Heterogeneity of diabetes outcomes among asians and pacific islanders in the US: the diabetes study of northern california (DISTANCE).

ObjectiveEthnic minorities with diabetes typically have lower rates of cardiovascular outcomes and higher rates of end-stage renal disease (ESRD) compared with whites. Diabetes outcomes among Asian and Pacific Islander subgroups have not been disaggregated.Research design and methodsWe performed a prospective cohort study (1996-2006) of patients enrolled in the Kaiser Permanente Northern California Diabetes Registry. There were 64,211 diabetic patients, including whites (n = 40,286), blacks (n = 8,668), Latinos (n = 7,763), Filipinos (n = 3,572), Chinese (n = 1,823), Japanese (n = 951), Pacific Islanders (n = 593), and South Asians (n = 555), enrolled in the registry. We calculated incidence rates (means ± SD; 7.2 ± 3.3 years follow-up) and created Cox proportional hazards models adjusted for age, educational attainment, English proficiency, neighborhood deprivation, BMI, smoking, alcohol use, exercise, medication adherence, type and duration of diabetes, HbA(1c), hypertension, estimated glomerular filtration rate, albuminuria, and LDL cholesterol. Incidence of myocardial infarction (MI), congestive heart failure, stroke, ESRD, and lower-extremity amputation (LEA) were age and sex adjusted.ResultsPacific Islander women had the highest incidence of MI, whereas other ethnicities had significantly lower rates of MI than whites. Most nonwhite groups had higher rates of ESRD than whites. Asians had ~60% lower incidence of LEA compared with whites, African Americans, or Pacific Islanders. Incidence rates in Chinese, Japanese, and Filipinos were similar for most complications. For the three macrovascular complications, Pacific Islanders and South Asians had rates similar to whites.ConclusionsIncidence of complications varied dramatically among the Asian subgroups and highlights the value of a more nuanced ethnic stratification for public health surveillance and etiologic research

Map Showing the Distribution of Surficial Sediments in Fishers Island Sound, New York, Connecticut, and Rhode Island

The data presented on this map were collected as part of a State of Connecticut and U.S. Geological Survey (USGS) cooperative program intended to further understand the marine geology of Connecticut and Long Island Sound. The purpose of this cooperative program is (1) to resolve sedimentologic and oceanographic problems and data gaps in Long Island Sound, (2) to integrate these findings with terrestrial data and the Pleistocene histories of Long Island and Connecticut, and (3) to initiate investigations of offshore resources that are keyed to the better management of Long Island Sound. With this in mind, the fundamental objectives of this study were to determine the distribution of surficial sediments in Fishers Island Sound and to describe the active sedimentary processes

Obesity and the food environment: income and ethnicity differences among people with diabetes: the Diabetes Study of Northern California (DISTANCE).

ObjectiveIt is unknown whether any association between neighborhood food environment and obesity varies according to individual income and/or race/ethnicity. The objectives of this study were to test whether there was an association between food environments and obesity among adults with diabetes and whether this relationship differed according to individual income or race/ethnicity.Research design and methodsSubjects (n = 16,057) were participants in the Diabetes Study of Northern California survey. Kernel density estimation was used to create a food environment score for each individual's residence address that reflected the mix of healthful and unhealthful food vendors nearby. Logistic regression models estimated the association between the modeled food environment and obesity, controlling for confounders, and testing for interactions between food environment and race/ethnicity and income.ResultsThe authors found that more healthful food environments were associated with lower obesity in the highest income groups (incomes 301-600% and >600% of U.S. poverty line) among whites, Latinos, and Asians. The association was negative, but smaller and not statistically significant, among high-income blacks. On the contrary, a more healthful food environment was associated with higher obesity among participants in the lowest-income group (<100% poverty threshold), which was statistically significant for black participants in this income category.ConclusionsThese findings suggest that the availability of healthful food environments may have different health implications when financial resources are severely constrained

Measurement of ambient aerosols in northern Mexico City by single particle mass spectrometry

International audienceContinuous ambient measurements with aerosol time-of-flight mass spectrometry (ATOFMS) were carried out in an industrial/residential section in the northern part of Mexico City as part of the Mexico City Metropolitan Area ? 2006 campaign (MCMA-2006) between 7?27 March, 2006. Biomass and organic carbon (OC) particle types were found to dominate the accumulation mode both day and night. The concentrations of both organic carbon and biomass particles were roughly equal early in the morning, but biomass became the largest contributor to the accumulation mode mass from the late morning until early evening. The diurnal pattern can be attributed to aging and/or a change in meteorology. Fresh elemental carbon (EC) particles were observed during rush hour. The majority of the EC particles were mixed with nitrate, sulfate, organic carbon and potassium. Submicron particles from industrial sources in the northeast were composed of an internal mixture of Pb, Zn, EC and Cl and peaked early in the morning. A unique nitrogen-containing organic (NOC) particle type was observed, and is hypothesized to be from industrial emissions based on the temporal profile and back trajectory analysis. This study provides unique insights into the real-time changes in single particle mixing state as a function of size and time for aerosols in Mexico City. These new findings indicate that biomass burning and industrial operations make significant contributions to particles in Mexico City. These sources have received relatively little attention in previous intensive field campaigns

Observation of playa salts as nuclei in orographic wave clouds

During the Ice in Clouds Experiment-Layer Clouds (ICE-L), dry lakebed, or playa, salts from the Great Basin region of the United States were observed as cloud nuclei in orographic wave clouds over Wyoming. Using a counterflow virtual impactor in series with a single-particle mass spectrometer, sodium-potassium-magnesium-calcium-chloride salts were identified as residues of cloud droplets. Importantly, these salts produced similar mass spectral signatures to playa salts with elevated cloud condensation nuclei (CCN) efficiencies close to sea salt. Using a suite of chemical characterization instrumentation, the playa salts were observed to be internally mixed with oxidized organics, presumably produced by cloud processing, as well as carbonate. These salt particles were enriched as residues of large droplets (>19 μm) compared to smaller droplets (>7 μm). In addition, a small fraction of silicate-containing playa salts were hypothesized to be important in the observed heterogeneous ice nucleation processes. While the high CCN activity of sea salt has been demonstrated to play an important role in cloud formation in marine environments, this study provides direct evidence of the importance of playa salts in cloud formation in continental North America has not been shown previously. Studies are needed to model and quantify the impact of playas on climate globally, particularly because of the abundance of playas and expected increases in the frequency and intensity of dust storms in the future due to climate and land use changes

Measurement of ambient aerosols in northern Mexico City by single particle mass spectrometry

Continuous ambient measurements with aerosol time-of-flight mass spectrometry (ATOFMS) were made in an industrial/residential section in the northern part of Mexico City as part of the Mexico City Metropolitan Area-2006 campaign (MCMA-2006). Results are presented for the period of 15–27 March 2006. The submicron size mode contained both fresh and aged biomass burning, aged organic carbon (OC) mixed with nitrate and sulfate, elemental carbon (EC), nitrogen-organic carbon, industrial metal, and inorganic NaK inorganic particles. Overall, biomass burning and aged OC particle types comprised 40% and 31%, respectively, of the submicron mode. In contrast, the supermicron mode was dominated by inorganic NaK particle types (42%) which represented a mixture of dry lake bed dust and industrial NaK emissions mixed with soot. Additionally, aluminosilicate dust, transition metals, OC, and biomass burning contributed to the supermicron particles. Early morning periods (2–6 a.m.) showed high fractions of inorganic particles from industrial sources in the northeast, composed of internal mixtures of Pb, Zn, EC and Cl, representing up to 73% of the particles in the 0.2–3μm size range. A unique nitrogen-containing organic carbon (NOC) particle type, peaking in the early morning hours, was hypothesized to be amines from local industrial emissions based on the time series profile and back trajectory analysis. A strong dependence on wind speed and direction was observed in the single particle types that were present during different times of the day. The early morning (3:30–10 a.m.) showed the greatest contributions from industrial emissions. During mid to late mornings (7–11 a.m.), weak northerly winds were observed along with the most highly aged particles. Stronger winds from the south picked up in the late morning (after 11 a.m.), resulting in a decrease in the concentrations of the major aged particle types and an increase in the number fraction of fresh biomass particles. The highest wind speeds were correlated with the highest number fraction of fresh biomass particles (up to 76% of the submicron number fraction) when winds were coming directly from fires that were located south and southeast of the city based on MODIS fire count data. This study provides a unique clock of hourly changes in single particle mixing state and sources as a function of meteorology in Mexico City. These new findings indicate that biomass burning and industrial emissions can make significant contributions to primary particle loadings in Mexico City that are strongly coupled with local meteorology

Hypoglycemia is More Common Among Type 2 Diabetes Patients with Limited Health Literacy: The Diabetes Study of Northern California (DISTANCE)

Little is known about the frequency of significant hypoglycemic events in actual practice. Limited health literacy (HL) is common among patients with type 2 diabetes, may impede diabetes self-management, and thus HL could increase the risk of hypoglycemia. To determine the proportion of ambulatory, pharmacologically-treated patients with type 2 diabetes reporting ≥1 significant hypoglycemic events in the prior 12 months, and evaluate whether HL is associated with hypoglycemia. Cross-sectional analysis in an observational cohort, the Diabetes Study of Northern California (DISTANCE). The subjects comprised 14,357 adults with pharmacologically-treated, type 2 diabetes who are seen at Kaiser Permanente Northern California (KPNC), a non-profit, integrated health care delivery system. Patient-reported frequency of significant hypoglycemia (losing consciousness or requiring outside assistance); patient-reported health literacy. At least one significant hypoglycemic episode in the prior 12 months was reported by 11% of patients, with the highest risk for those on insulin (59%). Patients commonly reported limited health literacy: 53% reported problems learning about health, 40% needed help reading health materials, and 32% were not confident filling out medical forms by themselves. After adjustment, problems learning (OR 1.4, CI 1.1-1.7), needing help reading (OR 1.3, CI 1.1-1.6), and lack of confidence with forms (OR 1.3, CI 1.1-1.6) were independently associated with significant hypoglycemia. Significant hypoglycemia was a frequent complication in this cohort of type 2 diabetes patients using anti-hyperglycemic therapies; those reporting limited HL were especially vulnerable. Efforts to reduce hypoglycemia and promote patient safety may require self-management support that is appropriate for those with limited HL, and consider more vigilant surveillance, conservative glycemic targets or avoidance of the most hypoglycemia-inducing medications

Intracluster medium of the merging cluster Abell 3395

We present a detailed imaging and spectral analysis of the merging environment of the bimodal cluster A3395 using X-ray and radio observations. X-ray images of the cluster show five main constituents of diffuse emission : A3395 NE, A3395 SW, A3395 NW, A3395 W, and a filament connecting NE to W. X-ray surface-brightness profiles of the cluster did not show any shock fronts in the cluster. Temperature and entropy maps show high temperature and high entropy regions in the W, the NW, the filament and between the NE and SW subclusters. The NE, SW and W components have X-ray bolometric luminosities similar to those of rich clusters of galaxies but have relatively higher temperatures. Similarly, the NW component has X-ray bolometric luminosity similar to that of isolated groups but with much higher temperature. It is, therefore, possible that all the components of the cluster have been heated by the ongoing mergers. The NE subcluster is the most massive and luminous constituent and other subclusters are found to be gravitationally bound to it. The W component is most probably either a clump of gas stripped off the SW due to ram pressure or a separate subcluster that has merged or is merging with the SW. No X-ray cavities are seen associated with the Wide Angle Tailed (WAT) radio source near the centre of the SW subcluster. Minimum energy pressure in the radio emission-peaks of the WAT galaxy is comparable with the external thermal pressure. The radio spectrum of the WAT suggests a spectral age of ~10Myr