Association between SGLT2 Inhibitors vs DPP-4 Inhibitors and Risk of Pneumonia Among Patients with Type 2 Diabetes

Context: Patients with diabetes are at a higher risk of pneumonia and pneumonia mortality. Sodium glucose co-transporter 2 inhibitors (SGLT2is), the latest class of glucose-lowering agents, were shown to reduce the risk of pneumonia in clinical trials. However, the real-world effectiveness of SGLT2is on the risk of pneumonia is largely unknown. Objective: To investigate the associations between SGLT2is use and the risk of pneumonia and pneumonia mortality compared with dipeptidyl peptidase-4 inhibitors (DPP4is) using an electronic medical database in Hong Kong. Design A retrospective cohort study. The “prevalent new-user” design was adopted to account for the previous exposure to the study drugs being compared. Propensity score (PS) matching (1:4) was used to balance the baseline characteristics of the 2 groups. Setting and participants Electronic health data of type 2 diabetes patients using SGLT2is and DPP4is between 2015 and 2018 was collected from the Clinical Data Analysis and Reporting System. Main Outcome Measures: Pneumonia incidence and mortality. Results: The PS-matched cohort consisted of 6664 users of SGLT2is and 26 656 users of DPP4is, with a mean follow-up of 3.8 years. Poisson regression showed that SGLT2is use was associated with lower risk of pneumonia compared with DPP4is with an absolute rate difference of 4.05 per 1000 person-years (95% CI, 2.61-5.51). The corresponding incidence rate ratio was 0.71 (95% CI, 0.62-0.81). Similar reduction in risk of pneumonia death was observed (hazard ratio 0.57; 95% CI, 0.42-0.77). Conclusion: Compared with DPP4is, SGLT2is use was associated with a reduced risk of pneumonia and pneumonia mortality in a real-world setting

Cosmic positron and antiproton constraints on the gauge-Higgs Dark Matter

We calculate the cosmic ray positron and antiproton spectra of a gauge-Higgs dark matter candidate in a warped five-dimensional $SO(5) \times U(1)$ gauge-Higgs unification model. The stability of the gauge-Higgs boson is guaranteed by the H parity under which only the Higgs boson is odd at low energy. The 4-point vertices of HHW^+W^- and HHZZ, allowed by H parity conservation, have the same magnitude as in the standard model, which yields efficient annihilation rate for $m_H > m_W$. The most dominant annihilation channel is $H H \to W^+ W^-$ followed by the subsequent decays of the $W$ bosons into positrons or quarks, which undergo fragmentation into antiproton. Comparing with the observed positron and antiproton spectra with the PAMALA and Fermi/LAT, we found that the Higgs boson mass cannot be larger than 90 GeV, in order not to overrun the observations. Together with the constraint on not overclosing the Universe, the valid range of the dark matter mass is restricted to 70-90 GeV.Comment: 13 pages, 3 figure

Persistent current in a one-dimensional ring of fractionally charged "exclusons''

The Aharonov-Bohm effect in a one-dimensional (1D) ring containing a gas of fractionally charged excitations is considered. It is shown that the low temperature behavior of the system is identical to that of free electrons with (integer) charge $e$. This is a direct consequence of the fact that the total charge in the ring is quantized in units of the electron charge. Anomalous oscillations of the persistent current amplitude with temperature are predicted to occur as a direct manifistation of the fractional nature of the quasiparticle charge. A 1D conducting ring with gate induced periodical potential is discussed as a possible set-up for an experimental observation of the predicted phenomenon.Comment: 4 pages, RevTex, uuencoded figure

Synthesis and Optimization of Reversible Circuits - A Survey

Reversible logic circuits have been historically motivated by theoretical research in low-power electronics as well as practical improvement of bit-manipulation transforms in cryptography and computer graphics. Recently, reversible circuits have attracted interest as components of quantum algorithms, as well as in photonic and nano-computing technologies where some switching devices offer no signal gain. Research in generating reversible logic distinguishes between circuit synthesis, post-synthesis optimization, and technology mapping. In this survey, we review algorithmic paradigms --- search-based, cycle-based, transformation-based, and BDD-based --- as well as specific algorithms for reversible synthesis, both exact and heuristic. We conclude the survey by outlining key open challenges in synthesis of reversible and quantum logic, as well as most common misconceptions.Comment: 34 pages, 15 figures, 2 table

Survey of charge symmetry breaking operators for dd -> alpha pi0

The charge-symmetry-breaking amplitudes for the recently observed d d -> alpha pi0 reaction are investigated. Chiral perturbation theory is used to classify and identify the leading-order terms. Specific forms of the related one- and two-body tree level diagrams are derived. As a first step toward a full calculation, a few tree-level two-body diagrams are evaluated at each considered order, using a simplified set of d and alpha wave functions and a plane-wave approximation for the initial dd state. The leading-order pion-exchange term is shown to be suppressed in this model because of poor overlap of the initial and final states. The higher-order one-body and short-range (heavy-meson-exchange) amplitudes provide better matching between the initial and final states and therefore contribute significantly and coherently to the cross section. The consequences this might have for a full calculation, with realistic wave functions and a more complete set of amplitudes, are discussed.Comment: REVTeX 4, 35 pages, 8 eps figures, submitted to PR

The impact of cardiovascular disease and chronic kidney disease on life expectancy and direct medical cost in a 10-year diabetes cohort study

Objective: The relative effects of various cardiovascular diseases (CVD) and varying severity of chronic kidney disease (CKD) on mortality risk, direct medical cost and life expectancy in patients with diabetes mellitus (DM) are unclear. The aim of this study was to evaluate these associations. / Research Design and Methods: This was a retrospective cohort study that included 208,792 adults with diabetes stratified into 12 disease status groups with varying combinations of heart disease, stroke, moderate CKD (eGFR:30-59ml/min/1.73m2) and severe CKD (eGFR: <30ml/min/1.73m2) in 2008-2010. The effect of risk mortality, annual direct medical costs and life expectancy were assessed using Cox regression, Gamma generalized linear with log link function, and flexible parametric survival models. / Results: Over a median follow-up of 8.5 years (1.6 million patient-years), 50,154 deaths were recorded. Mortality risks for patients with only a single condition among heart disease, stroke and moderate CKD were similar. The mortality risks were 1.75 times, 2.63 times and 3.58 times greater for patients with one, two and all three conditions (consisting of stroke, heart disease and moderate CKD), compared with patients without these diseases, suggesting an independent and individually additive effect for any combination. A similar trend was observed in annual public healthcare costs with 2.91, 3.90 and 3.88 fold increased costs for patients with one, two and three conditions, respectively. Increases in the number of conditions reduced life expectancy greatly, particularly in younger patients. Reduction in life expectancy for a 40-year-old with one, two and three conditions were 20, 25, 30 years for men and 25, 30, 35 years for women. A similar trend of greater magnitude was observed for severe CKD. / Conclusion: The effect of heart diseases, stroke, CKD and the combination of these conditions on all-cause mortality and direct medical costs are independent and cumulative. CKD, especially severe CKD, appears to have a particularly significant impact on life expectancy and direct medical costs in patients with diabetes. These finding supports the importance of preventing both CVD and CKD in patients with DM

Dijet Production at Hadron Colliders in Theories with Large Extra Dimensions

We consider the production of high invariant mass jet pairs at hadron colliders as a test for TeV scale gravitational effects. We find that this signal can probe effective Planck masses of about 10 TeV at the LHC with center of mass energy of 14 TeV and 1.5 TeV at the Tevatron with center of mass energy of 2 TeV. These results are compared to analogous scattering processes at leptonic colliders.Comment: 15 pages with 3 figure