Should scope of practice laws for advanced practice providers be revised?

The U.S. faces a projected shortage of primary care physicians. The authors of the June HPR newsletter discuss their studies showing that a care delivery model that expands the roles of nurse practitioners and physician assistants could help close the gap without affecting routine chronic disease care

The Hard X-Ray View of Reflection, Absorption, and the Disk-Jet Connection in the Radio-Loud AGN 3C 33

We present results from Suzaku and Swift observations of the nearby radio galaxy 3C 33, and investigate the nature of absorption, reflection, and jet production in this source. We model the 0.5-100 keV nuclear continuum with a power law that is transmitted either through one or more layers of pc-scale neutral material, or through a modestly ionized pc-scale obscurer. The standard signatures of reflection from a neutral accretion disk are absent in 3C 33: there is no evidence of a relativistically blurred Fe K$\alpha$ emission line, and no Compton reflection hump above 10 keV. We find the upper limit to the neutral reflection fraction is R<0.41 for an e-folding energy of 1 GeV. We observe a narrow, neutral Fe K$\alpha$ line, which is likely to originate at least 2,000 R_s from the black hole. We show that the weakness of reflection features in 3C 33 is consistent with two interpretations: either the inner accretion flow is highly ionized, or the black-hole spin configuration is retrograde with respect to the accreting material.Comment: 12 pages, 11 figures, 4 tables. Accepted for publication in Ap

Design of High Speed Comparator

A new CMOS dynamic comparator using dual input single output differential amplifier as latch stage suitable for high speed analog - to - digital converters with High Spee d, low power dissipation and immune to. Back - to - back inverter in the latch stage is replaced with dual - input single output differential amplifier. This topology completely removes the noise that is present in the input. The stru cture shows lower power dissipation and higher speed than the conventional comparators. The circuit is simulated with 1V DC supply voltage and 250 MHz clock frequency. The proposed topology is based on two cross coupled differential pairs positive feedback and switchable current source ces, has a lower power dissipation, higher speed, less area, and it is shown to be very robust against transistor mismatch, n oise immunity

Glucocentric drugs in cardiovascular disease protection and heart failure

Evidence for cardiovascular outcomes with older-generation antihyperglycemic drugs in the management of type 2 diabetes is based on aggregated data from prior randomized controlled trials and observational studies that were not focused on prespecified cardiovascular end points. Newer antihyperglycemic medications have undergone a rigorous evaluation of cardiovascular outcomes through randomized controlled trials since the US Food and Drug Administration imposed a mandatory requirement for all glucose-lowering drugs in 2008. The three classes of drugs that have been most extensively studied are dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter-2 (SGLT2) inhibitors, the latter two reporting significant reductions in adverse cardiovascular outcomes independent of their glycemic effect. Remarkably, it was the evidence from SGLT2 inhibitors cardiovascular outcome trials that prompted further evaluation of the drug class in patients with heart failure irrespective of their diabetes status, demonstrating a broader cardiometabolic effect of these drugs. In this review, we assess the evidence for cardiovascular outcomes with common older- and newer-generation glucose-lowering drugs in the management of type 2 diabetes. We also discuss emerging glucose-lowering drugs with novel metabolic targets that influence the risk of adverse cardiovascular events and expand on the role of these drugs beyond the management of type 2 diabetes