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US firms return virus loans as Treasury threatens penalties

  WASHINGTON (AP) — More than 40 public companies are pledging to return money to the government’s small business coronavirus fund now that Treasury Secretary Steven Mnuchin is threatening criminal prosecutions for...




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"For the first time in 15 years the quitting rate has gone up" - ecigarettes smoking cessation

It’s been 10 years since electronic cigarettes hit the shelves in a big way - and since there controversy has reigned about their health effects - are they less unhealthy than smoking traditional tobacco cigarettes, and will they increase nicotine dependence? Its to that last point that new research, published on BMJ.com is looking into -...




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Longitudinal Metabolome-Wide Signals Prior to the Appearance of a First Islet Autoantibody in Children Participating in the TEDDY Study

Children at increased genetic risk for type 1 diabetes (T1D) after environmental exposures may develop pancreatic islet autoantibodies (IA) at a very young age. Metabolic profile changes over time may imply responses to exposures and signal development of the first IA. Our present research in The Environmental Determinants of Diabetes in the Young (TEDDY) study aimed to identify metabolome-wide signals preceding the first IA against GAD (GADA-first) or against insulin (IAA-first). We profiled metabolomes by mass spectrometry from children’s plasma at 3-month intervals after birth until appearance of the first IA. A trajectory analysis discovered each first IA preceded by reduced amino acid proline and branched-chain amino acids (BCAAs), respectively. With independent time point analysis following birth, we discovered dehydroascorbic acid (DHAA) contributing to the risk of each first IA, and -aminobutyric acid (GABAs) associated with the first autoantibody against insulin (IAA-first). Methionine and alanine, compounds produced in BCAA metabolism and fatty acids, also preceded IA at different time points. Unsaturated triglycerides and phosphatidylethanolamines decreased in abundance before appearance of either autoantibody. Our findings suggest that IAA-first and GADA-first are heralded by different patterns of DHAA, GABA, multiple amino acids, and fatty acids, which may be important to primary prevention of T1D.




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Guyana deposits first royalty payment from oil

GEORGETOWN, Guyana, CMC – The Guyana government Friday confirmed that US$4.9 million had been deposited into the Natural Resources Fund as a result of the first royalty payment for the country’s crude oil. Finance Minister, Winston...




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Bell lays out vision on first day of workouts

Wednesday marked the first time that manager David Bell got to address Reds players as a group when he spoke to pitchers and catchers ahead of their first workout of Spring Training. Bell put a lot of thought into what he wanted to tell them.




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Commissioner excited for first OD in Cincy

Major League Baseball Commissioner Rob Manfred has never been to an Opening Day in Cincinnati. Manfred is excited to experience one for himself, now that he has the honor of being the grand marshal of the 100th Findlay Market Opening Day Parade on March 28.




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'Campfire drill' helps pitchers, catchers bond

After seeing improved communication between pitchers and catchers last year, the "campfire" drill was put back on the D-backs' schedule and took place Friday at Salt River Fields.




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Lamb continues to progress at first base

Jake Lamb's education at first base hit another checkpoint during Monday's initial full-squad workout when he went through bunt drills for the first time.




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Tomas getting work in at first base

As the D-backs went through fielding drills Tuesday, Yasmany Tomas spent his time at first base rather than in the outfield.




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First Evidence for a Dose-Response Relationship in Patients Treated with 166Ho Radioembolization: A Prospective Study

166Ho-microspheres have recently been approved for clinical use for hepatic radioembolization in the European Union. The aim of this study was to investigate the absorbed dose–response relationship and its association with overall survival for 166Ho radioembolization in patients with liver metastases. Methods: Patients treated in the HEPAR I and II studies who underwent an 18F-FDG PET/CT scan at baseline, a posttreatment 166Ho SPECT/CT scan, and another 18F-FDG PET/CT scan at the 3-mo follow-up were included for analysis. The posttreatment 166Ho-microsphere activity distributions were estimated with quantitative SPECT/CT reconstructions using a quantitative Monte Carlo–based method. The response of each tumor was based on the change in total lesion glycolysis (TLG) between baseline and follow-up and was placed into 1 of 4 categories, according to the PERCIST criteria, ranging from complete response to progressive disease. Patient-level response was grouped according to the average change in TLG per patient. The absorbed dose–response relationship was assessed using a linear mixed model to account for correlation of tumors within patients. Median overall survival was compared between patients with and without a metabolic liver response, using a log-rank test. Results: Thirty-six patients with a total of 98 tumors were included. The relation between tumor-absorbed dose and both tumor-level and patient-level response was explored. At a tumor level, a significant difference in geometric mean absorbed dose was found between complete response (232 Gy; 95% confidence interval [CI], 178–303 Gy; n = 32) and stable disease (147 Gy; 95% CI, 113–191 Gy; n = 28) (P = 0.01) and between complete response and progressive disease (117 Gy; 95% CI, 87–159 Gy; n = 21) (P = 0.0008). This constitutes a robust absorbed dose–response relationship. At a patient level, a significant difference was found between patients with complete or partial response (210 Gy; 95% CI, 161–274 Gy; n = 13) and patients with progressive disease (116 Gy; 95% CI, 81–165 Gy; n = 9) (P = 0.01). Patients were subsequently grouped according to their average change in TLG. Patients with an objective response (complete or partial) exhibited a significantly higher overall survival than nonresponding patients (stable or progressive disease) (median, 19 mo vs. 7.5 mo; log-rank, P = 0.01). Conclusion: These results confirm a significant absorbed dose–response relationship in 166Ho radioembolization. Treatment response is associated with a higher overall survival.




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First-in-Humans Imaging with 89Zr-Df-IAB22M2C Anti-CD8 Minibody in Patients with Solid Malignancies: Preliminary Pharmacokinetics, Biodistribution, and Lesion Targeting

Immunotherapy is becoming the mainstay for treatment of a variety of malignancies, but only a subset of patients responds to treatment. Tumor-infiltrating CD8-positive (CD8+) T lymphocytes play a central role in antitumor immune responses. Noninvasive imaging of CD8+ T cells may provide new insights into the mechanisms of immunotherapy and potentially predict treatment response. We are studying the safety and utility of 89Zr-IAB22M2C, a radiolabeled minibody against CD8+ T cells, for targeted imaging of CD8+ T cells in patients with cancer. Methods: The initial dose escalation phase of this first-in-humans prospective study included 6 patients (melanoma, 1; lung, 4; hepatocellular carcinoma, 1). Patients received approximately 111 MBq (3 mCi) of 89Zr-IAB22M2C (at minibody mass doses of 0.2, 0.5, 1.0, 1.5, 5, or 10 mg) as a single dose, followed by PET/CT scans at approximately 1–2, 6–8, 24, 48, and 96–144 h after injection. Biodistribution in normal organs, lymph nodes, and lesions was evaluated. In addition, serum samples were obtained at approximately 5, 30, and 60 min and later at the times of imaging. Patients were monitored for safety during infusion and up to the last imaging time point. Results: 89Zr-IAB22M2C infusion was well tolerated, with no immediate or delayed side effects observed after injection. Serum clearance was typically biexponential and dependent on the mass of minibody administered. Areas under the serum time–activity curve, normalized to administered activity, ranged from 1.3 h/L for 0.2 mg to 8.9 h/L for 10 mg. Biodistribution was dependent on the minibody mass administered. The highest uptake was always in spleen, followed by bone marrow. Liver uptake was more pronounced with higher minibody masses. Kidney uptake was typically low. Prominent uptake was seen in multiple normal lymph nodes as early as 2 h after injection, peaking by 24–48 h after injection. Uptake in tumor lesions was seen on imaging as early as 2 h after injection, with most 89Zr-IAB22M2C–positive lesions detectable by 24 h. Lesions were visualized early in patients receiving treatment, with SUV ranging from 5.85 to 22.8 in 6 target lesions. Conclusion: 89Zr-IAB22M2C imaging is safe and has favorable kinetics for early imaging. Biodistribution suggests successful targeting of CD8+ T-cell–rich tissues. The observed targeting of tumor lesions suggests this may be informative for CD8+ T-cell accumulation within tumors. Further evaluation is under way.




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Stocks Round Up | 38 stocks advance, 27 decline and 8 trade firm

The Jamaica Stock Exchange (JSE) Combined Index continued its mild rally on Thursday with an advance/decline ratio of 38/27 The index advanced marginally 2,427.05 points or 0.67 per cent to close at 364,908.47. The JSE Main Market Index was up 2,...




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Will a Devastating Bushfire Season Change Australia’s Climate Stance?

23 January 2020

Madeleine Forster

Richard and Susan Hayden Academy Fellow, International Law Programme

Professor Tim Benton

Research Director, Emerging Risks; Director, Energy, Environment and Resources Programme
With Australians experiencing first-hand the risks of climate change, Madeleine Forster and Tim Benton examine the influencers, at home or abroad, that could push the government towards more action.

2020-01-23-FireNSW.jpg

Residents look on as flames burn through bush on 4 January 2020 in Lake Tabourie, NSW. Photo: Getty Images.

The 2019–20 fire season in Australia has been unprecedented. To date, an estimated 18 million hectares of fire has cut swathes through the bush – an area greater than that of the average European country and over five times the size of blazes in the Amazon.

This reflects previous predictions of Australian science. Since 2008 and as recently as 2018, scientific bodies have warned that climate change will exacerbate existing conditions for fires and other climatic disasters in Australia. What used to be once-in-a-generation fires now re-appear within 10–15 years with increased ferocity, over longer seasons.

In a country known for climate denial and division, debate has erupted around bushfire management and climate change. One of these is whether controlled burns are the answer to Australia’s climate-affected fire conditions.

There is no single risk reduction strategy. Controlled burning remains key, if adapted to the environment and climate

But when three out of four seasons in a year can support destructive bushfires, there are clear limits to what controlled burning and other fire management techniques can achieve. Other ‘adaptation’ measures are also likely to provoke intense debate – including bush clearance. As one Australian expert offered to highlight where Australia has got to, families should probably not go on holiday to bush and beach during the height of summer when temperatures and fire risk peaks. 

So, unless Australia is prepared to debate radical changes to where people live and how land is used, the limits to adaptation imply the need for mitigation. This means supporting ambitious global greenhouse emissions reductions targets. As research from Victoria, one fire-prone state in Australia, highlights, ‘the emissions pathway we follow is the largest determinant of change to many variables [such as temperature] beyond the next few decades.’

Can Australia become a more active global partner on emissions?

Australia accounts for just over one per cent of global emissions, so reducing domestic emissions – even though on a per capita basis they are the highest in the world – will not reduce Australia’s climate risk. Showing international leadership and supporting a powerful coalition of the willing to tackle climate change is the only way ahead. By showing a willingness to adopt climate ambition, Australia can help more constructive worldwide action, and thereby reduce its own risk exposure. 

Leading by example is a politically difficult issue for Australia. Prime Minister Scott Morrison was re-elected in May 2019 on an economic stability platform, and a promise not to imperil employment growth through climate action. Australia has contested UN estimates that it will not meet its existing modest goals for domestic emissions, by seeking to rely on carryover credits from action under the Kyoto Protocol as proof of progress.

It has also distanced itself from concerns over global supply and demand in fossil fuels. Australia remains a global supplier for fossil fuels, including coal – the nation’s coal exports accounted for $67 billion in revenues in 2019 in an expanding but changing Asian market, supplying ‘some of the cheapest electricity in the world’.

Possible influencers of change

With Australians experiencing first-hand the risks of climate change, there is already pressure to do more. Many are sceptical this will translate into domestic targets or export policies that give Australia the moral authority to ask for more action on the global stage.

Here, diverse groups who share a common interest in seeing Australia recover from the bushfires and address future climate risks could be key.

Importantly this includes rural and urban-fringe communities affected by the bushfires. They were part of Morrison’s traditional supporter-base but are angry at the government’s handling of the crisis and increasingly see how tiptoeing around emissions (including exports) has also ‘buried’ open discussion at home on climate-readiness.

Australian states could also find themselves taking a lead role. Virtually all jurisdictions have now committed to their own goals, most based on zero-carbon goals by 2050 (as has New Zealand). These can support modelling for Australia’s energy transition from coal, through gas, to market competitive renewables, while also help to ensure this reflects community expectations on jobs, electricity prices and other costs. 

Other emerging voices include the insurance and banking sectors (the Reserve Bank of Australia warned of the long-term financial stability risks of climate change before the fires) and indigenous Australians (one group of Torres Strait Islanders have filed a complaint to the UN Human Rights Committee which, if heard, will place Australia’s emissions record under the spotlight again). Their challenge now is finding a common language on what a cohesive approach to addressing climate change risk looks like. 

The international picture is mixed. The United States’ poor federal climate policy is a buffer for Australia. French President Emmanuel Macron has tried to raise the cost of inaction for Australia in current EU–Australia trade negotiations, but many large emitters in the Indo-Pacific region remain key Australian trading partners, investors and buyers of Australian coal. 

In the meantime, the United Kingdom is preparing for the meeting of parties to the Paris Agreement in Glasgow in November. A key global event following Brexit, the UK will no doubt be hoping to encourage a leadership circle with national commitments that meet global need to make the Glasgow meeting a success.

The UK public has expressed enormous sympathy for Australia in the bushfires and outrage over ‘climate denialism.’ Australia’s experience will be a cautionary tale of the effects of climate change at the meeting. Could the UK also support Australia to become a less reluctant partner in global climate action?




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Return of the “firm” gets cautious welcome




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The First 100 Days: Summary of Major Immigration Actions Taken by the Trump Administration

During his first 100 days in office, President Trump has taken a sweeping set of actions on immigration, ranging from imposing a travel ban to cutting refugee admissions, "extreme" vetting, and fortifying immigration enforcement at the border and in the U.S. interior. This fact sheet examines the major immigration actions taken to date, legal challenges, and related policy and personnel developments.




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The First 100 Days: Immigration Policy in the Trump Administration

As the 100-day milestone for the Trump administration approaches, MPI's Doris Meissner and Muzaffar Chishti are joined by the former Director of U.S. Immigration and Customs Enforcement, Julie Myers Wood, and former DHS Assistant Secretary for Policy and Planning C. Stewart Verdery for a discussion of the administration's track record to date on immigration, the policies articulated in its executive orders, legal challenges, reactions by publics and policymakers, and the possible long-term effects of these policies.




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Firing Up Regional Brain Networks: The Promise of Brain Circulation in the ASEAN Economic Community

Given diverging demographics, rising educational attainment and wide variation in economic opportunities, countries in the Association of Southeast Asian Nations are poised to see an expansion of both the demand for and supply of skilled migrants willing and able to move. The convergence of these megatrends represents unique opportunities for human-capital development and brain circulation, as this report explores.




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Children on the Run: An Analysis of First-Hand Accounts from Children Fleeing Central America

This event with UN High Commissioner for Refugees António Guterres includes a discussion on the state of citizen security in Central America and the resulting humanitarian impact, featuring findings from Children on the Run, a UNHCR report based on interviews with more than 400 unaccompanied children from the region.




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Dallas Cowboys sign former first-round pick Cameron Erving

The Dallas Cowboys agreed to terms with free-agent offensive lineman Cameron Erving, the team announced Wednesday.




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Look: Police, firefighters fish baby geese out of highway storm sewer

Police and firefighters in Michigan came to the rescue of a family of baby geese that wandered out onto a busy highway and fell into a storm sewer.




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Arizona firefighters rescue puppy from deep hole at construction site

Firefighters in Arizona came to the rescue of a puppy that plunged into a 15-foot-deep hole at a construction site.




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Panthers' Derrick Brown to become first 2020 Round 1 pick to sign rookie deal

Former Auburn defensive tackle Derrick Brown agreed to his rookie contract with the Carolina Panthers on Friday.




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FDA approves first at-home saliva test for COVID-19

The first COVID-19 test using saliva samples that patients collect at home has been approved by the U.S. Food and Drug Administration.




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Feasibility of Outpatient Fully Integrated Closed-Loop Control: First studies of wearable artificial pancreas

Boris P. Kovatchev
Jul 1, 2013; 36:1851-1858
Diabetes Care Symposium




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In-Hospital Prognosis of Ppatients With Fasting Hyperglycemia After First Myocardial Infarction

John J O'Sullivan
Aug 1, 1991; 14:758-760
Short Report




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Coast Guard names Rear Adm. Melissa Bert as first female judge advocate general

The U.S. Coast Guard named Rear Adm. Melissa Bert as its first female judge advocate and chief counsel, its top legal position.




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Boeing presents first Loyal Wingman drone aircraft to Australia

Boeing announced Tuesday has presented its first unmanned aircraft to the Royal Australian Air Force.




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Effects of Gender-Affirming Hormone Therapy on Insulin Sensitivity and Incretin Responses in Transgender People

OBJECTIVE

The long-term influences of sex hormone administration on insulin sensitivity and incretin hormones are controversial. We investigated these effects in 35 transgender men (TM) and 55 transgender women (TW) from the European Network for the Investigation of Gender Incongruence (ENIGI) study.

RESEARCH DESIGN AND METHODS

Before and after 1 year of gender-affirming hormone therapy, body composition and oral glucose tolerance tests (OGTTs) were evaluated.

RESULTS

In TM, body weight (2.8 ± 1.0 kg; P < 0.01), fat-free mass (FFM) (3.1 ± 0.9 kg; P < 0.01), and waist-to-hip ratio (–0.03 ± 0.01; P < 0.01) increased. Fasting insulin (–1.4 ± 0.8 mU/L; P = 0.08) and HOMA of insulin resistance (HOMA-IR) (2.2 ± 0.3 vs. 1.8 ± 0.2; P = 0.06) tended to decrease, whereas fasting glucose (–1.6 ± 1.6 mg/dL), glucose-dependent insulinotropic polypeptide (GIP) (–1.8 ± 1.0 pmol/L), and glucagon-like peptide 1 (GLP-1) (–0.2 ± 1.1 pmol/L) were statistically unchanged. Post-OGTT areas under the curve (AUCs) for GIP (2,068 ± 1,134 vs. 2,645 ± 1,248 [pmol/L] x min; P < 0.01) and GLP-1 (2,352 ± 796 vs. 2,712 ± 1,015 [pmol/L] x min; P < 0.01) increased. In TW, body weight tended to increase (1.4 ± 0.8 kg; P = 0.07) with decreasing FFM (–2.3 ± 0.4 kg; P < 0.01) and waist-to-hip ratio (–0.03 ± 0.01; P < 0.01). Insulin (3.4 ± 0.8 mU/L; P < 0.01) and HOMA-IR (1.7 ± 0.1 vs. 2.4 ± 0.2; P < 0.01) rose, fasting GIP (–1.4 ± 0.8 pmol/L; P < 0.01) and AUC GIP dropped (2,524 ± 178 vs. 1,911 ± 162 [pmol/L] x min; P < 0.01), but fasting glucose (–0.3 ± 1.4 mg/dL), GLP-1 (1.3 ± 0.8 pmol/L), and AUC GLP-1 (2,956 ± 180 vs. 2,864 ± 93 [pmol/L] x min) remained unchanged.

CONCLUSIONS

In this cohort of transgender persons, insulin sensitivity but also post-OGTT incretin responses tend to increase with masculinization and to decrease with feminization.




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Dr. Bettie McKaig, first female ADA vice president, dies

Dr. Bettie R. McKaig, who served as the Association’s first vice president from 1998-99, died Feb. 3. She was 70.




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Indian Health Service, ADA collaborate on Give Kids A Smile for first time

It was a Give Kids A Smile event not only for the children of the Mississippi Band of Choctaw Indians but also no fewer than 117 Indian Health Service dental programs across 24 states that were participating in GKAS with the events alone estimated to involve 14,000 American Indian/Alaska Native children.




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Labor Dept. releases new guidance in response to Families First Coronavirus Response Act

The U.S. Department of Labor Wage and Hour Division released new guidance March 26 to help workers and employers understand provisions included in the Families First Coronavirus Response Act.




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ADA council affirms importance of code of ethics during COVID-19 pandemic

The ADA Council on Ethics, Bylaws and Judicial Affairs’ ethics subcommittee authored an online essay as part of its Ethical Moment series in the May issue of The Journal of the American Dental Association, affirming that the ADA Principles of Ethics and Code of Professional Conduct is just as important as ever when making the difficult decisions they encounter on a daily basis.




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U.S. fuel pumps see first weekly price rise since October

Fuel prices in the United States on average were just a penny higher at $2.25 per gallon, ending consecutive price declines that had occurred since October.




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Suicide risk high in first year after brain cancer diagnosis

People with brain cancer are at increased risk for suicide compared to the general population, particularly within the first year following diagnosis, a new analysis has found.




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15-minute COVID-19 test proves accurate at confirming infection

A new, point-of-care testing kit for COVID-19 that can deliver results in 15 minutes accurately diagnoses people more than 80 percent of time, an analysis has found.




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NASA lengthens SpaceX's first crewed mission to International Space Station

The duration of SpaceX's first mission with astronauts on board -- planned for launch at 4:32 p.m. EDT on May 27 from Florida -- has been extended from a few days to potentially weeks aboard the space station.




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Astronauts anticipate first crewed launch from U.S. soil in nine years

The two astronauts who are to begin a new era of human spaceflight from U.S. soil this month said Friday they hope to inspire generations of Americans.




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Trump’s First Year on Immigration Policy: Rhetoric vs. Reality

Looking back after one year in office, it is striking how just closely the Trump administration’s actions on immigration have hewed to priorities Donald Trump outlined in an uncommonly detailed policy speech in August 2016. This report revisits those pledges to assess where the administration has made the most and least headway, and what its policy agenda ahead might look like.




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Rupert Grint, Georgia Groome confirm daughter's birth

Rupert Grint, who played Ron Weasley in the "Harry Potter" films, welcomed his first child, a daughter, with his girlfriend, Georgia Groome.




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CBS orders first seasons of 'Clarice,' 'Equalizer,' 'B Positive' for 2020-21

CBS said it has ordered first seasons of three new shows -- "Clarice," "The Equalizer" and "B Positive" for the 2020-21 television season.




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[ Investing ] Open Question : What does an investor do when his stock notifies him...the company confirms a record date for a forward two for one stock split?




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Immigration-Related Policy Changes in the First Two Years of the Trump Administration

In the two years since President Trump entered office, U.S. immigration policy has changed in many ways. Some actions have received significant media attention and public scrutiny, and others have been implemented with little fanfare. This document chronicles these wide-reaching policy changes, covering immigration enforcement, the immigration courts, humanitarian admissions, visa processing, and more.




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Science Confirms: You Really Can't Buy Happiness

When Warren Buffett announced last week that he will be giving away more than $30 billion to improve health, nutrition and education, people all over America reflected on his remarkable generosity, pondered all the noble things the gift would achieve and asked themselves what they would do if...




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Dear first year, this isn’t something you can plan for (Part 3)

In case you want to catch up: here are Parts 1 & 2 of my first-year journey. We like to think that our life stories have happy endings, perhaps that we can carefully partition our lives into fourths of each … Continue reading





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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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Young Refugee Children: Their Schooling Experiences in the United States and in Countries of First Asylum

In this webinar, the authors of three papers on the experiences of refugee children present their findings, with a focus on how such experiences affect their mental health and education.




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Building Therapeutic Relationships: Choosing Words That Put People First

Jane K. Dickinson
Jan 1, 2017; 35:51-54
Commentary