Spectral properties of XRBs in dusty early-type galaxies

We present spectral properties of a total of 996 discrete X-ray sources resolved in a sample of 23 dusty early-type galaxies selected from different environments. The combined X-ray luminosity function of all the 996 sources within the optical \D of the sample galaxies is well described by a broken power law with a break at 2.71$\times$\te \lum and is close to the Eddington limit for a 1.4\Msun neutron star. Out of the 996, about 63\p of the sources have their X-ray luminosities in the range between few\tim\ts to 2.0 \tim \tn \lum and are like normal LMXBs; about 15-20\p with luminosities $<$ few \tim 10$^{37}$ \lum are either super-soft or very-soft sources; while the remainder represents ULXs, HMXBs or unrelated heavily absorbed harder sources. More XRBs have been detected in the galaxies from isolated regions while those from rich groups and clusters host very few sources. The X-ray color-color plot for these sources has enabled us to classify them as SNRs, LMXBs, HMXBs and heavily absorbed AGNs. The composite X-ray spectra of the resolved sources within \D region of each of the galaxies are best represented by a power law with the average photon spectral index close to 1.65. The contribution of the resolved sources to the total X-ray luminosity of their host is found to vary greatly, in the sense that, in galaxies like NGC 3379 the XRB contribution is about 81\p while for NGC 5846 it is only 2\p. A correlation has been evidenced between the cumulative X-ray luminosity of the resolved sources against the star formation rate and the Ks band luminosity of the target galaxies indicating their primordial origin.Comment: 15 Pages, 6 Figures & 2 Tables, Accepted for publication in New Astronom

Twisting K3 x T^2 Orbifolds

We construct a class of geometric twists of Calabi-Yau manifolds of Voisin-Borcea type (K3 x T^2)/Z_2 and study the superpotential in a type IIA orientifold based on this geometry. The twists modify the direct product by fibering the K3 over T^2 while preserving the Z_2 involution. As an important application, the Voisin-Borcea class contains T^6/(Z_2 x Z_2), the usual setting for intersecting D6 brane model building. Past work in this context considered only those twists inherited from T^6, but our work extends these twists to a subset of the blow-up modes. Our work naturally generalizes to arbitrary K3 fibered Calabi-Yau manifolds and to nongeometric constructions.Comment: 57 pages, 4 figures; uses harvmac.tex, amssym.tex; v3: minor corrections, references adde

Developing a Primary Care–Focused Intervention to Engage Patients With Osteoarthritis in Physical Activity: A Stakeholder Engagement Qualitative Study

Physical activity (PA) is important for managing osteoarthritis (OA), but many patients are inactive. Research is needed on strategies to leverage clinical encounters to engage patients in PA. Guided by the socioecological model of health behavior, this study aimed to engage stakeholders in the process of refining an Osteoarthritis Physical Activity Care Pathway (OA-PCP). Six focus groups and seven individual interviews were conducted with key stakeholders. Focus groups were specific to stakeholder roles and included patients with OA, support partners, and clinic personnel (n = 6 focus groups). Interview participants were local and national PA program representatives (n = 7 interviews). Data were analyzed by thematic analysis. Themes identified in the data included ways the OA-PCP can help patients with OA address challenges to PA engagement, strategies for connecting patients with PA resources, methods for implementing OA-PCP into clinical settings and potential use of PA trackers in the OA-PCP program. Stakeholders’ comments were summarized into key recommendations for OA-PCP. Some recommendations reinforced and led to refinements in planned aspects of OA-PCP, including tailoring to individual patients, involvement of a support partner, and addressing pain with PA. Other recommendations resulted in larger changes for OA-PCP, including the addition of three email- or mail-based contacts and not requiring use of a PA tracker. The refined OA-PCP program is being evaluated in an exploratory trial, with the ultimate goal of establishing a PA program for OA that can be successfully implemented in clinical settings

Health literacy, glycemic control, and physician-advised glucose self-monitoring use in type 2 diabetes

Objective: To measure the association between health literacy and both patient-reported and clinical outcomes in patients with non-insulin-treated type 2 diabetes. Research Design and Methods: We surveyed patients with non-insulin-treated type 2 diabetes (n = 448) from 15 primary care practices. The association between health literacy and patient-reported and clinical outcomes, including numeracy of self-monitoring of blood glucose (SMBG) use, how often physicians advised patients to conduct SMBG testing, and glycemic control (as measured by A1C), was investigated. Results: Study participants included 448 patients with non-insulin-treated type 2 diabetes located within central North Carolina. Participants with limited health literacy had poorer glycemic control (A1C 7.7 ± 1.1% vs. 7.5 ± 1.0%, P = 0.016) despite using SMBG testing more frequently (daily SMBG testing 49.3 vs. 30.7%, P = 0.001) compared to individuals with adequate health literacy. The difference in how often physicians advised patients to conduct SMBG testing between limited and adequate health literacy groups was not significant (P = 0.68). Conclusion: Limited health literacy was associated with poorer glyce-mic control and an increased frequency of SMBG testing in patients with non-insulin-treated type 2 diabetes. There was no significant difference in how often physicians advised patients to conduct SMBG testing between patients with limited and adequate health literacy

Glucose self-monitoring in non-insulin-treated patients with type 2 diabetes in primary care settings: A randomized trial

IMPORTANCE The value of self-monitoring of blood glucose (SMBG) levels in patients with non-insulin-treated type 2 diabetes has been debated. OBJECTIVE To compare 3 approaches of SMBG for effects on hemoglobin A1c levels and health-related quality of life (HRQOL) among people with non-insulin-treated type 2 diabetes in primary care practice. DESIGN, SETTING, AND PARTICIPANTS The Monitor Trial studywas a pragmatic, open-label randomized trial conducted in 15 primary care practices in central North Carolina. Participants were randomized between January 2014 and July 2015. Eligible patients with type 2 non-insulin-treated diabetes were: older than 30 years, established with a primary care physician at a participating practice, had glycemic control (hemoglobin A1c) levels higher than 6.5%but lower than 9.5%within the 6 months preceding screening, as obtained from the electronic medical record, and willing to comply with the results of random assignment into a study group. Of the 1032 assessed for eligibility, 450 were randomized. INTERVENTIONS No SMBG, once-daily SMBG, and once-daily SMBG with enhanced patient feedback including automatic tailored messages delivered via the meter. MAIN OUTCOMES AND MEASURES Coprimary outcomes included hemoglobin A1c levels and HRQOL at 52 weeks. RESULTS A total of 450 patients were randomized and 418 (92.9%) completed the final visit. There were no significant differences in hemoglobin A1c levels across all 3 groups (P = .74; estimated adjusted mean hemoglobin A1c difference, SMBG with messaging vs no SMBG, -0.09%; 95%CI, -0.31% to 0.14%; SMBG vs no SMBG, -0.05%; 95%CI, -0.27%to 0.17%). There were also no significant differences found in HRQOL. There were no notable differences in key adverse events including hypoglycemia frequency, health care utilization, or insulin initiation. CONCLUSIONS AND RELEVANCE In patients with non-insulin-treated type 2 diabetes, we observed no clinically or statistically significant differences at 1 year in glycemic control or HRQOL between patients who performed SMBG compared with those who did not perform SMBG. The addition of this type of tailored feedback provided through messaging via ameter did not provide any advantage in glycemic control

Graded Poisson-Sigma Models and Dilaton-Deformed 2D Supergravity Algebra

Fermionic extensions of generic 2d gravity theories obtained from the graded Poisson-Sigma model (gPSM) approach show a large degree of ambiguity. In addition, obstructions may reduce the allowed range of fields as given by the bosonic theory, or even prohibit any extension in certain cases. In our present work we relate the finite W-algebras inherent in the gPSM algebra of constraints to algebras which can be interpreted as supergravities in the usual sense (Neuveu-Schwarz or Ramond algebras resp.), deformed by the presence of the dilaton field. With very straightforward and natural assumptions on them --like demanding rigid supersymmetry in a certain flat limit, or linking the anti-commutator of certain fermionic charges to the Hamiltonian constraint-- in the ``genuine'' supergravity obtained in this way the ambiguities disappear, as well as the obstructions referred to above. Thus all especially interesting bosonic models (spherically reduced gravity, the Jackiw-Teitelboim model etc.)\ under these conditions possess a unique fermionic extension and are free from new singularities. The superspace supergravity model of Howe is found as a special case of this supergravity action. For this class of models the relation between bosonic potential and prepotential does not introduce obstructions as well.Comment: 22 pages, LaTeX, JHEP class. v3: Final version, to appear in JHE

Osteoarthritis physical activity care pathway (OA-PCP): Results of a feasibility trial

Background: To obtain information on feasibility and acceptability, as well as preliminary data on efficacy, of an Osteoarthritis Physical activity Care Pathway (OA-PCP). Methods: This was a single group pilot study involving 60 participants with symptomatic, physician diagnosed knee or hip OA, recruited from primary care clinics. Participants self-reported completing less than 150 min per week of moderate-to-vigorous physical activity (MVPA) at baseline. The 3-month OA-PCP intervention involved 3 physical activity (PA) coaching calls (focused on goal setting), three check-in emails and linkage with community-based or online resources to support PA. Efficacy outcomes were collected at baseline and 4-month follow-up. The primary efficacy outcome was minutes of MVPA, assessed via accelerometer. Secondary outcomes included minutes of light intensity activity, sedentary minutes, step counts, and Western Ontario and McMaster Universities (WOMAC) pain and function subscales. Participants were also asked to rate the helpfulness of the OA-PCP intervention on a scale of 0-10. Differences in efficacy outcomes between baseline and 4-month follow-up were assessed using paired t-tests. Results: Among participants beginning the study, 88% completed follow-up assessments and ≥ 90% completed each of the intervention calls. Average daily minutes of MVPA was 8.0 at baseline (standard deviation (SD) = 9.9) and 8.9 at follow-up (SD = 12.1, p = 0.515). There were no statistically significant changes in light intensity activity, sedentary time or step counts. The mean WOMAC pain score improved from 8.1 (SD = 3.6) at baseline to 6.2 (SD = 3.8) at follow-up (p < 0.001); the mean WOMAC function score improved from 26.2 (SD = 13.2) to 20.2 (SD = 12.5; p < 0.001). The mean rating of helpfulness was 7.6 (SD = 2.5). Conclusions: Results supported the feasibility and acceptability of the study, and participants reported clinically relevant improvements in pain and function. PA metrics did not improve substantially. Based on these results and participant feedback, modifications including enhanced self-monitoring are being made to increase the impact of the OA-PCP intervention on PA behavior. Trial registration: NCT03780400, December 19, 2018

D-instantons and twistors

Finding the exact, quantum corrected metric on the hypermultiplet moduli space in Type II string compactifications on Calabi-Yau threefolds is an outstanding open problem. We address this issue by relating the quaternionic-Kahler metric on the hypermultiplet moduli space to the complex contact geometry on its twistor space. In this framework, Euclidean D-brane instantons are captured by contact transformations between different patches. We derive those by recasting the previously known A-type D2-instanton corrections in the language of contact geometry, covariantizing the result under electro-magnetic duality, and using mirror symmetry. As a result, we are able to express the effects of all D-instantons in Type II compactifications concisely as a sum of dilogarithm functions. We conclude with some comments on the relation to microscopic degeneracies of four-dimensional BPS black holes and to the wall-crossing formula of Kontsevich and Soibelman, and on the form of the yet unknown NS5-brane instanton contributions.Comment: 47 pages, 1 figure, uses JHEP3.cl

Association of fenofibrate therapy with long-term cardiovascular risk in statin-treated patients with type 2 diabetes

IMPORTANCE: Patients with type 2 diabetes are at high risk of cardiovascular disease (CVD) in part owing to hypertriglyceridemia and low high-density lipoprotein cholesterol. It is unknown whether adding triglyceride-lowering treatment to statin reduces this risk. OBJECTIVE: To determine whether fenofibrate reduces CVD risk in statin-treated patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: Posttrial follow-up of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid Study between July 2009 and October 2014; 5 years of follow-up were completed for a total of 9.7 years at general community and academic outpatient research clinics in the United States and Canada. Of the original 5518 ACCORD Lipid Trial participants, 4644 surviving participants were selected based on the presence of type 2 diabetes and either prevalent CVD or CVD risk factors and high-density lipoprotein levels less than 50 mg/dL (<55 mg/dL for women and African American individuals). INTERVENTIONS: Passive follow-up of study participants previously treated with fenofibrate or masked placebo. MAIN OUTCOMES AND MEASURES: Occurrence of cardiovascular outcomes including primary composite outcome of fatal and nonfatal myocardial infarction and stroke in all participants and in prespecified subgroups. RESULTS: The 4644 follow-on study participants were broadly representative of the original ACCORD study population and included significant numbers of women (n = 1445; 31%), nonwhite individuals (n = 1094; 21%), and those with preexisting cardiovascular events (n = 1620; 35%). Only 4.3% of study participants continued treatment with fenofibrate following completion of ACCORD. High-density lipoprotein and triglyceride values rapidly equalized among participants originally randomized to fenofibrate or placebo. Over a median total postrandomization follow-up of 9.7 years, the hazard ratio (HR) for the primary study outcome among participants originally randomized to fenofibrate vs placebo (HR, 0.93; 95% CI, 0.83-1.05; P = .25) was comparable with that originally observed in ACCORD (HR, 0.92; 95% CI, 0.79-1,08; P = .32). Despite these overall neutral results, we continued to find evidence that fenofibrate therapy effectively reduced CVD in study participants with dyslipidemia, defined as triglyceride levels greater than 204 mg/dL and high-density lipoprotein cholesterol levels less than 34 mg/dL (HR, 0.73; 95% CI, 0.56-0.95). CONCLUSIONS AND RELEVANCE: Extended follow-up of ACCORD-lipid trial participants confirms the original neutral effect of fenofibrate in the overall study cohort. The continued observation of heterogeneity of treatment response by baseline lipids suggests that fenofibrate therapy may reduce CVD in patients with diabetes with hypertriglyceridemia and low high-density lipoprotein cholesterol. A definitive trial of fibrate therapy in this patient population is needed to confirm these findings. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00000620