Gestational diabetes mellitus- right person, right treatment, right time?

Background: Personalised treatment that is uniquely tailored to an individual’s phenotype has become a key goal of clinical and pharmaceutical development across many, particularly chronic, diseases. For type 2 diabetes, the importance of the underlying clinical heterogeneity of the condition is emphasised and a range of treatments are now available, with personalised approaches being developed. While a close connection between risk factors for type 2 diabetes and gestational diabetes has long been acknowledged, stratification of screening, treatment and obstetric intervention remains in its infancy. Conclusions: Although there have been major advances in our understanding of glucose tolerance in pregnancy and of the benefits of treatment of gestational diabetes, we argue that far more vigorous approaches are needed to enable development of companion diagnostics, and to ensure the efficacious and safe use of novel therapeutic agents and strategies to improve outcomes in this common condition

A homomorphism theorem and a Trotter product formula for quantum stochastic flows with unbounded coefficients

We give a new method for proving the homomorphic property of a quantum stochastic ow satisfying a quantum stochastic differential equation with unbounded coefficients, under some further hypotheses. As an application, we prove a Trotter product formula for quantum stochastic ows and obtain quantum stochastic dilations of a class of quantum dynamical semigroups generalizing results of [5

Downtown Providence Farmers Market Design

This market essentially combines a marketplace with an existing or new industrial building. The hybrid created results in space that has daily retail sales and hours, as well as other goods available at other times. The industrial aspect typically acts as the anchor, as the market’s activities help attract a different group of consumers at other business times. An example of this would be a seafood supply warehouse that also provides dining and entertainment as a nightlife destination

Maternal thyroid function and child educational attainment: prospective cohort study

Objective: To determine if first trimester maternal thyroid dysfunction is a critical determinant of child scholastic performance and overall educational attainment. Design: Prospective cohort study. Setting: Avon Longitudinal Study of Parents and Children cohort in the UK. Participants: 4615 mother-child pairs with an available first trimester sample (median 10 weeks gestation, interquartile range 8-12). Exposures: Free thyroxine, thyroid stimulating hormone, and thyroid peroxidase antibodies assessed as continuous measures and the seven clinical categories of maternal thyroid function. Main outcome measures: Five age-specific national curriculum assessments in 3580 children at entry stage assessment at 54 months, increasing up to 4461 children at their final school assessment at age 15. Results: No strong evidence of clinically meaningful associations of first trimester free thyroxine and thyroid stimulating hormone levels with entry stage assessment score or Standard Assessment Test scores at any of the key stages was found. Associations of maternal free thyroxine or thyroid stimulating hormone with the total number of General Certificates of Secondary Education (GCSEs) passed (range 0-16) were all close to the null: free thyroxine, rate ratio per pmol/L 1.00 (95% confidence interval 1.00 to 1.01); and thyroid stimulating hormone, rate ratio 0.98 (0.94 to 1.02). No important relationship was observed when more detailed capped scores of GCSEs allowing for both the number and grade of pass or when language, mathematics, and science performance were examined individually or when all educational assessments undertaken by an individual from school entry to leaving were considered. 200 (4.3%) mothers were newly identified as having hypothyroidism or subclinical hypothyroidism and 97 (2.1%) subclinical hyperthyroidism or hyperthyroidism. Children of mothers with thyroid dysfunction attained an equivalent number of GCSEs and equivalent grades as children of mothers with euthyroidism. Conclusions: Maternal thyroid dysfunction in early pregnancy does not have a clinically important association with impaired child performance at school or educational achievement

Radial Color Gradients in K+A Galaxies in Distant Clusters of Galaxies

Galaxies in rich clusters with z $\gtrsim$ 0.3 are observed to have a higher fraction of photometrically blue galaxies than their nearby counterparts. This raises the important question of what environmental effects can cause the termination of star formation between z $\approx$ 0.3 and the present. The star formation may be truncated due to ram-pressure stripping, or the gas in the disk may be depleted by an episode of star formation caused by some external perturbation. To help resolve this issue, surface photometry was carried out for a total of 70 early-type galaxies in the cluster Cl1358+62, at z $\sim$ 0.33, using two-color images from the Hubble Archive. The galaxies were divided into two categories based on spectroscopic criteria: 24 are type K+A (e.g., strong Balmer lines, with no visible emission lines), while the remaining 46 are in the control sample with normal spectra. Radial color profiles were produced to see if the K+A galaxies show bluer nuclei in relation to their surrounding disks. Specifically, a linear gradient was fit to the radial color profile of each galaxy. We find that the K+A galaxies on average tend to have slightly bluer gradients towards the center than the normals. A Kolmogorov-Smirnov two-sample test has been applied to the two sets of color gradients. The result of the test indicates that there is only a $\sim$2% probability that the K+A and normal samples are drawn from the same parent distribution. There is a possible complication from a trend in the apparent magnitude vs. color gradient relation, but overall our results favor the centralized star formation scenario as an important process in the evolution of galaxies in dense clusters.Comment: 16 pages, 12 figures, accepted for publication in A

Placental Structure in Type 1 Diabetes: Relation to Fetal Insulin, Leptin, and IGF-I

OBJECTIVE-Alteration of placental structure may influence fetal overgrowth and complications of maternal diabetes. We examined the placenta in a cohort of offspring of mothers with type I diabetes (OT1DM) to assess structural changes and determine whether these were related to maternal A1C, fetal hematocrit, fetal hormonal, or metabolic axes. RESEARCH DESIGN AND METHODS-Placental samples were analyzed using stereological techniques to quantify volumes and surface areas of key placental components in 88 OT1DM and 39 control subjects, and results related to maternal A1C and umbilical cord analytes (insulin, leptin, adiponectin, IGF-I, hematocrit, lipids, C-reactive protein, and interleukin-6). RESULTS-Intervillous space volume was increased in OT1DM (OT1DM 250 +/- 81 cm(3) VS. control 217 +/- 65 cm(3); P = 0.02) with anisomorphic growth of villi (P = 0.025). The placentas showed a trend to increased weight (OT1DM 690 +/- 19 g; control 641 +/- 22 g; P = 0.08), but villous, nonparenchymal, trophoblast, and capillary volumes did not differ. Villous surface area, capillary surface area, membrane thickness, and calculated morphometric diffusing capacity were also similar in type 1 diabetic and control subjects. A1C at 26-34 weeks associated with birth weight (r = 0.27, P = 0.03), placental weight (r = 0.41, P = 0.0009), and intervillous space volume (r = 0.38, P = 0.0024). In multivariate analysis of cord parameters in OT1DM, fetal IGF-I emerged as a significant correlate of most components (intervillous space, villous, trophoblast, and capillary volumes, all P < 0.01). By contrast, fetal insulin was only independently associated with capillary surface area (positive, r(2) = 6.7%; P = 0.02). CONCLUSIONS-There are minimal placental structural differences between OT1DM and control subjects. Fetal IGF-I but not fetal insulin emerges as a key correlate of placental substructural volumes, thereby facilitating feedback to the placenta regarding fetal metabolic deman

Perceptual properties of feedback stimuli influence the feedback‐related negativity in the flanker gambling task

A negative deflection in the event‐related potential is enhanced following error‐ and loss‐related feedback in decision‐making and simple gambling tasks. Researchers have assumed that the perceptual properties of the feedback stimuli are unimportant in explaining these effects. This assumption was tested in the present study through a flanker gambling task, in which the perceptual properties of the feedback were manipulated. Consistent with previous studies, loss elicited a larger feedback‐related negativity ( FRN ) than gain feedback. However, this FRN reward effect was modulated by the perceptual properties of the feedback stimuli. When gain and loss feedback were perceptually similar to each other, the enhancement of the FRN following the loss feedback was smaller compared to when the gain and loss feedback were different from each other. In addition, incongruent feedback elicited a larger FRN than congruent feedback; this FRN congruency effect was larger following gain than loss feedback. These results suggested that perceptual properties of the feedback stimuli play a role in the elicitation of the FRN .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108013/1/psyp12216.pd

Uncertainty Model For Quantitative Precipitation Estimation Using Weather Radars

This paper introduces an uncertainty model for the quantitatively estimate precipitation using weather radars. The model considers various key aspects associated to radar calibration, attenuation, and the tradeoff between accuracy and radar coverage. An S-band-radar case study is presented to illustrate particular fractional-uncertainty calculations obtained to adjust various typical radar-calibration elements such as antenna, transmitter, receiver, and some other general elements included in the radar equation. This paper is based in “Guide to the expression of Uncertainty in measurement” [1] and the results show that the fractional uncertainty calculated by the model was 40 % for the reflectivity and 30% for the precipitation using the Marshall Palmer Z-R relationship

Upper limits of intraocular pressure in glaucoma clinical trials

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110560/1/ceo12357.pd