Direct medical costs in the preceding, event and subsequent years of first severe hypoglycaemia requiring hospital transfer: A population-based cohort study

Aims To estimate healthcare services use and the direct medical costs accrued by patients with diabetes mellitus (DM) in the year of first severe hypoglycaemia (SH), the years before and after event year. Materials and Methods We analyzed a population‐based, retrospective cohort including all DM adults managed in primary care setting from the Hong Kong Hospital Authority between 2006‐2013. DM patients who had first recorded SH during the observation period were identified, and matched to control group of patients without SH based on the propensity score method. Direct medical costs in the years before, during and after the first SH were determined by summing up the costs of health services utilized within respective year. Results After matching, a total of 22,694 DM patients was identified in first recorded SH group (n=11,347) and non‐SH control group (n=11,347). Patients with first SH on average utilized 7.85 outpatient clinic visits, 1.89 emergency visits and 17.75 nights of hospitalization in the event year. Mean direct medical cost in the event year was US$11,751, more than twofold of that in the preceding year (US$4,846, p<0.001) and subsequent years (US$4,198‐4,700, p<0.001), and 4.5 times of that in two years before the event (US$2,481, p<0.001). Incremental costs of SH versus matched control in the event year and preceding year were US$10,873 (p<0.001) and US$3,974 (p<0.001), respectively. Conclusions SH is associated with excessive hospitalization admission rates and direct medical costs in the event year and, in particular, in the year before as compared to patients without SH

Size Scaling of Turbulent Transport in Magnetically Confined Plasmas

Transport scaling with respect to device size in magnetically confined plasmas is critically examined for electrostatic ion temperature gradient turbulence using global gyrokinetic particle simulations. It is found, by varying device size normalized by ion gyroradius while keeping other dimensionless plasma parameters fixed, that fluctuation scale length is microscopic in the presence of zonal flows. The local transport coefficient exhibits a gradual transition from a Bohm-like scaling for device sizes corresponding to present-day experiments to a gyro-Bohm scaling for future larger devices

A concerted systems biology analysis of phenol metabolism in Rhodococcus opacus PD630

Rhodococcus opacus PD630 metabolizes aromatic substrates and naturally produces branched-chain lipids, which are advantageous traits for lignin valorization. To provide insights into its lignocellulose hydrolysate utilization, we performed 13C-pathway tracing, 13C-pulse-tracing, transcriptional profiling, biomass composition analysis, and metabolite profiling in conjunction with 13C-metabolic flux analysis (13C-MFA) of phenol metabolism. We found that 1) phenol is metabolized mainly through the ortho–cleavage pathway; 2) phenol utilization requires a highly active TCA cycle; 3) NADPH is generated mainly via NADPH-dependent isocitrate dehydrogenase; 4) active cataplerotic fluxes increase plasticity in the TCA cycle; and 5) gluconeogenesis occurs partially through the reversed Entner–Doudoroff pathway (EDP). We also found that phenol-fed R. opacus PD630 generally has lower sugar phosphate concentrations (e.g., fructose 1,6-bisphosphatase) compared to metabolite pools in 13C-glucose-fed Escherichia coli (set as internal standards), while its TCA metabolites (e.g., malate, succinate, and α-ketoglutarate) accumulate intracellularly with measurable succinate secretion. In addition, we found that phenol utilization was inhibited by benzoate, while catabolite repressions by other tested carbon substrates (e.g., glucose and acetate) were absent in R. opacus PD630. Three adaptively-evolved strains display very different growth rates when fed with phenol as a sole carbon source, but they maintain a conserved flux network. These findings improve our understanding of R. opacus’ metabolism for future lignin valorization

A High-Quality Genome-Scale Model for Rhodococcus opacus Metabolism

Rhodococcus opacus is a bacterium that has a high tolerance to aromatic compounds and can produce significant amounts of triacylglycerol (TAG). Here, we present iGR1773, the first genome-scale model (GSM) of R. opacus PD630 metabolism based on its genomic sequence and associated data. The model includes 1773 genes, 3025 reactions, and 1956 metabolites, was developed in a reproducible manner using CarveMe, and was evaluated through Metabolic Model tests (MEMOTE). We combine the model with two Constraint-Based Reconstruction and Analysis (COBRA) methods that use transcriptomics data to predict growth rates and fluxes: E-Flux2 and SPOT (Simplified Pearson Correlation with Transcriptomic data). Growth rates are best predicted by E-Flux2. Flux profiles are more accurately predicted by E-Flux2 than flux balance analysis (FBA) and parsimonious FBA (pFBA), when compared to 44 central carbon fluxes measured by 13C-Metabolic Flux Analysis (13C-MFA). Under glucose-fed conditions, E-Flux2 presents an R2 value of 0.54, while predictions based on pFBA had an inferior R2 of 0.28. We attribute this improved performance to the extra activity information provided by the transcriptomics data. For phenol-fed metabolism, in which the substrate first enters the TCA cycle, E-Flux2’s flux predictions display a high R2 of 0.96 while pFBA showed an R2 of 0.93. We also show that glucose metabolism and phenol metabolism function with similar relative ATP maintenance costs. These findings demonstrate that iGR1773 can help the metabolic engineering community predict aromatic substrate utilization patterns and perform computational strain design

Anisotropic Scaling in Threshold Critical Dynamics of Driven Directed Lines

The dynamical critical behavior of a single directed line driven in a random medium near the depinning threshold is studied both analytically (by renormalization group) and numerically, in the context of a Flux Line in a Type-II superconductor with a bulk current $\vec J$. In the absence of transverse fluctuations, the system reduces to recently studied models of interface depinning. In most cases, the presence of transverse fluctuations are found not to influence the critical exponents that describe longitudinal correlations. For a manifold with $d=4-\epsilon$ internal dimensions, longitudinal fluctuations in an isotropic medium are described by a roughness exponent $\zeta_\parallel=\epsilon/3$ to all orders in $\epsilon$, and a dynamical exponent $z_\parallel=2-2\epsilon/9+O(\epsilon^2)$. Transverse fluctuations have a distinct and smaller roughness exponent $\zeta_\perp=\zeta_\parallel-d/2$ for an isotropic medium. Furthermore, their relaxation is much slower, characterized by a dynamical exponent $z_\perp=z_\parallel+1/\nu$, where $\nu=1/(2-\zeta_\parallel)$ is the correlation length exponent. The predicted exponents agree well with numerical results for a flux line in three dimensions. As in the case of interface depinning models, anisotropy leads to additional universality classes. A nonzero Hall angle, which has no analogue in the interface models, also affects the critical behavior.Comment: 26 pages, 8 Postscript figures packed together with RevTeX 3.0 manuscript using uufiles, uses multicol.sty and epsf.sty, e-mail [email protected] in case of problem

Examining the Support Peer Supporters Provide Using Structural Equation Modeling: Nondirective and Directive Support in Diabetes Management

Background: Little research has examined the characteristics of peer support. Pertinent to such examination may be characteristics such as the distinction between nondirective support (accepting recipients’ feelings and cooperative with their plans) and directive (prescribing “correct” choices and feelings). Purpose: In a peer support program for individuals with diabetes, this study examined (a) whether the distinction between nondirective and directive support was reflected in participants’ ratings of support provided by peer supporters and (b) how nondirective and directive support were related to depressive symptoms, diabetes distress, and Hemoglobin A1c (HbA1c). Methods: Three hundred fourteen participants with type 2 diabetes provided data on depressive symptoms, diabetes distress, and HbA1c before and after a diabetes management intervention delivered by peer supporters. At post-intervention, participants reported how the support provided by peer supporters was nondirective or directive. Confirmatory factor analysis (CFA), correlation analyses, and structural equation modeling examined the relationships among reports of nondirective and directive support, depressive symptoms, diabetes distress, and measured HbA1c. Results: CFA confirmed the factor structure distinguishing between nondirective and directive support in participants’ reports of support delivered by peer supporters. Controlling for demographic factors, baseline clinical values, and site, structural equation models indicated that at post-intervention, participants’ reports of nondirective support were significantly associated with lower, while reports of directive support were significantly associated with greater depressive symptoms, altogether (with control variables) accounting for 51% of the variance in depressive symptoms. Conclusions: Peer supporters’ nondirective support was associated with lower, but directive support was associated with greater depressive symptoms

Processing of ultrafine-size particulate metal matrix composites by advanced shear technology

Copyright @ 2009 ASM International. This paper was published in Metallurgical & Materials Transactions A 40A(3) and is made available as an electronic reprint with the permission of ASM International. One print or electronic copy may be made for personal use only. Systematic or multiple reproduction, distribution to multiple locations via electronic or other means, duplications of any material in this paper for a fee or for commercial purposes, or modification of the content of this paper are prohibited.Lack of efficient mixing technology to achieve a uniform distribution of fine-size reinforcement within the matrix and the high cost of producing components have hindered the widespread adaptation of particulate metal matrix composites (PMMCs) for engineering applications. A new rheo-processing method, the melt-conditioning high-pressure die-cast (MC-HPDC) process, has been developed for manufacturing near-net-shape components of high integrity. The MC-HPDC process adapts the well-established high shear dispersive mixing action of a twin-screw mechanism to the task of overcoming the cohesive force of the agglomerates under a high shear rate and high intensity of turbulence. This is followed by direct shaping of the slurry into near-net-shape components using an existing cold-chamber die-casting process. The results indicate that the MC-HPDC samples have a uniform distribution of ultrafine-sized SiC particles throughout the entire sample in the as-cast condition. Compared to those produced by conventional high-pressure die casting (HPDC), MC-HPDC samples have a much improved tensile strength and ductility.EP-SR

Avalanche Dynamics in Evolution, Growth, and Depinning Models

The dynamics of complex systems in nature often occurs in terms of punctuations, or avalanches, rather than following a smooth, gradual path. A comprehensive theory of avalanche dynamics in models of growth, interface depinning, and evolution is presented. Specifically, we include the Bak-Sneppen evolution model, the Sneppen interface depinning model, the Zaitsev flux creep model, invasion percolation, and several other depinning models into a unified treatment encompassing a large class of far from equilibrium processes. The formation of fractal structures, the appearance of $1/f$ noise, diffusion with anomalous Hurst exponents, Levy flights, and punctuated equilibria can all be related to the same underlying avalanche dynamics. This dynamics can be represented as a fractal in $d$ spatial plus one temporal dimension. We develop a scaling theory that relates many of the critical exponents in this broad category of extremal models, representing different universality classes, to two basic exponents characterizing the fractal attractor. The exact equations and the derived set of scaling relations are consistent with numerical simulations of the above mentioned models.Comment: 27 pages in revtex, no figures included. Figures or hard copy of the manuscript supplied on reques

Efficacy of a Commercial Weight Management Program Compared with a Do-It-Yourself Approach: A Randomized Clinical Trial

Importance: Given the prevalence of obesity, accessible and effective treatment options are needed to manage obesity and its comorbid conditions. Commercial weight management programs are a potential solution to the lack of available treatment, providing greater access at lower cost than clinic-based approaches, but few commercial programs have been rigorously evaluated. Objective: To compare the differences in weight change between individuals randomly assigned to a commercial weight management program and those randomly assigned to a do-it-yourself (DIY) approach. Design, Setting, and Participants: This 1-year, randomized clinical trial conducted in the United States, Canada, and United Kingdom between June 19, 2018, and November 30, 2019, enrolled 373 adults aged 18 to 75 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45. Assessors were blinded to treatment conditions. Interventions: A widely available commercial weight management program that included reduced requirements for dietary self-monitoring and recommendations for a variety of DIY approaches to weight loss. Main Outcomes and Measures: The primary outcomes were the difference in weight change between the 2 groups at 3 and 12 months. The a priori hypothesis was that the commercial program would result in greater weight loss than the DIY approach at 3 and 12 months. Analyses were performed on an intention-To-Treat basis. Results: The study include 373 participants (272 women [72.9%]; mean [SD] BMI, 33.8 [5.2]; 77 [20.6%] aged 18-34 years, 74 [19.8%] aged 35-43 years, 82 [22.0%] aged 44-52 years, and 140 [37.5%] aged 53-75 years). At 12 months, retention rates were 88.8% (166 of 187) for the commercial weight management program group and 95.7% (178 of 186) for the DIY group. At 3 months, participants in the commercial program had a mean (SD) weight loss of-3.8 (4.1) kg vs-1.8 (3.7) kg among those in the DIY group. At 12 months, participants in the commercial program had a mean (SD) weight loss of-4.4 (7.3) kg vs-1.7 (7.3) kg among those in the DIY group. The mean difference between groups was-2.0 kg (97.5% CI,-2.9 to-1.1 kg) at 3 months (P <.001) and-2.6 kg (97.5% CI,-4.3 to-0.8 kg) at 12 months (P <.001). A greater percentage of participants in the commercial program group than participants in the DIY group achieved loss of 5% of body weight at both 3 months (40.7% [72 of 177] vs 18.6% [34 of 183]) and 12 months (42.8% [71 of 166] vs 24.7% [44 of 178]). Conclusions and Relevance: Adults randomly assigned to a commercial weight management program with reduced requirements for dietary self-monitoring lost more weight and were more likely to achieve weight loss of 5% at 3 and 12 months than adults following a DIY approach. This study contributes data on the efficacy of commercial weight management programs and DIY weight management approaches. Trial Registration: ClinicalTrials.gov Identifier: NCT03571893