Relationship between hemoglobin glycation index and risk of hypoglycemia in type 2 diabetes with time-in-range in target

BACKGROUND In patients with type 2 diabetes mellitus(T2DM),the risk of hypoglycemia also occurs in at a time-in-range(TIR)of>70%.The hemoglobin glycation index(HGI)is considered the best single factor for predicting hypoglycemia,and offers new perspectives for the individualized treatment of patients with well-controlled blood glucose levels that are easily ignored in clinical settings.All participants underwent a 7-days continuous glucose monitoring(CGM)using a retrospective CGM system.We obtained glycemic variability indices using the CGM system.We defined HGI as laboratory hemoglobin A1c minus the glucose management indicator.Patients were categorized into low HGI(HGI<0.5)and high HGI groups(HGI≥0.5)according to HGI median(0.5).Logistic regression and receiver operating characteristic curve analyses were used to determine the risk factors for hypoglycemia.RESULTS We included 129 subjects with T2DM(54.84±12.56 years,46%male)in the study.Median TIR score was 90%.The high HGI group exhibited lower TIR and greater time below range with higher hemoglobin A1c than the low HGI group;this suggests more glycemic excursions and an increased incidence of hypoglycemia in the high HGI group.Multivariate analyses revealed that mean blood glucose,standard deviation of blood glucose and HGI were independent risk factors for hypoglycemia.Receiver operating characteristic curve analysis indicated that the HGI was the best predictor of hypoglycemia.In addition,the optimal cut-off points for HGI,mean blood glucose,and standard deviation of blood glucose in predicting hypoglycemia were 0.5%,7.2 mmol/L and 1.4 mmol/L respectively.CONCLUSION High HGI was significantly associated with greater glycemic excursions and increased hypoglycemia in patients with TIR>70%.Our findings indicate that HGI is a reliable predictor of hypoglycemia in this population.

To Improve the Accuracy of Laser Pulse Range Finding by Time Scale-Up

A method of improving the accuracy of laser pulse range finding from ±10 m to ±1 m inexpensively by means of time scale up is described. Time scale up can stretch the entire flight time by a factor of 1 000 and then the stretched result is counted to calculate the distance. The use of this technique decreases the resolution of counting from nanosecond to microsecond, therefore a separate counting oscillator followed by an interpolation operation is unnecessary. This technique can improve the accuracy of laser pulse range finding inexpensively and effectively.

Continuous glucose monitoring defined time-in-range is associated with sudomotor dysfunction in type 2 diabetes

BACKGROUND Time in range(TIR),as a novel metric for glycemic control,has robust relevance with diabetic complications.Diabetic peripheral neuropathy(DPN)is characterized by sudomotor dysfunction.AIM To explore the relationship between TIR obtained from continuous glucose monitoring(CGM)and sudomotor function detected by SUDOSCAN in subjects with type 2 diabetes.METHODS The research enrolled 466 inpatients with type 2 diabetes.All subjects underwent 3-d CGM and SUDOSCAN.SUDOSCAN was assessed with electrochemical skin conductance in hands(HESC)and feet(FESC).Average feet ESC<60μS was defined as sudomotor dysfunction(+),otherwise it was sudomotor dysfunction(-).TIR refers to the percentage of time when blood glucose is between 3.9-10 mmol/L during 1 d period.RESULTS Among the enrolled subjects,135(28.97%)presented with sudomotor dysfunction.Patients with sudomotor dysfunction(+)showed a decreased level of TIR(P<0.001).Compared to the lowest tertile of TIR,the middle and the highest tertiles of TIR was associated with an obviously lower prevalence of sudomotor dysfunction(20.51%and 21.94%vs 44.52%)(P<0.001).In addition,with the increase of TIR,HESC and FESC increased(P<0.001).Regression analysis demonstrated that TIR was inversely and independently linked with the prevalence of sudomotor dysfunction after adjusting for confounding values(odds ratio=0.979,95%CI:0.971-0.987,P<0.001).CONCLUSION The tight glycemic control assessed by TIR is of vitally protective value for sudomotor dysfunction in type 2 diabetes mellitus.

Influence of statistical time range on estimating seismicity parameters

The influence of non-uniqueness in selecting statistical time ranges on seismicity parameters of b value and annual mean occurrence rate ν4 is widely analyzed and studied. The studied result states that the influence of statistical time range on the b value is generally smaller than on the annual mean rate. Owing to the exponentially functional relation between the annual mean rate and b value, the variation of b value by varying statistical time range brings about decrease or increase in the annual mean rates of each magnitude interval with power progression law. These results will exert a synthetic effect on seismic safety evaluation results in various regions in our country.

Patients’time in therapeutic range on warfarin among atrial fibrillation patients in Warfarin Medication Therapy Adherence Clinic

BACKGROUND The quality of warfarin therapy can be determined by the time in the therapeutic range(TTR)of international normalized ratio(INR).The estimated minimum TTR needed to achieve a benefit from warfarin therapy is≥60%.AIM To determine TTR and the predictors of poor TTR among atrial fibrillation patients who receive warfarin therapy.METHODS A retrospective observational study was conducted at a cardiology referral center in Selangor,Malaysia.A total of 420 patients with atrial fibrillation and under follow-up at the pharmacist led Warfarin Medication Therapeutic Adherence Clinic between January 2014 and December 2018 were included.Patients’clinical data,information related to warfarin therapy,and INR readings were traced through electronic Hospital Information system.A data collection form was used for data collection.The percentage of days when INR was within range was calculated using the Rosendaal method.The poor INR control category was defined as a TTR<60%.Predictors for poor TTR were further determined by using logistic regression.RESULTS A total of 420 patients[54.0%male;mean age 65.7(10.9)years]were included.The calculated mean and median TTR were 60.6%±20.6%and 64%(interquartile range 48%-75%),respectively.Of the included patients,57.6%(n=242)were in the good control category and 42.4%(n=178)were in the poor control category.The annual calculated mean TTR between the year 2014 and 2018 ranged from 59.7%and 67.3%.A high HAS-BLED score of≥3 was associated with poor TTR(adjusted odds ratio,2.525;95%confidence interval:1.6-3.9,P<0.001).CONCLUSION In our population,a high HAS-BLED score was associated with poor TTR.This could provide an important insight when initiating an oral anticoagulant for these patients.Patients with a high HAS-BLED score may obtain less benefit from warfarin therapy and should be considered for other available oral anticoagulants for maximum benefit.

The Use of Standardized Reporting and Time-in-Range in the Management of Diabetes: A Consensus Report

Introduction: The exhaustion of healthcare resources due to the rising prevalence in Saudi Arabia mandates the search for each method that can help in better control of diabetes. Methods: The gathered task force gath-ered to develop an explicit, evidence-based consensus for the use of time-in-range targets as guidance for better glycemic control while using continuous glucose monitoring (CGM). This article has the recommenda-tions of this expert panel. Results: HbA1c and self-monitoring blood glu-cose (SMBG) are not enough to detect blood glucose (BG) fluctuations on a daily basis. The incorporation of technology like FreeStyle Libre with its applications like Libre View is now used in many institutes in Saudi Ara-bia. This system is comprehensive and has all the standardized metrics needed. However, training and support are always needed. Barriers and challenges include the awareness & experience of the technology, the time barrier, the patients’ barriers, the technical barriers, and of course, the availability barrier. All the barriers and challenges should be dealt with by designing new training programs. Conclusion: The expert panel recom-mended using CGMs technology in people with type 1 diabetes (T1DM) children and adults, type 2 diabetes (T2DM) on multiple insulin injections, gestational diabetes (GDM) who need further glycemic control, and those at high risk for hypoglycemia. In addition, we recommend using them for a short period for those who require intensive BG control or during acute illness or stress. In addition, Ambulatory Glucose Profile (AGP) could be used as an educational tool for any individuals with DM to study the im-pact of certain elements of lifestyle modifications on their immediate BG level.

Elderly Disabled Patients in Oral Anticoagulation Treatment: An Evaluation of a Bioanalyst-Led Management Program Reaching an Average of 72% of Time in Therapeutic Range

Introduction: The need for anticoagulation therapy increases with age, mainly due to the increased prevalence of atrial fibrillation. Time in therapeutic range (TTR) is a marker of the quality of the therapy as TTR is inversely correlated with adverse reactions. We developed a bioanalyst-led management program for control of warfarin treatment in elderly disabled patients in their own home and maintain a high TTR. Material and Methods: Residents in nursing home settings were included. Visiting nurses measured INR with a point of care testing device. If INR was within Therapeutic Range (TR), the nurse dosed warfarin unaltered. If INR was out of TR, the visiting nurse contacted a specially trained bioanalyst by phone. An explanation was sought, and a new dosage plan was made. Results: A total of 579 patients were included;356 females (61%). Mean age was 79.6 years. Approximately 10% were residents in nursing home settings and the rest in domiciliary care. TTR was 72%. The subtherapeutic values were 15% and supratherapeutic values 13%. In total, 139 patients died during the study period. Ten deaths could be related to possible side effects of warfarin treatment. Conclusions: Our results indicate that a bioanalyst-led program is able to simplify anticoagulation monitoring, while maintaining INR control similar to a specialized clinic. Furthermore, we avoided hospitalizations when INR was unacceptably high by treating the patient with oral vitamin-K at home. Our findings could be helpful when planning warfarin treatment in elderly, fragile patients.

Efficient Dynamic Time Warping by Adaptively Controlling the Valid Warping Range

Dynamic time warping(DTW)spends most of the time in generating the correlation table,and it establishes the global path constraints to reduce the time complexity.However,the global constraints restrain just in terms of the time axis.In this paper,we therefore propose another version of DTW,to be called branch-and-bound DTW(BnB-DTW),which adaptively controb its global path constraints by reflecting the contents of input patterns. Experimental results show that the suggested BnB-DTW algorithm performs more efficiently than other conventional DTW approaches while not increasing the optimal warping cost.

Time in range as a useful marker for evaluating retinal functional changes in diabetic retinopathy patients

·AIM:To elucidate the relationship between macular sensitivity and time in range(TIR)obtained from continuous glucose monitoring(CGM)measures in diabetic patients with or without diabetic retinopathy(DR).·METHODS:This was a cross-sectional study including 100 eyes of non-DR patients and 60 eyes of DR patients.An advanced microperimetry was used to quantitate the retinal mean sensitivity(MS)and fixation stability in central macula.TIR of 3.9-10.0 mmol/L was evaluated with CGM.Pearson coefficient analysis and multiple linear regression analysis were used to assess the correlation between TIR and retinal sensitivity.·RESULTS:In a comparison of non-DR patients,significant differences(P<0.05)were found in Hb A1c,TIR,coefficient of variation(CV),standard deviation of blood glucose(SDBG)and mean amplitude of glucose excursion(MAGE)values in DR patients.Besides,those DR patients had significantly poor best-corrected visual acuity(BCVA,log MAR,P=0.001).In terms of microperimetry parameters,retinal mean sensitivity(MS)and the percentages of fixation points located within 2°and 4°diameter circles were significantly decreased in the DR group(P<0.001,P<0.001,P=0.02,respectively).The bivariate contour ellipse area(BCEA)encompassing 68.2%,95.4%,99.6%of fixation points were all significantly increased in the DR group(P=0.01,P=0.006,P=0.01,respectively).Correlation analysis showed that MS were significantly correlated with Hb A1c(P=0.01).TIR was positively correlated with MS(r=0.23,P=0.01).SDBG was negatively correlated with MS(r=-0.24,P=0.01)but there was no correlation between CV and MAGE with MS(P>0.05).A multivariable linear regression analysis was performed to prove that TIR and SDBG were both independent risk factors for MS reduction in the DR group.·CONCLUSION:TIR is correlated with retinal MS reduction in DR patients,suggesting a useful option for evaluating DR progression.

Frequency response range of terahertz pulse coherent detection based on THz-induced time-resolved luminescence quenching

It has been proposed previously that the coherent detection of a terahertz（THz） pulse can be achieved based on the time-resolved luminescence quenching. In this paper, we investigate the frequency response range of this novel detection technology by simulating the motion of carriers in gallium arsenide（GaAs） by the ensemble Monte Carlo method. At room temperature, for a direct-current（DC） voltage of 20 kV/cm applied to the semiconductor（GaAs） and sampling time o140 fs, the luminescence quenching phenomena induced by terahertz pulses with different center frequencies are studied The results show that the quenching efficiency is independent of the THz frequency when the frequency is in a range o0.1 THz–4 THz. However, when the frequency exceeds 4 THz, the efficiency decreases with the increase of frequency Therefore, the frequency response range is 0.1 THz–4 THz. Moreover, when the sampling time is changed to 100 fs the frequency response range is extended to be approximately 0.1 THz–5.6 THz. This study of the frequency-dependen characteristics of the luminescence response to the THz pulse can provide a theoretical basis for the exploration of THz detection technology.

Integrated method for measuring distance and time difference between small satellites

The advancement of small satellites is promoting the development of distributed satellite systems,and for the latter,it is essential to coordinate the spatial and temporal relations between mutually visible satellites.By now,dual one-way ranging(DOWR)and two-way time transfer(TWTT)are generally integrated in the same software and hardware system to meet the limitations of small satellites in terms of size,weight and power(SWaP)consumption.However,studies show that pseudo-noise regenerative ranging(PNRR)performs better than DOWR if some advanced implementation technologies are employed.Besides,PNRR has no requirement on time synchronization.To apply PNRR to small satellites,and meanwhile,meet the demand for time difference measurement,we propose the round-way time difference measurement,which can be combined with PNRR to form a new integrated system without exceeding the limits of SWaP.The new integrated system can provide distributed small satellite systems with on-orbit high-accuracy and high-precision distance measurement and time difference measurement in real time.Experimental results show that the precision of ranging is about 1.94 cm,and that of time difference measurement is about 78.4 ps,at the signal to noise ratio of 80 dBHz.

A New Range Sidelobe Suppression Technique for Randomly Intermittent Spectra HF Radar Signal

The randomly intermittent spectra (RIS) signal is employed to combat spectrum congestion in radar and other radio services to evade the external interferences in high-frequency (HF) and ultrahigh-frequency (UHF) bands. However, the spectra discontinuity of the signal gets rise to high range sidelobes when matching the reflected echo, which is much more difficult for targets detection. So it is indispensable to investigate the technique for sidelobes suppression of the range profile when RIS signal is utilized, This paper introduced a new processing technique based on time domain filtering to lower the range sidelobes. A robust and effetive algorithm is adopted to solve the coefficients of the filter, and the restriction on the desired response of the filter is derived. The simulation results show that the peak range sidelobe can be reduced to -27 dB from -9.5 dB while the frequency band span (FBS) is 200 kHz.

Development of a wide-range and fast-response digitizing pulse signal acquisition and processing system for neutron flux monitoring on EAST

The neutron count rate fluctuation reaches six orders of magnitude between the ohmic plasma scenario and high power of auxiliary heating on an experimental advanced superconducting tokamak(EAST).The measurement result of neutron flux monitoring(NFM)is a significant feedback parameter related to the acquisition of radiation protection-related information and rapid fluctuations in neutron emission induced by plasma magnetohydrodynamic activity.Therefore,a wide range and high time resolution are required for the NFM system on EAST.To satisfy these requirements,a digital pulse signal acquisition and processing system with a wide dynamic range and fast response time was developed.The present study was conducted using a field-programmable gate array(FPGA)and peripheral component interconnect extension for instrument express(PXIe)platform.The digital dual measurement modes,which are composed of the pulse-counting mode and AC coupled square integral's Campbelling mode,were designed to expand the measurement range of the signal acquisition and processing system.The time resolution of the signal acquisition and processing system was improved from 10 to 1 ms owing to utilizing highspeed analog-to-digital converters(ADCs),a high-speed PXIe communication with a direct memory access(DMA)mode,and online data preprocessing technology of FPGA.The signal acquisition and processing system was tested experimentally in the EAST radiation field.The test results showed that the time resolution of NFM was improved to 1 ms,and the dynamic range of the neutron counts rate was expanded to more than 10^(6) counts per second.The Campbelling mode was calibrated using a multipoint average linear fitting method;subsequently,the fitting coefficient reached 0.9911.Therefore,the newly developed pulse signal acquisition and processing system ensures that the NFM system meets the requirements of high-parameter experiments conducted on EAST more effectively.

Association Between Diurnal Temperature Range and Respiratory Tract Infections

Objective This study aimed to assess the association between emergency-room visits for respiratory tract infection （RTI） with diurnal temperature range （DTR）, a weather parameter closely associated with urbanization and global climate change. Methods We conducted a semiparametric time-series analysis to estimate the percentage increase in emergency-room visits for RTI associated with changes in DTR after adjustment for daily weather conditions （temperature and relative humidity） and outdoor air pollution. Results DTR was significantly associated with daily emergency-room visits for RTI. An increase of 1 ~C in the current-day （LO） and in the 2-day moving average （L01） DTR corresponded to a 0.94% [95% confidence interval （CI）, 0.34%-1.55%] and 2.08% （95% CI, 1.24%-2.93%） increase in emergency-room visits for RTI, respectively. Conclusion DTR was associated with increased risk of RTI. More studies are needed to understand the impact of DTR on respiratory health.

On designing memory state feedback controller for linear systems with interval time-varying delay

This paper is concerned with the design of a memory state feedback controller for linear systems with interval time-varying delays.The time delay is assumed to be a time-varying continuous function belonging to a given interval,which means that the lower and upper bounds of time-varying delay are available.First,a less conservative delay-range-dependent stability criteria is proposed by using a new interval fraction method.In the process of controller synthesis,the history information of system is considered in the controller design by introducing the lower delay state.Moreover,the usual memoryless state feedback controller for the underlying systems could be considered as a special case of the memory case.Finally,two numerical examples are given to show the effectiveness of the proposed method.

Time-optimal rendezvous transfer trajectory for restricted cone-angle range solar sails

The advantage of solar sails in deep space exploration is that no fuel consumption is required. The heliocentric distance is one factor influencing the solar radiation pressure force exerted on solar sails. In addition, the solar radiation pressure force is also related to the solar sail orientation with respect to the sunlight direction. For an ideal flat solar sail, the cone angle between the sail normal and the sunlight direction determines the magnitude and direction of solar radiation pressure force. In general, the cone angle can change from 0° to 90°. However, in practical applications, a large cone angle may reduce the efficiency of solar radiation pressure force and there is a strict requirement on the attitude control. Usually, the cone angle range is restricted less more than an acute angle （for example, not more than 40°） in engineering practice. In this paper, the time-optimal transfer trajectory is designed over a restricted range of the cone angle, and an indirect method is used to solve the two point boundary value problem associated to the optimal control problem. Relevant numerical examples are provided to compare with the case of an unrestricted case, and the effects of different maximum restricted cone angles are discussed. The results indicate that （1） for the condition of a restricted cone-angle range the transfer time is longer than that for the unrestricted case and （2） the optimal transfer time increases as the maximum restricted cone angle decreases.

基于重构距离向分谱法的时序InSAR电离层校正及分析

合成孔径雷达干涉技术(InSAR)受电离层延迟影响较大,特别是在低高纬地区,用于时序InSAR解算的干涉对数量大大减少,严重影响了低频合成孔径雷达(SAR)系统的监测精度.针对该问题,引入重构距离向分谱法(RRSSI),将其扩展为时序InSAR电离层误差估计与校正方法.为测试方法性能,获取2006年6月至2010年8月间覆盖阿拉斯加Anaktuvuk河区域的ALOS-1 PALSAR数据进行实验.实验结果表明:本文方法能够有效估计时序InSAR结果中的电离层误差,且对小空间尺度电离层扰动具有较高的敏感性;经提出方法校正后,研究区域的年平均形变速率均值从校正前的1.46 cm/a降至0.49 cm/a,而标准差则从1.16 cm/a降至0.65 cm/a,精度显著提升;选取时序点的累积形变由校正前的大幅波动变得更加平稳,更符合形变规律.

Association of point in range withβ-cell function and insulin sensitivity of type 2 diabetes mellitus in cold areas

Background and Objective:Self-monitoring of blood glucose(SMBG)is crucial for achieving a glycemic target and upholding blood glucose stability,both of which are the primary purpose of anti-diabetic treatments.However,the association between time in range(TIR),as assessed by SMBG,andβ-cell insulin secretion as well as insulin sensitivity remains unexplored.Therefore,this study aims to investigate the connections between TIR,derived from SMBG,and indices representingβ-cell functionality and insulin sensitivity.The primary objective of this study was to elucidate the relationship between short-term glycemic control(measured as points in range[PIR])and bothβ-cell function and insulin sensitivity.Methods:This cross-sectional study enrolled 472 hospitalized patients with type 2 diabetes mellitus(T2DM).To assessβ-cell secretion capacity,we employed the insulin secretion-sensitivity index-2(ISSI-2)and(ΔC-peptide_(0-120)/Δglucose_(0-120))×Matsuda index,while insulin sensitivity was evaluated using the Matsuda index and HOMA-IR.Since SMBG offers glucose data at specific point-in-time,we substituted TIR with PIR.According to clinical guidelines,values falling within the range of 3.9-10 mmol were considered"in range,"and the corresponding percentage was calculated as PIR.Results:We observed significant associations between higher PIR quartiles and increased ISSI-2,(ΔC-peptide_(0-120)/Δglucose_(0-120))×Matsuda index,Matsuda index(increased)and HOMA-IR(decreased)(all P<0.001).PIR exhibited positive correlations with log ISSI-2(r=0.361,P<0.001),log(ΔC-peptide_(0-120)/Δglucose_(0-120))×Matsuda index(r=0.482,P<0.001),and log Matsuda index(r=0.178,P<0.001)and negative correlations with log HOMA-IR(r=-0.288,P<0.001).Furthermore,PIR emerged as an independent risk factor for log ISSI-2,log(ΔC-peptide_(0-120)/Δglucose_(0-120))×Matsuda index,log Matsuda index,and log HOMA-IR.Conclusion:PIR can serve as a valuable tool for assessingβ-cell function and insulin sensitivity.

THE VLASOV-POISSON-BOLTZMANN SYSTEM NEAR MAXWELLIANS FOR LONG-RANGE INTERACTIONS

In this article, we are concerned with the construction of global smooth small-amplitude solutions to the Cauchy problem of the one species Vlasov-Poisson-Boltzmann system near Maxwellians for long-range interactions. Compared with the former result obtained by Duan and Liu in [12] for the two species model, we do not ask the initial perturbation to satisfy the neutral condition and our result covers all physical collision kernels for the full range of intermolecular repulsive potentials.