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Background: Medical data, which is critical to human existence, is used to identify potential people prone to any specific complication or disease by the application of appropriate data mining (DM) techniques. DM is specifically applied to extract details for diagnosis, prediction, prevention, and treatment of various diseases. According to the International Diabetes Federation (IDF) 2019 atlas report, diabetes caused 4.2 million deaths over the globe, and hence, it is critical to diagnose diabetes at an early stage. Material and method: Even though many techniques are available to diagnose diabetes, the methods are not efficient to find hidden patterns with the desired accuracy for correct decision-making. Thus, this paper presents an integrated approach of synthetic minority oversampling technique (SMOTE) and sequential minimal optimization (SMO) algorithms for predicting diabetes. In this proposed two-phase classification model, the first step is pre-processing of data using the SMOTE algorithm, and the second step is SMO classifier. The output of the pre-processing is given to SMO to increase the performance of the classifier. Result: This classification model achieved an accuracy rate of 99.07% on the PIMA Indian diabetes dataset (PIDD) using our proposed approach. PIDD has been taken from UCI repository for this proposed work; however, the National Institute of Diabetes and digestive kidney disease owned the PIDD. The dataset contains 768 female patients, details each with 8 numeric and one decision class attribute. Conclusion: The output of the study confirms that the proposed integrated approach of DM could be used as an expert system for diagnosing diabetes in patients at an early stage. The extracted features from this study will be used for the development of a prognostic tool in the form of a mobile application for early diabetes detection. [ABSTRACT FROM AUTHOR]

Now a day's Diabetic disease(Dd) is common disease among people which causes damage to kidney, heart and may eventually lead to death. Early detection of diabetics is very much essential to avoid kidney and heart failure. Effective treatment for Dd are available through it requires early diagnosis and the continuous monitoring of diabetic patients. Also many physical tests can be used to detect Dd but are time consuming. The objective of our research paper is to give decision about the presence of diabetics by applying ensemble of machine learning classifying algorithms on features extracted from output of different datasets. It will give us accuracy of which algorithm will be suitable and more accurate for prediction of the disease. Decision making for predicting the presence of diabetic is performed using Linear Regression(LR), Logistic Regression(LoR), K Nearest Neighbors(KNN), Decision Tree(DT), Support Vector Machine(SVM), Naïve Bayes(NB), Random Forest(RF), The experimental results has been analysed by using Jupyter Notebook. Among all the mentioned Supervised machine learning algorithm RF approach show a highest classification accuracy (CA) of 89.58. From this, we can infer that for diabetic the RF approach gives the best performance compared to all other approaches. [ABSTRACT FROM AUTHOR]

Prospective studies in informative populations are crucial to increasing our knowledge of disease. In this perspective, we describe a half century of studies in an American Indian population that transformed our understanding of kidney disease in type 2 diabetes, now recognized as the leading cause of kidney failure worldwide. Serial examinations conducted for many years that included the collection of data and samples across multiple domains captured an unprecedented volume of clinical, physiologic, morphometric, genomic, and transcriptomic data. This work permitted us to extensively characterize the course and determinants of diabetic kidney disease, its pathophysiologic underpinnings, and important secular trends of urgent concern to populations worldwide, including the emergence of youth-onset type 2 diabetes and its effect on development of diabetic kidney disease in midlife. By combining these data using the tools of integrative biology, we are developing new mechanistic insights into the development and progression of diabetic kidney disease in type 2 diabetes. These insights have already contributed to the identification and successful therapeutic targeting of a novel pathway in DKD. We anticipate that this work will continue to expand our understanding of this complex disease and influence its management in the coming years. [ABSTRACT FROM AUTHOR]

The article examines the location specific issues surrounding the overland mail routes and the establishment of the Pima Indian Reservation near Tucson, Arizona in 1852-1860. It discussed the organization of the Butterfield Overland Mail Co. and the San Antonio and San Diego Mail Line and their selection of the Pima villages as central stage and mail stop in 1858. The economic benefits provided by the mail lines for Pima and Maricopa are also discussed.

Much of what is known regarding Historic period Native American communities is based on studying documents that were written by non-indigenous peoples. However, archaeological excavations in a portion of the Blackwater Village within the Gila River Indian Community provide another perspective on Native American life ways within south-central Arizona during the late 1800s. The latter nineteenth century was a pivotal time for the Akimel O'Odham (i.e., Pima) who have long lived within the Phoenix Basin, and they experienced dramatic changes in their subsistence strategies, settlement patterns, craft production, and other cultural practices during this time. These recent investigations demonstrate that the Akimel O'Odham were not passive recipients of Euroamerican culture, and instead they chose to adopt some aspects of non-native practices while at the same time retaining important traditions. As a result, the Akimel O'Odham have successfully maintained their society in the face of tremendous hardships, and Blackwater Village remains a vibrant settlement to this day. [ABSTRACT FROM AUTHOR]

Abstract: Prevalence of diabetes and obesity in Mexican Pima Indians is low, while prevalence in US Pima Indians is high. Although lifestyle likely accounts for much of the difference, the role of genetic factors is not well explored. To examine this, we genotyped 359 single nucleotide polymorphisms, including established type 2 diabetes and obesity variants from genome‐wide association studies (GWAS) and 96 random markers, in 342 Mexican Pimas. A multimarker risk score of obesity variants was associated with body mass index (BMI; β = 0.81 kg/m2 per SD, P = 0.0066). The mean value of the score was lower in Mexican Pimas than in US Pimas (P = 4.3 × 10−11), and differences in allele frequencies at established loci could account for approximately 7% of the population difference in BMI; however, the difference in risk scores was consistent with evolutionary neutrality given genetic distance. To identify loci potentially under recent natural selection, allele frequencies at 283 variants were compared between US and Mexican Pimas, accounting for genetic distance. The largest differences were seen at HLA markers (e.g., rs9271720, difference = 0.75, P = 8.7 × 10–9); genetic distances at HLA were greater than at random markers (P = 1.6 × 10–46). Analyses of GWAS data in 937 US Pimas also showed sharing of alleles identical by descent at HLA that exceeds its genomic expectation (P = 7.0 × 10–10). These results suggest that, in addition to the widely recognized balancing selection at HLA, recent directional selection may also occur, resulting in marked allelic differentiation between closely related populations. [ABSTRACT FROM AUTHOR]

Pima Indians living in Arizona have a high prevalence of obesity, and we have previously shown that a relatively lower energy expenditure (EE) predicts weight and fat mass gain in this population. EE is a familial trait (heritability = 0.52); therefore, in the current study, we aimed to identify genetic variants that affect EE and thereby influence BMI and body fatness in Pima Indians. Genotypic data from 491,265 variants were analyzed for association with resting metabolic rate (RMR) and 24-h EE assessed in a whole-room calorimeter in 507 and 419 Pima Indians, respectively. Variants associated with both measures of EE were analyzed for association with maximum BMI and percent body fat (PFAT) in 5,870 and 912 Pima Indians, respectively. rs11014566 nominally associated with both measures of EE and both measures of adiposity in Pima Indians, where the G allele (frequency: Pima Indians = 0.60, Europeans <0.01) associated with lower 24-h EE (β = -33 kcal/day per copy), lower RMR (β = -31 kcal/day), higher BMI (β = +0.6 kg/m2), and higher PFAT (β = +0.9%). However, the association of rs11014566 with BMI did not directionally replicate when assessed in other ethnic groups. rs11014566 tags rs144895904, which affected promoter function in an in vitro luciferase assay. These variants map to GPR158, which is highly expressed in the brain and interacts with two other genes (RGS7 and CACNA1B) known to affect obesity in knockout mice. Our results suggest that common ethnic-specific variation in GPR158 may influence EE; however, its role in weight gain remains controversial, as it either had no association with BMI or associated with BMI but in the opposite direction in other ethnic groups. [ABSTRACT FROM AUTHOR]

This case considers the politics of reuse in the realm of "Big Data." It focuses on the history of a particular collection of data, extracted and digitized from patient records made in the course of a longitudinal epidemiological study involving Indigenous members of the Gila River Indian Community Reservation in the American Southwest. The creation and circulation of the Pima Indian Diabetes Dataset (PIDD) demonstrates the value of medical and Indigenous histories to the study of Big Data. By adapting the concept of the "digital native" itself for reuse, I argue that the history of the PIDD reveals how data becomes alienated from persons even as it reproduces complex social realities of the circumstances of its origin. In doing so, this history highlights otherwise obscured matters of ethics and politics that are relevant to communities who identify as Indigenous as well as those who do not. [ABSTRACT FROM AUTHOR]

We previously identified a locus linked to total cholesterol (TC) concentration in Pima Indians on chromosome 19p. To characterize this locus, we genotyped > 2000 SNPs in 1838 Pimas and assessed association with log(TC). We observed evidence for association with log(TC) with rs2278426 (3.5% decrease/copy of the T allele; P = 5.045 × 10 − 6 ) in the ANGPTL8 (angiopoietin-like 8) gene. We replicated this association in 2413 participants of the San Antonio Mexican American Family Study (SAMAFS: 2.0% decrease per copy of the T allele; P = 0.005842). In a meta-analysis of the combined data, we found the strongest estimated effect with rs2278426 ( P = 2.563 × 10 − 7 ). The variant T allele at rs2278426 predicts an Arg59Trp substitution and has previously been associated with LDL-C and HDL-C. In Pimas and SAMAFS participants, the T allele of rs2278426 was associated with reduced HDL-C levels ( P = 0.000741 and 0.00002, respectively), and the combined estimated effect for the two cohorts was − 3.8% ( P = 8.526 × 10 − 8 ). ANGPTL8 transcript and protein levels increased in response to both glucose and insulin. The variant allele was associated with increased levels of cleaved ANGPTL3. We conclude that individuals with the variant allele may have lower TC and HDL-C levels due to increased activation of ANGPTL3 by ANGPTL8. [ABSTRACT FROM AUTHOR]

The article discusses the topic of carceral subjugation as seen in the case of the Gila River Indian Community (GRIC) Reservation in the U.S. where almost 15,000 Japanese Americans were imprisoned in 1942-1946. It examines how the logics of colonialism, carceral state, and settler colonialism have benefited or disadvantaged the settler state. The GRIC was the dwelling place of the Akimel O'odham and the Pee Posh tribes of Native Americans.

While Akimel O'odham agricultural identity is one cornerstone of this study of petitions sent to the federal government, the study's aims include an analysis of the petitions in terms of how their form and content reenact the values of cooperation and cocreation embodied in Akimel O'odham sacred stories. Socioethical expectations modeled in the petitions challenge the Indian Office's efforts at assimilation and its conception of modernity based in Western hegemony, revealing a counterhegemonic definition based in mutually beneficial responsibilities and in what later advocates call human rights. [ABSTRACT FROM AUTHOR]

Objective: The global epidemics of type 2 diabetes and obesity have been attributed to the interaction between lifestyle changes and genetic predisposition to these diseases. We compared the prevalences of type 2 diabetes and obesity in Mexican Pima Indians, presumed to have a high genetic predisposition to these diseases, to those in their non-Pima neighbors, both of whom over a 15-year period experienced a transition from a traditional to a more modern lifestyle.Research Design and Methods: Prevalence of diabetes, impaired fasting glucose, impaired glucose tolerance, and obesity in Mexican Pimas (n = 359) and non-Pima Mexicans (n = 251) were determined in 2010 using methods identical to those used in 1995.Results: During this 15-year period, age-adjusted diabetes prevalence was unchanged in Pima men (5.8% in 1995 vs. 6.1% in 2010) yet increased in non-Pima men from 0.0 to 8.6% (P < 0.05). Diabetes prevalence tended to increase in both Pima women (9.4 vs. 13.4%) and non-Pima women (4.8 vs. 9.5%). Age-adjusted prevalence of obesity increased significantly in all groups (6.6 vs. 15.7% in Pima men; 8.5 vs. 20.5% in non-Pima men; 18.9. vs 36.3% in Pima women; 29.5 vs. 42.9% in non-Pima women).Conclusions: Type 2 diabetes prevalence increased between 1995 and 2010 in non-Pima men, and to a lesser degree in women of both groups, but it did not increase in Pima men. Prevalence of obesity increased among Pimas and non-Pimas of both sexes. These changes occurred concomitantly with an environmental transition from a traditional to a more modernized lifestyle. [ABSTRACT FROM AUTHOR]

Despite the original intent of the cooperative farm established by the Bureau of Plant Industry on the Gila River Reservation, it siphoned economic value from Pima families into the regional economy, revealing the impact of resource depletion and wage labor on the Pima and their strategies of managing socioeconomic change. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the accuracy of the PIMA point-of-care CD4 analyzer (PIMA) under field conditions in comparison to the current CD4 count system (FACSCalibur), and to evaluate the operational suitability and acceptability of health professionals (HP) and HIV-patients in using the PIMA in health clinics in the Amazon Region. Methods: CD4 counts were measured onsite by the PIMA using fingerprick blood and in the reference laboratory by both the PIMA and FACSCalibur using venous blood. We used the Bland–Altman method to estimate the mean bias, and calculated the sensitivity and specificity at <200 and <500 cell/μL thresholds. Patients (n = 404) and HP (n = 7) were interviewed on the acceptability and operational suitability of the PIMA. Results: Using fingerprick blood (n = 337), the PIMA showed a concordance correlation coefficient (Rc) of 0.81, mean difference of -111.9 cell/μL, 93.1%/98.5% sensitivity, and 89.2%/56.7% specificity at <200 and <500 cell/μL thresholds, respectively. Venous blood (n = 340) showed an Rc of 0.89, mean difference of -83.4 cell/μL, 98.3%/97.5% sensitivity, and 93.9%/66.0% specificity at <200 and <500 cell/μL thresholds, respectively. The capillary PIMA was well accepted and found operationally appropriate by patients and HP. Conclusions: The agreement between both instruments was poor and the PIMA underestimated CD4 cell counts, which was more pronounced at CD4 counts ≥500 cell/μl. The PIMA’s performance with fingerprick blood was less reliable than its performance with venous blood. In Brazil, where antiretroviral treatment is initiated regardless of CD4 counts, the PIMA’s systematic bias towards CD4 underestimation may limit its role for monitoring HIV-patients. [ABSTRACT FROM AUTHOR]

This study examines the ideologies shaping the first cooperative venture between the Bureau of Indian Affairs (BIA) and the Bureau of Plant Industry (BPI), focusing the BIA's role as a labor contractor and the Pima's efforts to exert control over the conditions and valuation of their economic participation. Examination of the bureaus' records and extant testimonies of Pima leaders deepens contemporary understanding of the common aims of government officials and Pima farmers, the sources of tension among these stakeholders, and the mechanisms by which Pima laborers adapted economic strategies to maintain cultural continuity. Although sometimes working in synergy, the aims of the bureaus and local Anglo farmers more often compromised the economic aims of the Pima even as the BIA and the press acknowledged the debt to the native laborers cultivating exotic crops in southern Arizona. [ABSTRACT FROM AUTHOR]

The article discusses the significance of U.S. land speculator Alexander John Chandler to develop land in the Salt River Valley in Arizona and its impact upon the Gila River Native American Reservation and Pima and Maricopa Indians between 1891 and 1911. It examines Chandler's business partnerships to develop access to the Gila River, his political clout and exploitation of U.S. government natural resource policies, and the establishment of the town of Chandler, Arizona.

In this study, the Pima Indian Diabetes dataset was categorized with 8 different classifiers. The data were taken from the University of California Irvine Machine Learning Repository's web site. As a classifier, 6 different neural networks [probabilistic neural network (PNN), learning vector quantization, feedforward networks, cascade-forward networks, distributed time delay networks (DTDN), and time delay networks], the artificial immune system, and the Gini algorithm from decision trees were used. The classifier's performance ratios were studied separately as accuracy, sensitivity, and specificity and the success rates of all of the classifiers are presented. Among these 8 classifiers, the best accuracy and specificity values were achieved with the DTDN and the best sensitivity value was achieved with the PNN. [ABSTRACT FROM AUTHOR]

In this paper we present an Akimel O'odham (Pima) food production calendar. The environmental and biological data for the calendar derive in large part from information gathered in the nineteenth and twentieth centuries CE. The social and cultural data are derived from what we know of the Akimel O'odham (Pima) Indians, a Native American group that has lived along the Middle Gila River in southern Arizona. Plants considered include a Mesoamerican suite (maize, beans, cucurbits, cotton) as well as major local species (mesquite, agave, saguaro, cholla). Animals considered include lagomorphs, rodents, and deer. The major changes in Akimel O'odham (Pima) agriculture after the Spanish entrada are evaluated. We argue that much of the production calendar can plausibly be retrodicted into prehistory, specifically to that archaeological culture called Hohokam. [ABSTRACT FROM AUTHOR]

This paper analyzes the distribution of flaked-stone projectile points from southern Arizona that have previously been suggested to date to the Historic period. The locations of these artifacts within the Gila River Indian Community and other lines of evidence including ceramic data are consistent with ethnohistorically and ethnographically documented Akimel O'odham settlement patterns along the middle Gila River. The results of this analysis demonstrate that the three point types considered here were indeed produced during the Protohistoric and Historic periods, and it appears that it is possible to characterize diagnostic projectile point types from this time. These data also provide corroborating evidence for historically documented population movements during the Historic period. [ABSTRACT FROM AUTHOR]

Parent-of-origin effects were observed in an Icelandic population for several genetic variants associated with type 2 diabetes, including those in KLF14 (rs4731702), MOB2 (rs2334499), an KCNQ1 (rs2237892, rs231362). We analyzed parent-of-origin effects for these variants, along with two others in KCNQ1 identified in previous genome-wide association studies (rs2237895, rs2299620), in 7,351 Pima Indians from 4,549 nuclear families; 34% of participants had diabetes. In a subset of 287 normoglycemic individuals, acute insulin secretion was measured by an intravenous glucose tolerance test. Statistically significant (P < 0.05) parent-of-origin effects were seen for association with type 2 diabetes for all variants. The strongest effect was seen at rs2299620 in KCNQ1; the C allele was associated with increased diabetes when maternally derived (odds ratio [OR], 1.92; P = 4.1 10-12), but not when paternally derived (OR, 0.93; P = 0.47; P 9.9 x 10-6 for difference in maternal and paternal effects). A maternally derived C allele also was associated with a 28% decrease in insulin secretion (P = 0.002). This study confirms parent-of-origin effects in the association with type 2 diabetes for variants in KLF14, MOB2, and KCNQ1. In Pima Indians, the effect of maternally derived KCNQ1 variants appears to be mediated through decreased insulin secretion and is particularly strong, accounting for 4% of the variance in liability to diabetes. [ABSTRACT FROM AUTHOR]

A prior linkage scan in Pima Indians identified a putative locus for type two diabetes (T2D) and body mass index (BMI) on chromosome 11q23-25. Association mapping across this region identified single nucleotide polymorphisms (SNPs) in the trehalase gene ( TREH) that were associated with T2D. To assess the putative connection between trehalase activity and T2D, we performed a linkage study for trehalase activity in 570 Pima Indians who had measures of trehalase activity. Strong evidence of linkage of plasma trehalase activity (LOD = 7.0) was observed in the TREH locus. Four tag SNPs in TREH were genotyped in these subjects and plasma trehalase activity was highly associated with three SNPs: rs2276064, rs117619140 and rs558907 ( p = 2.2 × 10-1.4 × 10), and the fourth SNP, rs10790256, was associated conditionally on these three ( p = 2.9 × 10). Together, the four tag SNPs explained 51 % of the variance in plasma trehalase activity and 79 % of the variance attributed to the linked locus. These four tag SNPs were further genotyped in 828 subjects used for association mapping of T2D, and rs558907 was associated with T2D (odds ratio (OR) 1.94, p = 0.002). To assess replication of the T2D association, all four tag SNPs were additionally genotyped in two non-overlapping samples of Native Americans. Rs558907 was reproducibly associated with T2D in 2,942 full-heritage Pima Indians (OR 1.27 p = 0.03) and 3,897 'mixed' heritage Native Americans (OR 1.21, p = 0.03), and the strongest evidence for association came from combining all samples (OR 1.27 p = 1.6 × 10, n = 7,667). However, among 320 longitudinally studied subjects, measures of trehalase activity from a non-diabetic exam did not predict those who would eventually develop diabetes versus those who would remain non-diabetic (hazard ratio 0.94 per SD of trehalase activity, p = 0.29). We conclude that variants in TREH control trehalase activity, and although one of these variants is also reproducibly associated with T2D, it is likely that the effect of the SNP on risk of T2D occurs by a mechanism different than affecting trehalase activity. Alternatively, TREH variants may be tagging a nearby T2D locus. [ABSTRACT FROM AUTHOR]

The article discusses writer and activist Carlos Montezuma's advocacy for the Akimel and Tohono O'odham communities in Arizona . The author argues that this work demonstrates Montezuma's role in fighting against the U.S. Indian Bureau and in the development of progressivism in American Indian politics. Montezuma's relationship to his Yavapai heritage is also discussed. Other topics include the Fort McDowell Indian Reservation in Arizona and accounts of Montezuma's life by other Native Americans.

Obsidian provenance studies within the Phoenix Basin of south-central Arizona have become increasingly comprehensive during the last four decades. As a result, broad regional and temporal trends have been defined regarding Preclassic (ca. A.D. 650-1150) and Classic period (ca. A.D. 1150-1450) socioeconomic interactions in the Hohokam core area. However, Historic period patterns are still poorly understood, and these data are essential for understanding the relationship between the prehistoric Hohokam and historical Akimel O'Odham. The association between the Akimel O'Odham and Hohokam has been debated since Euro-Americans first visited the area in the late 1600s, yet this issue is still not fully resolved. This article presents analyses of historical obsidian from the Sacate site that suggest that long-term trends in cultural patterns within the Phoenix Basin continued unbroken into the Historic period. These continuities provide another line of evidence that the Akimel O'Odham are the direct cultural descendants of the Hohokam [ABSTRACT FROM AUTHOR]

Background: The type 2 deiodinase gene ( DIO2) encodes a deiodinase that converts the thyroid prohormone, thyroxine, to the biologically active triiodothyronine. Thyroid hormones regulate energy balance and may also influence glucose metabolism. Therefore, we hypothesized that variations in DIO2 could contribute to obesity or type 2 diabetes mellitus (T2DM) in Pima Indians. Methods: Sequencing of the DIO2 gene in DNA from 83 Pima Indians identified 12 single-nucleotide polymorphisms (SNPs). Several of these SNPs were in perfect genotypic concordance among the 83 samples that were sequenced, and all 12 could be divided into five linkage disequilibrium groups. One representative SNP from each group (Thr92Ala, rs225011, rs225015, rs6574549, and a rare 5′ flanking SNP) was selected for further genotyping for association analyses. In this study, the five selected variants in DIO2, as described above, were genotyped in three groups of Pima Indians: (i) a case ( n=150)/control ( n=150) group for early-onset T2DM (onset age <25 years); (ii) a case ( n=362)/control ( n=127) group for obesity; (iii) a large ( n=1,311, cases n=810/controls n=501) family-based group, of which 256 nondiabetic subjects had undergone detailed metabolic phenotyping. Results: The Thr92Ala variant common in Pima Indians, rs225011, and rs225015 were modestly associated with early-onset T2DM ( p=0.01-0.04) in the case-control study, but were not associated with obesity in the obesity case-control study, nor associated with T2DM (at any age) or body-mass index (BMI; as a quantitative trait) in the family-based analysis. Thr92Ala, rs225011, rs225015, and rs6574549 were also nominally associated with hepatic glucose output ( p=0.02). rs6574549 was associated with fasting insulin ( p=0.02), insulin action ( p=0.04), and energy expenditure ( p=0.02). None of these nominal associations remained statistically significant after corrections for multiple testing. Conclusions: We propose that variation in DIO2 may have a subtle role in altering metabolic processes that lead to early-onset T2DM, but this gene does not have a large impact on T2DM at older ages, nor does DIO2 influence BMI in the Pima Indian population. [ABSTRACT FROM AUTHOR]

This text discusses, principally through oral testimonies, the process of historic change and geographic displacement of the Odham community of Las Calenturas Pozo-Prieto at Caborca City in the northeast of Sonora, in the second half of the 20th century. The Mexican government's policies on land distribution as well as the selective use of natural resources played a decisive role in this process, particularly in the prejudice of the Odham. This work describes the geographic mobility of the place of origin from a rural desert environment to the urban city of destination. Furthermore, it briefly addresses the perception of the Odham relating to this dynamic of social change that caused them to reconfigure themselves as an ethnic group in a socially and culturally distinct environment, the city. [TRANSLATION]

Background: In 1995, a study was conducted to identify the effects of traditional and westernized environments on the prevalence of type 2 diabetes in Pima Indians (Pimas) in Mexico and the United States. The study concluded that the more traditional lifestyle in Mexico had a protective effect against this metabolic disorder. In the ensuing 15 years, the environmental circumstances of the Mexican Pimas changed, and a follow-up study was conducted to determine the role environmental change plays in the development of diabetes in this genetically susceptible population. A major element of environmental transition relates to land-use and land-cover (LULC) changes that could affect physical activity and promote an obesogenic environment. This study examined changes in the region's LULC to determine whether there have been transitions in agricultural land use and urbanization that would be consistent with a more sedentary lifestyle. Changes were assessed from 1994 aerial photographs and 2007 satellite images. Results: The land-cover analysis showed that mixed vegetation and dense trees cover most of the study area. It suggested a rural environment that includes a low percentage of impermeable areas, and it indicated that the area experiencing human intervention covers 7% of the total area. The land-use-change findings showed a decrease or no change in agricultural or ranching areas and a decrease in farmland due to reforestation or revegetation. Three variables from the land-use-change analysis were examined as proxies for lifestyle change: urban development, dwelling-unit density, and variation in the road network. Two of the measures--the amount of urbanization and the number and density of dwelling units--showed increases, most notably in the town of Maycoba. There were only minor changes in the road network: most of the road segments are short and concentrated in Maycoba where most of the buildings, points of interest (e.g., church, stores), and cars are located. Conclusions: The LULC in Maycoba and surrounding settlements had changed during the study period. LULC change was used as a proxy to examine lifestyle changes that can affect levels of physical activity. [ABSTRACT FROM AUTHOR]

Features of melanocortin-4 receptor (MC4R) deficiency have been observed to be more pronounced in childhood. Longitudinal data from a population-based study were used to separate the phenotypic effects of MC4R deficiency during childhood and adulthood. The MC4R exon was sequenced in 6,760 individuals of predominantly Pima Indian heritage, and discovered mutations were functionally assessed in vitro. Effects on BMI, height, and slope of BMI change were assessed during childhood (ages 5--20 years) and adulthood (ages 20--45 years). Six mutations affecting MC4R function, including three that may be private to Pima Indians, were found in 159 individuals (2.4%). The slope of BMI increase was greater in individuals carrying an MC4R mutation compared with noncarriers during childhood but not during adulthood. The final adult height obtained was higher in individuals with MC4R deficiency. There was an increased risk for developing type 2 diabetes in individuals with a defective MC4R during childhood and adulthood, but this was only independent of BMI in childhood. The greater rates of body mass accumulation and risk of type 2 diabetes before the age of 20 years in individuals with MC4R deficiency indicate that the effects of these mutations are more apparent during the active growth of childhood. Diabetes 61:250--257, 2012 [ABSTRACT FROM AUTHOR]

Abstract: Genetic variation in SIRT1 affects obesity-related phenotypes in several populations. The purpose of this study was to determine whether variation in SIRT1 affects susceptibility to obesity or type 2 diabetes in Pima Indians, a population with very high prevalence and incidence rates of these diseases. Genotypic data from single nucleotide polymorphisms (SNPs) identified by sequencing regions of SIRT1 combined with SNPs in/near SIRT1 from a prior genome-wide association study determined that 4 tag SNPs (rs7895833, rs10509291, rs7896005, and rs4746720) could capture information across this gene and its adjacent 5′ region. The tag SNPs were genotyped in a population-based sample of 3501 Pima Indians (44% had diabetes, 58% female) for association with type 2 diabetes and BMI. Metabolic trait data and adipose biopsies were available on a subset of these subjects. Two tag SNPs, rs10509291 and rs7896005, were nominally associated with type 2 diabetes (P =0.01, OR=1.25 95%CI 1.05–1.48, and P =0.02, OR=1.17 95%CI 1.02–1.34, respectively; additive P values adjusted for age, sex, birth year, and family membership), but not BMI (adjusted P values 0.52 and 0.45, respectively). Among metabolically characterized subjects with normal glucose tolerance (N=243), those carrying the diabetes risk allele (T) for rs10509291 and (G) for rs7896005 had a reduced acute insulin response (AIR) to an intravenous glucose bolus (adjusted P =0.045 and 0.035, respectively). SIRT1 expression in adipose biopsies was negatively correlated with BMI (adjusted P =0.00001). We conclude that variation in SIRT1 is nominally associated with reduced AIR and increased risk for type 2 diabetes. SIRT1 expression in adipose is correlated with BMI, but it remains unknown whether this is a cause or consequence of obesity. [Copyright &y& Elsevier]

The article looks at Native water-rights settlements in Arizona. Particular focus is given to settlements concerning the Salt River Pima-Maricopa Indian community and the Fort McDowell Yavapai Nation. According to the author, the interactions and negotiations between Native communities and non-Native stakeholders in these cases are similar to historic peace treaties made between Native peoples and the U.S. government. It is suggested that the settlements are also expressions of cross-cultural experience. Topics discussed include Native agency, the construction of dams, and the use of assimilation tools in Native politics.

With an adaptive partition procedure, we can partition a ''time course'' into consecutive non-overlapped intervals such that the population means/proportions of the observations in two adjacent intervals are significantly different at a given level αC. However, the widely used recursive combination or partition procedures do not guarantee a global optimization. We propose a modified dynamic programming algorithm to achieve a global optimization. Our method can provide consistent estimation results. In a comprehensive simulation study, our method shows an improved performance when it is compared to the recursive combination/partition procedures. In practice, αC can be determined based on a cross-validation procedure. As an application, we consider the well-known Pima Indian Diabetes data. We explore the relationship among the diabetes risk and several important variables including the plasma glucose concentration, body mass index and age. [ABSTRACT FROM AUTHOR]

Abstract: Variants in the engulfment and cell motility 1 gene, ELMO1, have previously been associated with kidney disease attributed to type 2 diabetes. The Pima Indians of Arizona have high rates of diabetic nephropathy, which is strongly dependent on genetic determinants; thus, we sought to investigate the role of ELMO1 polymorphisms in mediating susceptibility to this disease in this population. Genotype distributions were compared among 141 individuals with nephropathy and 416 individuals without heavy proteinuria in a family study of 257 sibships, and 107 cases with diabetic ESRD and 108 controls with long duration diabetes and no nephropathy. We sequenced 17.4kb of ELMO1 and identified 19 variants. We genotyped 12 markers, excluding those in 100% genotypic concordance with other variants or with a minor allele frequency <0.05, plus 21 additional markers showing association with ESRD in earlier studies. In the family study, the strongest evidence for association was with rs1345365 (odds ratio [OR]=2.42 per copy of A allele [1.35–4.32]; P =0.001) and rs10951509 (OR=2.42 per copy of A allele [1.31–4.48]; P =0.002), both of which are located in intron 13 and are in strong pairwise linkage disequilibrium (r 2 =0.97). These associations were in the opposite direction from those observed in African Americans, which suggests that the relationship between diabetic kidney disease and ELMO1 variation may involve as yet undiscovered functional variants or complex interactions with other biological variables. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This paper reviews a methodology for evolving fuzzy classification which allows data to be processed in online mode by recursively modifying a fuzzy rule base on a per-sample basis from data streams. In addition, it shows how this methodology can be improved and applied to the field of diagnostics, for two popular medical problems. Method: The vast majority of existing methodologies for fuzzy medical diagnostics require the data records to be processed in offline mode, as a batch. Unfortunately this allows only a snapshot of the actual domain to be analysed. Should new data records become available they require cost sensitive calculations due to the fact that re-learning is an iterative procedure. eClass is a relatively new architecture for evolving fuzzy rule-based systems, which overcomes these problems. However, it is data order dependent as different orders of the data result into different rule bases. Nonetheless, it is shown that models of eClass can be improved by arranging the order of the incoming data using a simple optimization strategy. Results: In regards to the Pima Indians diabetes dataset, an accuracy of 79.37% was obtained, which is 0.84% lower than the highest in the literature. The proposed optimization strategy increased the accuracy and specificity of the model by 4.05% and 7.63% respectively. For the dermatology dataset, an accuracy of 97.55% was obtained, which is 1.65% lower than the highest in the literature. In this case, the proposed optimization strategy improved the accuracy of the model by 4.82%. The improved algorithm has been compared to other existing algorithms and seems to outperform the majority. Conclusions: This paper has shown that eClass can effectively be applied to the classification of diabetes and dermatological diseases from discrete numerical samples. The results of using a novel optimization strategy indicate that the accuracy of eClass models can be further improved. Finally, the system can mine human readable rules which could enable medical experts to gain better understanding of a sample under analysis throughout the traditional diagnostic process. [Copyright &y& Elsevier]

Abstract: Objectives: Understanding why prolonged Bazett-corrected QT interval (QTc) is a risk factor for mortality is difficult, because QTc is positively correlated with heart rate. To optimally distinguish the effects of QT interval and heart rate on mortality, QT interval and heart rate were modeled separately and jointly in Pima Indians. Methods: The effects of QT and heart rate on all-cause and cause-specific mortality were assessed in the overall study population and according to the presence or absence of diabetes using multivariable time-dependent proportional hazards models. Results: Among 1488 nondiabetic and 990 diabetic subjects ≥25 years old, 81 nondiabetic and 149 diabetic subjects died during a median follow-up of 7.3 years. When included in the same regression model, QT and heart rate each predicted all-cause mortality [hazard ratios per standard deviation (SD) (95% confidence interval)=1.31 (1.10–1.57) and 1.57 (1.32–1.87) respectively]. In nondiabetic subjects, hazard ratios for all-cause mortality were 1.54 (1.19–1.99) for QT and 1.86 (1.46–2.37) for heart rate. In diabetic subjects, hazard ratios for all-cause mortality were lower, 1.27 (1.00–1.62) for QT and 1.41 (1.12–1.78) for heart rate. In the overall study population, neither QT nor heart rate significantly predicted cardiovascular disease (CVD) mortality [hazard ratios=1.13 (0.77–1.64) and 1.46 (0.98–2.19)] when adjusted for each other. Heart rate unadjusted for QT, however, predicted CVD mortality [hazard ratio=1.34 (1.00–1.79)] in a separate model. Conclusions: QT prolongation and high heart rate both predict all-cause mortality in Pima Indians, but heart rate was consistently the stronger predictor of the two. [Copyright &y& Elsevier]

The purpose of this brief communication is to report the results of an analysis of maxillary premolar accessory ridges (MxPAR), a common but understudied accessory ridge that may occur both mesial and distal to the central ridge of the buccal cusp of upper premolars. We developed a new five-grade scoring plaque to better categorize MxPAR variation. Subsequently, we conducted a population analysis of MxPAR frequency in 749 dental casts of South African Indian, American Chinese, Alaskan Eskimo, Tohono O'odham (Papago), Akimel O'odham (Pima), Solomon Islander, South African Bantu, and both American and South African Whites. Northeast Asian and Asian-derived populations exhibited the highest MxPAR frequencies while Indo-Euro- pean samples (South African Indians, American and South African Whites) exhibited relatively low frequencies. The Solomon Islanders and South African Bantu samples exhibited intermediate frequencies. Our analysis indicates that statistically significant differences in MxPAR frequency exist between major geographic populations. As a result, the MxPAR plaque has now been added to the Arizona State University Dental Anthropology System, an important contribution as maxillary premolar traits are underrepresented in analyses of dental morphology. [ABSTRACT FROM AUTHOR]

OBJECTIVE--We examined secular trends in the frequency distribution of albuminuria and estimated glomerular filtration rate (eGFR) in subjects with type 2 diabetes in 1982-1988 and 2001-2006, two periods associated with major changes in the management of diabetes. RESEARCH DESIGN AND METHODS--The cross-sectional study included Pima Indians ≥15 years old with type 2 diabetes and measures of serum creatinine and urinary albumin-to-creatinine ratios (ACR). The continuous probability density distributions of ACR and eGFR were compared for the two time periods, eGFR was calculated using the Modification of Diet in Renal Disease Study equation. RESULTS--The overall standardized distribution of ACR shifted toward lower values between time periods (P = 0.001), whereas the standardized distribution of eGFR did not (P = 0.45). In the first period, eGFR was <60 ml/min per 1.73 m² in 6.5% of the 837 subjects. Of these, 9.3% had normal ACR, 7.4% had microalbuminuria, and 83.3% had macroalbuminuria. In the second period, the prevalence of low eGFR was similar (6.6% of the 1,310 subjects). Among those with low eGFR, normal ACR prevalence doubled to 17.2%, microalbuminuria prevalence nearly tripled to 19.5%, and macroalbuminuria prevalence declined to 63.2%. Twice as many subjects in the second period received antihypertensive medicines and 30% more received hypoglycemic medicines than in the first period. CONCLUSIONS--The distribution of albuminuria changed significantly among diabetic Pima Indians over the past 20 years, as treatment with medicines to control hyperglycemia and hypertension increased. The distribution of eGFR, however, remained unchanged. Consequently, the frequency of chronic kidney disease characterized by normoalbuminuria and low eGFR doubled. [ABSTRACT FROM AUTHOR]

Diagnosis tasks are among the most interesting activities in which to implement intelligent systems. The major objective of the paper is to be a guide for the readers, who want to develop an automated decision support system for detection of diabetics and subjects having risk factors of diabetes. The purpose was to determine an optimum classification scheme with high diagnostic accuracy for this problem. Several different classification algorithms were tested and their performances in detection of diabetics were compared. The performance of the classification algorithms was illustrated on the Pima Indians diabetes data set. The present research demonstrated that the modified mixture of experts (MME) achieved diagnostic accuracies which were higher than that of the other automated diagnostic systems. [ABSTRACT FROM AUTHOR]

OBJECTIVE--Haploinsufficiency of SIM1 is a cause of rare monogenic obesity. To assess the role of SIM1 in polygenic obesity, this gene was analyzed in the Pima Indian population, which has a high prevalence of obesity. RESEARCH DESIGN AND METHODS--SIM1 was sequenced in 96 individuals. Variants (n = 46) were genotyped in a population-based sample of 3,250 full-heritage Pima Indians and in a separate replication sample of 2,944 predominately non-full-heritage subjects from the same community. RESULTS--Variants spanning the upstream region of SIM1 through intron 8 were associated with BMI in the full-heritage Pima Indians, where the strongest associations (P ∼ 10[sup -4] to 10[sup -6]) were with common variants (risk allele frequency 0.610.67). The difference in mean BMI between individuals homozygous for the major allele compared with homozygotes for the minor allele was ∼2.2 kg/m² (P = 2 x 10[sup -5] for rs3213541). These associations replicated in the separate sample of subjects from the same community (P = 5 x 10[sup -3] for rs3213541). The strongest associations (P = 4 x 10[sup -7], controlled for age, sex, birth year, and heritage) were seen in the combined sample (n = 6,194). The risk allele for obesity was more common in full-heritage Pimas than in the mixed-heritage subjects. Two variants (rs3734353 and rs3213541) were also genotyped in 1,275 severely obese and 1,395 lean control subjects of French European ancestry. The Pima risk alleles were the minor alleles in the European samples, and these variants did not display any significant association (P > 0.05). CONCLUSIONS--Common variation in SIM1 is associated with BMI on a population level in Pima Indians where the risk allele is the major allele. Diabetes 58:1682-1689, 2009 [ABSTRACT FROM AUTHOR]

The article examines the impact that United States federal land policy and the arrival of settlers in the Gila River Valley had on the Pima Indians in the late 19th-century. The author discusses the cultural, social and economic importance of agriculture to the Pima and the role that the Gila River played in allowing them to independently thrive in the region. The article then examines how U.S. federal land policy encouraged settlement in the Gila River Valley and hurt the Pima by depriving them of the river's resources.

Objective: In severely obese individuals and patients with diabetes, accumulation and activation of macrophages in adipose tissue has been implicated in the development of obesity-associated complications, including insulin resistance. We sought to determine whether in a healthy population, adiposity, sex, age, or insulin action is associated with adipose tissue macrophage content (ATMc) and/or markers of macrophage activation.Research Design and Methods: Subcutaneous ATMc from young adult Pima Indians with a wide range of adiposity (13-46% body fat, by whole-body dual-energy X-ray absorptiometry) and insulin action (glucose disposal rate 1.6-9 mg/kg estimated metabolic body size/min, by glucose clamp) were measured. We also measured expression in adipose tissue of factors implicated in macrophage recruitment and activation to determine any association with ATMc and insulin action.Results: ATMc, as assessed by immunohistochemistry (Mphi) and by macrophage-specific gene expression (CD68, CD11b, and CSF1R), were correlated with percent body fat, age, and female sex. Gene expression of CD68, CD11b, and CSF1R but not Mphi was correlated negatively with glucose disposal rate but not after adjustment for percent body fat, age, and sex. However, adipose tissue expression of plasminogen activator inhibitor type-1 (PAI-1) and CD11 antigen-like family member C (CD11c), markers produced by macrophages, were negatively correlated with adjusted glucose disposal rate (r = -0.28, P = 0.05 and r = -0.31, P = 0.03).Conclusions: ATMc is correlated with age and adiposity but not with insulin action independent of adiposity in healthy human subjects. However, PAI-1 and CD11c expression are independent predictors of insulin action, indicating a possible role for adipose tissue macrophage activation. [ABSTRACT FROM AUTHOR]

OBJECTIVE--In recent genome-wide association studies, variants in CDKAL1, SLC30A8, HHEX, EXT2, IGF2BP2, CDKN2B, LOC387761, and FTO were associated with risk for type 2 diabetes in Caucasians. We investigated the association of these single nucleotide polymorphisms (SNPs) and some additional tag SNPs with type 2 diabetes and related quantitative traits in Pima Indians. RESEARCH DESIGN AND METHODS--Forty-seven SNPs were genotyped in 3,501 Pima Indians informative for type 2 diabetes and BMI, among whom 370 had measures of quantitative traits. RESULTS--FTO provided the strongest evidence for replication, where SNPs were associated with type 2 diabetes (odds ratio = 1.20 per copy of the risk allele, P = 0.03) and BMI (P = 0.002). None of the other previously reported SNPs were associated with type 2 diabetes; however, associations were found between CDKAL1 and HHEXvariants and acute insulin response (AIR), where the Caucasian risk alleles for type 2 diabetes were associated with reduced insulin secretion in normoglycemic Pima Indians. Multiallelic analyses of carrying risk alleles for multiple genes showed correlations between number of risk alleles and type 2 diabetes and impaired insulin secretion in normoglycemic subjects (P = 0.006 and 0.0001 for type 2 diabetes and AIR, respectively), supporting the hypothesis that many of these genes influence diabetes risk by affecting insulin secretion. CONCLUSIONS--Variation in FTO impacts BMI, but the implicated common variants in the other genes did not confer a significant risk for type 2 diabetes in Pima Indians. However, confidence intervals for their estimated effects were consistent with the small effects reported in Caucasians, and the multiallelic "genetic risk profile" identified in Caucasians is associated with diminished early insulin secretion in Pinto Indians. Diabetes 58: 478-488, 2009 [ABSTRACT FROM AUTHOR]

OBJECTIVE--In severely obese individuals and patients with diabetes, accumulation and activation of macrophages in adipose tissue has been implicated in the development of obesity-associated complications, including insulin resistance. We sought to determine whether in a healthy population, adiposity, sex, age, or insulin action is associated with adipose tissue macrophage content (ATMc) and/or markers of macrophage activation. RESEARCH DESIGN AND METHODS--Subcutaneous ATMc from young adult Pima Indians with a wide range of adiposity (13-46% body fat, by whole-body dual-energy X-ray absorptiometry) and insulin action (glucose disposal rate 1.6-9 mg/kg estimated metabolic body size/min, by glucose clamp) were measured. We also measured expression in adipose, tissue of factors implicated in macrophage recruitment and activation to determine any association with ATMc and insulin action. RESULTS--ATMc, as assessed by immunohistochemistry (Mphi) and by macrophage-specific gene expression (CD68, CD11b, and CSF1R), were correlated with percent body fat, age, and female sex. Gene expression of CD68, CD11b, and CSF1R but not Mphi was correlated negatively with glucose disposal rate but not after adjustment for percent body fat, age, and sex. However, adipose tissue expression of plasminogen activator inhibitor type-1 (PAI-1) and CD11 antigen-like family member C (CD11c), markers produced by macrophages, were negatively correlated with adjusted glucose disposal rate (r = -0.28, P = 0.05 and r = -0.31, P = 0.03). CONCLUSIONS--ATMc is correlated with age and adiposity but not with insulin action independent of adiposity in healthy human subjects. However, PAI-1 and CD11c expression are independent predictors of insulin action, indicating a possible role for adipose tissue macrophage activation. Diabetes 58: 385-393, 2009 [ABSTRACT FROM AUTHOR]

The article presents a commentary on the etiology of type 2 diabetes in the Pima Indian population of Arizona. According to research, the population's type 2 diabetes is characterized by obesity and insulin resistance. Also discussed are the link between the ABCC8 1420H variant and the increased diabetes risk and increased body weight and the risk of homozygous infants with severe hyperinsulinism.

OBJECTIVE--Humans with functional variants in the melanocortin 4 receptor (MC4R) are obese, hyperphagic, and hyperinsulinemic but have been reported to have no difference in energy expenditure. RESEARCH DESIGN AND METHODS--We investigated the association of two MC4R variants, Arg165Gln (R165Q) and A insertion at nucleotide 100 (NT100), with adiposity in 3,074 full-heritage Pima Indians, a subset of whom had metabolic measures including 24-h energy expenditure (n = 252) and resting metabolic rate (RMR) (n = 364). RESULTS--Among the 3,074 subjects, 43 were heterozygous for R165Q and 14 for NT100 (frequency = 0.007 and 0.002). Mean (± SD) BMI was higher among subjects with R165Q (39.3 ± 8.6 kg/m²) or NT100 (41.2 ± 7.8) than subjects without either variant (37.1 ± 8.4) (P = 0.04 and 0.02, adjusted for age, sex, and birth year and accounting for family membership). The 24-h energy expenditure (four with NT100; three with R165Q) or RMR (six with NT100; two with R165Q) was lower in heterozygous subjects but only met statistical significance when heterozygous subjects were combined and compared with subjects without either variant: least-squares means, 2,163 kcal/24 h (95% CI 2,035-2,291) vs. 2,307 kcal/24 h (2,285-2,328), P = 0.03 for 24-h energy expenditure, and 1,617 kcal/24 h (1,499-1,734) vs. 1,754 kcal/24 h (1,736-1,772), P = 0.02 for RMR; adjusted for age, sex, fat-free mass, and fat mass). For RMR, this difference persisted, even after accounting for family membership. CONCLUSIONS--Pima Indians heterozygous for R165Q or NT100 in MC4R have higher BMIs and lower energy expenditure (by ∼140 kcal/day), indicating that lower energy expenditure was a component of the increased adiposity. Diabetes 57: 3267-3272, 2608 [ABSTRACT FROM AUTHOR]

OBJECTIVE--A prior genome-wide association (GWA) study in Pima Indians identified variants within PCLO that were associated with early-onset type 2 diabetes. PCLO encodes a presynaptic cytomatrix protein that functions as a Ca[sup 2+] sensor that may be involved in insulin secretion and/or insulin action. Therefore, PCLO was analyzed as a candidate gene for type 2 diabetes. RESEARCH DESIGN AND METHODS--Sequencing of PCLO identified four nonsynonymous variants and a 10-amino acid insertion. These variants, together with 100 additional variants identified by sequencing or chosen from databases, were genotyped for association analysis in the same 895 subjects analyzed in the prior GWA study (300 case subjects with diabetes onset at aged <25 years, 334 nondiabetic control subjects aged >45 years, and 261 discordant siblings of the case or control subjects for within-family analyses), as well as 415 nondiabetic Pima Indians who had been metabolically phenotyped for predictors of diabetes. Selected variants were further genotyped in a population-based sample of 3,501 Pima Indians. RESULTS--Four variants were modestly associated with early-onset type 2 diabetes in both general and within-family analyses (P = 0.004-0.04, recessive model), where the diabetes risk allele was also nominally associated with a lower insulin-mediated glucose disposal rate (P = 0.009-0.14, recessive model) in nondiabetic Pima Indians. However, their association with diabetes in the population-based sample was weaker (P = 0.02-0.20, recessive model). CONCLUSIONS--Variation within PCLO may have a modest effect on early-onset type 2 diabetes, possibly as a result of reduced insulin action, but has minimal, if any, impact on population-based risk for type 2 diabetes. Diabetes 57:3156-3160, 2008 [ABSTRACT FROM AUTHOR]

Although diabetic nephropathy is a very rare cause of kidney failure during childhood, the underlying events leading to progressive kidney injury begin during childhood in many patients with type 1 diabetes mellitus (T1DM) and in increasing numbers of children with type 2 diabetes mellitus (T2DM). The Pima Indians of Arizona represent an exceptionally thoroughly studied population suffering from very high rates of T2DM and diabetic nephropathy (T2DN). This population well illustrates the often inexorable progression from glomerular hyperfiltration to microalbuminuria to overt proteinuria and loss of glomerular filtration rate (GFR), paralleled by the accumulation of mesangial matrix and basement membrane, glomerular hypertrophy, loss of podocytes and eventual glomerular sclerosis and interstitial fibrosis. Structural changes quantitatively account for the loss of GFR in T2DN. The mechanism of albuminuria (and its relationship to GFR loss) is much less clear. There is strong functional and structural evidence for defects in glomerular size-selectivity (shunts) due to podocyte pathology, but only beginning at relatively high levels of proteinuria (albumin/creatinine ratios > 3000 mg/g). Podocyte loss accompanies, and may underlie, the loss of glomeruli to sclerosis. At this point, most evidence in humans suggests detachment of intact podocytes from the glomerular basement membrane, rather than apoptosis, as the predominant mechanism of podocyte loss. [ABSTRACT FROM AUTHOR]

We introduce multicovariate-adjusted regression (MCAR), an adjustment method for regression analysis, where both the response (Y) and predictors (X1, ..., Xp) are not directly observed. The available data have been contaminated by unknown functions of a set of observable distorting covariates, Z1, ..., Zs, in a multiplicative fashion. The proposed method substantially extends the current contaminated regression modelling capability, by allowing for multiple distorting covariate effects. MCAR is a flexible generalisation of the recently proposed covariate-adjusted regression method, an effective adjustment method in the presence of a single covariate, Z. For MCAR estimation, we establish a connection between the MCAR models and adaptive varying coefficient models. This connection leads to an adaptation of a hybrid backfitting estimation algorithm. Extensive simulations are used to study the performance and limitations of the proposed iterative estimation algorithm. In particular, the bias and mean square error of the proposed MCAR estimators are examined, relative to a baseline and a consistent benchmark estimator. The method is also illustrated with a Pima Indian diabetes data set, where the response and predictors are potentially contaminated by body mass index and triceps skin fold thickness. Both distorting covariates measure aspects of obesity, an important risk factor in type 2 diabetes. [ABSTRACT FROM AUTHOR]

Abstract: Data can be classified according to their properties. Classification is implemented by developing a model with existing records by using sample data. One of the aims of classification is to increase the reliability of the results obtained from the data. Fuzzy and crisp values are used together in medical data. Regarding to this, a new method is presented for classification of data of a medical database in this study. Also a hybrid neural network that includes artificial neural network (ANN) and fuzzy neural network (FNN) was developed. Two real-time problem data were investigated for determining the applicability of the proposed method. The data were obtained from the University of California at Irvine (UCI) machine learning repository. The datasets are Pima Indians diabetes and Cleveland heart disease. In order to evaluate the performance of the proposed method accuracy, sensitivity and specificity performance measures that are used commonly in medical classification studies were used. The classification accuracies of these datasets were obtained by k-fold cross-validation. The proposed method achieved accuracy values 84.24% and 86.8% for Pima Indians diabetes dataset and Cleveland heart disease dataset, respectively. It has been observed that these results are one of the best results compared with results obtained from related previous studies and reported in the UCI web sites. [Copyright &y& Elsevier]