TY - JOUR A1 - Liu, Ruo-Yu A1 - Yan, Huirong A1 - Wang, Xiang-Yu A1 - Shao, Shi A1 - Li, Hui T1 - Gamma-Ray production in the extended halo of the galaxy and possible implications for the origin of galactic cosmic rays JF - The astrophysical journal : an international review of spectroscopy and astronomical physics N2 - Various studies have implied the existence of a gaseous halo around the Galaxy extending out to similar to 100 kpc. Galactic cosmic rays (CRs) that propagate to the halo, either by diffusion or by convection with the possibly existing large-scale Galactic wind, can interact with the gas therein and produce gamma-rays via proton-proton collision. We calculate the CR distribution in the halo and the gamma-ray flux, and explore the dependence of the result on model parameters such as diffusion coefficient, CR luminosity, and CR spectral index. We find that the current measurement of isotropic gamma-ray background (IGRB) at less than or similar to TeV with the Fermi Large Area Telescope already approaches a level that can provide interesting constraints on the properties of Galactic CR (e.g., with CR luminosity L-CR <= 1041 erg s(-1)). We also discuss the possibilities of the Fermi bubble and IceCube neutrinos originating from the proton-proton collision between CRs and gas in the halo, as well as the implication of our results for the baryon budget of the hot circumgalactic medium of our Galaxy. Given that the isotropic gamma-ray background is likely to be dominated by unresolved extragalactic sources, future telescopes may extract more individual sources from the IGRB, and hence put even more stringent restrictions on the relevant quantities (such as Galactic CR luminosity and baryon budget in the halo) in the presence of a turbulent halo that we consider. KW - cosmic rays KW - Galaxy: halo KW - gamma rays: diffuse background KW - neutrinos Y1 - 2019 U6 - https://doi.org/10.3847/1538-4357/aaf567 SN - 0004-637X SN - 1538-4357 VL - 871 IS - 1 PB - IOP Publ. Ltd. CY - Bristol ER - TY - JOUR A1 - Mühlenbruch, Kristin A1 - Zhuo, Xiaohui A1 - Bardenheier, Barbara A1 - Shao, Hui A1 - Laxy, Michael A1 - Icks, Andrea A1 - Zhang, Ping A1 - Gregg, Edward W. A1 - Schulze, Matthias Bernd T1 - Selecting the optimal risk threshold of diabetes risk scores to identify high-risk individuals for diabetes prevention BT - a cost-effectiveness analysis JF - Acta Diabetologica N2 - Aims: Although risk scores to predict type 2 diabetes exist, cost-effectiveness of risk thresholds to target prevention interventions are unknown. We applied cost-effectiveness analysis to identify optimal thresholds of predicted risk to target a low-cost community-based intervention in the USA. Methods: We used a validated Markov-based type 2 diabetes simulation model to evaluate the lifetime cost-effectiveness of alternative thresholds of diabetes risk. Population characteristics for the model were obtained from NHANES 2001-2004 and incidence rates and performance of two noninvasive diabetes risk scores (German diabetes risk score, GDRS, and ARIC 2009 score) were determined in the ARIC and Cardiovascular Health Study (CHS). Incremental cost-effectiveness ratios (ICERs) were calculated for increasing risk score thresholds. Two scenarios were assumed: 1-stage (risk score only) and 2-stage (risk score plus fasting plasma glucose (FPG) test (threshold 100 mg/dl) in the high-risk group). Results: In ARIC and CHS combined, the area under the receiver operating characteristic curve for the GDRS and the ARIC 2009 score were 0.691 (0.677-0.704) and 0.720 (0.707-0.732), respectively. The optimal threshold of predicted diabetes risk (ICER < $50,000/QALY gained in case of intervention in those above the threshold) was 7% for the GDRS and 9% for the ARIC 2009 score. In the 2-stage scenario, ICERs for all cutoffs >= 5% were below $50,000/QALY gained. Conclusions: Intervening in those with >= 7% diabetes risk based on the GDRS or >= 9% on the ARIC 2009 score would be cost-effective. A risk score threshold >= 5% together with elevated FPG would also allow targeting interventions cost-effectively. KW - diabetes mellitus KW - type 2 KW - cost-effectiveness analysis KW - lifestyle risk reduction KW - clinical prediction rule Y1 - 2019 U6 - https://doi.org/10.1007/s00592-019-01451-1 SN - 0001-5563 SN - 0940-5429 SN - 1432-5233 VL - 57 IS - 4 SP - 447 EP - 454 PB - Springer CY - Mailand ER -