Dyslipidemia treatment of patients with diabetes mellitus in a US managed care plan: a retrospective database analysis

<p>Abstract</p> <p>Background</p> <p>To evaluate real-world pharmacologic treatment of mixed dyslipidemia in patients with diabetes mellitus (DM).</p> <p>Methods</p> <p>All commercial health plan members in a large US managed care database with complete lipid panel results (HDL-C, LDL-C, TG) between 1/1/2006 and 12/31/2006 were identified (N = 529,236). DM patients (N = 53,679) with mixed dyslipidemia were defined as having any 2 suboptimal lipid parameters (N = 28,728). Lipid treatment status 6 months pre- and post-index date was determined using pharmacy claims for any lipid therapy.</p> <p>Results</p> <p>Post-index, 41.1% of DM patients with 2 abnormal lipid parameters and 45.1% with 3 abnormal lipid parameters did not receive lipid-modifying treatment. Post-index treatment rates were 57.4%, 63.6%, and 66.4% for patients with LDL-C, HDL-C, and TG in the most severe quartiles, respectively. Statin monotherapy was the primary lipid-modifying regimen prescribed (54.8% and 47.8% of patients with any 2 and all 3 lipids not at goal, respectively). Less than 30% of treated patients received combination therapy.</p> <p>Conclusion</p> <p>Over 40% of DM patients with mixed dyslipidemia received no lipid-modifying therapy during the follow-up period. Those who were treated were primarily prescribed statin monotherapy. This study suggests that DM patients are not being treated to ADA-suggested targets.</p

The incidence of pelvic fractures and related surgery in the Finnish adult population: a nationwide study of 33,469 patients between 1997 and 2014

Background and purpose - Information on the epidemiological trends of pelvic fractures and fracture surgery in the general population is limited. We therefore determined the incidence of pelvic fractures in the Finnish adult population between 1997 and 2014 and assessed the incidence and trends of fracture surgery.Patients and methods - We used data from the Finnish National Discharge Register (NHDR) to calculate the incidence of pelvic fractures and fracture surgery. All patients 18 years of age or older were included in the study. The NHDR covers the whole Finnish population and gives information on health care services and the surgical procedures performed.Results and interpretation - We found that in Finnish adults the overall incidence of hospitalization for a pelvic fracture increased from 34 to 56/100,000 person-years between 1997 and 2014. This increase was most apparent for the low-energy fragility fractures of the elderly female population. The ageing of the population is likely therefore to partly explain this increase. The annual number and incidence of pelvic fracture surgery also rose between 1997 and 2014, from 118 (number) and 3.0 (incidence) in 1997 to 187 and 4.3 in 2014, respectively. The increasing number and incidence of pelvic fractures in the elderly population will increase the need for social and healthcare services. The main focus should be on fracture prevention.Peer reviewe

Time dependence of Fe/O ratio within a 3D solar energetic particle propagation model including drift

Context. The intensity profiles of iron and oxygen in Solar Energetic Particle (SEP) events often display differences that result in a decreasing Fe/O ratio over time. The physical mechanisms behind this behaviour are not fully understood, but these observational signatures provide important tests of physical modelling efforts. Aims. In this paper we study the propagation of iron and oxygen SEP ions using a 3D model of propagation which includes the effect of guiding centre drift in a Parker spiral magnetic field. We derive time intensity profiles for a variety of observer locations and study the temporal evolution of the Fe/O ratio. Methods. We use a 3D full orbit test particle model which includes scattering. The configuration of the interplanetary magnetic field is a unipolar Parker spiral. Particles are released instantaneously from a compact region at two solar radii and allowed to propagate in 3D. Results. Both Fe and O experience significant transport across the magnetic field due to gradient and curvature drifts. We find that Fe ions drift more than O ions due to their larger mass-to-charge ratio, so that an observer that is not magnetically well connected to the source region will observe Fe arriving before O, for particles within the same range in energy per nucleon. As a result, for the majority of observer locations, the Fe/O ratio displays a decrease in time. Conclusions. We conclude that propagation effects associated with drifts produce a decay over time of the Fe/O ratio, qualitatively reproducing that observed in SEP event profiles

Evolution of kinklike fluctuations associated with ion pickup within reconnection outflows in the Earth's magnetotail

Magnetic reconnection (MR) in Earth's magnetotail is usually followed by a systemwide redistribution of explosively released kinetic and thermal energy. Recently, multispacecraft observations from the THEMIS mission were used to study localized explosions associated with MR in the magnetotail so as to understand subsequent Earthward propagation of MR outbursts during substorms. Here we investigate plasma and magnetic field fluctuations/structures associated with MR exhaust and ion-ion kink mode instability during a well documented MR event. Generation, evolution and fading of kinklike oscillations are followed over a distance of 70 000 km from the reconnection site in the midmagnetotail to the more dipolar region near the Earth. We have found that the kink oscillations driven by different ion populations within the outflow region can be at least 25 000 km from the reconnection site.Comment: 11 pages, 4 figure

On the characterization of magnetic reconnection in global MHD simulations

The conventional definition of reconnection rate as the electric field parallel to an x-line is problematic in global MHD simulations for several reasons: the x-line itself may be hard to find in a non-trivial geometry such as at the magnetopause, and the lack of realistic resistivity modelling leaves us without reliable non-convective electric field. In this article we describe reconnection characterization methods that avoid those problems and are practical to apply in global MHD simulations. We propose that the reconnection separator line can be identified as the region where magnetic field lines of different topological properties meet, rather than by local considerations. The global convection associated with reconnection is then quantified by calculating the transfer of mass, energy or magnetic field across the boundary of closed and open field line regions. The extent of the diffusion region is determined from the destruction of electromagnetic energy, given by the divergence of the Poynting vector. Integrals of this energy conversion provide a way to estimate the total reconnection efficiency

Distal radius fractures in the elderly population

We found no clear evidence of the clinical superiority of distal radius fracture surgery among older adults at one year.Surgical treatment, however, may yield a faster recovery to previous level of activity in elderly patients.With operative treatment, hardware-based problems may warrant secondary operations and implant removal, whereas in non-operative treatment, symptomatic loss of alignment and malunion can occur.In elderly patients, non-operative treatment can be considered to be the gold standard.Peer reviewe

The magnetotail reconnection region in a global MHD simulation

International audienceThis work investigates the nature and the role of magnetic reconnection in a global magnetohydrodynamic simulation of the magnetosphere. We use the Gumics-4 simulation to study reconnection that occurs in the near-Earth region of the current sheet in the magnetotail. We locate the current sheet surface and the magnetic x-line that appears when reconnection starts. We illustrate the difference between quiet and active states of the reconnection region: variations in such quantities as the current sheet thickness, plasma flow velocities, and Poynting vector divergence are strong. A characteristic feature is strong asymmetry caused by non-perpendicular inflows. We determine the reconnection efficiency by the net rate of Poynting flux into the reconnection region. The reconnection efficiency in the simulation is directly proportional to the energy flux into the magnetosphere through the magnetopause: about half of all energy flowing through the magnetosphere is converted from an electromagnetic into a mechanical form in the reconnection region. Thus, the tail reconnection that is central to the magnetospheric circulation is directly driven; the tail does not exhibit a cycle of storage and rapid release of magnetic energy. We find similar behaviour of the tail in both synthetic and real event runs

Drift-induced deceleration of Solar Energetic Particles

We investigate the deceleration of Solar Energetic Particles (SEPs) during their propagation from the Sun through interplanetary space, in the presence of weak to strong scattering in a Parker spiral configuration, using relativistic full orbit test particle simulations. The calculations retain all three spatial variables describing particles’ trajectories, allowing to model any transport across the magnetic field. Large energy change is shown to occur for protons, due to the combined effect of standard adiabatic deceleration and a significant contribution from particle drift in the direction opposite to that of the solar wind electric field. The latter drift-induced deceleration is found to have a stronger effect for SEP energies than for galactic cosmic rays. The kinetic energy of protons injected at 1 MeV is found to be reduced by between 35 and 90% after four days, and for protons injected at 100 MeV by between 20 and 55%. The overall degree of deceleration is a weak function of the scattering mean free path, showing that, although adiabatic deceleration plays a role, a large contribution is due to particle drift. Current SEP transport models are found to account for drift-induced deceleration in an approximate way and their accuracy will need to be assessed in future work

From Sun to Interplanetary Space: What is the Pathlength of Solar Energetic Particles?

Solar energetic particles (SEPs), accelerated during solar eruptions, propagate in turbulent solar wind before being observed with in situ instruments. In order to interpret their origin through comparison with remote sensing observations of the solar eruption, we thus must deconvolve the transport effects due to the turbulent magnetic fields from the SEP observations. Recent research suggests that the SEP propagation is guided by the turbulent meandering of the magnetic fieldlines across the mean magnetic field. However, the lengthening of the distance the SEPs travel, due to the fieldline meandering, has so far not been included in SEP event analysis. This omission can cause significant errors in estimation of the release times of SEPs at the Sun. We investigate the distance traveled by the SEPs by considering them to propagate along fieldlines that meander around closed magnetic islands that are inherent in turbulent plasma. We introduce a fieldline random walk model which takes into account the physical scales associated to the magnetic islands. Our method remedies the problem of the diffusion equation resulting in unrealistically short pathlengths, and the fractal dependence of the pathlength of random walk on the length of the random-walk step. We find that the pathlength from the Sun to 1au can be below the nominal Parker spiral length for SEP events taking place at solar longitudes 45E to 60W, whereas the western and behind-the-limb particles can experience pathlengths longer than 2au due to fieldline meandering