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Neutron scattering studies of kinetic processes are often flux limited. For processes which can be repeated many times, this can be mitigated by stroboscopic reintegration. The recorded scattering ...

Objective: To report the successful use of glucagon-like peptide-1 (GLP-1) receptor agonist therapy in the treatment of a patient with a history of hypertriglyceridemia-induced acute pancreatitis. Methods: The clinical presentation, laboratory data, and imaging studies for the acute pancreatitis episode and 1 year post-discharge follow-up are described. Results: A 51-year-old Caucasian male with a history of diabetes, hypertension, and dyslipidemia presented to the local Emergency Department with back pain, abdominal pain, nausea, and vomiting. His presenting laboratory values included serum lipase 7,901 U/L, serum amylase 39 U/L, and triglycerides 7,686 mg/dL. Abdominal computed tomography scan results were consistent with diffuse pancreatitis; ultrasound ruled out the presence of gallstones and the patient denied any history of alcohol abuse. The patient was diagnosed with acute pancreatitis due to hypertriglyceridemia. After discharge, the patient's serum triglyceride concentration was aggressively managed with combination anti-lipidemia therapy and his diabetes was subsequently treated with a GLP-1 receptor agonist. There was no recurrence of pancreatitis after 1 year of follow-up. Conclusion: GLP-1 receptor agonist product labels warn against their use in patients with a history of pancreatitis. This case illustrates that healthcare providers may consider subsequent GLP-1 therapy for patients with diabetes in whom a known cause of pancreatitis has been adequately managed. Abbreviations: A1C = glycosylated hemoglobin A1C EMA = European Medicines Agency FDA = Food and Drug Administration GLP-1 = glucagon-like peptide-1 T2DM = type 2 diabetes mellitus TG = triglyceride

To determine the efficacy of at least 1 year of teriparatide therapy on bone mineral density (BMD), T-scores, and rates of occurrence of fractures in patients with a history of resolved secondary hyperparathyroidism due to vitamin D deficiency and to compare its efficacy with that in patients without a history of resolved secondary hyperparathyroidism.In this retrospective study based on a search of electronic medical records, we collected the following data: patient demographics, doses of calcium and vitamin D supplementation, duration of teriparatide treatment, history and treatment of secondary hyperparathyroidism, BMD information, T-scores, and any history of fractures. Paired and unpaired t tests, the Fisher exact test, and the Wilcoxon rank sum test were used for statistical analysis.Ninety-five patients (7 with a history of resolved secondary hyperparathyroidism due to vitamin D deficiency and 88 without such a history) fulfilled the study inclusion criteria. Baseline characteristics (demographics, median calcium and vitamin D supplementation doses, mean BMD, mean T-scores, and fracture rates before teriparatide therapy) were similar between the 2 groups. In comparison with baseline data, after a mean of 21 months of teriparatide therapy: (1) hip BMD and T-scores did not change in either study group (with no significant differences between the 2 groups), (2) spine BMD and T-scores significantly improved in both study groups (with no significant differences between them), and (3) wrist T-scores significantly worsened in both study groups (with wrist BMD significantly lower in patients without a history of secondary hyperparathyroidism). No patients with a history of secondary hyperparathyroidism sustained a fracture while receiving teriparatide therapy versus 6 of 88 patients without a history of secondary hyperparathyroidism (P = .624).Patients with a history of resolved secondary hyperparathyroidism attributable to vitamin D deficiency responded to teriparatide therapy in a fashion similar to patients without such a history.

A dedicated media processor is used in many mobile consumer devices to accelerate video, image, graphics, and display processing. Increased demand for higher pixel resolution, higher quality image and video processing, more graphics performance necessitates dramatically increased signal processing capabilities. To provide the increased performance at acceptable cost and power requires redesign of the traditional architecture. By wisely partitioning algorithms across programmable and fixed-function blocks, the performance goals can be met while still maintaining flexibility for new feature requirements and new standards. For a better than acceptable user experience and playback time, all IPs (display, graphics, video, and imaging) have to be optimized as an ''end to end'' system. In this paper, an overview of the future trends of multimedia IP processor architectures is provided that describes the implications on system architecture, power, and performance.

Quick simple testing methods are needed to evaluate alternative wood materials for marine construction because traditional borer resistant materials are becoming scarce or are no longer permitted due to concerns over environmental emissions of preservatives. Laboratory tests can provide species-specific information on rates of wood biodeterioration by wood borers under optimum conditions, in contrast to field trials where more than one borer species may be present and conditions are variable. The methodology described herein relies on the assumption that faecal pellet production rate in limnoriids must match feeding rate quite closely. Thus, the number of faecal pellets produced by individual specimens of Limnoria quadripunctata, while feeding on a non-durable and non-toxic wood species – Pinus sylvestris sapwood – in different test conditions, was monitored over a period of 15 days. Mortality and moulting were also registered. Several variables likely to affect survival and feeding rates were investigated in order to optimise the test conditions. Temperature and salinity regime affected both survival and feeding rates while moulting cycle affected feeding rates. The optimisation of this test methodology aims to provide the basis for a standard laboratory test with the wood-boring crustacean Limnoria.

To evaluate the 1-year efficacy and safety of treatment with exenatide in combination with insulin (a use not approved by the US Food and Drug Administration).Electronic medical records of 3 private-practice endocrinologists were reviewed to identify patients with type 2 diabetes mellitus (T2DM) receiving insulin who subsequently began exenatide therapy. Patients' baseline hemoglobin A1c (A1C) levels, weights, lipid profiles, blood pressures, and medication utilization were compared with corresponding data obtained after a minimal duration of 12 months.We identified 134 patients with T2DM initiating exenatide therapy in combination with insulin between April 2005 and April 2006. One-year follow-up information was available for 124 patients. Exenatide use resulted in a significant 0.87% reduction in A1C (P.001), despite a 45% discontinuation of premeal insulin use (P.001), a 9-U reduction in mean premeal insulin doses (P = .0066), a reduction in the median number of daily insulin injections from 2 to 1 (P = .0053), and a 59% discontinuation rate of sulfonylurea use (P = .0088). Exenatide use was associated with a mean weight loss of 5.2 kg (P.001), with 72% of evaluable patients losing weight. Forty-eight patients (36%) discontinued exenatide therapy during the first year, primarily attributable to gastrointestinal intolerance. Fourteen patients (10%) experienced hypoglycemia, most of which was mild.Exenatide in combination with insulin in patients with T2DM was associated with significant reductions in A1C and weight after 1 year of therapy. This was offset, however, by an exenatide discontinuation rate of 36%, primarily due to adverse gastrointestinal effects.

To determine the effectiveness and safety of colesevelam hydrochloride (HCl) and ezetimibe combination therapy in statin-intolerant patients with dyslipidemia and diabetes mellitus (DM) or metabolic syndrome (MS).We identified potential study subjects through a computerized text search of patient electronic medical records using the terms colesevelam, WelChol, ezetimibe, and Zetia. Medical records were subsequently reviewed to identify all patients with DM or MS. Baseline total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and triglyceride levels immediately before the initiation of therapy with colesevelam HCl (1.875 g twice a day) or ezetimibe (10 mg daily) were compared with those after a minimum of 3 months of single drug therapy and after a minimum of 3 months of combination therapy. Drug safety was evaluated by review of transaminase levels and reports of side effects or drug discontinuation.The computerized search initially identified 91 electronic medical records; 16 patients fulfilled all study criteria. Baseline patient demographics included a mean age of 62.5 (+/-11.8) years and a mean body mass index of 31.4 (+/-5.2) kg/m2; 50% of patients were female, 75% had type 2 DM, and 25% had MS. In comparison with baseline, colesevelam HCl-ezetimibe combination therapy was associated with significant reductions in mean levels of total cholesterol (27.5%), LDL-C (42.2%), and non-HDL-C (37.1%). In addition, 50% of patients achieved the National Cholesterol Education Program Adult Treatment Panel III LDL-C target of less than 100 mg/dL. Therapy was well tolerated, with no significant changes in mean transaminase levels, no reports of myalgia, and no discontinuation of therapy.Colesevelam HCl-ezetimibe combination therapy was associated with improved TC, LDL-C, and non-HDL-C lipid profiles and was well tolerated. Such therapy may be a reasonable consideration for statin-intolerant patients with DM or MS who have elevated cholesterol levels.

The heterotrich ciliate Mirofolliculina limnoriae occurs in an obligate association with wood-boring species of the isopod Limnoria. It attaches to the dorsal surface of the limnoriid pleotelson. Folliculinid-bearing populations of Limnoria tripunctata from the Ria Formosa, Portugal, and of Limnoria quadripunctata from Portsmouth, UK, were sampled. Up to four folliculinids were found on one individual of L. quadripunctata and up to twelve on L. tripunctata. There was no evidence that folliculinid load increased with host size. The nature of the epibiont/basibiont relationship was examined by observing animals with and without epibionts, kept individually with small sticks of wood in cell culture wells over periods of up to 15 days. Faecal pellet production and moulting were recorded. In both host species, feeding rate as measured by faecal pellet production was significantly lower in animals bearing folliculinids. Feeding rate also diminished with the onset of moulting, but returned to the original rate within a week after moulting. The estimated intermoult period for the population of L. tripunctata examined was about 25 days and for L. quadripunctata was about 32 days. However, the proportion of individuals moulting over the period of observation declined with increasing size in L. tripunctata, suggesting increasing length of intermoult period with age. As the host faces toward the blind end of its tunnel and ventilates the burrow with its pleopods, the folliculinids are well placed to intercept particulate food in the incoming water stream. There are no clear advantages for the host in the association, but the suppression of feeding and the potential of the folliculinids to hinder swimming during dispersal migrations indicate that the association should be viewed as ectoparasitism rather than mutualism or commensalism.

To evaluate the clinical utility of pioglitazone therapy in patients who previously received troglitazone.We undertook an observational study involving patients with type 2 diabetes, who were originally treated with troglitazone and subsequently converted to pioglitazone therapy. Drug efficacy was evaluated by comparing baseline hemoglobin A1c (HbA1c) levels, weight, blood pressure, and lipid profiles (during troglitazone treatment) with corresponding values 6 months after final pioglitazone dose titration. Drug safety was evaluated by review of hepatic enzyme levels and documented reports of side effects.The study cohort consisted of 316 patients in whom pioglitazone therapy was initiated after they had received troglitazone for at least 1 year. Discontinuation of pioglitazone treatment subsequently occurred in 43 patients; in 7 additional patients, no follow-up occurred. We found no significant difference between baseline and follow-up mean HbA1c values. Aspartate aminotransferase levels did not significantly change after 6 months of pioglitazone therapy; however, alanine aminotransferase levels increased by a statistically significant 3.8 U/L (95% confidence interval, 2.6 to 4.9). Pioglitazone treatment was discontinued because of edema in 29 of the 309 evaluable patients (9.4%).Pioglitazone was as effective as troglitazone in maintaining HbA1c levels. The hepatic safety of pioglitazone was also demonstrated.

The American health care system has changed dramatically during the past 50 years. We no longer live in the days of cradle-to-grave care by a single family practice doctor who knew us and our medical history like the back of his hand. Health care is far more fluid and fast-paced; we often change insurance companies and primary care physicians. We are shuffled from one high-end specialist to another with great regularity, often with little or no communication between them. In addition, technologic advances in medicine have skyrocketed the science far beyond what the average person can comprehend. Despite these so-called advances, perhaps because of them, we have never been more vulnerable in the health care world.

Background: Electrocardiogram (ECG)-based detection of left ventricular systolic dysfunction (LVSD) has poor specificity and positive predictive value, even when including major ECG abnormalities such as left bundle branch block (LBBB) within the criteria for diagnosis. Advanced ECG (A-ECG), using multiparameter scores, has superior diagnostic utility to strictly conventional ECG for identifying various cardiac pathologies, including LVSD. Methods:We evaluated the diagnostic utility of A-ECG in a case-control study of 40 patients with LVSD (LV ejection fraction (LVEF)

Objectives. To evaluate the impact of a 2-year, pharmacy students run, diabetes home visitation program for patients with poorly controlled diabetes mellitus. Methods. Eighty patients with poor glycemic control (HbA1C > 10%) were randomized to intervention (home visitations) or control (no intervention) groups. Two groups of selected fourth-year pharmacy students conducted monthly home visits with assigned patients for consecutive 1-year intervals. Results. Thirty patients completed the 2-year intervention; 40 patients comprised the control group. Mean baseline HbA1C levels of the treatment and control groups (11.2 ± 1.3% and 10.7 ± 1.6%, respectively) did not significantly change after 2 years (10.0 ± 2% and 9.9 ± 2.5%, respectively; P= 0.467). Two treatment group patients experienced a total of 2 ED visits compared to 11 control patients who had a total of 16 visits to a hospital emergency department (ED) (P =0.027 and 0.115, respectively). Thirteen treatment group patients experienced a total of 14 hos...

Design considerations, particularly thermal design considerations, for terminal storage of spent nuclear fuel in a bedded salt repository are discussed in a set of four papers which address: thermal criteria, uncoupling thermal problems, near-field temperatures, and optimization of mine arrangement. This paper outlines the thermal criteria used in the conceptual design of a bedded salt repository and discusses the historical rationale behind developments of each criterion.

The calculation of near-field salt temperatures is necessary in the design of a bedded salt repository to evaluate alternative storage arrangements. Transient salt temperatures calculated for this purpose with a finite-difference conduction code are reported. An approximate but more efficient conduction code, which can be used in future design efforts for initial scanning of alternatives, is also described.

The development of a mine layout for a nuclear waste repository in bedded salt is discussed. Optimizations of storage room arrangements and mine arrangements are addressed separately, and a conceptual repository design based on these optimizations is described.

Spent nuclear fuel assemblies stored in bedded salt can be modeled with a large array of dimensioned decay heat sources (spent fuel assemblies) in an extended thermal conducting media. Although a finite-difference or finite-element representation of the total storage facility could be established, regions of the repository should be analyzed separately since a model of the total repository would require formidable digital computing capacity. This paper explains the basis for thermally analyzing the total storage facility with separate models for the stored fuel assembly package and the salt medium. In addition, the effect of fuel assembly packaging on the maximum fuel temperature, the related problems of fuel handling prior to storage, and uncoupling of the effects of mine ventilation and conduction in the salt medium are discussed.