Prevalence of gestational diabetes mellitus in eastern and southeastern Asia: A systematic review and meta-analysis

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aim. To review the prevalence of gestational diabetes mellitus (GDM) in Eastern and Southeastern Asia. Methods. We systematically searched for observational studies on GDM prevalence from January 2000 to December 2016. Inclusion criteria were original English papers, with full texts published in peer-reviewed journals. The quality of included studies was evaluated using the guidelines of the National Health and Medical Research Council, Australia. Fixed effects and random effects models were used to estimate the summary prevalence of GDM and the corresponding 95% confidence intervals (CI). Results. A total of 4415 papers were screened, and 48 studies with 63 GDM prevalence observations were included in the final review. The pooled prevalence of GDM was 10.1% (95% CI: 6.5%–15.7%), despite substantial variations across nations. The prevalence of GDM in lower- or upper-middle income countries was about 64% higher than in their high-income counterparts. Moreover, the one-step screening method was twice more likely to be used in diagnosing GDM when compared to the two-step screening procedure. Conclusions. The prevalence of GDM in Eastern and Southeastern Asia was high and varied among and within countries. There is a need for international uniformity in screening strategies and diagnostic criteria for GDM

The effect of non-neovascular age-related macular degeneration on face recognition performance

PURPOSE: There is a well-established research base surrounding face recognition in patients with age-related macular degeneration (AMD). However, much of this existing research does not differentiate between results obtained for 'wet' AMD and 'dry' AMD. Here, we test the hypothesis that face recognition performance is worse in patients with dry AMD compared with visually healthy peers. METHODS: Patients (>60 years of age, logMAR binocular visual acuity 0.7 or better) with dry AMD of varying severity and visually healthy age-related peers (controls) completed a modified version of the Cambridge Face Memory Test (CFMT). Percentage of correctly identified faces was used as an outcome measure for performance for each participant. A 90% normative reference limit was generated from the distribution of CFMT scores recorded in the visually healthy controls. Scores for AMD participants were then specifically compared to this limit, and comparisons between average scores in the AMD severity groups were investigated. RESULTS: Thirty patients (median [interquartile range] age of 76 [70, 79] years) and 34 controls (median age of 70 [64, 75] years) were examined. Four, seventeen and nine patients were classified as having early, intermediate and late AMD (geographic atrophy) respectively. Five (17%) patients recorded a face recognition performance worse than the 90% limit (Fisher's exact test, p = 0.46) set by controls; four of these had geographic atrophy. Patients with geographic atrophy identified fewer faces on average (±SD) (61% ± 22%) than those with early and intermediate AMD (75 ± 11%) and controls (74% ± 11%). CONCLUSIONS: People with dry AMD may not suffer from problems with face recognition until the disease is in its later stages; those with late AMD (geographic atrophy) are likely to have difficulty recognising faces. The results from this study should influence the management and expectations of patients with dry AMD in both community practice and hospital clinics

On the Low Energy Decrease in Galactic Cosmic Ray Secondary/Primary Ratios

Galactic cosmic ray (GCR) secondary/primary ratios such as B/C and (Sc+Ti+V)/Fe are commonly used to determine the mean amount of interstellar material through which cosmic rays travel before escaping from the Galaxy (Λ_(esc)). These ratios are observed to be energy-dependent, with a relative maximum at ~1 GeV/nucleon, implying a corresponding peak in Λ_(esc). The decrease in Λ_(esc) at energies above 1 GeV/nucleon is commonly taken to indicate that higher energy cosmic rays escape more easily from the Galaxy. The decrease in Λ_(esc) at energies <1 GeV/nuc is more controversial; suggested possibilities include the effects of a galactic wind or the effects of distributed acceleration of cosmic rays as they pass through the interstellar medium. We consider two possible explanations for the low energy decrease in Λ_(esc) and attempt to fit the combined, high-resolution measurements of secondary/primary ratios from ~0.1 to 35 GeV/nuc made with the CRIS instrument on ACE and the C2 experiment on HEAO-3. The first possibility, which hypothesizes an additional, local component of low-energy cosmic rays that has passed through very little material, is found to have difficulty simultaneously accounting for the abundance of both B and the Fe-secondaries. The second possibility, suggested by Soutoul and Ptuskin, involves a new form for Λ_(esc) motivated by their diffusion-convection model of cosmic rays in the Galaxy. Their suggested form for Λ_(esc)(E) is found to provide an excellent fit to the combined ACE and HEAO data sets

GCR Neon Isotopic Abundances: Comparison with Wolf-Rayet Star Models and Meteoritic Abundances

Measurements of the neon isotopic abundances from the ACE-CRIS experiment are presented. These abundances have been obtained in seven energy intervals over the energy range of ~80≤E≤280 MeV/nucleon. The ^(22)Ne/^(20)Ne source ratio is derived using the measured ^(21)Ne/^(20)Ne abundance as a "tracer" of secondary production of the neon isotopes. We find that the ^(22)Ne/^(20)Ne abundance ratio at the cosmic-ray source is a factor of 5.0±0.2 greater than in the solar wind. The GCR ^(22)Ne/^(20)Ne ratio is also shown to be considerably larger than that found in anomalous cosmic rays, solar energetic particles, most meteoritic samples of matter, and interplanetary dust particles. Recent two-component Wolf-Rayet models provide predictions for the ^(22)Ne/^(20)Ne ratio and other isotope ratios. Comparison of the CRIS neon, iron, and nickel isotopic source abundance ratios with predictions indicate possible enhanced abundances of some neutron-rich nuclides that are expected to accompany the ^(22)Ne excess

The Phosphorus/Sulfur Abundance Ratio as a Test of Galactic Cosmic-Ray Source Models

Galactic cosmic-ray (GCR) elemental abundances display a fractionation compared to solar-system values that appears ordered by atomic properties such as the first ionization potential (FIP) or condensation temperature (volatility). Determining which parameter controls the observed fractionation is crucial to distinguish between GCR origin models. The Cosmic-Ray Isotope Spectrometer (CRIS) instrument on board NASA's Advanced Composition Explorer (ACE) spacecraft can measure the abundances of several elements that break the general correlation between FIP and volatility (e.g., Na, P, K, Cu, Zn, Ga, and Ge). Phosphorus is a particularly interesting case as it is a refractory (high condensation temperature) element with a FIP value nearly identical to that of its semi-volatile neighbor, sulfur. Using a leaky-box galactic propagation model we find that the P/S and Na/Mg ratios in the GCR source favor volatility as the controlling parameter

Breastfeeding duration in mothers who express breast milk: a cohort study

BACKGROUND: The expression of breast milk allows a mother to be away intermittently from her infant while continuing to breastfeed. The aim of this study was to investigate the association between expression of breast milk and breastfeeding duration METHODS: A cohort study of 12 months duration. The mothers were recruited from two public maternity hospitals in Perth, Australia between mid-September 2002 and mid-July 2003. While in hospital, participating mothers completed a questionnaire that included questions on how they were feeding their newborn. Telephone interviews conducted at regular periods monitored changes in infant feeding practices, including expression of breast milk. Multivariate Cox regression analysis was used to explore the association between breast milk expression and the duration of any breastfeeding. RESULTS: A total of 587 mothers, or 55% of those eligible, participated in the study. Of these 93.5% were breastfeeding at discharge from hospital. Mothers who expressed breast milk (at one or more time periods) were less likely to discontinue any breastfeeding before six months (Relative Risk 0.71, 95% CI 0.52, 0.98) than those who had never expressed milk. CONCLUSION: This study found that mothers who express breast milk are more likely to breastfeed to six months (any breastfeeding). While further research is required in different cultures to confirm these results, the appropriate use of expressed breast milk may be a means to help mothers to achieve six months of full breastfeeding while giving more lifestyle options

Measuring dynamic levels of self-perceived anxiety and concern during simulated mobility tasks in people with non-neovascular age-related macular degeneration.

BACKGROUND/AIMS: To assess response to real-world mobility scenarios in people with dry age-related macular degeneration (AMD) using a computer-based test. METHODS: Participants were shown 18 point-of-view computer-based movies simulating walking through real-world scenarios, and pressed a button during scenes which would cause them self-perceived anxiety or concern in their day-to-day life. Button pressure was recorded throughout. Pressure traces were generated, which aligned with each movie time point. Group averages based on AMD severity were generated. Bootstrapped confidence intervals (CIs) for responses by group were generated around traces. Traces were examined to discover events causing the greatest differences between groups. RESULTS: Participants had early/no AMD (n=8), intermediate AMD (n=7) or geographic atrophy (n=15 (GA)). Median (IQR) logMAR visual acuity was 0.04 (-0.04, 0.18), 0.26 (0.10, 0.40) and 0.32 (0.20, 0.56), respectively. Participants with intermediate AMD or GA recorded greater pressure than those with early and no AMD (Kruskal-Wallis, p=0.04). Four events involving navigating stairs and three under low luminance elicited greatest differences between groups (p<0.001). CONCLUSION: People with intermediate AMD or GA likely experience higher levels of concern associated with mobility. The test highlights areas of specific concern. Results should be useful in patient management and educating the public about the everyday effects of AMD

Constraints on cosmic-ray acceleration and transport from isotope observations

Observations from the Cosmic Ray Isotope Spectrometer (CRIS) on ACE have been used to derive constraints on the locations, physical conditions, and time scales for cosmic-ray acceleration and transport. The isotopic composition of Fe, Co, and Ni is very similar to that of solar system material, indicating that cosmic rays contain contributions from supernovae of both Type II and Type Ia. The electron-capture primary ^(59)Ni produced in supernovae has decayed, demonstrating that a time ≳10^5 yr elapses before acceleration of the bulk of the cosmic rays and showing that most of the accelerated material is derived from old stellar or interstellar material rather than from fresh supernova ejecta

Measurements of the isotopes of lithium, beryllium, and boron from ACE/CRIS

The isotopes of lithium, beryllium, and boron (LiBeB) are known in nature to be produced primarily by CNO spallation and α-α fusion from interactions between cosmic rays and interstellar nuclei. While the dominant source of LiBeB isotopes in the present epoch is cosmic-ray interactions, other sources are known to exist, including the production of ^(7)Li from big bang nucleosynthesis. Precise observations of galactic cosmic-ray LiBeB in addition to accurate modeling of cosmic-ray transport can help to constrain the relative importance among the different production mechanisms. The Cosmic Ray Isotope Spectrometer (CRIS) on the Advanced Composition Explorer (ACE) has measured nuclei with 2 ≲ Z ≲ 30 in the energy range ~30–500 MeV/nucleon since 1997 with good statistical accuracy. We present measurements of the isotopic abundances of LiBeB and discuss these observations in the context of previous cosmic-ray measurements and spectroscopic observations