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- Zhou, Bin, et al.
(författare)
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Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants
- 2016
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Ingår i: The Lancet. - : Elsevier B.V.. - 0140-6736 .- 1474-547X. ; 387:10027, s. 1513-1530
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Tidskriftsartikel (refereegranskat)abstract
- Background: One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are aff ecting the number of adults with diabetes.Methods: We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue.Findings: We used data from 751 studies including 4372000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4.3% (95% credible interval 2.4-17.0) in 1980 to 9.0% (7.2-11.1) in 2014 in men, and from 5.0% (2.9-7.9) to 7.9% (6.4-9.7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28.5% due to the rise in prevalence, 39.7% due to population growth and ageing, and 31.8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target.Interpretation: Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults aff ected, has increased faster in low-income and middle-income countries than in high-income countries.
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- Danaei, Goodarz, et al.
(författare)
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Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331288 participants
- 2015
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Ingår i: The Lancet Diabetes & Endocrinology. - 2213-8595 .- 2213-8587. ; 3:8, s. 624-637
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Tidskriftsartikel (refereegranskat)abstract
- Background Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA(1c). We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA(1c) (HbA(1c) >= 6 . 5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG >= 7 . 0 mmol/L or 2hOGTT >= 11 . 1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings Population prevalence of diabetes based on FPG- or-2hOGTT was correlated with prevalence based on FPG alone (r= 0 . 98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA(1c) was lower than prevalence based on FPG in 42 . 8% of age-sex-survey groups and higher in another 41 . 6%; in the other 15 . 6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA(1c)-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA(1c) 6 . 5% or more had a pooled sensitivity of 52 . 8% (95% CI 51 . 3-54 . 3%) and a pooled specificity of 99 . 74% (99 . 71-99 . 78%) compared with FPG 7 . 0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30 . 5% (28 . 7-32 . 3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA(1c) versus FPG. Interpretation Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA(1c)-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.
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- Sabri, M. H. M., et al.
(författare)
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Initial electric field changes of lightning flashes in tropical thunderstorms and their relationship to the lightning initiation mechanism
- 2019
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Ingår i: Atmospheric research. - : ELSEVIER SCIENCE INC. - 0169-8095 .- 1873-2895. ; 226, s. 138-151
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, the key finding is that all the examined first classic Initial Breakdown (IB) pulses in tropical flashes within the reversal distance were found to be initiated by a clearly detectable Initial E-field Change or IEC (45 -CG, 32 normal IC, and 3 IC initiated by +NBE). The durations of IECs for both -CG and IC flashes in tropical storms were longer than in Florida storms. On the other hand, for the magnitudes of the E-change, the values were smaller compared to Florida storms with averages of 0.30 V/m compared to 1.65 V/m for -CG flashes, and -0.81 V/m compared to -6.30 V/m for IC flashes. The IEC process of lightning flashes in tropical regions took longer to increase the local electric field in order to produce the first IB pulse because of the smaller magnitude of E-change. On the other hand, in Florida storms, the IEC process took a shorter time to increase the local electric field to produce the first IB pulse because of the larger magnitude of E-change. We found that very high frequency (VHF) pulses for tropical thunderstorms started sometime prior to the onset of the IECs. They started between 12.69 and 251.60 mu s before the initiation of the IEC for two normal IC flashes. The first two VHF pulses were detected alone without narrow IB pulses (fast antenna and slow antenna records) or any pulses from the B-field and dE/dt records. Furthermore, the VHF pulses for three IC flashes initiated by + NBEs were also detected before the onset of the IEC. The IEC started immediately after the detection of the + NBE. It is clear that the IEC is initiated by VHF pulses. It can be suggested that lightning is initiated by Fast Positive Breakdowns or FPBs (which emit strong VHF pulses and large + NBEs) and is followed by several negative breakdowns (weak VHF pulses and/or weak NBE-type pulses) before the IEC started. For the case of normal IC flashes, several weaker VHF pulses (mean values of 41.97 mV and 46.4 mV compared to the amplitudes of the VHF pulses of + NBEs of around 800 mV) were detected before the onset of the IEC. As FPBs can occur with a wide range of VHF strengths and E-change amplitudes, it can be suggested these weak VHF pulses accompanied by narrow IB pulses or weak NBE-type pulses detected before the onset of IEC are actually FPBs followed by negative breakdowns or several attempted FPBs.
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- Gomes, Ashen, et al.
(författare)
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Impulse flashover characteristics of oil palm trunk (OPT) veneer plywood
- 2018
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Ingår i: 34th International Conference on Lightning Protection, ICLP 2018. - : Institute of Electrical and Electronics Engineers Inc.. - 9781538666357
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Konferensbidrag (refereegranskat)abstract
- Oil palm is one of the largest crop industries in South East Asia, thus, it is of importance to use all parts of the Oil palm trees. Recently Oil Palm Trunks (OPT) have been used to make veneer, which can be processed to produce plywood. Even though OPT plywood doesn't have the same mechanical properties as timber, with proper treatment and adhesives during the processing of veneer to plywood, it can be made to compete with hardwood. OPT plywood has been used in various applications from wooden appliances to housing and roofing structures. These structures are at risk of surface flashovers through lightning and electrical breakdowns. However, no study has been conducted on the effects or characteristics of OPT plywood. In this paper, the effects of impulse surface flashover under different conditions on three-layered OPT plywood has been analyzed. Experiments were conducted to identify the characteristics of OPT under clean and dry, clean and wet, and contaminated surface conditions for both parallel and perpendicular fiber orientations. The 50% breakdown voltage was determined by the up and down method. Results identified the importance of the fibre orientation and the decrease in breakdown voltage under contaminants.
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- Eyjolfsdottir, H., et al.
(författare)
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Targeted delivery of nerve growth factor to the cholinergic basal forebrain of Alzheimer's disease patients: application of a second-generation encapsulated cell biodelivery device
- 2016
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Ingår i: Alzheimers Research & Therapy. - : Springer Science and Business Media LLC. - 1758-9193. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Targeted delivery of nerve growth factor (NGF) has emerged as a potential therapy for Alzheimer's disease (AD) due to its regenerative effects on basal forebrain cholinergic neurons. This hypothesis has been tested in patients with AD using encapsulated cell biodelivery of NGF (NGF-ECB) in a first-in-human study. We report our results from a third-dose cohort of patients receiving second-generation NGF-ECB implants with improved NGF secretion. Methods: Four patients with mild to moderate AD were recruited to participate in an open-label, phase Ib dose escalation study with a 6-month duration. Each patient underwent stereotactic implant surgery with four NGF-ECB implants targeted at the cholinergic basal forebrain. The NGF secretion of the second-generation implants was improved by using the Sleeping Beauty transposon gene expression technology and an improved three-dimensional internal scaffolding, resulting in production of about 10 ng NGF/device/day. Results: All patients underwent successful implant procedures without complications, and all patients completed the study, including implant removal after 6 months. Upon removal, 13 of 16 implants released NGF, 8 implants released NGF at the same rate or higher than before the implant procedure, and 3 implants failed to release detectable amounts of NGF. Of 16 adverse events, none was NGF-, or implant-related. Changes from baseline values of cholinergic markers in cerebrospinal fluid (CSF) correlated with cortical nicotinic receptor expression and Mini Mental State Examination score. Levels of neurofilament light chain (NFL) protein increased in CSF after NGF-ECB implant, while glial fibrillary acidic protein (GFAP) remained stable. Conclusions: The data derived from this patient cohort demonstrate the safety and tolerability of sustained NGF release by a second-generation NGF-ECB implant to the basal forebrain, with uneventful surgical implant and removal of NGF-ECB implants in a new dosing cohort of four patients with AD.
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