Background: Reducing glycosylated hemoglobin (HbA1c) to near or less than 7% in patients with diabetes is associated with diminished microvascular complications, but this level is not consistently achieved. The purpose of this study was to examine the relationship between fluctuations in HbA1c and changes in estimated glomerular filtration rate (eGFR) and estimated stage of chronic kidney disease (CKD) in an academic primary care practice.Methods: We analyzed data from 791 diabetic primary care patients (25% white; 75% African American) enrolled between 1998 to 2002 and followed through 2008 (mean follow-up, 7.6 ؎ 1.9 years). We calculated baseline and final follow-up eGFR using the Modification of Diet in Renal Disease equation. We examined the relationship between fluctuations in HbA1c and changes in eGFR and stage of CKD using multivariable linear and logistic regression models that controlled for demographic and clinical variables associated with CKD progression.Results: From baseline to follow-up, mean eGFR in African Americans declined to a greater extent and more rapidly than in whites. Age, mean systolic blood pressure, initial HbA1c, initial eGFR, and number of HbA1c values (all P < .01) were significant predictors of change in eGFR. Among HbA1c fluctuation measures, the strongest predictor of change in eGFR was the proportion of HbA1c values >7% (P ‫؍‬ .02); however, this contributed little to explaining model variance.Conclusion: These data suggest that traditional demographic and clinical risk factors remain significantly associated with changes in eGFR and that the pattern of variability in HbA1c is only modestly important in contributing to changes in eGFR among African-American and white diabetic patients in primary care.(J Am Board Fam Med 2011;24:391-398.)

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The RHSP is meeting some interim objectives conducive to its long-term goal of developing physicians who will practice primary care medicine in rural, underserved areas of North Carolina.

Fellowship training exhibited a positive psychological effect on the graduate respondents versus the general physician population. Scores on various well-being scales were higher than the general Family Medicine physician population as a whole, although stress levels were also higher. Female physicians seem to garner a much larger gain in satisfaction than male fellowship graduates, who score slightly worse than the general family medicine population on the satisfaction with life and Perceived Stress Scales.

Virtualization has been the main driver behind the rise of Cloud computing. Despite Cloud computing's tremendous benefits to many applications (e.g., enterprise, Web, game/ multimedia, life sciences, and data analytics), its success in High Performance Computing (HPC) domain has been limited. The oft-cited reason is, apparently, latency caused by virtualization. Meanwhile, the rising popularity of virtualization has compelled CPU vendors to incorporate virtualization technology (VT) in chips. This hardware VT is believed to accelerate context switching, speed up memory address translation, and enable I/O direct access; those are basically sources of virtualization overheads. This paper reports the evaluation on computation and communication performance of different virtualized environments, i.e., Xen and KVM, leveraging hardware VT. Different network fabrics, namely Gigabit Ethernet and InfiniBand, were employed and tested in the virtualized environments and their results were compared against those in the native environments. A real-world HPC application (an MPI-based hydrodynamic simulation) was also used to assess the performance. Outcomes indicate that hardware-assisted virtualization can bring HPC-as-a-Service into realization.