Classification-based data mining for identification of risk patterns associated with hypertension in Middle Eastern population A 12-year longitudinal study

Hypertension is a critical public health concern worldwide. Identification of risk factors using traditional multivariable models has been a field of active research. The present study was undertaken to identify risk patterns associated with hypertension incidence using data mining methods in a cohort of Iranian adult population. Data on 6205 participants (44 men) age > 20 years, free from hypertension at baseline with no history of cardiovascular disease, were used to develop a series of prediction models by 3 types of decision tree (DT) algorithms. The performances of all classifiers were evaluated on the testing data set. The Quick Unbiased Efficient Statistical Tree algorithm among men and women and Classification and Regression Tree among the total population had the best performance. The C-statistic and sensitivity for the prediction models were (0.70 and 71) in men, (0.79 and 71) in women, and (0.78 and 72) in total population, respectively. In DT models, systolic blood pressure (SBP), diastolic blood pressure, age, and waist circumference significantly contributed to the risk of incident hypertension in both genders and total population, wrist circumference and 2-h postchallenge plasma glucose among women and fasting plasma glucose among men. In men, the highest hypertension risk was seen in those with SBP > 115mm Hg and age > 30 years. In women those with SBP > 114 mmHg and age>33 years had the highest risk for hypertension. For the total population, higher risk was observed in those with SBP > 114mm Hg and age > 38 years. Our study emphasizes the utility of DTs for prediction of hypertension and exploring interaction between predictors. DT models used the easily available variables to identify homogeneous subgroups with different risk pattern for the hypertension. Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All

An application of association rule mining to extract risk pattern for type 2 diabetes using tehran lipid and glucose study database

Background: Type 2 diabetes, common and serious global health concern, had an estimated worldwide prevalence of 366 million in 2011, which is expected to rise to 552 million people, by 2030, unless urgent action is taken. Objectives: The aim of this study was to identify risk patterns for type 2 diabetes incidence using association rule mining (ARM). Patients and Methods: A population of 6647 individuals without diabetes, aged � 20 years at inclusion, was followed for 10-12 years, to analyze risk patterns for diabetes occurrence. Study variables included demographic and anthropometric characteristics, smoking status, medical and drug history and laboratory measures. Results: In the case of women, the results showed that impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), in combination with body mass index (BMI) � 30 kg/m2, family history of diabetes, wrist circumference > 16.5 cm and waist to height � 0.5 can increase the risk for developing diabetes. For men, a combination of IGT, IFG, length of stay in the city (> 40 years), central obesity, total cholesterol to high density lipoprotein ratio � 5.3, low physical activity, chronic kidney disease and wrist circumference > 18.5 cm were identified as risk patterns for diabetes occurrence. Conclusions: Our study showed that ARM is a useful approach in determining which combinations of variables or predictors occur together frequently, in people who will develop diabetes. The ARM focuses on joint exposure to different combinations of risk factors, and not the predictors alone. © 2015, Research Institute For Endocrine Sciences and Iran Endocrine Society

Autonomous frequency domain identification: Theory and experiment

The analysis, design, and on-orbit tuning of robust controllers require more information about the plant than simply a nominal estimate of the plant transfer function. Information is also required concerning the uncertainty in the nominal estimate, or more generally, the identification of a model set within which the true plant is known to lie. The identification methodology that was developed and experimentally demonstrated makes use of a simple but useful characterization of the model uncertainty based on the output error. This is a characterization of the additive uncertainty in the plant model, which has found considerable use in many robust control analysis and synthesis techniques. The identification process is initiated by a stochastic input u which is applied to the plant p giving rise to the output. Spectral estimation (h = P sub uy/P sub uu) is used as an estimate of p and the model order is estimated using the produce moment matrix (PMM) method. A parametric model unit direction vector p is then determined by curve fitting the spectral estimate to a rational transfer function. The additive uncertainty delta sub m = p - unit direction vector p is then estimated by the cross spectral estimate delta = P sub ue/P sub uu where e = y - unit direction vectory y is the output error, and unit direction vector y = unit direction vector pu is the computed output of the parametric model subjected to the actual input u. The experimental results demonstrate the curve fitting algorithm produces the reduced-order plant model which minimizes the additive uncertainty. The nominal transfer function estimate unit direction vector p and the estimate delta of the additive uncertainty delta sub m are subsequently available to be used for optimization of robust controller performance and stability

Swarms of Femtosats for Synthetic Aperture Applications

The Silicon Wafer Integrated Femtosatellites (SWIFT) Swarm Project presents a new paradigm-shifting definition of spacecraft technology that can enable flight of swarms of fully capable femtosats. One of the most important applications of SWIFT is a distributed aperture array. New swarm Golay array configurations are introduced and shown to dramatically increase the effective diameter derived from optical performance metrics. A system cost analysis based on this comparison justifies deploying a large number of spacecraft for sparse aperture applications

Long-term effectiveness of a lifestyle intervention on the prevention of type 2 diabetes in a middle-income country

This study aims to assess the effects of a community-based lifestyle intervention program on the incidence of type 2 diabetes (T2D). For this purpose, three communities in Tehran were chosen; one community received a face-to-face educational session embedded in a long-term community-wide lifestyle intervention aimed at supporting lifestyle changes. We followed up 9,204 participants (control: 5,739, intervention: 3,465) triennially from 1999 to 2015 (Waves 1–5). After a median follow-up of 3.5 years (wave 2), the risk of T2D was 30% lower in the intervention community as compared with two control communities by (Hazard-ratio: 0.70 [95% CI 0.53; 0.91]); however, the difference was not statistically significant in the following waves. After a median follow-up of 11.9 years (wave 5), there was a non-significant 6% reduction in the incidence of T2D in the intervention group as compared to the control group (Hazard-ratio: 0.94 [0.81, 1.08]). Moreover, after 11.9 years of follow-up, the intervention significantly improved the diet quality measured by the Dietary Approaches to Stop Hypertension concordance (DASH) score. Mean difference in DASH score in the intervention group versus control group was 0.2 [95% CI 0.1; 0.3]. In conclusion, the intervention prevented T2D by 30% in the short-term (3.5 years) but not long-term; however, effects on improvement of the diet maintained in the long-term.Registration: This study is registered at IRCT, a WHO primary registry (https://irct.ir). The registration date 39 is 2008-10-29 and the IRCT registration number is IRCT138705301058N1

Preoperative 99mTc-sestamibi scintigraphy in patients with primary hyperparathyroidism and concomitant nodular goiter: Comparison of SPECT-CT, SPECT, and planar imaging

Background: Investigations using a hybrid single photon emission computed tomography/computed tomography (SPECT-CT) scanning technique have been carried out in limited studies and have shown mixed results. However, the assessment of this technique for the detection of parathyroid adenoma in patients with a nodular goiter was performed in only one study with a small sample size. The aim of this prospective study was to assess the role of Tc-sestamibi parathyroid SPECT-CT scans for localization of parathyroid adenomas with a concomitant nodular goiter using Tc-methoxyisobutyl isonitrile (MIBI) scintigraphy and to compare it with SPECT and planar imaging. Methods: This study was conducted on 48 patients with primary hyperparathyroidism and nodular goiter, who were candidates for parathyroid surgery and had been referred for parathyroid scintigraphy. The patients underwent an early set of planar Tc-MIBI scanning procedures first, followed by SPECT and CT scannings, and finally a delayed set of planar Tc-MIBI scannings. Sensitivity, specificity, negative and positive predictive values, and accuracy were determined on a per-parathyroid-gland basis for each scanning method, as defined by histology and follow-up. Results: The surgery was successful in 48 out of 50 patients with primary hyperparathyroidism concomitant with thyroid nodularity, and data were completed for 80 sites in 48 patients. The accuracy of SPECT-CT in correctly identifying a parathyroid adenoma was 85.00, versus 75.00% for SPECT (P=0.01, significant). The sensitivity and specificity for SPECT-CT were 77.55 and 96.77%, respectively, versus 67.34 and 87.09%, respectively, for SPECT (P=0.12 and 0.12, not significant). There were nine sites that showed better localization on SPECT-CT scans relative to SPECT images, of which five sites were located in the ectopic regions. Conclusion: The results of our study indicate that SPECT-CT is more accurate than sestamibi planar imaging and SPECT for the preoperative identification of parathyroid lesions in patients with primary hyperparathyroidism concomitant with thyroid nodularity. Also, we would recommend the use of SPECT-CT for a workup of all patients with ectopic glands who are scheduled for minimally invasive parathyroid surgery. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Control of micromachined deformable mirrors

A micromachined deformable mirror with pixelated electrostatic actuators is proposed. The paper begins with a physical description of the proposed mirror. Then a mathematical model in the form of a nonlinear partial differential equation describing the mirror surface deformations is derived. This model is used to derive the required voltages for the actuators to achieve a specified static deformation of the mirror surface. This is followed by the derivation of a static nonlinear feedback controller for achieving noninteracting actuation. Then the structure for a complete control system for wavefront correction is proposed. The paper concludes with a discussion of the physical implementation of the proposed control system

Recurrence of a neuroendocrine tumor of adrenal origin: a case report with more than a decade follow-up

Background: Neuroendocrine tumor (NET) with adrenocorticotropic hormone (ACTH) secretion are very rare. To our knowledge, no follow-up study is published for ACTH-secreting NET, regardless of the primary site, to show second occurrence of tumor after a long follow-up, following resection of primary tumor. Case presentation: Here, we describe a 49-year-old-man with cushingoid feature, drowsiness and quadriparesis came to emergency department at December 2005. Laboratory tests revealed hyperglycemia, metabolic alkalosis, severe hypokalemia, and chemical evidence of an ACTH-dependent hypercortisolism as morning serum cortisol of 57 μg /dL without suppression after 8 mg dexamethasone suppression test, serum ACTH level of 256 pg/mL, and urine free cortisol of > 1000 μg /24 h. Imaging showed only bilateral adrenal hyperplasia, without evidence of pituitary adenoma or ectopic ACTH producing tumors. Importantly, other diagnostic tests for differentiating Cushing disease (CD) from ectopic ACTH producing tumor, such as inferior petrosal sinus sampling (IPSS), corticotropin releasing hormone (CRH) stimulation test, octreotide scan or fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan were not available in our country at that time. Therefore, bilateral adrenalectomy was performed that led to clinical and biochemical remission of hypercortisolism and decreased ACTH level to < 50 pg/mL, findings suggestive of a primary focus of NET in adrenal glands. After 11 years uncomplicated follow up, the ACTH level elevated up to 341 pg/mL and re-evaluation showed a 2 cm nodule in the middle lobe of the right lung. Surgical excision of the pulmonary nodule yielded a carcinoid tumor with positive immunostaining for ACTH; leading to decrease in serum ACTH level to 98 pg/mL. Subsequently after 7 months, serum ACHT levels rose again. More investigation showed multiple lung nodules with metastatic bone lesions accompanied by high serum chromogranin level (2062 ng/mL), and the patient managed as a metastatic NET, with bisphosphonate and somatostatin receptor analogues. Conclusion: This case of surgically-treated NET showing a secondary focus of carcinoid tumor after one decade of disease-free follow-up emphasizes on the importance of long-term follow-up of ACTH-secreting adrenal NET. © 2021, The Author(s)

"Predictability of body mass index for diabetes: Affected by the presence of metabolic syndrome?"

<p>Abstract</p> <p>Background</p> <p>Metabolic syndrome (MetS) and body mass index (BMI, kg.m^-2) are established independent risk factors in the development of diabetes; we prospectively examined their relative contributions and joint relationship with incident diabetes in a Middle Eastern cohort.</p> <p>Method</p> <p>participants of the ongoing Tehran lipid and glucose study are followed on a triennial basis. Among non-diabetic participants aged≥ 20 years at baseline (8,121) those with at least one follow-up examination (5,250) were included for the current study. Multivariate logistic regression models were used to estimate sex-specific adjusted odd ratios (ORs) and 95% confidence intervals (CIs) of baseline BMI-MetS categories (normal weight without MetS as reference group) for incident diabetes among 2186 men and 3064 women, aged ≥ 20 years, free of diabetes at baseline.</p> <p>Result</p> <p>During follow up (median 6.5 years); there were 369 incident diabetes (147 in men). In women without MetS, the multivariate adjusted ORs (95% CIs) for overweight (BMI 25-30 kg/m2) and obese (BMI≥30) participants were 2.3 (1.2-4.3) and 2.2 (1.0-4.7), respectively. The corresponding ORs for men without MetS were 1.6 (0.9-2.9) and 3.6 (1.5-8.4) respectively. As compared to the normal-weight/without MetS, normal-weight women and men with MetS, had a multivariate-adjusted ORs for incident diabetes of 8.8 (3.7-21.2) and 3.1 (1.3-7.0), respectively. The corresponding ORs for overweight and obese women with MetS reached to 7.7 (4.0-14.9) and 12.6 (6.9-23.2) and for men reached to 3.4(2.0-5.8) and 5.7(3.9-9.9), respectively.</p> <p>Conclusion</p> <p>This study highlights the importance of screening for MetS in normal weight individuals. Obesity increases diabetes risk in the absence of MetS, underscores the need for more stringent criteria to define healthy metabolic state among obese individuals. Weight reduction measures, thus, should be encouraged in conjunction with achieving metabolic targets not addressed by current definition of MetS, both in every day encounter and public health setting.</p

Swarm Keeping Strategies for Spacecraft under J_2 and Atmospheric Drag Perturbations

This paper presents several new open-loop guidance methods for spacecraft swarms composed of hundreds to thousands of agents with each spacecraft having modest capabilities. These methods have three main goals: preventing relative drift of the swarm, preventing collisions within the swarm, and minimizing the propellant used throughout the mission. The development of these methods progresses by eliminating drift using the Hill-Clohessy-Wiltshire equations, removing drift due to nonlinearity, and minimizing the J_2 drift. In order to verify these guidance methods, a new dynamic model for the relative motion of spacecraft is developed. These dynamics include the two main disturbances for spacecraft in Low Earth Orbit (LEO), J_2 and atmospheric drag. Using this dynamic model, numerical simulations are provided at each step to show the effectiveness of each method and to see where improvements can be made. The main result is a set of initial conditions for each spacecraft in the swarm which provides the trajectories for hundreds of collision-free orbits in the presence of J_2. Finally, a multi-burn strategy is developed in order to provide hundreds of collision-free orbits under the influence of atmospheric drag. This last method works by enforcing the initial conditions multiple times throughout the mission thereby providing collision-free trajectories for the duration of the mission