Risk models and scores for type 2 diabetes: Systematic review

This article is published under a Creative Commons Attribution Non Commercial (CC BY-NC 3.0) licence that allows reuse subject only to the use being non-commercial and to the article being fully attributed (http://creativecommons.org/licenses/by-nc/3.0).Objective - To evaluate current risk models and scores for type 2 diabetes and inform selection and implementation of these in practice. Design - Systematic review using standard (quantitative) and realist (mainly qualitative) methodology. Inclusion - criteria Papers in any language describing the development or external validation, or both, of models and scores to predict the risk of an adult developing type 2 diabetes. Data sources - Medline, PreMedline, Embase, and Cochrane databases were searched. Included studies were citation tracked in Google Scholar to identify follow-on studies of usability or impact. Data extraction - Data were extracted on statistical properties of models, details of internal or external validation, and use of risk scores beyond the studies that developed them. Quantitative data were tabulated to compare model components and statistical properties. Qualitative data were analysed thematically to identify mechanisms by which use of the risk model or score might improve patient outcomes. Results - 8864 titles were scanned, 115 full text papers considered, and 43 papers included in the final sample. These described the prospective development or validation, or both, of 145 risk prediction models and scores, 94 of which were studied in detail here. They had been tested on 6.88 million participants followed for up to 28 years. Heterogeneity of primary studies precluded meta-analysis. Some but not all risk models or scores had robust statistical properties (for example, good discrimination and calibration) and had been externally validated on a different population. Genetic markers added nothing to models over clinical and sociodemographic factors. Most authors described their score as “simple” or “easily implemented,” although few were specific about the intended users and under what circumstances. Ten mechanisms were identified by which measuring diabetes risk might improve outcomes. Follow-on studies that applied a risk score as part of an intervention aimed at reducing actual risk in people were sparse. Conclusion - Much work has been done to develop diabetes risk models and scores, but most are rarely used because they require tests not routinely available or they were developed without a specific user or clear use in mind. Encouragingly, recent research has begun to tackle usability and the impact of diabetes risk scores. Two promising areas for further research are interventions that prompt lay people to check their own diabetes risk and use of risk scores on population datasets to identify high risk “hotspots” for targeted public health interventions.Tower Hamlets, Newham, and City and Hackney primary care trusts and National Institute of Health Research

XMM-Newton observations of SDSS J143030.22−-001115.1: an unusually flat spectrum AGN

We present XMM observations of the AGN SDSS 1430-0011. The low S/N spectrum of this source obtained in a snap shot Chandra observation showed an unusually flat continuum. With the follow up XMM observations we find that the source spectrum is complex; it either has an ionized absorber or a partially covering absorber. The underlying power-law is in the normal range observed for AGNs. The low luminosity of the source during Chandra observations can be understood in terms of variations in the absorber properties. The X-ray and optical properties of this source are such that it cannot be securely classified as either a narrow line Seyfert 1 or a broad line Seyfert 1 galaxy.Comment: Submitted to A

Anticarcinogenic potential of Withania coagulans fruit against skin papilomagenesis in swiss albino mice

Withania coagulans belongs to family Solanaceae and its beries are commonly known to be as good vegetable rennet. It has been reported to have withanolides which are known to be as a group of steroidal lactones found among members of Solanaceae. Withanolides are reported to have antitumor, antibacterial, anti-inflammatory, immune-suppressive, cyto-toxicity and antiulcer activities. In the present study, the anti-carcinogenic activity of Withania coagulans of aqueous and methanolic fruit extracts was investigated on DMBA induced skin papillomagenesis. Single topical application of 7,12-dimethylbenzanthracene (DMBA) of 100μg/100μl acetone, was given and one week later promoted by repeated application of Croton oil (1% in acetone/twice in a week ) till the end of experiment (16 weeks) in Swiss albino mice. Single topical application of Methanolic and Aqueous extract of Withania coagulans at the dose 1000mg/kg body weight along with DMBA+ Croton oil was found  effective in decreasing cumulative no. of papillomas, tumor yield, tumor incidence and tumor burden as compared to the Control group i.e. DMBA and Croton oil. Histo-pathological studies also showed positive results of the Withania coagulans extracts against DMBA as promoter and Croton oil as stimulator of causing papillomagenesis. Histological sections in all the groups show marked papillomatosis, hypergranulosis and hyperkeratosis with papillary projections but in the control group papilloma consisted of fibro-vascular core with lump of epithelia showing mild dysplasia, the signs of malignancy were prominent showing Keratinous pearl and  full thick dysplasia containing fibro-vascular core with lining epithelia. The tumor incidence in methanolic extract group are found statistically significant (p<0.05) in comparison to control group

Evidence for latency of Japanese encephalitis virus in T lymphocytes

Activation of latent Japanese encephalitis virus (JEV) in the spleen has been studied by co-cultivation with allogeneic or syngeneic cells. Activated virus was isolated by cocultivation from T lymphocytes of spleen, as shown by indirect immunofluorescence or by inoculation into mice. The B lymphocytes and macrophages of latently infected mice did not reactivate the virus. A higher proportion of Lyt 1 cells than Lyt 2 cells were harbouring JEV as shown by indirect immunofluorescence. The spleen cells from latently infected mice elicited the lymphoproliferative response but this was much lower than that observed in the controls. These findings suggest the establishment of latent JEV infection in T lymphocytes

Coulomb Interactions and Nanoscale Electronic Inhomogeneities in Manganites

We address the issue of endemic electronic inhomogeneities in manganites using extensive simulations on a new model with Coulomb interactions amongst two electronic fluids, one localized (polaronic), the other extended (band-like), and dopant ions. The long range Coulomb interactions frustrate phase separation induced by the strong on site repulsion between the fluids. A single quantum phase ensues which is intrinsically and strongly inhomogeneous at a nano-scale, but homogeneous on meso-scales, with many characteristics (including colossal responses)that agree with experiments. This, we argue, is the origin of nanoscale inhomogeneities in manganites, rather than phase competition and disorder related effects as often proposed.Comment: 4 pages, 3 figure