Treatment of type 2 diabetes by patient profile in the clinical practice of endocrinology in Spain: Delphi study results from the think twice program

Introduction: The aim of this Delphi study is to unveil the management of patients with type 2 diabetes (T2D) and different levels of complexity in the clinical practice in Spain. Methods: Based on the common management practices of T2D profiles reported by Spanish endocrinologists, a Delphi questionnaire of 55 statements was developed and responded to by a national panel (n = 101). Results: A consensus was reached for 30 of the 55 statements. Regarding overweight patients inadequately controlled with metformin, treatment with a sodium-glucose transport protein 2 inhibitor (SGLT2-I) is preferred over treatment with a dipeptidyl peptidase-4 inhibitor (DPP4-I). If the patient is already being treated with a DPP4-I, an SGLT2-I is added on to the treatment regimen rather than replacing the DPP4-I. Conversely, if the treatment regimen includes a sulfonylurea, it is usually replaced by other antihyperglycemic agents. Current treatment trends in uncontrolled obese patients include the addition of an SGLT2-I or a glucagon-like peptide-1 receptor agonist (GLP1-RA) to background therapy. When the glycated hemoglobin target is not reached, triple therapy with metformin ? GLP1-RA ? SGLT2-I is initiated. Although SGLT2-Is are the treatment of choice in patients with T2D and heart failure or uncontrolled hypertension, no consensus was reached regarding the preferential use of SGLT2- Is or GLP1-RAs in patients with established cardiovascular disease. Conclusion: Consensus has been reached for a variety of statements regarding the management of several T2D profiles. Achieving a more homogeneous management of complex patients with T2D may require further evidence and a better understanding of the key drivers for treatment choice

Comparisons between Cambrian Lagerstätten assemblages using multivariate, parsimony and Bayesian methods

© 2017 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 24 month embargo from date of publication (Dec 2017) in accordance with the publisher’s archiving policyExceptional fossil deposits exhibiting soft-part preservation, or Konservat-Lagerstätten, are prevalent in Cambrian rocks and provide detailed information on fossil assemblages not available from conventional deposits. It has long been recognised that many of these assemblages exhibit certain taxonomic similarities, with many elements seemingly having cosmopolitan distributions. These types of assemblages, particularly those of Cambrian age, have become known as Burgess Shale-type (BST) biotas, named for the famous deposit in the Canadian Rocky Mountains where fossils preserved in this way were first discovered. This study provides the first broad-scale analysis of the assemblage relationships between all major BST biotas. We compiled a database of the presences and absences of over 600 genera within 12 Lagerstätten from Laurentia, Siberia, South China and East Gondwana, ranging in age from Cambrian Series 2 through Series 3 (late-early to middle Cambrian; c. 518–502 Ma), and analysed this using a variety of quantitative methods in order to investigate the relationships between these sites. Non-metric multidimensional scaling (NMDS) ordination, cluster analysis and Parsimony Analysis of Endemicity (PAE) were used to group localities and examine relationships. We also used Bayesian inference and illustrate the benefits of this approach to biogeographic studies. Results suggest that both space and time have important effects on the taxonomic constitution of BST biotas, and that the similarity of these assemblages appears to increase from Series 2 through Series 3, largely driven by increases in cosmopolitanism of biomineralised taxa such as trilobites and brachiopods. There is also evidence of higher-level taxonomic turnover across this period. Endemic taxa help amplify these patterns, despite their frequent exclusion from biogeographic analyses

Stability of inflationary solutions driven by a changing dissipative fluid

In this paper the second Lyapunov method is used to study the stability of the de Sitter phase of cosmic expansion when the source of the gravitational field is a viscous fluid. Different inflationary scenarios related with reheating and decay of mini-blackholes into radiation are investigated using an effective fluid described by time--varying thermodynamical quantities.Comment: 17 pages, LaTeX 2.09, 2 figures. To be published in Classical and Quantum Gravit

Modeling discards in Trawling Mediterranean Northern Alboran Sea Fishery

Target and Bycatch species metrics estimated from fishery-dependent data were explored to assess their use in governance of habitat conservation in respect to fisheries. Fishing data collected by onboard observers in otter-trawl boats between 2011 and 2012 at monthly sampling frequency in the Alboran Sea (Western Mediterranean) were used to build maps of sensitivity to fishing stress. Maps were drawn by means kriging interpolation techniques of biomass and abundance (Catch Per Unit of Effort, CPUE) in kilogram and number per fishing hour of blue whiting (Micromesistius poutassou), European hake (Merluccius merluccius), and red mullets (Mullus barbatus and Mullus surmuletus) target species, seabreams (Pagellus acarne, Pagellus bogaraveo, and Pagellus erythrinus), and mackerels (Trachurus mediterraneus, Trachurus trachurus, and Trachurus picturatus) bycatch species and Bogue (Boops boops) bycatch discarded species. Modelling discards by means Generalised Additive Models (GAMs) use environmental (sea surface temperature and chlorophyll-a from satellite data and NAO climatic index); spatial (latitude, longitude, depth and port) and temporal (season, haul duration, moon phase), as well as technical (boat length and power) explanatory variables. The main causes of discards, for both target and bycatch species, are associated to the seasonality of the recruitment and the changes on the spatial distribution of habitat preferences along their ontogeny. Environmental variables did not reveal significant effects, showing that operational oceanography standard products must be not enough to assess discards, and therefore products providing information on specific ecological processes to discards must be designed with this purpose. In Bycatch species, such as sea breams, mackerels and bogue, discards were also highly dependent of the port and boat (fleet/boat strategies, power, etc, and market preferences). The higher discards corresponded to these bycatch pelagic or bentho-pelagic species. Keywords: Discards, Otter-trawl fisheries, fishery conservation, operational oceanography, spatial modelin

Warped Reheating in Multi-Throat Brane Inflation

We investigate in some quantitative details the viability of reheating in multi-throat brane inflationary scenarios by estimating and comparing the time scales for the various processes involved. We also calculate within perturbative string theory the decay rate of excited closed strings into KK modes and compare with that of their decay into gravitons; we find that in the inflationary throat the former is preferred. We also find that over a small but reasonable range of parameters of the background geometry, these KK modes will preferably tunnel to another throat (possibly containing the Standard Model) instead of decaying to gravitons due largely to their suppressed coupling to the bulk gravitons. Once tunneled, the same suppressed coupling to the gravitons again allows them to reheat the Standard Model efficiently. We also consider the effects of adding more throats to the system and find that for extra throats with small warping, reheating still seems viable.Comment: 29 pages, 4 figures, discussions on closed string decay expanded, references adde

Planck 2013 results. XXII. Constraints on inflation

We analyse the implications of the Planck data for cosmic inflation. The Planck nominal mission temperature anisotropy measurements, combined with the WMAP large-angle polarization, constrain the scalar spectral index to be ns = 0:9603 _ 0:0073, ruling out exact scale invariance at over 5_: Planck establishes an upper bound on the tensor-to-scalar ratio of r < 0:11 (95% CL). The Planck data thus shrink the space of allowed standard inflationary models, preferring potentials with V00 < 0. Exponential potential models, the simplest hybrid inflationary models, and monomial potential models of degree n _ 2 do not provide a good fit to the data. Planck does not find statistically significant running of the scalar spectral index, obtaining dns=dln k = 0:0134 _ 0:0090. We verify these conclusions through a numerical analysis, which makes no slowroll approximation, and carry out a Bayesian parameter estimation and model-selection analysis for a number of inflationary models including monomial, natural, and hilltop potentials. For each model, we present the Planck constraints on the parameters of the potential and explore several possibilities for the post-inflationary entropy generation epoch, thus obtaining nontrivial data-driven constraints. We also present a direct reconstruction of the observable range of the inflaton potential. Unless a quartic term is allowed in the potential, we find results consistent with second-order slow-roll predictions. We also investigate whether the primordial power spectrum contains any features. We find that models with a parameterized oscillatory feature improve the fit by __2 e_ _ 10; however, Bayesian evidence does not prefer these models. We constrain several single-field inflation models with generalized Lagrangians by combining power spectrum data with Planck bounds on fNL. Planck constrains with unprecedented accuracy the amplitude and possible correlation (with the adiabatic mode) of non-decaying isocurvature fluctuations. The fractional primordial contributions of cold dark matter (CDM) isocurvature modes of the types expected in the curvaton and axion scenarios have upper bounds of 0.25% and 3.9% (95% CL), respectively. In models with arbitrarily correlated CDM or neutrino isocurvature modes, an anticorrelated isocurvature component can improve the _2 e_ by approximately 4 as a result of slightly lowering the theoretical prediction for the ` <_ 40 multipoles relative to the higher multipoles. Nonetheless, the data are consistent with adiabatic initial conditions

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO