Long-term comparative safety analysis of the risks associated with adding or switching to a sulfonylurea as second-line Type 2 diabetes mellitus treatment in a US veteran population.

AIM: To examine the risks of all-cause mortality and cardiovascular events associated with adding vs switching to second-line therapies in a comparative safety study of people with Type 2 diabetes mellitus. METHODS: We conducted a retrospective cohort study using an as-treated analysis of people served by the Veterans Health Administration who were on metformin and subsequently augmented this treatment or switched to other oral glucose-lowering treatments between 1998 and 2012. This study included 145 250 people with long follow-up. Confounding was addressed through several strategies, involving weighted propensity score models with rich confounder adjustment and strict inclusion criteria, coupled with an incident-user design. RESULTS: Second-line use of sulfonylureas was related to higher mortality (hazard ratio 1.39, 95% CI 1.14, 1.70) and cardiovascular risks (hazard ratio 1.19, 95% CI 1.09, 1.30) compared with thiazolidinedione therapy. Differential hazards were associated with discontinuing or not discontinuing metformin; switching to sulfonylurea therapy was associated with a higher risk of all-cause mortality and cardiovascular events compared with all other therapies. Furthermore, add-on sulfonylurea therapy was associated with an elevated risk for both outcomes when compared with thiazolidinedione add-on therapy. CONCLUSIONS: The results of the present study may inform decisions on whether to augment or discontinue metformin; when considering the long-term risks, switching to a sulfonylurea appears unfavourable compared with other therapies. Instead, adding a thiazolidinedione to existing metformin therapy appears to be superior to adding or switching to a sulfonylurea.

Age-related differences in warning symbol comprehension and training effectiveness: effects of familiarity, complexity, and comprehensibility.

Age-related changes in selective attention, inhibitory efficiency, and the ability to form new associations suggest that older adults may have greater difficulty with more complex and less comprehensible symbols. We examined comprehension of symbols varying in terms of ratings of familiarity, complexity, and comprehensibility, by younger (aged 18-35) and older (aged 55-70) adults. It was found that older adults have greater difficulty than younger adults in comprehending warning symbols and that accident scenario training improves comprehension. Regression analyses indicated that familiarity and comprehensibility were important in determining performance on the pre-training comprehension test by both younger and older adults. However, training eliminated the effects of stimulus characteristics for younger adults, while older adults' comprehension continued to be significantly influenced by comprehensibility. We suggest that symbol design incorporates cues to knowledge to facilitate the linkage between new knowledge (i.e. the warning symbol) and relevant knowledge in long-term memory. Statement of Relevance: Symbol characteristics play an important role in age-related differences in warning symbol comprehension. To optimise comprehension by older adults, symbols should have a clear relationship with areal-world referent. Alternatively, symbol design could incorporate cues to knowledge to facilitate the linkage between new knowledge and relevant knowledge in long-term memory.

Asymmetrical facial expressions in portraits and hemispheric laterality: a literature review.

Studies of facial asymmetry have revealed that the left and the right sides of the face differ in emotional attributes. This paper reviews many of these distinctions to determine how these asymmetries influence portrait paintings. It does so by relating research involving emotional expression to aesthetic pleasantness in portraits. For example, facial expressions are often asymmetrical-the left side of the face is more emotionally expressive and more often connotes negative emotions than the right side. Interestingly, artists tend to expose more of their poser's left cheek than their right. This is significant, in that artists also portray more females than males with their left cheek exposed. Reasons for these psychological findings lead to explanations for the aesthetic leftward bias in portraiture.

Dosimetry of a silicone breast prosthesis.

Dose measurements were conducted in a phantom which simulates breast tissue and in another phantom which simulates a breast containing a silicone prosthesis. No detectable difference was found when the irradiations were carried out with tangential beams of 60Co radiation. The degree of backscatter and absorption of radiation by the prosthesis and phantom were also similar. A slight decrease in dose of approximately 8% was found at the interface between the prosthesis and muscle-equivalent material.

Evaluation of nonisothermal semi-infinite cylinder with specularly reflecting walls as a blackbody source.

The fractional deviation from blackbody radiation due to wall emissivity modestly differing from unity and due to the presence of a temperature gradient (dT/dx) at the open end of a specularly reflecting semi-infinite cylinder of diameter D and end temperature T(1) is shown to be [Equation].

Transmission characteristics of specularly reflecting light pipes uniformly irradiated by obliquely inclined rays.

The light-pipe efficiency or fraction of the incident energy transmitted from one end to the other is expressed as a function of the wall reflectivity rho and geometrical parameters. Light pipes with both circular and rectangular cross sections are considered. The analysis includes skew rays and is mathematically exact within the limits of geometrical optics and a constant specular wall reflectivity. The distribution along the light pipe of the average intensity incident upon the walls is also derived.

Absorber for solar power.

A simple, economical absorber utilizing a new principle of operation to achieve very low reradiation losses while generating temperatures limited by material properties of quartz is described. Its performance is analyzed and indicates approximately 90% thermal efficiency and 73% conversion efficiency for an earth based unit with moderately concentrated (~tenfold) sunlight incident. It is consequently compatible with the most economic of concentrator mirrors (stamped) or mirrors deployable in space. Space applications are particularly attractive, as temperatures significantly below 300 K are possible and permit even higher conversion efficiency.

Determination of electron concentrations from two intensity measurements within the h line.

A method for calculating the electron concentration il dense plasmas containing hydrogen is suggested which utilizes two intensity measurements at separate points within the profile of the H(beta) line. The relative intensity observed by two detectors is expressed as a function of the electron concentration, plasma temperature, and instrumental parameters such as resolution and wavelength separation between measurements. Electron concentrations between 10(15) cm(-3) and 10(17) cm(-3) may be read directly from graphs presented in this article.