The durability of oral diabetic medications: Time to A1c baseline and a review of common oral medications used by the primary care provider.

Introduction:Cost of generic medications has risen more in the past few years than any other time in history. While medical insurance covers much of these costs, health care professionals can better provide medications that have the longest duration of action when compared to placebo-treated controls. This will save health care costs and improve prescribing accuracy. Methods:Papers in PubMed were identified with keywords placebo. The study must be at least 2 years in length to evaluate the change in A1c over time. The primary endpoint was time to A1c neutrality (return of A1c to baseline at a maximum dose of single oral agent). A medication would be considered at neutrality if the 95% CI crossed baseline. Time to neutrality was averaged for each medication within the class and each summarized for class effect. Results:Effective therapy for the DPP-4 and sulfonylurea classes of medications are 3-4 years as compared to a 5-year time to A1c neutrality for metformin usage. In comparison, the projected time to A1c neutrality was approximately 6-8 years for rosiglitazone and pioglitazone. While only a few studies have been published in the SGLT-2 class of medication, the time to A1c neutrality was also 6-8 years with Canagliflozin and full dosage of Empagliflozin. Conclusion:Metformin appears to have a 5-year duration of effect before the A1c returns to baseline. The sulfonylureas and DPP-4 inhibitors class of medications have one of the shortest durability which ranges between 3.3 to 4.4 years. In contrast, the SGLT-2 class of medication and the TZD class of medications has a projected time to A1c neutrality from 6-8 years. Diabetic duration of therapy as compared to placebo should be listed with those medications tested so the provider can choose wisely

Ages and metallicities of faint red galaxies in the Shapley Supercluster

We present results on the stellar populations of 232 quiescent galaxies in the Shapley Supercluster, based on spectroscopy from the AAOmega spectrograph at the AAT. The key characteristic of this survey is its coverage of many low-luminosity objects (sigma ~ 50 km/s), with high signal-to-noise (~45 per Angstrom). Balmer-line age estimates are recovered with ~25% precision even for the faintest sample members. We summarize the observations and absorption line data, and present correlations of derived ages and metallicities with mass and luminosity. We highlight the strong correlation between age and alpha-element abundance ratio, and the anti-correlation of age and metallicity at fixed mass, which is shown to extend into the low-luminosity regime.Comment: Four pages, three figures; To appear in Proceedings of IAU Symp. 245 "Formation and Evolution of Galaxy Bulges", (Oxford, July 16-20 2007), Eds. Martin Bureau, Lia Athanassoula, and Beatriz Barbu

Electronic Image Stabilization for Mobile Robotic Vision Systems

When a camera is affixed on a dynamic mobile robot, image stabilization is the first step towards more complex analysis on the video feed. This thesis presents a novel electronic image stabilization (EIS) algorithm for small inexpensive highly dynamic mobile robotic platforms with onboard camera systems. The algorithm combines optical flow motion parameter estimation with angular rate data provided by a strapdown inertial measurement unit (IMU). A discrete Kalman filter in feedforward configuration is used for optimal fusion of the two data sources. Performance evaluations are conducted by a simulated video truth model (capturing the effects of image translation, rotation, blurring, and moving objects), and live test data. Live data was collected from a camera and IMU affixed to the DAGSI Whegs™ mobile robotic platform as it navigated through a hallway. Template matching, feature detection, optical flow, and inertial measurement techniques are compared and analyzed to determine the most suitable algorithm for this specific type of image stabilization. Pyramidal Lucas-Kanade optical flow using Shi-Tomasi good features in combination with inertial measurement is the EIS algorithm found to be superior. In the presence of moving objects, fusion of inertial measurement reduces optical flow root-mean-squared (RMS) error in motion parameter estimates by 40%. No previous image stabilization algorithm to date directly fuses optical flow estimation with inertial measurement by way of Kalman filtering

The church music of Michael Wise

It would bo bcypnd the scope of this thesis to make a detailed, technical analysis of his nuoical style, especially as the whole of his output may be examined in the two volumes of transcriptions accompanying the thesis. This essay discusses some of the opinions expressed by historians in the past, and attempts to teat the validity of those opinions in the light of my own discoveries during the years 1969 and 1970

Los And The Science Of The Elohim

This study re-examines what have been commonplace propositions for Blake criticism: that Los is Blake\u27s chief symbol for the activity of imagination in the prophecies; that the theme of Los\u27s labours, his attempt in Golgonooza to practise the Science of the Elohim, serves as a focus for Blake\u27s critique of, and alternative to, the science of Bacon, Newton and Locke ; and that Blake\u27s opposition to the latter stems from his rejection of its Cartesian foundation, its dualism of mind and body, subjective and objective realms. This study begins by attempting to show that, while we have agreed to place Los at the centre of Blake\u27s anti-Cartesian argument, we have approached and expounded this argument with a critical discourse that is shaped by, and, however unwittingly, promulgates the dualism of mind or imagination and nature. Whether we say, with Northrop Frye, that nature for Blake is sub-moral, subhuman, sub-imaginative; or whether we say, with Tilottoma Rajan, that Blake is naive because he refuses to accept that imagination lacks the substantiality of things; we are attributing to Blake the idea of an imagination-nature opposition, and interpreting his argument in terms consistent with the assumptions of Cartesian discourse. The formal assumption of Los\u27s Science of the Elohim, this study contends, is Blake\u27s claim that Nature is Imagination itself. As a critique of Descartes or Newton, this claim (I will attempt to show) is consistent with Werner Heisenberg\u27s thesis that the nature itself or objective reality posited by Cartesian science is not an object of knowledge for contemporary physics. The theme of Los\u27s Elohistic labours in Golgonooza to separate Ulro from Generation articulates Blake\u27s distinction between the Cartesian concept of nature as a reality external to imagination (a reality unknown and unknowable, Blake argues, except as the product of the idolatrous act which posits it), and nature understood as a Vision of the Science of the Elohim, the World of Generation, which consists of the mundane order of things and appearances we perceive and know, and of the vegetative functions which express and sustain our capacity to live upon Earth

Performance indicators for primary care groups; an evidence-based approach

The NHS Executive and Department of Health have proposed a wide range of performance indicators many of which are applicable to future primary care groups Some of these indicators reflect access and efficiency, but few of the effectiveness indicators are based on primary care interventions for which there is evidence that increased uptake results in improved health outcomes We present a method to identify important primary care interventions of proved efficacy and suggest performance indicators that could monitor their use Our evidence based approach may be a complementary way of identifying areas for performance indicators to those proposed by the NHS Executive and Department of Health Our suggested indicators are more likely to help turn evidence into everyday practice and to have an impact on the population's healt

The First Population II Stars Formed in Externally Enriched Mini-halos

We present a simulation of the formation of the earliest Population II stars, starting from cosmological initial conditions and ending when metals created in the first supernovae are incorporated into a collapsing gas-cloud. This occurs after a supernova blast-wave collides with a nearby mini-halo, inducing further turbulence that efficiently mixes metals into the dense gas in the center of the halo. The gas that first collapses has been enriched to a metallicity of Z ~ 2e-5 Zsun. Due to the extremely low metallicity, collapse proceeds similarly to metal-free gas until dust cooling becomes efficient at high densities, causing the cloud to fragment into a large number of low mass objects. This external enrichment mechanism provides a plausible origin for the most metal-poor stars observed, such as SMSS J031300.36-670839.3, that appear to have formed out of gas enriched by a single supernova. This mechanism operates on shorter timescales than the time for low-mass mini-halos (M < 5e5 Msun) to recover their gas after experiencing a supernova. As such, metal-enriched stars will likely form first via this channel if the conditions are right for it to occur. We identify a number of other externally enriched halos that may form stars in this manner. These halos have metallicities as high as 0.01 Zsun, suggesting that some members of the first generation of metal-enriched stars may be hiding in plain sight in current stellar surveys.Comment: Accepted for publication in MNRAS. Minor updates and one additional figure. Movies and images available at http://www.roe.ac.uk/~brs/pop2prim

Effect of an Acute Bout of Exercise using an Altitude Training Mask Simulating 12,000 ft on Physiological and Perceptual Variables

The use of altitude training masks by the average person has increased in recent years with numerous endorsements by famous athletes, yet few studies can be found on the acute effects during exercise while wearing an altitude training mask (ATM). PURPOSE: To examine the acute physiological and perceptual effects of wearing an altitude training mask during exercise. METHODS: Fifteen participants (age=24.5±3.5 yrs., height=169.1±10.9 cm, weight=75.6±22.31 kg, BMI=26.0±4.92 kg/m²) completed two trails either wearing an ATM simulating 12,000 ft (~3,600 m) or not. Trial order was counterbalanced and randomized with the second trail exactly one week later. Participants were asked to not ingest a heavy meal or caffeine 3 hours prior to testing as well as complete a Physical Activity Readiness Form (PAR-Q) and consent form before testing. Variables tested were heart rate, blood pressure, blood oxygen concentration (SPO₂), blood lactate and rate of perceived exertion (RPE). Measurements were taken when the participant first entered (baseline), after a 10 minute sit (seated without movement), after a four-minute walk (3.0 mph at level incline), after a four-minute run (5.0 mph at level incline), and after a three-minute recovery (standing in place). A 2 (trial) x 5 (time) factorial ANOVA, with repeated measures on both factors, was used to determine the differences with the alpha set at 0.05. RESULTS: There were no significant differences between trials for heart rate, blood pressure, SPO2, blood lactate and RPE at any of the time points. CONCLUSION: The effect of the mask is not great enough to elicit significant changes in perceptual or physiological variables during acute exercise