Patterns of Adherence to Oral Hypoglycemic Agents: Patterns, Correlates, and Outcomes

Despite the development of effective pharmacological therapy to prevent both macrovascular and microvascular complications and adverse events, diabetes control remains sub-optimal. Poor adherence to recommended regimens is a causal factor in preventable morbidity and mortality in diabetic patients. Sub-groups of patients with differing longitudinal profiles of adherence may yield differing treatment outcomes. Identifying characteristics associated with longitudinal profiles can potentially alert clinicians to patients at risk for poor clinical outcomes allowing for early intervention and follow-up. Furthermore, few studies have examined the role of adherence improvements as a mediator of intervention effect on glycemic control. In this work we sought to identify patterns, correlates and outcomes of adherence to oral hypoglycemic agents. We also assessed whether adherence improvements mediated a brief interventions effect on glycemic control. Longitudinal analysis via growth curve mixture modeling was carried out to classify 180 patients who participated in an adherence intervention according to patterns of adherence to oral hypoglycemic agents across 12 weeks. Adherence was assessed using the Medication Event Monitoring System. Hemoglobin A1c assays were used to measure glycemic control as the clinical outcome. Individual patient residential data was geo-coded at the tract level. Three patterns of adherence to oral hypoglycemic agents were identified: adherent, increasing adherence, and nonadherent. Both individual and neighborhood level factors were identified that were associated with patterns of adherence. Patients with an increasing adherence pattern were more likely to have a Hemoglobin A1c (HbA1c) \u3c 7% (adjusted odds ratio = 14.52, 95% CI [2.54, 82.99]) at 12 weeks in comparison with patients with the nonadherent pattern. Across the whole sample, longitudinal adherence profiles mediated 35.2 % (13.2, 81.0 %) of the effect of a brief adherence intervention on glycemic control [from odds ratio (OR) = 8.48, 95 % confidence interval (CI) (3.24, 22.2) to 4.00, 95 % CI (1.34, 11.93)]. These findings imply that the identification of patients with type 2 diabetes at risk of nonadherence is important for clinical prognosis and the development and delivery of interventions

Mass accretion rate of the galactic black hole A0620-00 in its quiescent state

Our recent radio observation using the Giant Meter Radio Telescope (GMRT) of the galactic black hole transient A0620-00 at 1.280GHz revealed a micro-flare of a few milli-Jansky. Assuming an equipartition of magnetic energy and the gravitational potential energy of accreting matter, it is possible to estimate the upper limit of the accretion rate. Assuming a black hole mass of $10M_\odot$ residing at the center, we find this to be at the most ${\dot M} = (8.5 \pm 1.4) \times 10^{-11} M_\odot$ yr$^{-1}$. This is consistent with earlier estimates of accretion rates based on optical and X-ray observations.Comment: 3 pages 1 figur

Having a direct look:analysis of DNA damage and repair mechanisms by next generation sequencing

AbstractGenetic information is under constant attack from endogenous and exogenous sources, and the use of model organisms has provided important frameworks to understand how genome stability is maintained and how various DNA lesions are repaired. The advance of high throughput next generation sequencing (NGS) provides new inroads for investigating mechanisms needed for genome maintenance. These emerging studies, which aim to link genetic toxicology and mechanistic analyses of DNA repair processes in vivo, rely on defining mutational signatures caused by faulty replication, endogenous DNA damaging metabolites, or exogenously applied genotoxins; the analysis of their nature, their frequency and distribution. In contrast to classical studies, where DNA repair deficiency is assessed by reduced cellular survival, the localization of DNA repair factors and their interdependence as well as limited analysis of single locus reporter assays, NGS based approaches reveal the direct, quantal imprint of mutagenesis genome-wide, at the DNA sequence level. As we will show, such investigations require the analysis of DNA derived from single genotoxin treated cells, or DNA from cell populations regularly passaged through single cell bottlenecks when naturally occurring mutation accumulation is investigated. We will argue that the life cycle of the nematode Caenorhabditis elegans, its genetic malleability combined with whole genome sequencing provides an exciting model system to conduct such analysis

Three-Dimensional Simulations of Magnetized Thin Accretion Disks around Black Holes: Stress in the Plunging Region

We describe three-dimensional general relativistic magnetohydrodynamic simulations of a geometrically thin accretion disk around a non-spinning black hole. The disk has a thickness $h/r\sim0.05-0.1$ over the radial range $(2-20)GM/c^2$. In steady state, the specific angular momentum profile of the inflowing magnetized gas deviates by less than 2% from that of the standard thin disk model of Novikov & Thorne (1973). Also, the magnetic torque at the radius of the innermost stable circular orbit (ISCO) is only $\sim2$ of the inward flux of angular momentum at this radius. Both results indicate that magnetic coupling across the ISCO is relatively unimportant for geometrically thin disks.Comment: 4 pages, 4 figures, ApJL accepte

Was UV spectral solar irradiance lower during the recent low sunspot minimum?

A detailed analysis is presented of solar UV spectral irradiance for the period between May 2003 and August 2005, when data are available from both the Solar Ultraviolet pectral Irradiance Monitor (SUSIM) instrument (on board the pper Atmosphere Research Satellite (UARS) spacecraft) and the Solar Stellar Irradiance Comparison Experiment (SOLSTICE) instrument (on board the Solar Radiation and Climate Experiment (SORCE) satellite). The ultimate aim is to develop a data composite that can be used to accurately determine any differences between the “exceptional” solar minimum at the end of solar cycle 23 and the previous minimum at the end of solar cycle 22 without having to rely on proxy data to set the long‐term change. SUSIM data are studied because they are the only data available in the “SOLSTICE gap” between the end of available UARS SOLSTICE data and the start of the SORCE data. At any one wavelength the two data sets are considered too dissimilar to be combined into a meaningful composite if any one of three correlations does not exceed a threshold of 0.8. This criterion removes all wavelengths except those in a small range between 156 nm and 208 nm, the longer wavelengths of which influence ozone production and heating in the lower stratosphere. Eight different methods are employed to intercalibrate the two data sequences. All methods give smaller changes between the minima than are seen when the data are not adjusted; however, correcting the SUSIM data to allow for an exponentially decaying offset drift gives a composite that is largely consistent with the unadjusted data from the SOLSTICE instruments on both UARS and SORCE and in which the recent minimum is consistently lower in the wave band studied

General Relativistic Magnetohydrodynamic Simulations of the Hard State as a Magnetically-Dominated Accretion Flow

(Abridged) We present one of the first physically-motivated two-dimensional general relativistic magnetohydrodynamic (GRMHD) numerical simulations of a radiatively-cooled black-hole accretion disk. The fiducial simulation combines a total-energy-conserving formulation with a radiative cooling function, which includes bremsstrahlung, synchrotron, and Compton effects. By comparison with other simulations we show that in optically thin advection-dominated accretion flows, radiative cooling can significantly affect the structure, without necessarily leading to an optically thick, geometrically thin accretion disk. We further compare the results of our radiatively-cooled simulation to the predictions of a previously developed analytic model for such flows. For the very low stress parameter and accretion rate found in our simulated disk, we closely match a state called the "transition" solution between an outer advection-dominated accretion flow and what would be a magnetically-dominated accretion flow (MDAF) in the interior. The qualitative and quantitative agreement between the numerical and analytic models is quite good, with only a few well-understood exceptions. According to the analytic model then, at significantly higher stress or accretion, we would expect a full MDAF to form. The collection of simulations in this work also provide important data for interpreting other numerical results in the literature, as they span the most common treatments of thermodynamics, including simulations evolving: 1) the internal energy only; 2) the internal energy plus an explicit cooling function; 3) the total energy without cooling; and 4) total energy including cooling. We find that the total energy formulation is a necessary prerequisite for proper treatment of radiative cooling in MRI accretion flows.Comment: 13 pages, 7 figures, submitted to Ap

Calorimetric observation of single He2* excimers in a 100 mK He bath

We report the first calorimetric detection of individual He2* excimers within a bath of superfluid 4He. The detector used in this work is a single superconducting titanium transition edge sensor (TES) with an energy resolution of 1 eV, immersed directly in the helium bath. He2* excimers are produced in the surrounding bath using an external gamma-ray source. These excimers exist either as short-lived singlet or long-lived triplet states. We demonstrate detection (and discrimination) of both states: in the singlet case the calorimeter records the absorption of a prompt 15 eV photon, and in the triplet case the calorimeter records a direct interaction of the molecule with the TES surface, which deposits a distinct fraction of the 15 eV, released upon decay, into the surface. We also briefly discuss the detector fabrication and characterization

A New Ultraluminous X-ray Source in the Nearby Edge-on Spiral NGC 891

We report the discovery of a new candidate ultraluminous X-ray source (ULX) in the nearby edge-on spiral galaxy NGC 891. The source, which has an absorbed flux of F_X ~ 10^-12 erg/s/cm^2 (corresponding to L_X > 10^40 erg/s at 9 Mpc), must have begun its outburst in the past 5 years as it is not detected in prior X-ray observations between 1986 and 2006. We try empirical fits to the XMM-Newton spectrum, finding that the spectrum is fit very well as emission from a hot disk, a cool irradiated disk, or blurred reflection from the innermost region of the disk. The simplest physically motivated model with an excellent fit is a hot disk around a stellar-mass black hole (a super-Eddington outburst), but equally good fits are found for each model. We suggest several follow-up experiments that could falsify these models.Comment: 6 pages, 4 figures, 1 table. Accepted to ApJ Letter

Patterns of Adherence to Oral Hypoglycemic Agents and Glucose Control among Primary Care Patients with Type 2 Diabetes

Researchers sought to examine whether there are patterns of oral hypoglycemic-agent adherence among primary-care patients with type 2 diabetes that are related to patient characteristics and clinical outcomes. Longitudinal analysis via growth curve mixture modeling was carried out to classify 180 patients who participated in an adherence intervention according to patterns of adherence to oral hypoglycemic agents across 12 weeks. Three patterns of change in adherence were identified: adherent, increasing adherence, and nonadherent. Global cognition and intervention condition were associated with pattern of change in adherence (p \u3c .05). Patients with an increasing adherence pattern were more likely to have an Hemoglobin A1c) \u3c 7%; adjusted odds ratio = 14.52, 95% CI (2.54, 82.99) at 12 weeks, in comparison with patients with the nonadherent pattern. Identification of patients with type 2 diabetes at risk of nonadherence is important for clinical prognosis and the development and delivery of interventions

Patterns of Adherence to Oral Hypoglycemic Agents and Glucose Control among Primary Care Patients with Type 2 Diabetes

Researchers sought to examine whether there are patterns of oral hypoglycemic-agent adherence among primary-care patients with type 2 diabetes that are related to patient characteristics and clinical outcomes. Longitudinal analysis via growth curve mixture modeling was carried out to classify 180 patients who participated in an adherence intervention according to patterns of adherence to oral hypoglycemic agents across 12 weeks. Three patterns of change in adherence were identified: adherent, increasing adherence, and nonadherent. Global cognition and intervention condition were associated with pattern of change in adherence (p \u3c .05). Patients with an increasing adherence pattern were more likely to have an Hemoglobin A1c) \u3c 7%; adjusted odds ratio = 14.52, 95% CI (2.54, 82.99) at 12 weeks, in comparison with patients with the nonadherent pattern. Identification of patients with type 2 diabetes at risk of nonadherence is important for clinical prognosis and the development and delivery of interventions