Modifiable Barriers to Optimal Outcomes in Gout Management

Improving patient outcomes in chronic disease is of critical importance to the future of health care. Gout, affecting 4% of the US population, is a highly treatable chronic disease from which patients experience unnecessarily suboptimal outcomes. In this dissertation, I demonstrate how interrelated patient and provider factors affect patient outcomes in gout. First, I describe how only 14% of gout patients know their serum urate (SU) goal for urate lowering therapy (ULT) despite otherwise being knowledgeable about gout and its treatment. I then demonstrate the importance of multiple patient and provider factors in achieving SU goal. Specifically, I demonstrate that ULT medication adherence, ULT dose escalation and a high ULT starting dose are associated with SU goal attainment. However, I show that a high starting dose is also associated with worse SU goal attainment through its negative impact on medication adherence. These findings demonstrate not only the importance of patient and provider behaviors in achieving optimal outcomes, but also their interrelated nature. Finally, I report that there is no evidence from a large national study that ULT dose escalation reduces mortality among gout patients. In further analysis, I demonstrate that the lack of evidence could be due to inadequate final ULT doses observed even among patients receiving dose escalation. Importantly, the patient and provider factors I identify in this work are all modifiable. Future interventions should address the broad care context outlined in the Chronic Care Model to target these interrelated, modifiable factors and achieve optimal outcomes in gout

A computer operated mass spectrometer system

Digital computer system for processing mass spectrometer output dat

Computer control of mass analyzers

Digital computer control of mass spectrometer

Multiple Cyclotron Lines in the Spectrum of 4U 0115+63

We report phase resolved spectroscopy of the transient accreting pulsar, 4U0115+63. For the first time, more than two cylotron resonance scattering features are detected in the spectrum of an X-ray pulsar. The shape of the fundamental line appears to be complex, and this is in agreement with predictions of Monte-Carlo models. As in other pulsars, the line energies and optical depths are strong functions of pulse phase. One possible model for this is an offset of the dipole of the neutron star magnetic field.Comment: 5 pages. To appear in "Proceedings of the 5th Compton Symposium

New direction for gamma-rays

The origin of energetic gamma-ray bursts is still unknown. But the detection of polarization of gamma-rays provides fresh insight into the mechanism driving these powerful explosions.Comment: Nature "News & Views", RE Coburn & Boggs (astro-ph/0305377

Discovery of a Cyclotron Resonance Scattering Feature in the X-ray Spectrum of XTE J1946+274

Observations of the transient accreting pulsar XTE J1946+274 made with the Rossi X-ray Timing Explorer during the course of the 1998 September-November outburst, reveal a cyclotron resonance scattering feature (or "cyclotron line") in the hard X-ray spectrum near 35 keV. We determine a centroid energy of 36.2 +0.5/-0.7 keV, which implies a magnetic field strength of 3.1(1+z)x10^12 G, where z is the gravitational redshift of the scattering region. The optical depth, Tau = 0.33 +0.07/-0.06, and width, sigma = 3.37 +0.92/-0.75 keV, are typical of known cyclotron lines in other pulsars. This discovery makes XTE J1946+274 one of thirteen pulsars with securely detected cyclotron lines resulting in direct magnetic field measurements.Comment: Five pages including four postscript figures and two tables. Uses emulateapj5. Published in ApJ Letters: http://adsabs.harvard.edu/cgi-bin/nph-bib_query?bibcode=2001ApJ...563L..35

The Effects of Eight Weeks of Leucine/Whey Protein Supplementation and Resistance Training on Isokinetic Peak Torque

Resistance training can lead to significant increases in muscle size and strength. Supplementing the diet with leucine and whey protein purportedly increases protein synthesis, potentially accelerating the processes involved with hypertrophy and strength increases. PURPOSE: To examine the effects of leucine and whey protein supplementation during 8 weeks of unilateral dynamic constant external resistance (DCER) training on isokinetic peak torque. METHODS: Thirty-five men (mean age ± SD = 22.3 ± 2.3 y) volunteered to participate in this investigation. Participants were randomly assigned to one of three groups: supplement (SUPP), placebo (PLA), or control (CON). The SUPP and PL participants then trained the leg extensors of the dominant limb (based on kicking preference) three times per week for eight weeks. Leg extension peak torque was determined for all participants pretraining and post training at 0, 60, 120, 180, 240, and 300°.s-1 using an isokinetic dynamometer. RESULTS: The results indicated there was no significant time × velocity × group interaction (p = 0.55). There was, however, a significant time × group interaction. Both the SUPP group (p \u3c 0.001) and the PLA group (p = 0.02) demonstrated significant increases in peak torque from pretraining to post training, while the CON group did not (p = 0.59). There was no difference in the magnitude of the gain in isokinetic peak torque between the SUPP and PLA groups (p = 0.62). CONCLUSION: Isokinetic peak torque increased significantly following 8 weeks of DCER training. However, the increase in peak torque was not augmented by leucine and whey protein supplementation