Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006-2013.

ObjectiveTo examine temporal trends in utilization of glucose-lowering medications, glycemic control, and rate of severe hypoglycemia among patients with type 2 diabetes (T2DM).Research design and methodsUsing claims data from 1.66 million privately insured and Medicare Advantage patients with T2DM from 2006 to 2013, we estimated the annual 1) age- and sex-standardized proportion of patients who filled each class of agents; 2) age-, sex-, race-, and region-standardized proportion with hemoglobin A1c (HbA1c) <6%, 6 to <7%, 7 to <8%, 8 to <9%, ≥9%; and 3) age- and sex-standardized rate of severe hypoglycemia among those using medications. Proportions were calculated overall and stratified by age-group (18-44, 45-64, 65-74, and ≥75 years) and number of chronic comorbidities (zero, one, and two or more).ResultsFrom 2006 to 2013, use increased for metformin (from 47.6 to 53.5%), dipeptidyl peptidase 4 inhibitors (0.5 to 14.9%), and insulin (17.1 to 23.0%) but declined for sulfonylureas (38.8 to 30.8%) and thiazolidinediones (28.5 to 5.6%; all P < 0.001). The proportion of patients with HbA1c <7% declined (from 56.4 to 54.2%; P < 0.001) and with HbA1c ≥9% increased (9.9 to 12.2%; P < 0.001). Glycemic control varied by age and was poor among 23.3% of the youngest and 6.3% of the oldest patients in 2013. The overall rate of severe hypoglycemia remained the same (1.3 per 100 person-years; P = 0.72), declined modestly among the oldest patients (from 2.9 to 2.3; P < 0.001), and remained high among those with two or more comorbidities (3.2 to 3.5; P = 0.36).ConclusionsDuring the recent 8-year period, the use of glucose-lowering drugs has changed dramatically among patients with T2DM. Overall glycemic control has not improved and remains poor among nearly a quarter of the youngest patients. The overall rate of severe hypoglycemia remains largely unchanged

Converting 15-Minute Interval Electricity Load Data into Reduced Demand, Energy Reduction and Cash Flow

The file with the "a" is the PowerPoint presentation given at the Hot and Humid Conference.Whole-building-electric (WBE) 15-minute interval data is an extremely low-cost, easy approach to reap an immediate reduction in energy consumption. With the advance of lower cost Internet based metering technology integrated with TCP/IP Internet communications, equipment costs and installation issues are not the issues as were in the past. The challenge is to be able to interpret the data and then implement actions to correct operational and equipment problems and anomalies. This paper will address the types of data acquisition equipment and systems available and the different components of a data. Lastly, actual graphs of data will be presented to demonstrate how to dissect and analyze a data set and then implement measures that will optimize operations and maintenance of which will effect a reduction in energy costs.Energy Knowledge Grou

Investigation of radioactivity-induced backgrounds in EXO-200

The search for neutrinoless double-beta decay (0{\nu}{\beta}{\beta}) requires extremely low background and a good understanding of their sources and their influence on the rate in the region of parameter space relevant to the 0{\nu}{\beta}{\beta} signal. We report on studies of various {\beta}- and {\gamma}-backgrounds in the liquid- xenon-based EXO-200 0{\nu}{\beta}{\beta} experiment. With this work we try to better understand the location and strength of specific background sources and compare the conclusions to radioassay results taken before and during detector construction. Finally, we discuss the implications of these studies for EXO-200 as well as for the next-generation, tonne-scale nEXO detector.Comment: 9 pages, 7 figures, 3 table

The EXO-200 detector, part I: Detector design and construction

EXO-200 is an experiment designed to search for double beta decay of $^{136}$Xe with a single-phase, liquid xenon detector. It uses an active mass of 110 kg of xenon enriched to 80.6% in the isotope 136 in an ultra-low background time projection chamber capable of simultaneous detection of ionization and scintillation. This paper describes the EXO-200 detector with particular attention to the most innovative aspects of the design that revolve around the reduction of backgrounds, the efficient use of the expensive isotopically enriched xenon, and the optimization of the energy resolution in a relatively large volume

A magnetically-driven piston pump for ultra-clean applications

A magnetically driven piston pump for xenon gas recirculation is presented. The pump is designed to satisfy extreme purity and containment requirements, as is appropriate for the recirculation of isotopically enriched xenon through the purification system and large liquid xenon TPC of EXO-200. The pump, using sprung polymer gaskets, is capable of pumping more than 16 standard liters per minute (SLPM) of xenon gas with 750 torr differential pressure.Comment: 6 pages, 5 figure

Search for Neutrinoless Double-Beta Decay in 136^{136}Xe with EXO-200

We report on a search for neutrinoless double-beta decay of $^{136}$Xe with EXO-200. No signal is observed for an exposure of 32.5 kg-yr, with a background of ~1.5 x 10^{-3} /(kg yr keV) in the $\pm 1\sigma$ region of interest. This sets a lower limit on the half-life of the neutrinoless double-beta decay $T_{1/2}^{0\nu\beta\beta}$($^{136}$Xe) > 1.6 x 10$^{25}$ yr (90% CL), corresponding to effective Majorana masses of less than 140-380 meV, depending on the matrix element calculation

Pooling job physical exposure data from multiple independent studies in a consortium study of carpal tunnel syndrome

Pooling data from different epidemiological studies of musculoskeletal disorders (MSDs) is necessary to improve statistical power and to more precisely quantify exposure–response relationships for MSDs. The pooling process is difficult and time-consuming, and small methodological differences could lead to different exposure–response relationships. A subcommittee of a six-study research consortium studying carpal tunnel syndrome: (i) visited each study site, (ii) documented methods used to collect physical exposure data and (iii) determined compatibility of exposure variables across studies. Certain measures of force, frequency of exertion and duty cycle were collected by all studies and were largely compatible. A portion of studies had detailed data to investigate simultaneous combinations of force, frequency and duration of exertions. Limited compatibility was found for hand/wrist posture. Only two studies could calculate compatible Strain Index scores, but Threshold Limit Value for Hand Activity Level could be determined for all studies. Challenges of pooling data, resources required and recommendations for future researchers are discussed