207 research outputs found

    Patterns and trends of utilization of incretin-based medicines between 2008 and 2014 in three Italian geographic areas

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    Background: The incretin-based medicines GLP1 analogues (GLP1a) and dipeptidyl peptidase-4 inhibitors (DPP4i) are hypoglycaemic agents licensed for the treatment of type 2 diabetes mellitus (T2DM). Although these drugs possess comparable efficacy and low risk of hypoglycaemia, differences in terms of route of administration (subcutaneous versus oral), effect on body weight and gastrointestinal tolerabily can impact their actual use in clinical practice. This study aimed to describe the real-world utilization of incretin-based medicines in the Italian clinical practice. Methods: A multi-database, population-based, descriptive, cohort study was performed using administrative data collected between 2008 and 2014 from three Italian geographic areas. Subjects aged ≥18 were selected. New users were defined as those with ≥1 dispensing of GLP1a or DPP4i during the year of interest and none in the past. Trends of cumulative annual incidence of use in the general adult population were observed. New users of GLP1a or DPP4i were respectively described in terms of demographic characteristics and use of antidiabetic drugs during 1 year before and after the first incretin dispensing. Results: The overall study population included 4,943,952 subjects. A total of 7357 new users of GLP1a and 41,907 of DPP4i were identified during the study period. Incidence of use increased between 2008 (0.2‰ for both GLP1a and DPP4i) and 2011 (GLP1a = 0.6‰; DPP4i = 2.5‰) and slightly decreased thereafter. In 2014, 61% of new GLP1a users received once-daily liraglutide while 52% of new DPP4i users received metformin/DPP4i in fixed-dose. The percentage of new DPP4i users older than 65 years of age increased from 30.9 to 62.6% during the study period. Around 12% of new users had not received any antidiabetic before starting an incretin. Conclusions: During the study period, DPP4i rapidly became the most prescribed incretin-based medicine, particularly among older new user. The choice of the specific incretin-based medicine at first prescription appeared to be directed towards those with higher convenience of use (e.g. oral DPP4i rather than subcutaneous GLP1a, once-daily liraglutide rather than twice-daily exenatide). The non-negligibile use of incretin-based medicines as first-line pharmacotherapy for T2DM warrants further effectiveness and safety evaluations to better define their place in therapy

    Subaqueous basaltic magmatic explosions trigger phreatomagmatism: a case study from Askja, Iceland

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    Sequences of basaltic pillow lavas that transition upwards with systematic gradation from pillow fragment breccias to fluidal bomb-bearing breccia to bomb-bearing lapilli tuffs are common at Askja volcano, Iceland. Based on the detailed textural investigation of three of these sequences, we argue that they record temporally continuous transition from effusive to explosive products that were erupted from and deposited at or near a single subaqueous vent. The recognition of such sequences is important as they provide evidence for controls on the onset of explosive activity in subaqueous environments. Such investigations are complicated by the interplay of magmatic gas expansion, phreatomagmatic and mechanical granulation fragmentation mechanisms in the subaqueous eruptive environment. All of the sequences studied at Askja have textural, componentry and sedimentological characteristics suggestive of a close genetic and spatial relationship between the pillow lavas and all of the overlying glassy clastic deposits. The identification of magma fragmentation signatures in pyroclasts was accomplished through detailed textural studies of pyroclasts within the full range of grain sizes of a given deposit i.e. bomb/blocks, lapilli and fine ash. These textural characteristics were compared and evaluated as discriminators of fragmentation in pyroclastic deposits. The presence of angular vitric clasts within the breccia and lapilli tuff displaying fragile glassy projections indicates little or no postdepositional textural modification. A shift in vesicle and clast textures between the pillow lavas and the large concentration of fluidal bombs in the breccia indicate that the phreatomagmatic explosions were initially triggered by magmatic vesiculation. The initial magmatic gas expansion may have been triggered by depressurization caused by the drainage of the ice-confined lake surrounding Askja. The Fuel Coolant Interactions (FCI) of the more efficient phreatomagmatic explosion was enabled by the increase in the surface area to volume ratio of the fluidal bombs in the water, producing a premix of magma and water. The onset and increasing influence of phreatomagmatic fragmentation is preserved in the presence of very fine blocky ash particles and diminished presence of larger particles such as fluidal bombs. The textural, sedimentological and environmental characteristics of these deposits suggest that phreatomagmatic explosions can be triggered by initial magmatic gas expansion, but that it is likely one of many mechanisms for triggering such explosions

    Measurement of the inelastic proton-proton cross section at √s=13 TeV with the ATLAS detector at the LHC

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    This Letter presents a measurement of the inelastic proton-proton cross section using 60  μb −1 of pp collisions at a center-of-mass energy √s of 13 TeV with the ATLAS detector at the LHC. Inelastic interactions are selected using rings of plastic scintillators in the forward region (2.0710 −6 , where M X is the larger invariant mass of the two hadronic systems separated by the largest rapidity gap in the event. In this ξ range the scintillators are highly efficient. For diffractive events this corresponds to cases where at least one proton dissociates to a system with M X >13  GeV . The measured cross section is compared with a range of theoretical predictions. When extrapolated to the full phase space, a cross section of 78.1±2.9  mb is measured, consistent with the inelastic cross section increasing with center-of-mass energy

    Measurement of the W±Z boson pair-production cross section in pp collisions at √s=13TeV with the ATLAS detector

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    Measurement of VH, H → b b ¯ production as a function of the vector-boson transverse momentum in 13 TeV pp collisions with the ATLAS detector

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    Cross-sections of associated production of a Higgs boson decaying into bottom-quark pairs and an electroweak gauge boson, W or Z, decaying into leptons are measured as a function of the gauge boson transverse momentum. The measurements are performed in kinematic fiducial volumes defined in the `simplified template cross-section' framework. The results are obtained using 79.8 fb-1 of proton-proton collisions recorded by the ATLAS detector at the Large Hadron Collider at a centre-of-mass energy of 13 TeV. All measurements are found to be in agreement with the Standard Model predictions, and limits are set on the parameters of an effective Lagrangian sensitive to modifications of the Higgs boson couplings to the electroweak gauge bosons
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