Sodium-glucose cotransport protein-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been shown to reduce cardiovascular events in high-risk patients with type 2 diabetes mellitus (T2DM). We examined real-world use of these agents at a US academic medical center in the state of Mississippi. Prescriptions, provider specialty, and insurance status of users of SGLT2is and GLP-1RAs in patients with T2DM, and T2DM and cardiovascular disease (CVD) seen from 1st January 2013 to 30th June 2019 were obtained by electronic health records review. We identified 21,173 patients with T2DM and CVD. Overall, 306 (1.4%) and 349 (1.6%) patients received a SGLT2i and GLP-1RA, respectively. After the US Food and Drug Administration (FDA) expanded empagliflozin and liraglutide indications, a mean difference of 19.2 and 12.7 greater quarterly new prescriptions was noted, respectively, whereas no such rise in canagliflozin was observed. Primary care physicians accounted for 53.4% SGLT2i prescriptions, endocrinology for 30.3%, and cardiology for 6.0%. Primary care physicians accounted for 45.1% GLP-1RA prescriptions, endocrinology for 45.0%, and cardiology for 1.4%. Prescription patterns did not largely differ by patient insurance status. In conclusion, prescription of evidence-based therapies to improve CVD outcomes in high-risk patients with T2DM remains very low after several years of evidence generation. Low uptake was evident across insurance types. Modest increases in use were observed after regulatory expansions in labeling; however, cardiologists rarely engaged in prescription, underscoring the need for widespread implementation strategies across health care systems.

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The increase of greenhouse gas (i.e., CO(2)) levels in the atmosphere has caused noticeable climate change. Many nations are currently looking into methods of permanent underground storage for CO(2) in an attempt to mitigate this problem. The goal of this work is to develop a process for studying the total carbon content in soils before, during, and after CO(2) injection to ensure that no leakage is occurring or to determine how much is leaking if it is occurring and what effect it will have on the ecosystem between the injection formation and the atmosphere. In this study, we quantitatively determine the total carbon concentration in soil using laser-induced breakdown spectroscopy (LIBS). A soil sample from Starkville, Mississippi, USA was mixed with different amounts of carbon powder, which was used as a calibration for additional carbon in soil. Test samples were prepared by adding different but known amounts of carbon powder to a soil sample and then mixing with polyvinyl alcohol binder before being pressed into pellets. LIBS spectra of the test samples were collected and analyzed to obtain optimized conditions for the measurement of total carbon in soil with LIBS. The total carbon content in the samples was also measured by a carbon analyzer, and the data (average of triplicates) were used as a reference in developing calibration curves for a modified version of the single linear regression model and the multiple linear regression model. The calibration data were then used to determine the total carbon concentration of an unknown sample. This work is intended to be used in the initial development of a miniaturized, field-portable LIBS analyzer for CO(2) leak detection.

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This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.