest situated just proximal to the atretic zone.Keywords: Ileal atresia, plain radiograph, clinical assessmen

Endocrinology in the time of covid-19: A rapid evolution of knowledge and care

American singer-writer and visual artist Bob Dylan produced the song "The Times They Are a-Changin" in the 1960s, which became a rallying cry for the civil rights and anti-war movements in that decade [...]

Urethro-cutaneous fistula after hypospadia repair: a single institution study

Urethro-cutaneous fistula (UCF) is one of the most frequently seen complications of hypospadias surgery requiring reoperation; it occurs with an incidence of between 4% and 28%. Risk factors associated with the development of UCF can be classified as preoperative, intraoperative or postoperative. The aim of this study was to determine the association of perioperative risk factors and the development of urethrocutaneous fistula after hypospadias repair. A retrospective review of patients who had undergone hypospadias repair at Kenyatta National Hospital between 2013 and 2017 was conducted. 114 patient records were retrieved. The incidence of UCF was 47%. Risk factors that were significantly associated with UCF are hypospadias type (p=0.028), lack of a protective intermediate layer (p=0.002), and presence of postoperative complications (p=0.001). Age at surgery, suture material, type of repair and use of catheter/stents were not significant factors. Multivariate analysis showed wound infection and meatal stenosis as the most significant factors associated with UCF development.Keywords: Hypospadias, Urethro-cutaneous fistula, Risk factors, Wound infection, Meatal stenosi

A preference-based, multi-unit auction for pricing and capacity allocation

The final publication is available at Elsevier via https://dx.doi.org/10.1016/j.cor.2017.09.024 © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/We study a pricing and allocation problem of a seller of multiple units of a homogeneous item, and present a semi-market mechanism in the form of an iterative ascending-bid auction. The auction elicits buyers' preferences over a set of options offered by the seller, and processes them with a random-priority assignment scheme to address buyers' "fairness" expectations. The auction's termination criterion is derived from a mixed-integer programming formulation of the preference-based capacity allocation problem. We show that the random priority- and preference-based assignment policy is a universally truthful mechanism which can also achieve a Pareto-efficient Nash equilibrium. Computational results demonstrate that the auction mechanism can extract a substantial portion of the centralized system's profit, indicating its effectiveness for a seller who needs to operate under the "fairness" constraint

Non-alcoholic fatty liver disease: relationship with cardiovascular risk markers and clinical endpoints

Non-alcoholic fatty liver disease (NAFLD) is a common diagnosis and is increasing in prevalence worldwide. NAFLD is usually asymptomatic at presentation; progression of the disease is unpredictable, leading to the development of a variety of techniques for screening, diagnosis and risk stratification. Clinical methods in current use include serum biomarker panels, hepatic ultrasound, magnetic resonance imaging, and liver biopsy. NAFLD is strongly associated with the metabolic syndrome, and the most common cause of death for people with the condition is cardiovascular disease. Whether NAFLD is an independent cardiovascular risk factor needs exploration. NAFLD has been associated with surrogate markers of cardiovascular disease such as carotid intima-media thickness, the presence of carotid plaque, brachial artery vasodilatory responsiveness and CT coronary artery calcification score. There is no effective medical treatment for NAFLD and evidence is lacking regarding the efficacy of interventions in mitigating cardiovascular risk. Health care professionals managing patients with NAFLD should tackle the issue with early identification of risk factors and aggressive modification. Current management strategies therefore comprise lifestyle change,with close attention to known cardiovascular risk factors