Social inequalities in prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation in participants in the Health Surveys for England series

OBJECTIVES: To ascertain the extent of socioeconomic and health condition inequalities in people with diagnosed and undiagnosed diabetes and impaired glucose regulation (IGR) in random samples of the general population in England, as earlier diagnosis of diabetes and treatment of people with IGR can reduce adverse sequelae of diabetes. Various screening instruments were compared to identify IGR, in addition to undiagnosed diabetes. DESIGN: 5, annual cross-sectional health examination surveys; data adjusted for complex survey design. SETTING: Random selection of private homes across England, new sample annually 2009-2013. PARTICIPANTS: 5, nationally representative random samples of the general, free-living population: ≥1 adult interviewed in 24 254 of 36 889 eligible addresses selected. 18 399 adults had a valid glycated haemoglobin (HbA1c) measurement and answered the diabetes questions. MAIN OUTCOME MEASURES: Diagnosed diabetes, undiagnosed diabetes (HbA1c ≥48 mmol/mol), IGR (HbA1c 42-47 mmol/mol). RESULTS: Overall, 11% of the population had IGR, 2% undiagnosed and 6% diagnosed diabetes. Age-standardised prevalence was highest among Asian (19% (95% CI 16% to 23%), 3% (2% to 5%) and 12% (9% to 16%) respectively) and black participants (17% (13% to 21%), 2% (1% to 4%) and 14% (9% to 20%) respectively). These were also higher among people with lower income, less education, lower occupational class and greater deprivation. Education (OR 1.49 (95% CI 1.27 to 1.74) for no qualifications vs degree or higher) and income (1.35 (1.12 to 1.62) for lowest vs highest income quintile) remained significantly associated with IGR or undiagnosed diabetes on multivariate regression. The greatest odds of IGR or undiagnosed diabetes were with increasing age over 34 years (eg, OR 18.69 (11.53 to 30.28) aged 65-74 vs 16-24). Other significant associations were ethnic group (Asian (3.91 (3.02 to 5.05)), African-American (2.34 (1.62 to 3.38)) or 'other' (2.04 (1.07 to 3.88)) vs Caucasian); sex (OR 1.32(1.19 to 1.46) for men vs women); body mass index (3.54 (2.52 to 4.96) for morbidly obese vs not overweight); and waist circumference (2.00 (1.67 to 2.38) for very high vs low). CONCLUSIONS: Social inequalities in hyperglycaemia exist, additional to well-known demographic and anthropometric risk factors for diabetes and IGR

DIFFERENCES BETWEEN RADIO-LOUD AND RADIO-QUIET γ-RAY PULSARS AS REVEALED BY <i>FERMI</i>

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A 2000 BPS LPC vocoder based on multiband excitation

This paper presents an improved mixed LPC vocoder at 2000 bps using Multi-Band Excitation analysis by a synthesis algorithm. The new vocoder determines the voiced/unvoiced characteristics harmonic by harmonic in a frame, and finds the first voiced/unvoiced transition as the cut-off frequency, which is more accurate and efficient than traditional cut-off frequency detection. The synthetic speech below the cut-off frequency is excited by a series of voiced harmonics, while the signal above the cut-off frequency is simulated by a noise source. The final output speech is the sum of these two outputs. To increase the naturalness and clearness of the synthesized speech, this model applies phase prediction and spectral enhancement in the synthesizer. It is also possible to reduce the bit rate to 1200 bps. Informal listening tests indicate that the output speech possesses higher intelligibility and quality than that of the 2.4 kbps LPC-10e standard, and is comparable with the 4.8 kbps FS1016 CELP vocoder.published_or_final_versio

Radiographic periapical healing associated with root treated teeth accessed through existing crowns: a historical controlled cohort study

Objectives: The aim of this study was to determine the periapical healing rate and complications arising from non-surgical root canal treatment (NSRCT) conducted through the existing and retained restoration, compared to that conducted after removal of restoration (direct or indirect) with subsequent placement of a new crown. / Materials and methods: Two-hundred-and-forty-five teeth met the inclusion criteria and were followed up for 2 years. One-hundred-and-six teeth had NSRCT completed through existing cast restorations, and 57 and 82 had the existing crowns and direct restorations removed (respectively) and received a new crown after NSRCT. Periapical healing was assessed radiographically using strict (complete healing) and loose (complete and incomplete healing) criteria. Multivariable logistic regression models were used to investigate the effect of prior restoration removal on periapical healing following NSRCT, adjusting for potential confounding (p < 0.05). / Results: There was no significant (p > 0.05) difference in the periapical healing rates amongst teeth accessed through existing crowns (72%, 90%) versus those where crowns (79%, 93%) or direct restorations (77%, 90%) were removed for NSRCT. The findings were adjusted for the significant influencing factor: size of pre-operative radiolucency (p < 0.05). Of the 109 teeth that were initially accessed through existing crowns, 9 (8%) displayed porcelain fracture or crown de-cementation. / Conclusion: Performing root canal treatment through an existing full coverage restoration did not compromise periapical healing and was associated with a low incidence of associated complications. / Clinical relevance: Crown removal before NSRCT is not mandatory for periapical healing but requires a judicious pre-assessment of current and future marginal and restorative integrity

On the nature of the omega tri-layer periodicity in rapidly cooled Ti-15Mo

High angle annular dark field (HAADF) images of the omega phase in metastable beta titanium alloys exhibit tri-layered periodicity. However, it is unclear if this indicates preferential site occupation, or is related to the structural modification of omega formation. Here, the periodicity was studied using a combination of HAADF imaging and electron energy loss spectroscopy. The results show that there is no preferential site occupancy or ordering and that the observed intensity variations are related to the imaging conditions.This work was supported by the Rolls-Royce/EPSRC Strategic Partnership (EP/H022309/1, EP/H500375/1 & EP/M005607/1).This is the final version. It was first published by Elsevier at http://www.sciencedirect.com/science/article/pii/S1359646215002213

Phase equilibria in the Fe-Mo-Ti ternary system at 1000 °C

An isothermal section of the Fe-Mo-Ti ternary system at 1000 °C has been constructed using data acquired from a series of seven alloys. The limit of solubility of Fe in the continuous A2 phase field between Ti and Mo has been determined, as have the extents to which Mo may be accommodated in the B2 TiFe phase, and Ti in the D8$_5$ Fe$_7$Mo$_6$ phase. The B2, D8$_5$ and C14 Fe$_2$ (Ti, Mo) intermetallics were found to have limited tolerance for non-stoichiometric compositions. The positions of the A2 + B2 + C14 and A2 + C14 + D8$_5$ three-phase fields were determined, along with the extents of the A2 + B2, A2 + D8$_5$, A2 + C14, C14 + B2 and C14 + D8$_5$ two-phase fields. No ternary phases were observed in any of the alloys studied.This work was support by the Rolls-Royce/EPSRC Strategic Partnership under EP/H022309/1, EP/H500375/1 and EP/M005607/1.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.ijrmhm.2016.07.00

The silent epidemic of obesity in The Gambia: evidence from a nationwide, population-based, cross-sectional health examination survey

OBJECTIVES: Non-communicable diseases account for 70% of global deaths; 80% occur in low-income and middle-income countries. The rapid increase of obesity in sub-Saharan Africa is a concern. We assessed generalised and abdominal obesity and their associated risk factors among adults in The Gambia. DESIGN: Nationwide cross-sectional health examination survey using the WHO STEPwise survey methods. SETTING: The Gambia. PARTICIPANTS: This study uses secondary analysis of a 2010 nationally representative random sample of adults aged 25-64 years (78% response rate). The target sample size was 5280, and 4111 responded. Analysis was restricted to non-pregnant participants with valid weight and height measurements (n=3533). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome variable was generalised obesity, using WHO body mass index (BMI) thresholds. Analyses used non-response weighting and adjusted for the complex survey design. We conducted multinomial logistic regression analysis to identify factors associated with BMI categories. The secondary outcome variable was abdominal obesity, defined as high waist circumference (using the International Diabetes Federation thresholds for Europeans). RESULTS: Two-fifths of adults were overweight/obese, with a higher obesity prevalence in women (17%, 95% CI 14.7 to 19.7; men 8%, 95% CI 6.0 to 11.0). 10% of men and 8% of women were underweight. Urban residence (adjusted relative risk ratio 5.8, 95% CI 2.4 to 14.5), higher education (2.3, 1.2 to 4.5), older age, ethnicity, and low fruit and vegetable intake (2.8, 1.1 to 6.8) were strongly associated with obesity among men. Urban residence (4.7, 2.7 to 8.2), higher education (2.6, 1.1 to 6.4), older age and ethnicity were associated with obesity in women. CONCLUSION: There is a high burden of overweight/obesity in The Gambia. While obesity rates in rural areas were lower than in urban areas, obesity prevalence was higher among rural residents in this study compared with previous findings. Preventive strategies should be directed at raising awareness, discouraging harmful beliefs on weight, and promoting healthy diets and physical activity

Explanatory factors for health inequalities across different ethnic and gender groups: data from a national survey in England

BACKGROUND: The objective of this study was to examine the relative contribution of factors explaining ethnic health inequalities (EHI) in poor self-reported health (pSRH) and limiting long-standing illness (LLI) between Health Survey for England (HSE) participants. METHOD: Using HSE 2003-2006 data, the odds of reporting pSRH or of LLI in 8573 Bangladeshi, Black African, Black Caribbean, Chinese, Indian, Irish and Pakistani participants was compared with 28,470 White British participants. The effects of demographics, socioeconomic position (SEP), psychosocial variables, community characteristics and health behaviours were assessed using separate regression models. RESULTS: Compared with White British men, age-adjusted odds (OR, 95% CI) of pSRH were higher among Bangladeshi (2.05, 1.34 to 3.14), Pakistani (1.77, 1.34 to 2.33) and Black Caribbean (1.60, 1.18 to 2.18) men, but these became non-significant following adjustment for SEP and health behaviours. Unlike Black Caribbean men, Black African men exhibited a lower risk of age-adjusted pSRH (0.66, 0.43 to 1.00 (p=0.048)) and LLI (0.45, 0.28 to 0.72), which were significant in every model. Likewise, Chinese men had a lower risk of age-adjusted pSRH (0.51, 0.26 to 1.00 (p=0.048)) and LLI (0.22, 0.10 to 0.48). Except in Black Caribbean women, adjustment for SEP rendered raised age-adjusted associations for pSRH among Pakistani (2.51, 1.99 to 3.17), Bangladeshi (1.85, 1.08 to 3.16), Black Caribbean (1.78, 1.44 to 2.21) and Indian women (1.37, 1.13 to 1.66) insignificant. Adjustment for health behaviours had the largest effect for South Asian women. By contrast, Irish women reported better age-adjusted SRH (0.70, 1.51 to 0.96). CONCLUSIONS: SEP and health behaviours were major contributors explaining EHI. Policies to improve health equity need to monitor these pathways and be informed by them