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Diabetes in the Emergency Department: Acute Care of Diabetes Patients

Candace D. McNaughton
Apr 1, 2011; 29:51-59
Feature Articles




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Within-Trial Evaluation of Medical Resources, Costs, and Quality of Life Among Patients With Type 2 Diabetes Participating in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL)

OBJECTIVE

To compare medical resource use, costs, and health utilities for 14,752 patients with type 2 diabetes who were randomized to once-weekly exenatide (EQW) or placebo in addition to usual diabetes care in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL).

RESEARCH DESIGN AND METHODS

Medical resource use data and responses to the EuroQol 5-Dimension (EQ-5D) instrument were collected at baseline and throughout the trial. Medical resources and medications were assigned values by using U.S. Medicare payments and wholesale acquisition costs, respectively. Secondary analyses used English costs.

RESULTS

Patients were followed for an average of 3.3 years, during which time those randomized to EQW experienced 0.41 fewer inpatient days (7.05 vs. 7.46 days; relative rate ratio 0.91; P = 0.05). Rates of outpatient medical visits were similar, as were total inpatient and outpatient costs. Mean costs for nonstudy diabetes medications over the study period were ~$1,600 lower with EQW than with placebo (P = 0.01). Total within-study costs, excluding study medication, were lower in the EQW arm than in the placebo arm ($28,907 vs. $30,914; P ≤ 0.01). When including the estimated cost of EQW, total mean costs were significantly higher in the EQW group than in the placebo group ($42,697 vs. $30,914; P < 0.01). With English costs applied, mean total costs, including exenatide costs, were £1,670 higher in the EQW group than the placebo group (£10,874 vs. £9,204; P < 0.01). There were no significant differences in EQ-5D health utilities between arms over time.

CONCLUSIONS

Medical costs were lower in the EQW arm than the placebo arm, but total costs were significantly higher once the cost of branded exenatide was incorporated.




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Northrop Grumman, Raytheon partner for Next Generation Interceptor bid

Northrop Grumman Corp. and Raytheon Missiles and Defense will partner to develop the Defense Department's next missile interceptor, they announced on Monday.




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ADA standards committees invite interested parties to upcoming meetings

Those interested in developing dental standards that ensure product safety and efficacy and offer useful information on new and emerging technologies can attend upcoming meetings of the American Dental Association's standards committees.




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HIPAA fee limitation no longer applies to third-party access to health records

Following a ruling in federal court two days prior, the Department of Health and Human Services announced Jan. 25 that the Health Insurance Portability and Accountability Act Privacy Rule fee limitations do not apply to requests to transmit copies of records to third-parties.




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ADA, other dental organizations ask Labor Department to help small businesses

The ADA, along with a large group of other dental organizations, told the U.S. Department of Labor that they are concerned about provisions in HR 6201, the Families First Coronavirus Response Act as related to family and medical leave and paid sick leave.




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Labor Department says employers with fewer than 50 employees may be exempt from new law

Employers with fewer than 50 employees, including dental practices, may be exempt from a provision in the Families First Coronavirus Response Act that requires them to provide emergency paid sick leave and expanded medical leave to employees in certain COVID-19 circumstances, the Department of Labor said April 1.




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ADA asks Treasury Department, Small Business Administration to clarify intent of interim rule

The Association continues to wait for clear guidance from the U.S. Department of Treasury and Small Business Administration on the best way to help dentists considering applying for Paycheck Protection Program 7(a) loans and Economic Injury Disaster Loans.




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ADA seeks participants for 2020 SNODENT review

The American Dental Association is seeking qualified individuals to join a canvass committee to consider approval of the 2020 revision of the Systemized Nomenclature of Dentistry.




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ADA urges third-party payers to adapt coding, billing procedures to help patients recover

The American Dental Association sent a letter to third-party payers urging that administrators of dental benefit plans adjust and adapt reimbursement procedures important to dentists and patients — including coverage for temporary procedures and adjusting fee schedules to account for cost of increasing infection control procedures ¬— in the midst of the “unprecedented and extraordinary circumstances dentists and their patients face” during the pandemic.




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ADA advocates that third-party payers modify fee schedules as dentists consider going back to work

The ADA is urging third-party payers to alter their fees to account for the increasing cost of personal protective equipment that dentists are using to protect themselves, their staff and patients.




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UCLA dental school researchers create nanoparticle that could improve bone defect treatment

A team of researchers at the University of California, Los Angeles School of Dentistry has developed a nanoparticle that could improve treatment for bone defects.




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Department of Labor releases Pandemic Unemployment Assistance FAQ

The Department of Labor released an FAQ April 27 that addresses common questions about work search and job refusal when an individual receives Pandemic Unemployment Assistance.




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Dow, Total part of group that raised $1B to clean plastic in ocean

Some 30 companies including Dow, Total and other big makers of plastic raised $1 billion to contribute to cleaner ocean waters.




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Diabetes Is Associated With Worse Long-term Outcomes in Young Adults After Myocardial Infarction: The Partners YOUNG-MI Registry

OBJECTIVE

We sought to determine the prevalence of diabetes and associated cardiovascular outcomes in a contemporary cohort of young individuals presenting with their first myocardial infarction (MI) at age ≤50 years.

RESEARCH DESIGN AND METHODS

We retrospectively analyzed records of patients presenting with a first type 1 MI at age ≤50 years from 2000 to 2016. Diabetes was defined as a hemoglobin A1c ≥6.5% (48 mmol/mol) or a documented diagnosis of or treatment for diabetes. Vital status was ascertained for all patients, and cause of death was adjudicated.

RESULTS

Among 2,097 young patients who had a type 1 MI (mean age 44.0 ± 5.1 years, 19.3% female, 73% white), diabetes was present in 416 (20%), of whom 172 (41%) were receiving insulin. Over a median follow-up of 11.2 years (interquartile range 7.3–14.2 years), diabetes was associated with a higher all-cause mortality (hazard ratio 2.30; P < 0.001) and cardiovascular mortality (2.68; P < 0.001). These associations persisted after adjusting for baseline covariates (all-cause mortality: 1.65; P = 0.008; cardiovascular mortality: 2.10; P = 0.004).

CONCLUSIONS

Diabetes was present in 20% of patients who presented with their first MI at age ≤50 years and was associated with worse long-term all-cause and cardiovascular mortality. These findings highlight the need for implementing more-aggressive therapies aimed at preventing future adverse cardiovascular events in this population.




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A Randomized Trial Evaluating the Efficacy and Safety of Fast-Acting Insulin Aspart Compared With Insulin Aspart, Both in Combination With Insulin Degludec With or Without Metformin, in Adults With Type 2 Diabetes (Onset 9)

OBJECTIVE

To evaluate the efficacy and safety of fast-acting insulin aspart (faster aspart) compared with insulin aspart (IAsp), both with insulin degludec with or without metformin, in adults with type 2 diabetes not optimally controlled with a basal-bolus regimen.

RESEARCH DESIGN AND METHODS

This multicenter, double-blind, treat-to-target trial randomized participants to faster aspart (n = 546) or IAsp (n = 545). All available information, regardless of treatment discontinuation or use of ancillary treatment, was used for evaluation of effect.

RESULTS

Noninferiority for the change from baseline in HbA1c 16 weeks after randomization (primary end point) was confirmed for faster aspart versus IAsp (estimated treatment difference [ETD] –0.04% [95% CI –0.11; 0.03]; –0.39 mmol/mol [–1.15; 0.37]; P < 0.001). Faster aspart was superior to IAsp for change from baseline in 1-h postprandial glucose (PPG) increment using a meal test (ETD –0.40 mmol/L [–0.66; –0.14]; –7.23 mg/dL [–11.92; –2.55]; P = 0.001 for superiority). Change from baseline in self-measured 1-h PPG increment for the mean over all meals favored faster aspart (ETD –0.25 mmol/L [–0.42; –0.09]); –4.58 mg/dL [–7.59; –1.57]; P = 0.003). The overall rate of treatment-emergent severe or blood glucose (BG)–confirmed hypoglycemia was statistically significantly lower for faster aspart versus IAsp (estimated treatment ratio 0.81 [95% CI 0.68; 0.97]).

CONCLUSIONS

In combination with insulin degludec, faster aspart provided effective overall glycemic control, superior PPG control, and a lower rate of severe or BG-confirmed hypoglycemia versus IAsp in adults with type 2 diabetes not optimally controlled with a basal-bolus regimen.




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Instability of Insulin Aspart Diluted in Dextrose




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Coldest material in the cosmos could help scientists find dark matter particles

Researchers suggest the coldest material in the universe could reveal the presence of dark matter particles.





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How the Brain Helps Partisans Admit No Gray

President Bush came to Washington promising to be a uniter, but public opinion polls show that apart from a burst of camaraderie after Sept. 11, 2001, America is more bitterly divided and partisan than ever.




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The Magic Ingredient: Party Unity

Hillary Rodham Clinton has half a dozen good reasons she thinks she is the best Democratic candidate for president. They are called Pennsylvania and Ohio, Arkansas and Nevada, New Jersey and New Mexico -- states she has won in the Democratic primary contest.




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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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Teaching in the Time of Coronavirus, Part I

Hi all, 2020 has been a complicated year so far, and things are only going to get more complicated as the COVID-19 pandemic. I’ve been thinking a lot about teaching recently, (as I’m the instructor for a class of undergrad … Continue reading




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Beyond Transactional Deals: Building Lasting Migration Partnerships in the Mediterranean

Since the 2015–16 refugee crisis, European policymakers have eagerly sought cooperation with origin and transit countries in the hopes of stemming unauthorized migration to Europe. This approach is neither new, nor without its limitations. By examining the evolution of two longstanding Mediterranean partnerships—between Spain and Morocco, and Italy and Tunisia—this report offers insights on what has and has not worked.




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EU Migration Partnerships: A Work in Progress

In 2016, the European Union announced with fanfare a new Migration Partnership Framework to inform cooperation with countries of origin and transit. While the bloc has long recognized collaboration as key to achieving its migration-management aims, EU partnerships face persistent challenges, including looking beyond short-term enforcement goals and taking into account partner needs, capacity, and objectives.




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Preparing for the Unknown: Designing Effective Predeparture Orientation for Resettling Refugees

Refugees encounter a range of challenges after resettlement—from adjusting to a new culture and language, to finding a job. Many resettlement countries invest in predeparture orientation to help refugees develop the knowledge, skills, and attitudes to face these challenges. This report explores the many forms these programs take, highlighting important design questions and key elements that effective programs share.




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Silt Part 1 - land and time under the sea

Warning: The Broomway is unmarked and very hazardous to pedestrians.
 
Warning: Do not approach or touch any object as it may explode and kill you.
 
 
The "Silt" chapter of the book contains some of Macfarlane's most hypnotic writing. It is also the chapter that made me realize that I am not innately the adventurous type of person. Unlike Macfarlane, I'm just not going to walk over unmarked mud paths at low time while running the risk of accidentally being sucked into the undertow and drowned(since he did the walk on a Sunday, he didn't have to worry about being accidentally shot by the Ministry of Defense). But I admire him for doing so.
 
The Broomway is called the deadliest path in Britain. It gets its name from 400 brooms which were used to mark the path to Foulness. When the tide comes in twice a day, other markers are swept away. Until compasses were affordable, people who walked the Broomway carried thread with them. As they passed a broom, they tied the end of the thread to the broom and continued walking. If they felt they had missed the next broom, they could follow the thread back to the previous broom.
 
Macfarlane walked the Broomway with his friend David Quentin, a book dealer turned tax lawyer who prefers to walk barefoot. In the end the mud was bad enough that Macfarlane also walked barefoot to save his sneakers. He left them at their starting point and was able to refind them when they doubled back to the beginning of their path.
 
As Macfarlane walked, he recollected that the land under the Broomway had once been called Doggerland, the home of Megolithic hunter-gatherers. This in turn made him recall the fact that the sea coasts of Norfolk and Suffolk in England are being eroded. Entire towns are being swallowed up by the sea, and houses that were once inland are now being abandoned because they are too close to the shore.
 
Although Macfarlane remembers many historical and geographical facts as he walks, he is also sucked in by the queer atmosphere of the The Broomland. Not entirely land, not entirely water, it exists in a liminal state. To Macfarlane:
 
"These borders do not correspond to national boundaries, and papers and documents are unrequired at them.Their traverse is generally unbiddable, and no reliable map exists of their routes and outlines. They exist even in unfamiliar landscapes: there when you cross a certain watershed, treeline or snowline, or enter rain, storm, or mist, or pass from boulder clay onto sand, or chalk onto greenstone. Such moments are rites of passage that reconfigure local geographies, leaving known placed outlandish or quickened, revealing continents within countries." (p. 78)
 
Space, distance, and direction become distorted because of the light over the sands, the movement of the tides, and the constant erosion of the land. A simple walk over the sea shore is a trek that could easily end in disaster where Macfarlane joins the dead of a drowned country.





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Silt Part 2 - Fighting the sea

On October 29th, 2012, Hurricane Sandy hit the tri-state area. I was lucky enough to be unaffected as I live on a hill in a central portion of Queens but I had two family members who lost power for a week. I also had co-workers who live in some of the most hard-hit areas of Brooklyn and Queens. Rereading Macfarlane's "Silt" chapter after Sandy was a sobering experience as I wondered what such a walk in parts of Queens or New Jersey would involve.

In the aftermath of Sandy, I've listened to radio interviews with Dutch engineers who have advocated sea gates and houses on stilts. I've read proposals about sea walls.  In the past week, Governor Cuomo has suggested a buyout of homes in areas likely to flooded again in the future. Once the state buys the land, the homes will be demolished and the land left empty. To quote Governor Cuomo, "there are some parcels that Mother Nature owns...She may only visit once every few years...but she owns the parcel and when she comes to visit, she visits."

However, people who live in flooded and devastated areas such as Freeport, Breezy Point or the Rockaways are reluctant to say goodbye to their communities and shore-based lifestyles. Mr. Cuomo accepts that man cannot ultimately defeat nature, which is why, for example, parts of the English coast are crumbling away without the UK spending billions on sea walls or sea gates (although London is protected by the Thames Barrier). Inhabitants of New York and New Jersey seem more willing to fight nature with man-made barriers, artificially-created natural shorelines, and architectural changes such as in the Netherlands. In the end, residents of NYC will have to decide how much money they wish to spend to protect and maintain their current lifestyles and residences.




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Memory in a House - part 1

Lucy Boston had led an adventurous life for a woman of her time. She had dropped out of Oxford University to become a nurse during WWI and worked in a hospital in Normandy. She had married her cousin, had her son Peter, divorced her husband, and moved to Germany and Italy to paint. When Peter started Cambridge, Lucy also moved to Cambridge and began obsessively painting King's College Chapel. Then in 1939, she bought The Manor, Hemingford Grey.

In Memory in a House, Lucy describes the two years that it took to restore The Manor as "which were by far the happiest of my life, even in spite of the war that broke out as soon as the builders began." (p. 19) In fact, she views her realtionship with the house as a love affair. She was aware that the house, which was built as a Norman manor in 1120 by Payne Osmundsen, was very historic, and she eventually documented everything she found and all the changes she made.

The forced restoration was brought about by the fact that the house was structually unsound due to cheap and unskillful renovations over the years. Faced with unsupported structural beams, walls cracking from top to bottom, and drastically sloping floors, Lucy was had no choice but to fix these problems. She was lucky enough to get honest and competent builders and architects to help her with the delicate job of historical renovation.

It becomes clear while reading the book that restoring the house was as much a creative endeavor for Lucy as painting a picture, or writing fiction. She was extremely sensitive to atmosphere, and accepted the physical imperfections of the house as part of the character that it had developed as it aged. She was also willing to change her mind about the alterations and restoration as she went along; the dining room, which she had thought was hopeless and would be used just as a corridor, became the center of her life, connecting the interior of the house with its equally important exterior garden.



  • Children of Green Knowe
  • Lucy Maria Boston
  • Manor at Hemingford Grey
  • Memory in a House

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Visiting Lucy Boston's House, Part 2

Since we were early for our 2 PM house tour, we decided to explore the gardens. Lucy talks about designing and building the gardens in her memoir Memory in a House, which also contains some black and white photos of the gardens back when she published the book. However, I did not realize until her daughter-in-law Diana Boston gave us the tour how much of the gardens Lucy build from scratch. Apparently most of the yard was just meadow until she set to work.

What stunned me, Val, and Dave was how large the gardens were in size. We split up in the gardens, and they saw only the more cultivated side:


 
 
 


until I took them to see the the other side of the house, which has a  moat that surrounds three sides of it, a flowering meadow, and a bamboo thicket:







The bamboo thicket is where the gorilla Hanno lives in A Stranger at Green Knowe. The moat is a a constant presence in the books because when it floods, the house is cut off on an island, the way it was originally designed to be by its Norman builder, Payne Osmundson. The story of the builders of the house is told in The Stones of Green Knowe, which is the last of the series. The River Ouse features in The River at Green Knowe, and can be seen from the yard and the windows of the house.

One of my friends commented that the house and garden must be smaller than I expected since I had read the books first as a child and was now an adult. This is not quite true. Although the house was small - the walls are three feet thick so the exterior is larger than the interior, the gardens were bigger than expected. Boston gardened in the warm weather and wrote and created patchwork in the cold weather. It is amazing to see the variety of garden sections that she created. In my next post, I will discuss the gardens in terms of the books and of my experiences as a child both as her reader and as someone who grew up in a decent-sized yard and in fine public parks.





  • Children of Green Knowe
  • Diana Boston
  • Lucy Maria Boston
  • Manor at Hemingford Grey

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Expansion of legal migration opportunities for third-country nationals, particularly in middle- and low-skill sectors, holds potential but should not be oversold as migration management tool, new study cautions

BRUSSELS — While the European Union has called on Member States to expand channels for foreign workers as a way to meet labour market needs and potentially tackle spontaneous migration, they have struggled to deliver on this pledge. To date, policies have focused more on attracting high-skilled workers, but less attention has been paid to admission of low- or middle-skilled nationals. Policymakers would do well not to overestimate the potential of legal channels to reduce irregular migration.




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As European policymakers take stock of seasonal worker programmes, MPI Europe brief outlines principles to improve these schemes for all parties

Findings will be discussed during 25 February MPI Europe – SVR webinar




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Seeking Participants for a Study on How COVID-19 is Affecting Sex and Relationships

The COVID-19 coronavirus pandemic is causing a number of societal changes that are new to nearly all of us, with governments around the world locking down cities and countries in an attempt to slow the spread of the virus. This situation is pushing some people together, but pulling others apart—and we’ve never seen anything quite like it in the modern era. Countless media articles have been written about the ways in which this is affecting people’s sex lives and relationships; however, most of them are purely speculative. This led some of my colleagues at the Kinsey Institute and I to wonder what’s really happening—and we’ve designed a study to help us better understand how emergency situations like this affect people’s sexual and romantic lives, which may help us to better plan and prepare for similar events in the future.



  • Professional Issues in Psychology

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How Do You Help a Partner Who is Depressed? Advice From a Sex Therapist

Depression is one of the most common mental health issues in the United States. In fact, according to the National Institutes of Mental Health, 1 in 14 Americans experienced an episode of major depression in the last year alone. Given the circumstances surrounding the current COVID-19 coronavirus pandemic, many in the mental health community predict that the number will be even higher this year because these circumstances are creating a “perfect storm” of depression risks. The widespread prevalence of depression has a lot of implications for our lives, even if we don’t personally have depression ourselves. Many of us will have loved ones, such as a romantic partner, who develops depression at some point. In these situations, it’s common for people to wonder how they can help their partner most effectively. So what should they do?




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How to create meaningful connections while apart | Priya Parker

Author Priya Parker shares tools for creating meaningful connections with friends, family and coworkers during the coronavirus pandemic -- and shows how we can take advantage of gatherings that are unique to this moment of social distancing. "We don't necessarily need to gather more," she says. "We need to gather better." (This virtual conversation is part of the TED Connects series, hosted by head of TED Chris Anderson and current affairs curator Whitney Pennington Rodgers. Recorded March 27, 2020)




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Teenagers Who Believe They Are Particularly Intelligent Tend To Be More Narcissistic And Happier With Life

By Emily Reynolds. But self-assessed intelligence was not actually related to objective measures of intelligence




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Utah Ruling Highlights Sticky Issue of Partisan School Board Elections

In Florida, Indiana, Kansas, North Carolina, Tennessee and Utah, Republicans are arguing that candidates for local and state school boards should run on party tickets.




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Nebraska Education Department accused of software-pirating




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Utah Ruling Highlights Sticky Issue of Partisan School Board Elections

In Florida, Indiana, Kansas, North Carolina, Tennessee and Utah, Republicans are arguing that candidates for local and state school boards should run on party tickets.




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Utah Will Ask for Test Participation Waiver From ESSA

Utah's state board members said last week that they support its state's test participation law which conflicts with the Every Student Succeeds Act.




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Rhode Island to Promote Blended Learning Through Nonprofit Partnership

The Rhode Island Department of Education and the nonprofit Learning Accelerator are teaming to develop a strategic plan and a communications strategy aimed at expanding blended learning.




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Connecticut Supreme Court OKs Part of Newtown Parents' Gun Industry Lawsuit

The state's highest court allowed some claims brought on behalf of relatives of victims of the 2012 mass shooting at Sandy Hook Elementary School to proceed against the firearms industry.




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NAIA partners with NFL to launch women's flag football as a recognized varsity sport

Women's flag football is set to be an official NAIA sport as soon as 2021.




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Child Protection Systems Royal Commission progress report September 2019 : safe and well, supporting families, protecting children / Department for Child Protection.




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Safe and well : supporting families, protecting children : the Government of South Australia's strategy for keeping families and children safe and well / Department for Child Protection.

'"Safe and well" outlines the actions the Government of South Australia is taking to support families at risk of entering the child protection system, protect children from harm when they come into care, and invest in young people to leave care with opportunities for a bright future.




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Spot the ethical solutions in estate administration dilemmas : part 1 / presented by Pam McEwin, Treloar & Treloar.




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Spot the ethical solutions in estate administration dilemmas : part 2 / presented by Pam McEwin, Treloar & Treloar.




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Tax red flags for practitioners : taxation of deceased estates / prsented by Ian Raspin, BNR Partners.




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Partnerships of Discretionary Trusts.




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First Nations people participation in environmental watering 2018-19.