bluuebunny/crossref_metadata_2025_split huggingface dataset:
Higher HbA1c Levels Should Be Used to Diagnose Diabetes and Prediabetes in Blacks
Authors: STAIMEZ LISA R. , FORD CHRISTOPHER N. , DANIELS LAUREN , GONZALEZ ADRIANA , KHAN FARAH N. , RHEE MARY , WILSON PETER W. , PHILLIPS LAWRENCE S. 
Published: June 2018

Blacks have higher HbA1c levels than whites with similar glucose levels, suggesting that universal diagnostic criteria could lead to overdiagnosis of diabetes and prediabetes in blacks. We hypothesized alternative HbA1c diagnostic criteria could reduce misclassification in blacks. Data from 3,603 non-Hispanic (NH) white (67.6%) and 1,721 NH black (32.4%), nonpregnant adults (18-70 year) were included from 5 cycles (2005-2014) of the National Health and Nutrition Examination Survey with HbA1c and plasma glucose measures (i.e., fasting and 2 hour from oral glucose tolerance test, OGTT). Diabetes and prediabetes by HbA1c was compared with ’true’ OGTT classification to identify alternative HbA1c values with the lowest misclassification (false positives + false negatives). Survey-weighted rates were computed across a series of HbA1c cutpoints for diabetes (HbA1c ≥5.7 to ≥7.3%) and HbA1c ranges for prediabetes (4.9-5.6% to 6.8-7.5%) in 0.1% increments. By ADA OGTT criteria, the prevalence of diabetes and prediabetes in whites was 4.6% and 42.1%, respectively, and in blacks, 4.2% and 36.9%. Under ADA criteria for diabetes, misclassification was similar in whites (3.7%) and blacks (3.5%), but blacks had 6.3 times the rate of false positives (1.1% blacks vs. 0.2%; p&lt;0.001) and 0.76 times false negatives (57.3 vs. 75.1%, p=0.016). Diabetes misclassification was lowest in whites at HbA1c ≥6.3% (3.4% misclassified) and in blacks at ≥6.9% (3.2%). Prediabetes misclassification was similar in whites (35.8%) and blacks (33.9%), but blacks had 2.8 times the rate of false positives (24.5% vs. 8.6%; p&lt;0.001) and 0.68 times that of whites (50.0 vs. 73.2%, p&lt;0.001). Misclassification was lowest in whites at HbA1c 5.6-6.3% (34.3% misclassified) and in blacks at 5.9-6.6% (31.3%).
Conclusion: Overdiagnosis of diabetes and prediabetes is disproportionately high among NH blacks compared to NH whites. Increasing the HbA1c diagnostic thresholds by 0.3-0.6% for NH blacks could potentially avert 3.2 million false positives.

Disclosure
L.R. Staimez: None. C.N. Ford: None. L. Daniels: None. A. Gonzalez: None. F.N. Khan: None. M. Rhee: None. P.W. Wilson: None. L.S. Phillips: Other Relationship; Self; DIASYST Inc.. Research Support; Self; Amylin Pharmaceuticals, Eli Lilly and Company, Novo Nordisk Inc., Sanofi-Aventis, PhaseBio Pharmaceuticals, Inc., Roche Diabetes Care Health and Digital Solutions, AbbVie Inc., Vascular Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., GlaxoSmithKline plc., Pfizer Inc.. Other Relationship; Self; Novartis Pharmaceuticals Corporation, Merck & Co., Inc..
Duplicate Oral Glucose Tolerance Tests Provide Highly Reproducible Results for the Diagnosis of Diabetes in Africans—The Africans in America Study
Authors: BRIKER SARA M. , KABAKAMBIRA JEAN DAMASCENE , BAKER RAFEAL L. , DUBOSE CHRISTOPHER , MABUNDO LILIAN , CHUNG STEPHANIE T. , UTUMATWISHIMA JEAN N. , SUMNER ANNE E. 
Published: June 2018

With the diabetes epidemic spreading across Africa, undiagnosed diabetes threatens health. As the reproducibility of the OGTT in Africans is not known, the value of using the OGTT to diagnose diabetes (DM) in Africans is uncertain. Therefore, the Africans in America study enrolled 62 blacks (71% male, age 40±11y (mean±SD), BMI 27.8±4.6 kg/m2) who were born in Africa, identified as healthy and currently live in the Washington, DC area. Two OGTT were performed with 11±9 days between tests. The OGTT was used to define normal glucose tolerance (NGT), prediabetes (preDM) and DM. For reproducibility, the κ statistic was used and interpreted by conventional standards (slight 0.00 to 0.20, fair 0.21 to 0.40; substantial 0.61 to 0.80, excellent 0.81 to 1.0). At the 1st OGTT, NGT, preDM and DM were diagnosed in 40%, 26% and 34% of Africans, resp. At the 2nd OGTT, NGT, preDM and DM were diagnosed in 40%, 32% and 27%, resp. When all 3 glucose tolerance categories were considered, the κ statistic was 0.76. Dividing the cohort into 2 groups (with and without DM), the κ statistic increased to 0.85. Furthermore, no one diagnosed with DM on the first 1st OGTT was diagnosed with NGT on the 2nd OGTT (Table). In addition, no one without DM on the 1st OGTT was diagnosed with DM on the 2nd OGTT (Table). Based on data from Africans living in America, the OGTT is highly reproducible for the detection of DM.

Disclosure
S.M. Briker: None. J. Kabakambira: None. R.L. Baker: None. C. DuBose: None. L. Mabundo: None. S.T. Chung: None. J.N. Utumatwishima: None. A.E. Sumner: None.
Novel Nomogram for Screening the Risk of Developing Diabetes in a Korean Population
Authors: CHUNG SEUNG MIN , MOON JUN SUNG , YOON JI SUNG , WON KYU CHANG 
Published: June 2018

Aims: We propose a novel nomogram, which graphically expresses the numerical relationship between type 2 diabetes (T2D) and disease-related risk factors.
Methods: Data of 8999 patients from the 2013-2014 Korean National Health and Nutrition Examination Survey were analyzed. Multiple logistic regression analysis was performed to assess risk factors for T2D and a nomogram was constructed based on screened risk factors. A receiver operating curve (ROC) and calibration plot were created to evaluate the accuracy of the nomogram.
Results: The risk factor with the greatest impact on the incidence of T2D was age over 60 years (OR=9.458), followed by presence of dyslipidemia and cardiovascular disease (OR=8.981), family history of T2D (OR=2.916), abdominal obesity (OR=1.759), hypertension (OR=1.747), male gender (OR=1.549), current-smoking status (OR=1.523), lower education level (OR=1.417), and lower income (OR=1.300). The area under the ROC curve (AUC) showed statistically significant determination (AUC=0.826). The equation of the calibration plot was drawn along the ideal line; coefficient of determination was 0.864.
Conclusion: Our proposed nomogram could accurately predict the incidence risk of T2D from nationwide data. The novel nomogram can be a useful tool for screening patients with T2D incidence in a Korean population.

Disclosure
S. Chung: None. J. Moon: None. J. Yoon: None. K. Won: None.
Hypertension Is Associated with a Higher Progression Rate of Insulin Resistance and the Incidence of Diabetes
Authors: LIN CHIA-HUNG , LI HUNG-YUAN 
Published: June 2018

Background: Hypertension is a risk factor of diabetes. However, the underlying mechanisms are not fully elucidated. Therefore, we investigated this issue in a prospective cohort in Taiwan.
Methods: A total of 1177 subjects without diabetes at baseline were enrolled from 20to 2016 at National Taiwan University Hospital Yun-Lin branch with a median follow-up period of 4.5 years. Diabetes was diagnosed by the results of OGTT and HbA1c, or if antidiabetic agents were used. Insulin resistance index by the Homeostatic model assessment 2 (HOMA2-IR) were used to estimate insulin resistance.
Results: Subjects with hypertension by the JNC7 criteria had higher HOMA-IR at baseline and was associated with increased incidence of diabetes, adjusted for HOMA2-%B, HOMA2-IR, BMI, HbA1c, plasma triglyceride, age, gender, family history of diabetes and plasma CRP (adjusted HR 1.51, 95% CI 1.04-2.20, p=0.030). Subjects with treated hypertension had the highest risk of diabetes, followed by subjects with newly-diagnosed hypertension, compared with subjects with pre-hypertension and normal subjects. The progression rate of HOMA2-IR every 5 years (δHOMA2-IR/5 year) was higher in subjects with hypertension than in subjects without hypertension (adjusted p=0.001). Subjects with treated hypertension had the highest δHOMA2-IR/5 year, followed by subjects with newly-diagnosed hypertension, compared with normal subjects (adjusted p for trend=0.05). However, hypertension by the 2017 ACC/AHA criteria was not significantly associated with incident diabetes in adjusted models. The δHOMA2-IR/5 year for hypertension by this criteria was lower than that by the JNC7 criteria.
Conclusion: Hypertension is associated with an accelerated progression of insulin resistance and an increased risk of diabetes. Application of 2017 ACC/AHA criteria for hypertension attenuates the associations.

Disclosure
C. Lin: None. H. Li: None.
Copeptin as a Novel Biomarker of Obesity-Induced Insulin Resistance and Metabolic Syndrome
Authors: ELTABAKH SOAD M.M. , ZEIDAN MOHAMED , MAGED HALA , ZIKRY MAGDY , KHEDR MARWA 
Published: June 2018

The objective of the study was to evaluate whether circulating Copeptin could be used as a novel biomarker associated with measures of insulin resistance and presence of metabolic syndrome in obese individuals. The study was carried out on three groups: G1: Twenty obese individuals with metabolic syndrome, G2: Twenty age-matched obese adults without metabolic syndrome, and G3: control group: Twenty age-matched non obese healthy adult voluntrrers. Both group (1) and (2) were selected to be obese with Body Mass Index (BMI) is greater than 30kg/m2. All groups were subjected to: complete physical examination, assessment of metabolic syndrome criteria according to the National Heart, Lung and Blood Institute (NHLBI) and the American Heart Association (AHA), fasting plasma glucose (FPG), fasting insulin, lipid profile, assessment of insulin resistance by HOMA-IR and measurement of plasma Copeptin level using ELISA technique. The results of Plasma Copeptin levels were significantly increased in G1 than the other two groups (median 38.30 ng/ml for G1 vs. 25.and 23.00 in G2 and G3 respectively, P &lt; 0.001). Evident Positive correlation were found between plasma Copeptin level and HOMA-IR, FBG, TG, WC and BMI, and Negative correlation with HDL level (P &lt;0.for HOMA-IR and FPG; P &lt; 0.01 for TG, WC, BMI, and HDL). The area under the receiver-operating characteristic curve (AUC) for Copeptin was 0.79 (95% confidence interval, CI:0.67 to 0.89).
Conclusion: Our results suggest that circulating Copeptin could be used as a possible biomarker of obesity-induced insulin resistance that provide diagnostic advantage to measures of metabolic syndrome. Further prospective multi center studies on a large scale of cases are needed.

Disclosure
S.M.M. Eltabakh: None. M. Zeidan: None. H. Maged: None. M. Zikry: None. M. Khedr: None.
Circulating Metabolites and the Risk of Type 2 Diabetes—A Prospective Study of 10,938 Young Adults from Four Finnish Cohorts
Authors: AHOLA-OLLI ARI V. , MUSTELIN LINDA , KALIMERI MARIA , KETTUNEN JOHANNES , JOKELAINEN JARI J. , AUVINEN JUHA , PUUKKA KATRI S. , HAVULINNA AKI S. , LEHTIMÄKI TERHO , KÄHÖNEN MIKA , SALOMAA VEIKKO , PEROLA MARKUS , JARVELIN MARJO-RIITTA , ALA-KORPELA MIKA , WURTZ PETER 
Published: June 2018

Background: Advances in metabolomics have allowed high-throughput metabolic profiling of large population samples. We aimed to identify circulating lipids and metabolites predictive of the risk for type 2 diabetes in young adults.
Methods: Nuclear magnetic resonance metabolomics was used to quantify 229 metabolic measures in 10,938 individuals from four Finnish cohorts (mean age 35 years, range 24-45). Associations between baseline metabolites and diabetes onset during 7-15 years of follow-up (330 incident cases) were assessed by logistic regression adjusted for sex, baseline age and glucose.
Findings: Out of 229 metabolic measures, 174 were associated with risk for incident diabetes in meta-analysis of the four cohorts (P&lt;0.001; range of odds ratios (OR) per 1-SD: 0.41-1.85). Among the strongest biomarkers were increased concentrations of branched-chained and aromatic amino acids (OR: 1.54-1.74) and triglycerides in very-low-density lipoproteins (VLDL; OR 1.78), and lower levels of omega-6 fatty acids (OR 0.61) and free cholesterol within large high-density lipoprotein (HDL; OR 0.41). A biomarker score was derived in three of the cohorts, comprised of phenylalanine, free cholesterol in large HDL, and the ratio of cholesterol esters to total lipids in large VLDL. When validated in the fourth cohort, those in the upper quartile of the biomarker score had considerably higher 15-year-risk for diabetes compared to those in the lowest quartile (OR 16.1).
Interpretation: Metabolic aberrations across multiple molecular pathways are predictive of the long-term risk of type 2 diabetes in young adults. Comprehensive metabolic profiling may facilitate targeting preventive interventions at young asymptomatic individuals at increased risk for type 2 diabetes.

Disclosure
A.V. Ahola-Olli: None. L. Mustelin: Employee; Self; Nightingale Health Ltd. M. Kalimeri: Employee; Self; Nightingale Health Oy. J. Kettunen: Other Relationship; Self; Nightingale Ltd. J.J. Jokelainen: None. J. Auvinen: None. K.S. Puukka: None. A.S. Havulinna: None. T. Lehtimäki: None. M. Kähönen: None. V. Salomaa: Other Relationship; Self; Novo Nordisk Inc.. M. Perola: None. M. Jarvelin: None. M. Ala-Korpela: None. P. Wurtz: Employee; Self; Nightingale Health. Stock/Shareholder; Self; Nightingale Health.
Impact of “Mismatches” in HbA1c vs. Glucose on Diagnosis as Diabetes or Prediabetes
Authors: GONZALEZ ADRIANA , CUI XIANGQIN , STAIMEZ LISA R. , FORD CHRISTOPHER N. , KHAN FARAH N. , WILSON PETER W. , PHILLIPS LAWRENCE S. , RHEE MARY 
Published: June 2018

HbA1c is widely used for diagnosis and management of diabetes and prediabetes, but HbA1c may be high or low relative to underlying glucose levels in different individuals-“mismatches.” We hypothesized that “high mismatches” could lead to overdiagnosis, and “low mismatches” to underdiagnosis of diabetes and prediabetes. We pooled 31generally healthy subjects without known diabetes from the Screening for Impaired Glucose Tolerance study (n=1571) and the VA Screening for Diabetes study (n=1535); each had a 75g OGTT and a 50g glucose challenge on separate days. Subjects were 66% male, 65% black, with mean age 52 year, BMI 30 kg/m2 and HbA1c 5.6%. By ADA OGTT criteria, 56% had normal glucose metabolism (NGM, FPG &lt;100 and 2hPG &lt;140), 37% had prediabetes (PreDM), and 7% had T2DM (FPG &gt;125 or 2hPG &gt;199). To approximate glucose levels during the day, we took the mean of each subject’s OGTT FPG and 2hPG, and 1 hPG after 50 g glucose. Linear regression was used to derive [predicted HbA1c = 0.0078*GLUC + 4.70], from which the HbA1c Glycation Index (HGI) for each subject was expressed as [observed-predicted HbA1c]. Subjects were divided into tertiles according to their HGI levels: “high mismatch” (high HGI), “no mismatch” (mod HGI), and “low mismatch” (low HGI). The “high mismatch” group was enriched in African-Americans (84%) and males (78%) but otherwise clinically comparable, all p&lt;0.001. By ADA OGTT criteria, the distribution of NGM, PreDM, and T2DM (55%, 37%, 7%, resp) was comparable across HGI tertiles. However, by ADA HbA1c criteria, the “no mismatch” group had 67% NGM, 32% PreDM, and 1% T2DM, but “high mismatches” were 7% NGM, 80% PreDM, and 13% T2DM-mostly abnormal, and “low mismatches” were 96% NGM, 4% PreDM, and 0% T2DM-mostly normal.
Conclusion: “Mismatches” in HbA1c vs. glucose are common, and could lead to errors if the diagnosis is based only on HbA1c - overdiagnosis in “high mismatches”, and underdiagnosis in “low mismatches.” FPG and/or OGTT should be used to complement HbA1c in diagnosing diabetes and prediabetes.

Disclosure
A. Gonzalez: None. X. Cui: None. L.R. Staimez: None. C.N. Ford: None. F.N. Khan: None. P.W. Wilson: None. L.S. Phillips: Other Relationship; Self; DIASYST Inc.. Research Support; Self; Amylin Pharmaceuticals, Eli Lilly and Company, Novo Nordisk Inc., Sanofi-Aventis, PhaseBio Pharmaceuticals, Inc., Roche Diabetes Care Health and Digital Solutions, AbbVie Inc., Vascular Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., GlaxoSmithKline plc., Pfizer Inc.. Other Relationship; Self; Novartis Pharmaceuticals Corporation, Merck & Co., Inc.. M. Rhee: None.
Screening for Cystic Fibrosis–Related Diabetes and Prediabetes—Evaluating 1,5-Anhydroglucitol, Fructosamine, Glycated Albumin, and Hemoglobin A1c
Authors: TOMMERDAHL KALIE L. , BRINTON JOHN T. , VIGERS TIM B. , NADEAU KRISTEN J. , ZEITLER PHIL , CHAN CHRISTINE L. 
Published: June 2018

Dysglycemia in the cystic fibrosis (CF) population is widespread and screening via oral glucose tolerance tests (OGTT) can be burdensome. Our primary aim was to investigate 1,5-anhydroglucitol (1,5AG), fructosamine (FA), glycated albumin (%GA), and hemoglobin A1c (HbA1c) as screening tests for cystic fibrosis-related prediabetes (CFPD) and cystic fibrosis-related diabetes (CFRD) in youth with CF as defined by the OGTT 2-hour glucose (2hG). Our secondary aim was to determine if alternate screening tests can identify those with better or worse lung function (forced expiratory volume in 1 second, FEV1%; forced vital capacity, FVC%). Youth 10-18 years with CF had 1,5AG, FA, %GA, HbA1c, and a 2 hour OGTT collected during a single study visit. Pearson’s correlation coefficient determined the correlation between all 4 glycemic estimates and 2hG. Receiver Operative Characteristic (ROC) curves were generated. The Youden Index determined optimal cut points for predicting CFPD (2hG≥140-200 mg/dL) and CFRD (2hG≥200 mg/dL). Lung function measures above and below these cutpoints were compared. Fifty-eight youth with CF participated (2hG&lt;140, n=31; CFPD, n=17; CFRD, n=10; mean age 14±3.5 years, 43% male, BMI z-score 0.0±0.8, FEV1% 90±15.0, FVC% 99±14.1). FA, %GA, and HbA1c correlated with 2hG (p-&lt;0.05). ROC area under the curves (ROC-AUCs) for all 4 alternate markers were low for both CFPD (0.53-0.67) and CFRD (0.56-0.66). HbA1c had the highest ROC-AUC of 0.66 (95% CI: 0.47-0.84) for identifying CFRD and 0.67 (95% CI: 0.53-0.8) for CFPD. When lung function was compared stratifying above and below the Youden cutpoint for CFRD, only HbA1c identified significant differences in FVC% (105% vs. 96%, p=0.02); FEV1% was not statistically significant (96% vs. 88%, p=0.06). All 4 alternate markers had poor diagnostic accuracy for identifying CFRD by 2hG, although HbA1c may be useful in detecting CFPD and in stratifying individuals with CF by lung function.

Disclosure
K.L. Tommerdahl: None. J.T. Brinton: None. T.B. Vigers: None. K.J. Nadeau: None. P. Zeitler: Consultant; Self; Daiichi Sankyo Company, Limited, Merck & Co., Inc., Eli Lilly and Company, Takeda Development Center Americas, Inc., Boehringer Ingelheim GmbH. C.L. Chan: None.
Racial/Ethnic Disparities in the Prevalence of Diabetes and Prediabetes among Four Million Overweight and Obese Adults in the U.S.
Authors: ZHU YEYI , ARTERBURN DAVID , DALEY MATTHEW F. , DESAI JAY R. , FITZPATRICK STEPHANIE L. , HORBERG MICHAEL A. , KOEBNICK CORINNA , MCCORMICK EMILY V. , OSHIRO CARYN , YOUNG DEBORAH R. , FERRARA ASSIAMIRA 
Published: June 2018

Racial/ethnic disparities in diabetes remain a persistent public health concern. We aimed to examine racial/ethnic disparities in the prevalence of diabetes and prediabetes by body mass index (BMI) category, in a large racial/ethnically and regionally diverse cohort of overweight and obese insured adults in the U.S. Data were from the Patient Outcomes Research to Advance Learning (PORTAL) network-Overweight and Obese Cohort, a consortium of 3 integrated health care systems. A total of 4,490,649 members (50% white, 22.7% Hispanic, 11.3% black, 10.6% Asian, 1.4% Native Hawaiian/Other Pacific Islander, 0.6% American Indian/Alaskan Native, and 4.3% other/unknown) aged ≥18 years during 2012 or 2013, with a BMI ≥23.0 kg/m2 were included. Ascertainment of diabetes and prediabetes were based on diagnosis codes, medication use, and laboratory results according to the ADA criteria. Age-adjusted prevalence was derived by BMI and racial/ethnic groups. Overall, the age-standardized prevalence of diabetes and prediabetes was 17.5% and 34.5%, respectively. A linear increasing trend was observed in prevalence of diabetes and prediabetes across BMI categories within racial/ethnic groups (all P-for-trend &lt;0.001), except for prediabetes among Asian and Native Hawaiian/Other Pacific Islander, who tended to have a higher prevalence of diabetes and prediabetes compared to white across BMI categories, even more pronounced at a lower BMI. At BMI 23.0-24.9 kg/m2, the age-standardized prevalence of diabetes among Asians was 16.9%, comparable to that among white at BMI 30.0-34.9 kg/m2; the age-standardized prevalence of prediabetes was 37.3% among Asians at BMI 23.0-24.9 kg/m2, even higher than that among white at BMI ≥50.0 kg/m2.
In conclusion, disproportional impact of BMI on diabetes and prediabetes among minority groups highlight the importance of tailored screening, prevention, and intervention strategies to mitigate the risk of diabetes and prediabetes.

Disclosure
Y. Zhu: None. D. Arterburn: None. M.F. Daley: None. J.R. Desai: None. S.L. Fitzpatrick: None. M.A. Horberg: None. C. Koebnick: None. E.V. Mccormick: None. C. Oshiro: None. D.R. Young: None. A. Ferrara: None.
Plasma Lipidomic Profiles in Relation to Incident Type 2 Diabetes among Women with a History of Gestational Diabetes Mellitus
Authors: LI JUN , LIANG LIMING , HU FRANK , ZHANG CUILIN , TOBIAS DEIRDRE 
Published: June 2018

Background: Dyslipidemia is a risk factor of type 2 diabetes (T2D). Women with a history of gestational diabetes (GDM) have a greater T2D risk; however, whether lipids patterns contribute to risk of progression remains unclear.
Methods: We conducted a nested case-control study of incident T2D among women enrolled in the Nurses’ Health Study II reporting a history of GDM prior to the first blood collection (1995-1999) and followed-up through 2013. Plasma lipidomics containing 180 metabolites were measured in a subset of 175 incident cases and 176 age-matched controls by liquid chromatography-mass spectrometry. We constructed lipid networks using a weighted-correlation algorithm, and examined the association of individual lipids and sub-networks with T2D risk using logistic regression, adjusting for established T2D risk factors.
Results: We identified 39 lipids species significantly associated with T2D risk (FDR&lt;0.05), and observed different association patterns (in which associations were differed by numbers of carbon and double-bonds) across various lipid classes. We constructed 5 co-regulating lipid sub-networks, one of which (featuring the interactions between diacylglycerol, triacylglycerol, and phosphatidylethanolamine with mid-length carbon and less double-bonds) was significantly associated with incident T2D risk (odds ratio for increasing quartiles was 1 [reference], 2.4, 3.4, and 4.4; P-trend=0.0008). The addition of significant lipid species to a base model (13 traditional risk factors and medications) to predict incident T2D increased the c-statistics from 0.83 to 0.90 (P=0.001) with a corresponding categorical net reclassification index of 0.27 (P&lt;0.001) in cross-validation.
Conclusions: The dysregulation of certain lipid specie/class may contribute to a higher risk of incident T2D after a GDM pregnancy. Plasma lipid species and the network signatures may aid future clinical risk assessment and targeted interventions.

Disclosure
J. Li: None. L. Liang: None. F. Hu: None. C. Zhang: None. D. Tobias: None.