Inertia Groups Research Articles

Factors Associated with Diabetes-Related Clinical Inertia in a Managed Care Population and Its Effect on Hemoglobin A1c Goal Attainment: A Claims-Based Analysis.

Despite evidence showing the benefits of treatment intensification following an elevated hemoglobin A1c (A1c), clinical inertia, or failure to establish and/or escalate treatment to achieve treatment goals, is a concern among patients diagnosed with type 2 diabetes (T2DM). Clinical inertia may contribute to increased health care utilization and costs due to poor clinical outcomes in MCOs. To (a) identify factors associated with clinical inertia in T2DM and (b) determine differences in A1c goal attainment between patients who experience clinical inertia versus treatment intensification in a commercially insured population. Medical and pharmacy claims data were used to identify commercially insured patients in a regional MCO with a recorded A1c ≥ 8.0% between January 1, 2013, and December 31, 2015. In the 4 months following the first elevated A1c value (index date), patients were classified into 2 groups: treatment intensification or clinical inertia. Treatment intensification was defined as the addition of ≥ 1 new noninsulin antihyperglycemic medication, the addition of insulin, or a dose increase of any current noninsulin antihyperglycemic medication. Patients were required to have ≥ 1 follow-up A1c value 6-12 months after the index date and continuous enrollment in the health plan for 12 months before and after the index date. Patients were excluded if they had a diagnosis for gestational diabetes or type 1 diabetes or if they were on insulin in the pre-index period. The primary outcome of attaining A1c < 7.0% was compared between groups after propensity score matching (PSM). Factors associated with clinical inertia were identified using logistic regression. 3,078 patients, with a mean (SD) age of 54.4 (10.6) years and a mean (SD) baseline A1c of 9.6% (1.7), were included in the study. Of these, 1,093 patients (36%) experienced clinical inertia. After PSM, 1,760 patients remained; 880 in each group. In the clinical inertia group, 23% of patients achieved an A1c < 7.0% in the post-index period, compared with 35% in the treatment intensification group (P < 0.001). A greater likelihood of experiencing clinical inertia was associated with baseline treatment with 2 (OR = 1.51, 95% CI = 1.22-2.86; P < 0.001) or ≥ 3 (OR = 1.78, 95% CI = 1.30-2.42; P < 0.001) antihyperglycemic medications (vs. none), baseline age ≥ 65 years (OR = 2.11, 95% CI = 1.63-2.74; P < 0.001), and diagnosis of coronary heart disease (OR = 1.44, 95% CI = 1.10-1.88; P = 0.007). A baseline A1c ≥ 9.0% (vs. 8.0%-8.9%) was associated with a lower likelihood of experiencing clinical inertia (OR = 0.56, 95% CI = 0.48-0.66; P < 0.001). More than a third of patients in a commercially insured population with T2DM and a baseline A1c ≥ 8% experienced clinical inertia. Clinical inertia resulted in worse A1c outcomes over the 12-month follow-up period. Results of this study suggest that treatment intensification should be monitored, with efforts made to educate health care providers on strategies aimed at improving glycemic control for high-risk patients. This study was funded by a grant from Janssen Scientific Affairs, which was involved in study design, interpretation of results, and manuscript review. Wander reports consulting fees from Sanofi Aventis outside the submitted work. McAdam-Marx reports grants from Sanofi Aventis and AstraZeneca outside the submitted work. Pesa and Bailey were employees of Janssen Scientific Affairs during the conduct of the study. Bailey also reports stock ownership in Johnson and Johnson. This study was presented as a poster at the Academy of Managed Care Pharmacy Nexus 2017; October 16-19, 2017; Grapevine, TX.

Effects of moderate vs. high iso-inertial loads on power, velocity, work and hamstring contractile function after flywheel resistance exercise.

Flywheel iso-inertial training has been shown to positively affect muscular strength and sports performance (e.g. agility). However, implementing such eccentrically-biased training during a microcycle needs to be carefully planned due to its purported effects on the neuromuscular system that can last for hours/days post-exercise. This study aimed at using tensiomyography to verify the effects of different inertias during the hip extension exercise on the contractile function of biceps femoris and semitendinosus muscles of the dominant leg for up to 72 hours post-exercise. Thirty participants (24.4 ± 3.4 years) were divided into 0.075 or 0.1 kg·m2 inertia groups and a control group. Magnitude-based analysis was used for the comparisons. Several tensiomyography parameters were changed after both intensities of flywheel exercise (in most cases indicating a decrement in muscle stiffness), whereas most between-group differences suggested that in the semitendinosus muscle, the higher inertia (0.1 kg·m2) influenced the muscle stiffness parameters more (e.g. Dm = maximal radial displacement) while in the biceps femoris, the greater effect was caused by the lower inertia (0.075 kg·m2) (e.g. Tc = contraction time). Most changes in contractile properties of the investigated muscles occur within 24 hours post-exercise, but can persist for up to 72 hours. However, higher inertia (0.1 kg·m2) influenced the stiffness of the semitendinosus muscle more, while in the biceps femoris, the greater effect was caused by the lower inertia (0.075 kg·m2). These findings should be considered by practitioners when prescribing flywheel iso-inertial training.

Влияние группы инерции S-блока на дифференциальную характеристику блочного шифра

Влияние группы инерции S-блока на дифференциальную характеристику блочного шифра

The classification of 2‐connected 7‐manifolds

We present a classification theorem for closed smooth spin 2-connected 7-manifolds M. This builds on the almost-smooth classification from the first author's thesis. The main additional ingredient is an extension of the Eells-Kuiper invariant for any closed spin 7-manifold, regardless of whether the spin characteristic class p_M in the fourth integral cohomology of M is torsion. In addition we determine the inertia group of 2-connected M - equivalently the number of oriented smooth structures on the underlying topological manifold - in terms of p_M and the torsion linking form.

When are permutation invariants Cohen–Macaulay over all fields ?

We prove that the polynomial invariants of a permutation group are Cohen-Macaulay for any choice of coefficient field if and only if the group is generated by transpositions, double transpositions, and 3-cycles. This unites and generalizes several previously known results. The "if" direction of the argument uses Stanley-Reisner theory and a recent result of Christian Lange in orbifold theory. The "only-if" direction uses a local-global result based on a theorem of Raynaud to reduce the problem to an analysis of inertia groups, and a combinatorial argument to identify inertia groups that obstruct Cohen-Macaulayness.

Galois realizations with inertia groups of order two

There are several variants of the inverse Galois problem which involve restrictions on ramification. In this paper, we give sufficient conditions that a given finite group [Formula: see text] occurs infinitely often as a Galois group over the rationals [Formula: see text] with all nontrivial inertia groups of order [Formula: see text]. Notably any such realization of [Formula: see text] can be translated up to a quadratic field over which the corresponding realization of [Formula: see text] is unramified. The sufficient conditions are imposed on a parametric polynomial with Galois group [Formula: see text] — if such a polynomial is available — and the infinitely many realizations come from infinitely many specializations of the parameter in the polynomial. This will be applied to the three finite simple groups [Formula: see text], [Formula: see text] and [Formula: see text]. Finally, the applications to [Formula: see text] and [Formula: see text] are used to prove the existence of infinitely many optimally intersective realizations of these groups over the rational numbers (proved for [Formula: see text] by the first author in [J. König, On intersective polynomials with nonsolvable Galois group, Comm. Alg. 46(6) (2018) 2405–2416.

A FEW EXPLICIT EXAMPLES OF COMPLEX DYNAMICS OF INERTIA GROUPS ON SURFACES—A QUESTION OF PROFESSOR IGOR DOLGACHEV

We give a few explicit examples which answer a question of Professor Igor Dolgachev on complex dynamics of the inertia group of a smooth rational curve on a projective K3 surface and its variants for a rational surface and a non-projective K3 surface.

Inertia groups of high-dimensional complex projective spaces

For a complex projective space the inertia group, the homotopy inertia group and the concordance inertia group are isomorphic. In complex dimension 4n+1, these groups are related to computations in stable cohomotopy. Using stable homotopy theory, we make explicit computations to show that the inertia group is non-trivial in many cases. In complex dimension 9, we deduce some results on geometric structures on homotopy complex projective spaces and complex hyperbolic manifolds.

Groupe fondamental des champs algébriques, inertie et action galoisienne

We study the action of the arithmetic Galois group on the geometric inertia subgroups of the fundamental group, in a tame but typically stacky context. The problem is analogous but more involved than the by now fairly well-understood situation of the procyclic inertia subgroups associated with the components of a divisor with normal crossings. A significant part of the text is devoted to introducing the necessary tools for a study which is in part motivated by and applied to the important example of the moduli stacks of curves, where the geometric inertia groups correspond to the automorphisms of algebraic curves of the type classified by the stack.

Decomposition types in minimally tamely ramified extensions of mathbb {Q}

We examine whether it is possible to realize finite groups G as Galois groups of minimally tamely ramified extensions of mathbb {Q} and also specify both the inertia groups and the further decomposition of the ramified primes.

Particle segregation in turbulent Couette–Poiseuille flow with vanishing wall shear

Inertial particles dispersed in wall-bounded flows in pipes and channels are known to accumulate close to the walls. The segregation ability depends greatly on the inertia-selection effects of the near-wall quasi-coherent turbulent structures, which are formed near both walls where shear stresses are high. Here, however, we investigated if and how particles segregate in the vicinity of walls in absence of mean shear. A tailor-made turbulent Couette–Poiseuille flow was designed such that the mean shear vanished at the moving wall, thereby resulting in an asymmetric flow with conventional near-wall turbulent structures only at one wall. In addition, Large-Scale Structures (LSSs) were observed in the flow, which greatly influenced the distribution of the inertial particles. Particles of five different inertia groups were embedded in the directly simulated turbulence field and examined. It was found that particles of high inertia segregated near the stationary wall where mean shear prevailed, but also near the moving wall where mean shear was absent. However, due to the qualitatively distinct near-wall flow structures, the inertia effects on the actual segregation were different at the two walls. Mechanisms causing the asymmetric wall-normal segregation were explored with the focus on the moving-wall region, where the quasi-coherent turbulent structures were absent, and the local fluid structures were dominated by imprints of the LSSs.

HOMOTOPY INERTIA GROUPS AND TANGENTIAL STRUCTURES

We show that if $M$ and $N$ have the same homotopy type of simply connected closed smooth $m$-manifolds such that the integral and mod-$2$ cohomologies of $M$ vanish in odd degrees, then their homotopy inertia groups are equal. Let $M^{2n}$ be a closed $(n-1)$-connected $2n$-dimensional smooth manifold. We show that, for $n=4$, the homotopy inertia group of $M^{2n}$ is trivial and if $n=8$ and $H^n(M^{2n};\mathbb{Z})\cong \mathbb{Z}$, the homotopy inertia group of $M^{2n}$ is also trivial. We further compute the group $\mathcal{C}(M^{2n})$ of concordance classes of smoothings of $M^{2n}$ for $n=8$. Finally, we show that if a smooth manifold $N$ is tangentially homotopy equivalent to $M^8$, then $N$ is diffeomorphic to the connected sum of $M^8$ and a homotopy $8$-sphere.

Therapeutic inertia and intensified treatment in diabetes mellitus prescription patterns: A nationwide population-based study in Taiwan.

ObjectiveTo measure therapeutic inertia by characterizing prescription patterns using secondary data obtained from the nationwide diabetes mellitus pay-for-performance (DM-P4P) programme in Taiwan.MethodsUsing reimbursement claims from Taiwan’s National Health Insurance Research Database, a nationwide retrospective cohort study was undertaken of patients with diabetes mellitus who participated in the DM-P4P programme from 2006–2008. Glycosylated haemoglobin results were used to evaluate modifications in therapy in response to poor diabetes control. Prescription patterns were used to assign patients to either a therapeutic inertia group or an intensified treatment group. Therapeutic inertia was defined as the failure to act on a known problem.ResultsThe research sample comprised of 168 876 patients with diabetes mellitus who had undergone 899 135 tests. Of these, 37.4% (336 615 visits) of prescriptions were for a combination of two types of drug and 27.7% (248 788 visits) were for a combination of three types of drug. The proportion of patients in the intensified therapy group who were prescribed more than two types of drug was considerably higher than that in the therapeutic inertia group.ConclusionIn many cases in the therapeutic inertia group only a single type of hypoglycaemic drug was prescribed or the dosage remained unchanged.

Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study.

Clinical inertia is a failure to intensify treatment according to evidence-based guidelines, and can have both short- and long-term adverse effects for type 2 diabetes (T2D). The aim of the present study was to demonstrate the effects of clinical inertia on glycemic control and diabetes-related complications. A retrospective cohort study was conducted at a university-based hospital in Thailand. Medical records were evaluated retrospectively from January 2010 to December 2014. Patients were classified into two groups: clinical inertia and non-inertia. Clinical inertia was defined as failure to initiate insulin within 3 months in patients with HbA1c ≥9% who were already taking two oral antidiabetic agents. From 1206 records, 98 patients with mean HbA1c of 10.3% were identified and enrolled in the study. The median follow-up time of these patients was 29.5 months and 68.4% were classified into the clinical inertia group. The mean (± SD) HbA1c decrement in the clinical inertia and non-inertia groups was 0.82 ± 1.50% and 3.02 ± 1.80%, respectively, at 6 months (P <0.001) and 1.46 ± 1.85% and 3.04 ± 1.76%, respectively, at the end of study (P <0.001). Clinical inertia was associated with a significantly shorter median time to progression of diabetic retinopathy (DR); log rank test, P = 0.02 and a higher incidence of DR progression (10 vs 2.2 cases per 1000 person-months; P = 0.003). The adjusted incidence rate ratio for DR progression in the clinical inertia group was 4.92 (95% confidence interval 1.11-21.77; P = 0.036). Being treated by general practitioners was the strongest risk factor associated with clinical inertia. Clinical inertia can cause persistently poor glycemic control and speed up the progression of DR in T2D.

Specialization results and ramification conditions

Given a hilbertian field k of characteristic zero and a finite Galois extension E/k(T) with group G such that E/k is regular, we produce some specializations of E/k(T) at points t0 ∈ P1(k) which have the same Galois group but also specified inertia groups at finitely many given primes. This result has two main applications. Firstly we conjoin it with previous works to obtain Galois extensions of Q of various finite groups with specified local behavior — ramified or unramified — at finitely many given primes. Secondly, in the case k is a number field, we provide criteria for the extension E/k(T) to satisfy this property: at least one Galois extension F/k of group G is not a specialization of E/k(T).

Therapeutic inertia in the management of hyperlipidaemia in type 2 diabetic patients: a cross-sectional study in the primary care setting.

To study the prevalence of therapeutic inertia in lipid management among type 2 diabetic patients in the primary care setting and to explore associated factors. This was a cross-sectional study involving type 2 diabetic patients with suboptimal lipid control followed up in all general out-patient clinics of Kowloon Central Cluster in Hong Kong from 1 October 2011 to 30 September 2013. Main outcome measures included prevalence of therapeutic inertia in low-density lipoprotein management among type 2 diabetic patients and its association with patient and physician characteristics. Based on an agreed standard, lipid control was suboptimal in 49.1% (n=9647) of type 2 diabetic patients who attended for a regular annual check-up (n=19 662). Among the sampled 369 type 2 diabetic patients with suboptimal lipid control, therapeutic inertia was found to be present in 244 cases, with a prevalence rate of 66.1%. When the attending doctors' profiles were compared, the mean duration of clinical practice was significantly longer in the therapeutic inertia group than the non-therapeutic inertia group. Doctors without prior training in family medicine were also found to have a higher rate of therapeutic inertia. Patients in the therapeutic inertia group had longer disease duration, a higher co-morbidity rate of cardiovascular disease, and a closer-to-normal low-density lipoprotein level. Logistic regression analysis revealed that lack of family medicine training among doctors was positively associated with the presence of therapeutic inertia whereas patient's low-density lipoprotein level was inversely associated. Therapeutic inertia was common in the lipid management of patients with type 2 diabetes in a primary care setting. Lack of family medicine training among doctors and patient's low-density lipoprotein level were associated with the presence of therapeutic inertia. Further study of the barriers and strategies to overcome therapeutic inertia is needed to improve patient outcome in this aspect of chronic disease management.

INERTIA GROUPS AND SMOOTH STRUCTURES OF (n-1)-CONNECTED 2n-MANIFOLDS

Let $M^{2n}$ denote a closed ($n-1$)-connected smoothable topological $2n$-manifold. We show that the group $\mathcal{C}(M^{2n})$ of concordance classes of smoothings of $M^{2n}$ is isomorphic to the group of smooth homotopy spheres $\bar{\Theta}_{2n}$ for $n=4$ or $5$, the concordance inertia group $I_{c}(M^{2n})=0$ for $n=3$, $4$, $5$ or $11$ and the homotopy inertia group $I_{h}(M^{2n})=0$ for $n=4$. On the way, following Wall's approach [16] we present a new proof of the main result in [9], namely, for $n=4$, $8$ and $H^{n}(M^{2n};\mathbb{Z})\cong \mathbb{Z}$, the inertia group $I(M^{2n})\cong \mathbb{Z}_{2}$. We also show that, up to orientation-preserving diffeomorphism, $M^{8}$ has at most two distinct smooth structures; $M^{10}$ has exactly six distinct smooth structures and then show that if $M^{14}$ is a $\pi$-manifold, $M^{14}$ has exactly two distinct smooth structures.

Inertia groups of a toric Deligne-Mumford stack, fake weighted projective stacks, and labeled sheared simplices

This paper determines the inertia groups (isotropy groups) of the points of a toric Deligne-Mumford stack $[Z/G]$ (considered over the category of smooth manifolds) that is realized from a quotient construction using a stacky fan or stacky polytope. The computation provides an explicit correspondence between certain geometric and combinatorial data. In particular, we obtain a computation of the connected component of the identity element $G_0 \subset G$ and the component group $G/G_0$ in terms of the underlying stacky fan, enabling us to characterize the toric DM stacks which are global quotients. As another application, we obtain a characterization of those stacky polytopes that yield stacks equivalent to weighted projective stacks and, more generally, to \textit {`fake' weighted projective stacks}. Finally, we illustrate our results in detail in the special case of \textit {labeled sheared simplices}, where explicit computations can be made in terms of the facet labels.

On a Conjecture for Rubin-Stark Elements in a Special Case

A conjecture on a relation between two different Rubin-Stark elements was recently proposed by the author, and also by Mazur and Rubin. For a tower of finite extensions of global fields $K/L/k$ such that $K/k$ is abelian, this conjecture gives a relation between Rubin-Stark elements $\varepsilon_{K,S,T,V}$ and $\varepsilon_{L,S,T,V'}$, where $S, T, V$ and $V'$ are suitable sets of places of $k$. In this paper, we prove this conjecture under the following three assumptions: (i) $V$ contains all infinite places of $k$; (ii) all $v\in S$ split completely in $L$; (iii) $\mathrm{Gal}(K/L)$ is the direct product of the inertia groups at $v\in S\setminus V$.

Association between birth conditions and glucose and cortisol profiles of periparturient dairy cows and neonatal calves

Parturition in cattle is a stressful event for both the dam and the offspring. Stress and pain can alter the energy profile of calves and calving cows, producing a metabolic...