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Use of Glucagon-Like Peptide 1 Receptor Agonists and Risk of Serious Renal Events: Scandinavian Cohort Study

OBJECTIVE

To assess the association between use of glucagon-like peptide 1 (GLP-1) receptor agonists and risk of serious renal events in routine clinical practice.

RESEARCH DESIGN AND METHODS

This was a cohort study using an active-comparator, new-user design and nationwide register data from Sweden, Denmark, and Norway during 2010–2016. The cohort included 38,731 new users of GLP-1 receptor agonists (liraglutide 92.5%, exenatide 6.2%, lixisenatide 0.7%, and dulaglutide 0.6%), matched 1:1 on age, sex, and propensity score to a new user of the active comparator, dipeptidyl peptidase 4 (DPP-4) inhibitors. The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes, and hospitalization for renal events. Secondary outcomes were the individual components of the main outcome. Hazard ratios (HRs) were estimated using Cox models and an intention-to-treat exposure definition. Mean (SD) follow-up time was 3.0 (1.7) years.

RESULTS

Mean (SD) age of the study population was 59 (10) years, and 18% had cardiovascular disease. A serious renal event occurred in 570 users of GLP-1 receptor agonists (incidence rate 4.8 events per 1,000 person-years) and in 722 users of DPP-4 inhibitors (6.3 events per 1,000 person-years, HR 0.76 [95% CI 0.68–0.85], absolute difference –1.5 events per 1,000 person-years [–2.1 to –0.9]). Use of GLP-1 receptor agonists was associated with a significantly lower risk of renal replacement therapy (HR 0.73 [0.62–0.87]) and hospitalization for renal events (HR 0.73 [0.65–0.83]) but not death from renal causes (HR 0.72 [0.48–1.10]). When we used an as treated exposure definition in which patients were censored at treatment cessation or switch to the other study drug, the HR for the primary outcome was 0.60 (0.49–0.74).

CONCLUSIONS

In this large cohort of patients seen in routine clinical practice in three countries, use of GLP-1 receptor agonists, as compared with DPP-4 inhibitors, was associated with a reduced risk of serious renal events.




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Confirming the Bidirectional Nature of the Association Between Severe Hypoglycemic and Cardiovascular Events in Type 2 Diabetes: Insights From EXSCEL

OBJECTIVE

We sought to confirm a bidirectional association between severe hypoglycemic events (SHEs) and cardiovascular (CV) event risk and to characterize individuals at dual risk.

RESEARCH DESIGN AND METHODS

In a post hoc analysis of 14,752 Exenatide Study of Cardiovascular Event Lowering (EXSCEL) participants, we examined time-dependent associations between SHEs and subsequent major adverse cardiac events (CV death, nonfatal myocardial infarction [MI] or stroke), fatal/nonfatal MI, fatal/nonfatal stroke, hospitalization for acute coronary syndrome (hACS), hospitalization for heart failure (hHF), and all-cause mortality (ACM), as well as time-dependent associations between nonfatal CV events and subsequent SHEs.

RESULTS

SHEs were uncommon and not associated with once-weekly exenatide therapy (hazard ratio 1.13 [95% CI 0.94–1.36], P = 0.179). In fully adjusted models, SHEs were associated with an increased risk of subsequent ACM (1.83 [1.38–2.42], P < 0.001), CV death (1.60 [1.11–2.30], P = 0.012), and hHF (2.09 [1.37–3.17], P = 0.001), while nonfatal MI (2.02 [1.35–3.01], P = 0.001), nonfatal stroke (2.30 [1.25–4.23], P = 0.007), hACS (2.00 [1.39–2.90], P < 0.001), and hHF (3.24 [1.98–5.30], P < 0.001) were all associated with a subsequent increased risk of SHEs. The elevated bidirectional time-dependent hazards linking SHEs and a composite of all CV events were approximately constant over time, with those individuals at dual risk showing higher comorbidity scores compared with those without.

CONCLUSIONS

These findings, showing greater risk of SHEs after CV events as well as greater risk of CV events after SHEs, validate a bidirectional relationship between CV events and SHEs in patients with high comorbidity scores.




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Risk Factors for First and Subsequent CVD Events in Type 1 Diabetes: The DCCT/EDIC Study

OBJECTIVE

The Diabetes Control and Complications Trial (DCCT) and its observational follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) demonstrated the dominant role of glycemia, second only to age, as a risk factor for a first cardiovascular event in type 1 diabetes (T1D). We now investigate the association between established risk factors and the total cardiovascular disease (CVD) burden, including subsequent (i.e., recurrent) events.

RESEARCH DESIGN AND METHODS

CVD events in the 1,441 DCCT/EDIC participants were analyzed separately by type (CVD death, acute myocardial infarction [MI], stroke, silent MI, angina, percutaneous transluminal coronary angioplasty/coronary artery bypass graft [PTCA/CABG], and congestive heart failure [CHF]) or as composite outcomes (CVD or major adverse cardiovascular events [MACE]). Proportional rate models and conditional models assessed associations between risk factors and CVD outcomes.

RESULTS

Over a median follow-up of 29 years, 239 participants had 421 CVD events, and 120 individuals had 149 MACE. Age was the strongest risk factor for acute MI, silent MI, stroke, and PTCA/CABG, while glycemia was the strongest risk factor for CVD death, CHF, and angina, second strongest for acute MI and PTCA/CABG, third strongest for stroke, and not associated with silent MI. HbA1c was the strongest modifiable risk factor for a first CVD event (CVD: HR 1.38 [95% CI 1.21, 1.56] per 1% higher HbA1c; MACE: HR 1.54 [1.30, 1.82]) and also for subsequent CVD events (CVD: incidence ratio [IR] 1.28 [95% CI 1.09, 1.51]; MACE: IR 1.89 [1.36, 2.61]).

CONCLUSIONS

Intensive glycemic management is recommended to lower the risk of initial CVD events in T1D. After a first event, optimal glycemic control may reduce the risk of recurrent CVD events and should be maintained.




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In-person graduation events tentatively back on in Cheyenne




events

In-person graduation events tentatively back on in Cheyenne




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In-person graduation events tentatively back on in Cheyenne




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Mobilities facing hydrometeorological extreme events.

9780081028827 (electronic bk.)




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Scalable high-resolution forecasting of sparse spatiotemporal events with kernel methods: A winning solution to the NIJ “Real-Time Crime Forecasting Challenge”

Seth Flaxman, Michael Chirico, Pau Pereira, Charles Loeffler.

Source: The Annals of Applied Statistics, Volume 13, Number 4, 2564--2585.

Abstract:
We propose a generic spatiotemporal event forecasting method which we developed for the National Institute of Justice’s (NIJ) Real-Time Crime Forecasting Challenge (National Institute of Justice (2017)). Our method is a spatiotemporal forecasting model combining scalable randomized Reproducing Kernel Hilbert Space (RKHS) methods for approximating Gaussian processes with autoregressive smoothing kernels in a regularized supervised learning framework. While the smoothing kernels capture the two main approaches in current use in the field of crime forecasting, kernel density estimation (KDE) and self-exciting point process (SEPP) models, the RKHS component of the model can be understood as an approximation to the popular log-Gaussian Cox Process model. For inference, we discretize the spatiotemporal point pattern and learn a log-intensity function using the Poisson likelihood and highly efficient gradient-based optimization methods. Model hyperparameters including quality of RKHS approximation, spatial and temporal kernel lengthscales, number of autoregressive lags and bandwidths for smoothing kernels as well as cell shape, size and rotation, were learned using cross validation. Resulting predictions significantly exceeded baseline KDE estimates and SEPP models for sparse events.




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Physical Exercise Prevents Stress-Induced Activation of Granule Neurons and Enhances Local Inhibitory Mechanisms in the Dentate Gyrus

Timothy J. Schoenfeld
May 1, 2013; 33:7770-7777
BehavioralSystemsCognitive




events

Academy launches online events programme




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Ependymal Vps35 Promotes Ependymal Cell Differentiation and Survival, Suppresses Microglial Activation, and Prevents Neonatal Hydrocephalus

Hydrocephalus is a pathologic condition associated with various brain diseases, including Alzheimer's disease (AD). Dysfunctional ependymal cells (EpCs) are believed to contribute to the development of hydrocephalus. It is thus of interest to investigate EpCs' development and function. Here, we report that vacuolar protein sorting-associated protein 35 (VPS35) is critical for EpC differentiation, ciliogenesis, and survival, and thus preventing neonatal hydrocephalus. VPS35 is abundantly expressed in EpCs. Mice with conditional knock-out (cKO) of Vps35 in embryonic (Vps35GFAP-Cre and Vps35Emx1-Cre) or postnatal (Vps35Foxj1-CreER) EpC progenitors exhibit enlarged lateral ventricles (LVs) and hydrocephalus-like pathology. Further studies reveal marked reductions in EpCs and their cilia in both Vps35GFAP-Cre and Vps35Foxj1-CreER mutant mice. The reduced EpCs appear to be due to impairments in EpC differentiation and survival. Additionally, both Vps35GFAP-Cre and Vps35Foxj1-CreER neonatal pups exhibit increased cell proliferation and death largely in a region close to LV-EpCs. Many microglia close to the mutant LV-EpC region become activated. Depletion of the microglia by PLX3397, an antagonist of colony-stimulating factor 1 receptor (CSF1R), restores LV-EpCs and diminishes the pathology of neonatal hydrocephalus in Vps35Foxj1-CreER mice. Taken together, these observations suggest unrecognized functions of Vps35 in EpC differentiation, ciliogenesis, and survival in neonatal LV, and reveal pathologic roles of locally activated microglia in EpC homeostasis and hydrocephalus development.

SIGNIFICANCE STATEMENT This study reports critical functions of vacuolar protein sorting-associated protein 35 (VPS35) not only in promoting ependymal cell (EpC) differentiation, ciliogenesis, and survival, but also in preventing local microglial activation. The dysfunctional EpCs and activated microglia are likely to induce hydrocephalus.




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All Smithsonian Museums and National Zoo Remain Open Through Friday; Events Canceled

With Washington, D.C. COVID-19 state of emergency, Smithsonian officials say museums to close Saturday, March 14; events canceled through May 3




events

Watch These Six Flower Bloom Events From Your Couch

Tulips, cherry blossoms and orchids supply a ray of hope during self-isolation




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Scots complaints about cancelled holidays and events soars as watchdog launches probe

COMPLAINTS about holidays have overtaken job concerns as the number one issue for hundreds of Scots contacting two independent national advice services every day during the coronavirus crisis.




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Cord Cutting Is Great, Except for Those Live Events

The more popular the stream, the worse it looks. There is a technology out there that would work, but its association with piracy has companies afraid of using it.




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Youth events bring together budding stars

Russia's Teenagers Football League, the springboard to success for Yuri Zhirkov and Alan Dzagoev, has held a series of events aimed at uniting different faiths and nationalities.




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Bovine Lactoferrin Prevents Invasive Fungal Infections in Very Low Birth Weight Infants: A Randomized Controlled Trial

Lactoferrin is a glycoprotein with anti-infective activities being part of the innate defensive network. Bovine and human lactoferrin share high homology. Bovine lactoferrin can prevent late-onset sepsis in preterm very low birth weight neonates.

In preterm very low birth weight infants, bovine lactoferrin is able to prevent not only late-onset sepsis but also systemic fungal infections. This protection is achieved independently from their colonization status. (Read the full article)




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Hypoxic and Hypercapnic Events in Young Infants During Bed-sharing

Sudden infant death syndrome remains the major cause of postneonatal death in developed countries. Although infant-parent bed-sharing following antenatal smoking or maternal consumption of alcohol on the bed-sharing night increases the risk of death, the mechanism is not known.

Bed-sharing infants experienced more oxygen desaturations and episodes of carbon dioxide rebreathing than cot-sleeping infants but showed appropriate behavioral and physiologic responses. A deficit in these responses in vulnerable infants could link to increased risk of sudden infant death syndrome. (Read the full article)




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Measuring Adverse Events and Levels of Harm in Pediatric Inpatients With the Global Trigger Tool

The Global Trigger Tool uses a sampling methodology to identify and measure harm rates. It has been shown to effectively detect adverse events when applied in the adult environment, but it has never been evaluated in a pediatric setting.

The Global Trigger Tool can be used in the pediatric inpatient environment to measure adverse safety events. We detected a 2 to 3 times higher harm rate than previously found with different metrics in this setting. (Read the full article)




events

Cough and Cold Medication Adverse Events After Market Withdrawal and Labeling Revision

In 2007, manufacturers voluntarily withdrew over-the-counter (OTC) infant cough and cold medications (CCMs) from the US market. A year later, manufacturers announced OTC CCM labeling would be revised to warn against OTC CCM use by children aged <4 years.

Among children aged <2 and 2 to 3 years, emergency department visits for CCM adverse events declined nationally after the withdrawal and labeling revision announcement relative to all adverse drug event visits. Unsupervised ingestions caused most CCM adverse events after each intervention. (Read the full article)




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Overweight Adolescents and Life Events in Childhood

Psychosocial stress in childhood has been associated with a greater risk of future overweight, although the associations have not always been consistent, the types of psychosocial stressors have often been somewhat extreme, and moderators of the association have rarely been examined.

Experiencing many negative life events in childhood, particularly with chronicity or events that are family health related, increases risk of overweight by age 15 years. Maternal obesity and greater delay of gratification for food each intensify this risk. (Read the full article)




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As dating apps try to pivot to virtual events, some users are trying to get people to violate social distancing rules

Source: www.businessinsider.com - Saturday, May 09, 2020
Dating apps like Tinder, Bumble, and Hinge have reported increased use amid the coronavirus pandemic, while touting virtual dating alternatives for users instead of meeting up in person. Swaths of users are still encouraging matches to break quarantine to have sex and go on dates, despite social distancing guidelines and fines to comply with them. An illustrator on Instagram has been collecting screenshots of these situations, and told Business Insider that users will brand themselves as "badasses," dispute the effectiveness of isolating, and lash out in anger and hurl abusive language when they're rejected. Spokespeople for Grindr, Tinder and Bumble told Business Insider they've informed users to adhere to social-distancing guidelines, but did not respond to inquiries about actions they're taking against users in places where violating lockdown orders can be against the law. Visit Business Insider's homepage for more stories . As millions remain confined to their homes to prevent the spread of coronavirus, the desire for human contact and connection has risen dramatically and led some to search for ways to break those social distancing rules. Popular dating apps — including Tinder , Bumble , and Hinge — have reported significant increases during the outbreak of swiping activity, matches between users, and messages exchanged. It's also led to the introduction of a breed of users who are interested in shirking lockdown orders, an




events

Combination Therapy Using Benznidazole and Aspirin During the Acute Phase of Experimental Chagas Disease Prevents Cardiovascular Dysfunction and Decreases Typical Cardiac Lesions in the Chronic Phase [Clinical Therapeutics]

Chagas disease, caused by the protozoan Trypanosoma cruzi, is one of the main causes of death due to cardiomyopathy and heart failure in Latin American countries. The treatment of Chagas disease is directed at eliminating the parasite, decreasing the probability of cardiomyopathy, and disrupting the disease transmission cycle. Benznidazole (BZ) and nifurtimox (NFX) are recognized as effective drugs for the treatment of Chagas disease by the World Health Organization, but both have high toxicity and limited efficacy, especially in the chronic disease phase. At low doses, aspirin (ASA) has been reported to protect against T. cruzi infection. We evaluated the effectiveness of BZ in combination with ASA at low doses during the acute disease phase and evaluated cardiovascular aspects and cardiac lesions in the chronic phase. ASA treatment prevented the cardiovascular dysfunction (hypertension and tachycardia) and typical cardiac lesions. Moreover, BZ+ASA-treated mice had a smaller cardiac fibrotic area than that in BZ-treated mice. These results were associated with an increase in the number of eosinophils and reticulocytes and level of nitric oxide in the plasma and cardiac tissue of ASA-treated mice relative to respective controls. These effects of ASA and BZ+ASA in chronically infected mice were inhibited by pretreatment with the LXA4 receptor antagonist, Boc-2, indicating that the protective effects of ASA are mediated by ASA-triggered lipoxin. These results emphasize the importance of exploring new drug combinations for treatments of acute phase of Chagas disease that are beneficial for chronic patients.




events

Lehigh Valley hosts virtual Transfer Thursday events

Prospective transfer students can explore the Lehigh Valley Campus virtually during the Transfer Thursday events




events

Early Diagnosis of Cystic Fibrosis Through Neonatal Screening Prevents Severe Malnutrition and Improves Long-Term Growth

Philip M. Farrell
Jan 1, 2001; 107:1-13
ARTICLES




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Timeline: Events leading up to the arrest of 2 men for murder of Ahmaud Arbery

After two prosecutors recused themselves from investigating Ahmaud Arbery's death, Gregory and Travis McMichael were arrested.




events

Remote events scheduled for Financial Literacy Month in April

The Sokolov-Miller Family Financial and Life Skills Center at Penn State has a slate of programming for Financial Literacy Month this April and is offering help to anyone in the University community who is anxious about their financial future.




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Student Activities offering virtual events this month

The Student Activities Office at Penn State Wilkes-Barre typically offers a full slate of activities for students and will continue to do so throughout April — even though the way those activities are delivered may look a little different.




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Virtual events provide information about campus, programs, and more

Virtual visits provide opportunities to learn about what Penn State York has to offer. Programming scheduled through May.




events

How to Create Events to Help Girls Prepare for STEM Careers

Want to encourage girls to become professional technologists? Here's how to make sure your girls-in-tech events help them to accurately set their Science, Technology, Engineering, and Mathematics (STEM) career expectations.





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African American History Month programs among 18 special events at the museums of the State of Delaware during February 2018

Highlights include programs on African-American life at the John Dickinson Plantation in the 18th century, the evolution of black recorded music and African-American archaeology in Delaware.




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National Women’s History Month events among 16 special programs at the museums of the State of Delaware during March 2018

Highlights include programs on women's suffrage, Harriet Tubman and the female vocalists of the Victor Talking Machine Company.




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Delaware Division of Historical and Cultural Affairs to sponsor 16 special events during April 2018

Highlights include Buena Vista’s First Annual Spring Open House, The Old State House's Coffee-Hour Lecture Series and programs on Delaware's Dutch heritage.




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Delaware Division of Historical and Cultural Affairs to sponsor seven special events during May 2018

Highlights include Dover Days programs, A Day in Old New Castle and “A Sailor’s Life for Me,” the Zwaanendael Museum’s 7th Annual Maritime Celebration.




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Delaware Division of Historical and Cultural Affairs to sponsor 11 special events during June 2018

Programs on Delaware heroes of the War of 1812, dyeing fabrics 18th-century style, and Separation Day in New Castle to be featured.






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Delaware Division of Historical and Cultural Affairs to sponsor 21 special events during September 2018

Native-American programming, Chautauqua shows and surviving the London Blitz among activities to be presented.




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Delaware Division of Historical and Cultural Affairs to sponsor 14 special events during October 2018

Early 1900s music education, the life of Delaware patriot Caesar Rodney and walking tours of St. Peter’s cemetery in Lewes among topics to be explored.




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Delaware Division of Historical and Cultural Affairs to sponsor 11 special events during November 2018

Changes to American society in the early 20th century, grave sites of notable New Castle veterans, and candle-making among topics to be explored.




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Delaware Division of Historical and Cultural Affairs to sponsor seven special events during January 2019

Highlights include activities celebrating Martin Luther King, Jr. Day, early jazz and the Avery’s Rest archaeological site.




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African American History Month programs among 13 special events at State of Delaware museums in February

Highlights include programs on the Underground Railroad, black recording artists and record labels from the early 20th century, and First African Baptist Church cemeteries in Philadelphia.




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Women’s History Month events among special programs at the museums of the State of Delaware in March 2019

Activities honor and celebrate women's lives and historic achievements.




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Delaware Division of Historical and Cultural Affairs to sponsor 14 special events during April 2019

Highlights include programs on the artist who created "His Master's Voice," the bombardment of Lewes and a festival at Fort Christina.




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Delaware Division of Historical and Cultural Affairs to sponsor five special events during May 2019

Dover Days, A Day in Old New Castle and the Zwaanendael Maritime Festival among programs to be offered.




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Delaware Division of Historical and Cultural Affairs to sponsor nine special events during June 2019

Separation Day, Black Music Month Celebration and a historic preservation symposium among programs to be offered.




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Delaware Division of Historical and Cultural Affairs to sponsor 11 special events during July 2019

Programs on Independence Day, baseball Hall-of-Famer William “Judy” Johnson and campfires at the John Dickinson Plantation to be featured.




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Delaware Division of Historical and Cultural Affairs to sponsor 13 special events during August 2019

Sherlock Holmes comes to Delaware, a screening of “How to Train Your Dragon—The Hidden World” and the history of women's suffrage in the First State to be featured.




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Delaware Division of Historical and Cultural Affairs to sponsor 14 special events during September 2019

Chautauqua tent shows, Native-American programming and a historical play on Caesar Rodney among the activities to be presented.