Inpatient hospital care and its costs among type 1 diabetic patients in Finland : a nationwide longitudinal study

Background. In Finland, the incidence of type 1 diabetes mellitus (T1DM) is the highest in the world, and it continues to increase steadily. No effective preventative interventions exist either for individuals at high risk or for the population as a whole. In addition to problems with daily lifelong insulin replacement therapy, T1DM patients with long-lasting disease suffer from various diabetes related complications. The complications can lead to severe impairments and reductions in functional capacity and quality of life and in the worst case they can be fatal. Longitudinal studies on the costs of T1DM are extremely rare, especially in Finland. Typically, in these studies, distinctions between the various types of diabetes have not been made, and costs have not been calculated separately for the sexes. Aims. The aim of this study was to describe inpatient hospital care and costs of inpatient care in a cohort of 5,166 T1DM patients by sex during 1973-1998 in Finland. Inpatient care and costs of care due to T1DM without complications, due to T1DM with complications and due to other causes were calculated separately. Material and Methods. The study population consisted of all Finnish T1DM patients diagnosed before the age of 18 years between January 1st in 1965 and December 31st in 1979 and derived from the Finnish population based T1DM register (N=5,120 in 1979 and N=4,701 in 1997). Data on hospitalisations were obtained from the Finnish Hospital Discharge Register. Results. In the early stages of T1DM, the majority of the use of inpatient care was due to the treatment of T1DM without complications. There were enormous increases in the use of inpatient care for certain complications when T1DM lasted longer (from 9.5 years to 16.5 years). For women, the yearly number of bed-days for renal complications increased 4.8-fold, for peripheral vascular disease 4.3-fold and for ophthalmic complications 2.5-fold. For men, the corresponding increases were as follows: 5-fold, 6.9-fold and 2.5-fold. The yearly bed-days for glaucoma increased 8-fold, nephropathy 7-fold and microangiopathy 6-fold in the total population. During these 7 years, the yearly numbers of bed-days for T1DM without complications dropped dramatically. The length of stay in inpatient care decreased notably, but hospital visits became more frequent when the length of duration of T1DM increased from 9.5 years to 16.5 years. The costs of treatments due to complications increased when T1DM lasted longer. Costs due to inpatient care of complications in the cohort 2.5-folded as duration of T1DM increased from 9.5 years to 16.5 years, while the total costs of inpatient care in the cohort dropped by 22% due to an 80% decrease in the costs of care of T1DM without complications. Treating complications of female patients was more expensive than treating complications of men when T1DM had lasted 9.5 years; the mean annual costs for inpatient care of a female diabetic (any cause) were 1,642 , and the yearly costs of care of complications were 237 . The corresponding yearly mean costs for a male patient were 1,198 and 167 . Treating complications of female patients was more expensive than that of male patients also when the duration of diabetes was 16.5 years, although the difference in average annual costs between sexes was somewhat smaller. Conclusions. In the early phases of T1DM, the treatment of T1DM without complications causes a considerable amount of hospital bed-days. The use of inpatient care due to complications of T1DM strongly increases with ageing of patients. The economic burden of inpatient care of T1DM is substantial.

Three-dimensional corner reflector of arbitrary apex angle

A method of analysing a 3-dimensional corner reflector antenna of arbitrary apex angle is given. Expressions have been obtained for the far field of the 3-dimensional corner reflector fed by a dipole. The radiation resistance and the directive gain of the antenna have been calculated. The method described is applicable even when the feed dipole is arbitrarily oriented. It is found that the radiation along a prescribed direction can be circularly polarised (right or left) by suitably orienting the feed dipole.

Hydrophobic channels in crystals of an alpha-aminoisobutyric acid pentapeptide

The crystal structure of the pentapeptide p-toluene-sulfonyl-(α-aminoisobutyryl)5-methyl ester (Tosyl-(Aib)5-OMe) has been determined in the space group PImage . Pentapeptide molecules are folded in the 310 helical conformation and packed together, so as to yield a hydrophobic channel with a minimim diameter of 5.2 �. The channel contains crystallographically disordered material. This structure provides a model for channel formation by hydrophobic peptide aggregates and should prove useful in studies of alamethicin, suzukacillin and related Aib containing membrane channels. Triclinic (PImage ) crystals of the pentapeptide are obtained in the presence of LiClO4 in aqueous methanol, whereas crystallization from methanol alone yields crystals in the space group Pbca. The conformations of the peptide in the two crystal forms are very similar and only the molecular packing is dramatically different.

Molecular structure of a cyclic tetrapeptide disulfide. A novel 310 helical conformation with an S-S bridge

The crystal structure of the cyclic peptide disulfide Boc-Cys-Pro-Aib-Cys-NHMe has been determined by X-ray diffraction. The peptide crystallizes in the space group P212121, with A = 8.646(1), B = 18.462(2), C = 19.678(3)Å and Z = 4. The molecules adopt a highly folded compact conformation, stabilized by two intramolecular 4→ 1 hydrogen bonds between the Cys (1) and Pro (2) CO groups and the Cys (4) and methylamide NH groups, respectively. The backbone conformational angles for the peptide lie very close to those expected for a 310 helix. The S-S bridge adopts a right handed twist with a dihedral angle of 82°. The structure illustrates the role of stereochemically constrained residues, in generating novel peptide conformations. Aib, α-aminoisobutyric acid; Z, benzyloxycarbonyl; Boc, t-butyloxycarbonyl; OMe, methyl ester; OBz, benzyl ester; NHMe, N-methylamide; Tosyl, p-toluenesulfonyl.

The Crystal Structure of Pivaloyl- D- prolyl-L- prolyl- L-alanyl-N- methylamide

Pivaloyl-D-prolyl-L-prolyl-L-analyl-N-methylam~de (I), C1UH32N40c4r,y stallizes in the orthorhombic space group P21212,w ith four molecules in a unit cell of dimensions a = 9.982 (l),b = 10.183 (3), c = 20.746 (2)A . The structure has been refined to R 0.048 for 1 745 observed reflections. All the peptide bonds in the molecule are trans and both the prolyl residues are in the CY-exo-conformation. The molecule assumes a highly folded conformation in which a Type II' DL bend is followed by a Type I LL bend, both stabilised by intramolecular 4 + 1 hydrogen bonds. This conformation, which has been observed for the first time, is of interest in relation to the structure of gramicidin S.

Structure and conformation of an anti-depressant drug, nitroxazepine hydrochloride monohydrate

CIsH20N3Oa+.C1-.H2 O, M r = 395, orthorhombic, Pn21a, a = 7.710 (4), b = 11.455 (3), c -- 21.199 (3)/k, Z = 4, V = 1872.4/k 3, D m = 1.38, D C = 1.403 g cm -3, F(000) = 832, g(Cu Kct) = 20.94 cm -l. Intensities for 1641 reflections were measured on a Nonius CAD-4 diffractometer; of these, 1470 were significant. The structure was solved by direct methods and refined to an R index of 0.045 using a blockdiagonal least-squares procedure. The angle between the least-squares planes through the benzene rings is 125.0 (5) ° and the side chain is folded similarly to one of the independent molecules of imipramine hydrochloride.

Non-Abelian monopoles break color. II. Field theory and quantum mechanics

Many grand unified theories (GUT's) predict non-Abelian monopoles which are sources of non-Abelian (and Abelian) magnetic flux. In the preceding paper, we discussed in detail the topological obstructions to the global implementation of the action of the "unbroken symmetry group" H on a classical test particle in the field of such a monopole. In this paper, the existence of similar topological obstructions to the definition of H action on the fields in such a monopole sector, as well as on the states of a quantum-mechanical test particle in the presence of such fields, are shown in detail. Some subgroups of H which can be globally realized as groups of automorphisms are identified. We also discuss the application of our analysis to the SU(5) GUT and show in particular that the non-Abelian monopoles of that theory break color and electroweak symmetries.

solation and characterization of monodeamidated derivatives of bovine pancreatic Ribonuclease A

The isolation and characterization of the initial intermediates formed during the irreversible acid denaturation of enzyme Ribonuclease A are described. The products obtained when RNase A is maintained in 0.5 M HCl at 30° for periods up to 20 h have been analyzed by ion-exchange chromatography on Amberlite XE-64. Four distinct components were found to elute earlier to RNase A; these have been designated RNase Aa2, Aa1c, Aa1b, and Aa1a in order of their elution. With the exception of RNase Aa2, the other components are nearly as active as RNase A. Polyacrylamide gel electrophoresis at near-neutral pH indicated that RNase Aa1a, Aa1b, and Aa1c are monodeamidated derivatives of RNase A; RNase Aa2 contains, in addition, a small amount of a dideamidated component. RNase Aa2, which has 75% enzymic activity as compared to RNase A, consists of dideamidated and higher deamidated derivatives of RNase A. Except for differences in the proteolytic susceptibilities at an elevated temperature or acidic pH, the monodeamidated derivatives were found to have very nearly the same enzymic activity and the compact folded structure as the native enzyme. Fingerprint analyses of the tryptic peptides of monodeamidated derivatives have shown that the deamidations are restricted to an amide cluster in the region 67–74 of the polypeptide chain. The initial acid-catalyzed deamidation occurs in and around the 65–72 disulfide loop giving rise to at least three distinct monodeamidated derivatives of RNase A without an appreciable change in the catalytic activity and conformation of the ribonuclease molecule. Significance of this specific deamidation occurring in highly acidic conditions, and the biological implications of the physiological deamidation reactions of proteins are discussed.

The truncated dielectric-coated conducting sphere-radiation and gain characteristic

An exhaustive study of the radiation and gain characteristics of a truncated dielectric-coated conducting spherical antenna excited in the symmetric TM mode has been reported. The effect of the various structure parameters on the radiation and the gain characteristics for a few even and odd order TM., modes for different structures is shown. The theorctical radiation patterns and gain have been compared with experiment. It is found that there is good agreement between theory and experiment in the case of TM es and TM os,modes. A theoretical and experimental study of the radiation and gain characcteristics in the frequency range 8.0 to 12.0 GHz has been reported.

The Structure of the Monosodium Salt of Cytidine(5')diphosphoethanolamine

CI1H19N4OIIP2.Na+.TH2 O, Mr = 594.08, is orthorhombic, space group P21212 l, with a = 6.946 (2), b = 12.503 (4), c = 28.264 (8)/k, U = 2454.6 A, a, D x = 1.61 Mg m -a, Z = 4, ~t(CuKa) = 2.612 mm -1, F(000) = 1244. Final R = 0.101 for 1454 observed reflections. The cytosine base is in the anti conformation with respect to the sugar (ZCN = 62"60) . The ribose exhibits an uncommon C(l')exo-C(2')endo puckering. The pyrophosphate has a characteristic staggered geometry. The conformation about P(2)-O(7') is trans (-103.4°). This makes CDPethanolamine more extended compared to the folded geometry of CDP-choline, which has a gauche conformation (71.3 o). The molecular interactions in the extended crystal structure, however, are similar to those found in CDP-choline, with the CMP-5' portions tightly bound by metal ligation and the phosphorylethanolamine parts only loosely held by water molecules.

Letter to Dr. Simeon Leo regarding a donation to Mount Sinai Hospital

Letter to Dr. Simeon Leo from Joseph Scherer about a donation to Mount Sinai Hospital. Handwritten in English script. Folded.

Letter of condolence to Dr. Simeon Leo

Condolence letter to Dr. Leo on the death of his father from Lina Straus. On white folded paper with gold gothic initial.

Three-dimensional corner reflector of arbitrary apex angle

A method of analysing a 3-dimensional corner reflector antenna of arbitrary apex angle is given. Expressions have been obtained for the far field of the 3-dimensional corner reflector fed by a dipole. The radiation resistance and the directive gain of the antenna have been calculated. The method described is applicable even when the feed dipole is arbitrarily oriented. It is found that the radiation along a prescribed direction can be circularly polarised (right or left) by suitably orienting the feed dipole.

Crystal structure of the amino acid-vitamin complex lysine pantothenatestar, open

L-Lysine d-pantothenate, a 1:1 amino acid-vitamin complex, crystallizes in the monoclinic space group P21 with Image Full-size image (1K) .The structure has been solved by direct methods and refined to an R value of 0.053 for 1868 observed reflections. The zwitterionic positively charged lysine molecules in the structure assume the sterically most favourable conformation with an all-trans side chain trans to the α-carboxylate group. The pantothenate anion has a somewhat folded conformation stabilised by an intramolecular bifurcated hydrogen bond. The unlike molecules aggregate into separate alternating layers. The molecules in the lysine layers form a head-to-tail sequence parallel to the a-axis. The interactions which hold the adjacent layers together include those between the side chain amino group of lysine and the carboxylate group in the pantothenate anion. The geometry of these interactions is such that each carboxylate group is sandwiched between two amino groups in a periodic arrangement of alternating carboxylate and amino groups.

Conformational analysis of D-pantothenic acid

The conformational analysis of d-pantothenic acid using classical semiempirical methods has been carried out. The pantothenic acid molecule can exist in the neutral form (I) or in the ionised form (II) with a deprotonated negatively charged carboxyl group. The neutral molecule as well as the anion is highly flexible and has an ensemble of several allowed conformations rather than one or two unique conformations. The distribution of allowed conformations indicate that the β-alanine as well as the pantoic acid part of the molecule prefers partially folded conformations. The conformation of the former is greatly affected by the ionisation state of the carboxyl group whereas that of the latter is not. Possibility of intramolecular hydrogen bonding in different allowed conformations has also been explored. A bifurcated hydrogen bond involving a carboxyl (or carboxylate) oxygen atom and a hydroxyl oxygen atom, as acceptors, and the amide nitrogen atom as the donor occurs frequently in both I and II. Amongst the two crystal structures containing pantothenic acid reported so far, the conformation of the molecule in l-lysine d-pantothenate lies in the allowed region and is stabilised by a bifurcated intramolecular hydrogen bond, whereas that in the calcium bromide salt falls in a disallowed region, presumably due to the requirement of tridentate metal coordination.