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Talk Evidence covid-19 update - pneumonia, guidelines, preprints and testing

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give...




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Coping with Covid with Monica Schoch-Spana and Jud Brewer

In this week’s episode, we discuss bystander guilt, convergence, brain hacks and “how you can sneeze on someone’s brain from anywhere in the world”. How can GPs cope with the myriad worries around treating patients during the current pandemic, both on the frontline and in general practice? How do we recognise and break unhelpful anxious behaviour...




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Diabetes and Cardiovascular Disease: The "Common Soil" Hypothesis

Michael P Stern
Apr 1, 1995; 44:369-374
Perspectives in Diabetes




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NCEP-Defined Metabolic Syndrome, Diabetes, and Prevalence of Coronary Heart Disease Among NHANES III Participants Age 50 Years and Older

Charles M. Alexander
May 1, 2003; 52:1210-1214
Complications




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Barbados to end 24-hour lockdown Monday

Barbados Prime Minister Mia Mottley has announced a phased reopening of government and business operations, ending a mandatory 24-hour lockdown imposed on April 3 amid the global coronavirus pandemic. The phased reopening will begin on...




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D-backs pair among best starting pitcher duos

Most Major League teams still use a five-man starting rotation, but it takes a lot more pitchers than that to make it through a 162-game season. It certainly helps to have a potent one-two punch at the top of the rotation.




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Widener among biggest prospect bargains

Considering the players that get the big bucks often get most of the attention when they are signed and drafted, let's take some time to look at the other end of the spectrum. Here are the biggest steals on the Top 100 Prospects list.




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This Month in JNM




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Fibrotic Encapsulation Is the Dominant Source of Continuous Glucose Monitor Delays

Continuous glucose monitor (CGM) readings are delayed relative to blood glucose, and this delay is usually attributed to the latency of interstitial glucose levels. However, CGM-independent data suggest rapid equilibration of interstitial glucose. This study sought to determine the loci of CGM delays. Electrical current was measured directly from CGM electrodes to define sensor kinetics in the absence of smoothing algorithms. CGMs were implanted in mice, and sensor versus blood glucose responses were measured after an intravenous glucose challenge. Dispersion of a fluorescent glucose analog (2-NBDG) into the CGM microenvironment was observed in vivo using intravital microscopy. Tissue deposited on the sensor and nonimplanted subcutaneous adipose tissue was then collected for histological analysis. The time to half-maximum CGM response in vitro was 35 ± 2 s. In vivo, CGMs took 24 ± 7 min to reach maximum current versus 2 ± 1 min to maximum blood glucose (P = 0.0017). 2-NBDG took 21 ± 7 min to reach maximum fluorescence at the sensor versus 6 ± 6 min in adipose tissue (P = 0.0011). Collagen content was closely correlated with 2-NBDG latency (R = 0.96, P = 0.0004). Diffusion of glucose into the tissue deposited on a CGM is substantially delayed relative to interstitial fluid. A CGM that resists fibrous encapsulation would better approximate real-time deviations in blood glucose.




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Renewable Energy: Generating Money

1 November 2007 , Number 7

City types are waking up to wind, waves and the sun and their potential to make energy – and money. This is just as new energy policies for Europe emerge with twenty percent targets for renewable energy and greenhouse gas cuts. Add to the mix climate change negotiations which will be back in Bali in December.

Kirsty Hamilton

Associate Fellow, Energy, Environment and Resources Programme

GettyImages-977104176.jpg

Solar panels lined up




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The EU’s Un-Common Agricultural Policy

Invitation Only Research Event

21 October 2019 - 8:30am to 10:00am

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Ian Mitchell, Co-Director, Development Cooperation in Europe; Senior Policy Fellow and Associate Fellow, Energy, Environment and Resources Department, Chatham House
Chair: Ana Yang, Head of Land Use and Food Systems, Hoffmann Centre for Sustainable Resource Economy, Chatham House

Despite its name, the EU’s Common Agricultural Policy (CAP) provides support to the agricultural sector that varies widely between the 27 member states. The OECD calculates the extent of this support at the EU level but members have blocked the organization calculating support levels for individual EU members. Overall, the EU’s producer support is equivalent to 20 per cent of farm income which is well-above the levels seen in the US at 12.2 per cent and China at 14.3 per cent.
 
This roundtable will discuss the first estimates of support levels by EU countries produced by Ian Mitchell from the Center for Global Development. It will look at both direct subsidies under the CAP and those that inflate market prices. The discussion will consider the implications for EU finance, for the potential role of EU subsidy reform and for the UK’s options after Brexit.
 
Attendance at this event is by invitation only. 

Event attributes

Chatham House Rule

Chloé Prendleloup




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COP26 Diplomatic Briefing Series: Money Matters: Climate Finance and the COP

Research Event

20 April 2020 - 9:00am to 10:30am

Event participants

Tenzin Wangmo, Lead Negotiator of the Least Developed Countries (LDC) Group 
Mattias Frumerie, Director at the Swedish Ministry for Foreign Affairs
Rachel Ward, Programme Director and Head of Policy at the Institutional Investors Group on Climate Change
Iseoluwa Akintunde, Mo Ibrahim Academy Fellow at Chatham House
Chair: Kirsty Hamilton, Associate Fellow, Chatham House

Finance plays a key role in enabling climate change mitigation and adaptation. It is also a contested issue in the UN climate negotiations. The fourth event in the Chatham House COP26 Diplomatic Briefing Series will explore the politics of climate finance in the context of the COP, and provide a comprehensive update of the main climate finance-related negotiation items and processes. The topic is particularly timely given that the UK Government has made climate finance one of its top thematic priorities for COP26 and that 2020 constitutes the deadline for developed countries to mobilise USD 100 billion per year to support climate action in developing countries.

Anna Aberg

Research Analyst, Energy, Environment and Resources Programme
020 7314 3629




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Covid-19’s impact on US medical research—shifting money, easing rules




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Doctors as Taxi Drivers: The Costs of Brain Waste among Highly Skilled Immigrants in the United States

A report release and presentation of first-ever U.S. estimates on the actual economic costs of skill underutilization for immigrants, their families, and the U.S. economy, in terms of forgone earnings and unrealized federal, state, and local taxes.




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Millionaire Emigration: The Allure of Investor Visas among China’s Elite

Over the past decade, immigrant investor programs have proliferated around the world, and Chinese applicants have dominated in a number of countries. In 2015, about 9,000 Chinese millionaires moved to other countries, many through so-called golden visa programs. This article explores the social and cultural factors driving well-off Chinese to move abroad and examines perceptions of elite emigration in China.




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E Pluribus Unum Prizes Panel Discussions and Awards Ceremony

This awards ceremony, honoring the 2011 recipients of the E Pluribus Unum Prizes — a national awards program for exceptional immigrant integration initiatives — featured panel discussions with the awardees and federal officials and remarks by White House Director of Intergovernmental Affairs Cecilia Muñoz and Assistant Secretary of Education Brenda Dann-Messier.




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E Pluribus Unum Prizes Panel Discussions and Awards Ceremony

This awards ceremony, honoring the 2011 recipients of the E Pluribus Unum Prizes -- a national awards program for exceptional immigrant integration initiatives -- featured panel discussions with the awardees and federal officials and remarks by White House Director of Intergovernmental Affairs Cecilia Muñoz and Assistant Secretary of Education Brenda Dann-Messier.




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2013 E Pluribus Unum Prizes Awards Ceremony

This awards ceremony honored the 2013 winners of the E Pluribus Unum Prizes, which provides $50,000 prizes to exceptional U.S. immigrant integration initiatives. The awardees took part in a panel discussion with White House and state officials, followed by remarks from Congressman Luis Gutierrez and U.S. Senator Amy Klobuchar.




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After 6 More Months, 31 Million New Domestic Violence Cases, Warns U.N.

Source:

Women and children are experiencing unprecedented levels of abuse and violence at home as stress and anxiety continue to mount due to the pandemic. Data from the United Nations reveal a 600% increase in the number women who have experienced partner violence, and projections suggest that if coronavirus lockdowns continue for six more months, there will be an estimated 31 million additional domestic violence cases around the world.






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Building Skills in North and Central America: Barriers and Policy Options toward Harmonizing Qualifications in Nursing

Amid aging populations and the growth of chronic diseases, the demand for skilled health-care professionals is on the rise in the United States, Canada, and Mexico. This report explores the policy implications, benefits, and challenges of harmonizing nursing qualifications in the region, suggesting that a more collaborative approach could result in greater supply and quality of nurses.




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Smartphone-Based Glucose Monitors and Applications in the Management of Diabetes: An Overview of 10 Salient "Apps" and a Novel Smartphone-Connected Blood Glucose Monitor

Joseph Tran
Oct 1, 2012; 30:173-178
Practical Pointers




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Self-Monitoring of Blood Glucose: The Basics

Evan M. Benjamin
Jan 1, 2002; 20:
Practical Pointers




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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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Health Care Expenditures Among Adults With Diabetes After Oregons Medicaid Expansion

OBJECTIVE

To compare trends in Medicaid expenditures among adults with diabetes who were newly eligible due to the Affordable Care Act (ACA) Medicaid expansion to trends among those previously eligible.

RESEARCH DESIGN AND METHODS

Using Oregon Medicaid administrative data from 1 January 2014 to 30 September 2016, a retrospective cohort study was conducted with propensity score–matched Medicaid eligibility groups (newly and previously eligible). Outcome measures included total per-member per-month (PMPM) Medicaid expenditures and PMPM expenditures in the following 12 categories: inpatient visits, emergency department visits, primary care physician visits, specialist visits, prescription drugs, transportation services, tests, imaging and echography, procedures, durable medical equipment, evaluation and management, and other or unknown services.

RESULTS

Total PMPM Medicaid expenditures for newly eligible enrollees with diabetes were initially considerably lower compared with PMPM expenditures for matched previously eligible enrollees during the first postexpansion quarter (mean values $561 vs. $793 PMPM, P = 0.018). Within the first three postexpansion quarters, PMPM expenditures of the newly eligible increased to a similar but slightly lower level. Afterward, PMPM expenditures of both groups continued to increase steadily. Most of the overall PMPM expenditure increase among the newly eligible was due to rapidly increasing prescription drug expenditures.

CONCLUSIONS

Newly eligible Medicaid enrollees with diabetes had slightly lower PMPM expenditures than previously eligible Medicaid enrollees. The increase in PMPM prescription drug expenditures suggests greater access to treatment over time.




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Impact of Treating Oral Disease on Preventing Vascular Diseases: A Model-Based Cost-effectiveness Analysis of Periodontal Treatment Among Patients With Type 2 Diabetes

OBJECTIVE

Previous randomized trials found that treating periodontitis improved glycemic control in patients with type 2 diabetes (T2D), thus lowering the risks of developing T2D-related microvascular diseases and cardiovascular disease (CVD). Some payers in the U.S. have started covering nonsurgical periodontal treatment for those with chronic conditions, such as diabetes. We sought to identify the cost-effectiveness of expanding periodontal treatment coverage among patients with T2D.

RESEARCH DESIGN AND METHODS

A cost-effectiveness analysis was conducted to estimate lifetime costs and health gains using a stochastic microsimulation model of oral health conditions, T2D, T2D-related microvascular diseases, and CVD of the U.S. population. Model parameters were obtained from the nationally representative National Health and Nutrition Examination Survey (NHANES) (2009–2014) and randomized trials of periodontal treatment among patients with T2D.

RESULTS

Expanding periodontal treatment coverage among patients with T2D and periodontitis would be expected to avert tooth loss by 34.1% (95% CI –39.9, –26.5) and microvascular diseases by 20.5% (95% CI –31.2, –9.1), 17.7% (95% CI –32.7, –4.7), and 18.4% (95% CI –34.5, –3.5) for nephropathy, neuropathy, and retinopathy, respectively. Providing periodontal treatment to the target population would be cost saving from a health care perspective at a total net savings of $5,904 (95% CI –6,039, –5,769) with an estimated gain of 0.6 quality-adjusted life years per capita (95% CI 0.5, 0.6).

CONCLUSIONS

Providing nonsurgical periodontal treatment to patients with T2D and periodontitis would be expected to significantly reduce tooth loss and T2D-related microvascular diseases via improved glycemic control. Encouraging patients with T2D and poor oral health conditions to receive periodontal treatment would improve health outcomes and still be cost saving or cost-effective.




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Watch: Monkey enters bank kiosk in India, removes front panel of ATM

Police in India said officers suspecting thieves were behind the damage to an ATM in a bank kiosk reviewed security camera footage and discovered the machine had been partially disassembled by a curious monkey.




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New Insulin Glargine 300 Units/mL Versus Glargine 100 Units/mL in People With Type 2 Diabetes Using Oral Agents and Basal Insulin: Glucose Control and Hypoglycemia in a 6-Month Randomized Controlled Trial (EDITION 2)

Hannele Yki-Järvinen
Dec 1, 2014; 37:3235-3243
Emerging Technologies and Therapeutics




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Prevalence of Hyper- and Hypoglycemia Among Inpatients With Diabetes: A national survey of 44 U.S. hospitals

Deborah J. Wexler
Feb 1, 2007; 30:367-369
BR Epidemiology/Health Services/Psychosocial Research




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Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Tadej Battelino
Aug 1, 2019; 42:1593-1603
International Consensus Report




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Serum 25-Hydroxyvitamin D3 Concentrations and Prevalence of Cardiovascular Disease Among Type 2 Diabetic Patients

Massimo Cigolini
Mar 1, 2006; 29:722-724
BR Cardiovascular and Metabolic Risk




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New Insulin Glargine 300 Units/mL Versus Glargine 100 Units/mL in People With Type 2 Diabetes Using Basal and Mealtime Insulin: Glucose Control and Hypoglycemia in a 6-Month Randomized Controlled Trial (EDITION 1)

Matthew C. Riddle
Oct 1, 2014; 37:2755-2762
Emerging Technologies and Therapeutics




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Liraglutide, a Long-Acting Human Glucagon-Like Peptide-1 Analog, Given as Monotherapy Significantly Improves Glycemic Control and Lowers Body Weight Without Risk of Hypoglycemia in Patients With Type 2 Diabetes

Tina Vilsbøll
Jun 1, 2007; 30:1608-1610
BR Emerging Treatments and Technologies




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Concentrations of Serum Vitamin D and the Metabolic Syndrome Among U.S. Adults

Earl S. Ford
May 1, 2005; 28:1228-1230
BR Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes




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Improved Glycemic Control in Poorly Controlled Patients with Type 1 Diabetes Using Real-Time Continuous Glucose Monitoring

Dorothee Deiss
Dec 1, 2006; 29:2730-2732
BR Emerging Treatments and Technologies




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International Consensus on Use of Continuous Glucose Monitoring

Thomas Danne
Dec 1, 2017; 40:1631-1640
Continuous Glucose Monitoring and Risk of Hypoglycemia




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Evaluating Clinical Accuracy of Systems for Self-Monitoring of Blood Glucose

William L Clarke
Sep 1, 1987; 10:622-628
Technical Article




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At least 194 killed in Kenya flooding this month

Flooding in Kenya's rainy season has killed 194 people and displaced more than 100,000 households this month, officials said Wednesday.




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Subdued ceremonies in Europe mark 75th anniversary of VE Day

French President Emanuel Macron led a series of events in Europe Friday that commemorate the 75th anniversary of Victory in Europe Day, with a small ceremony in Paris.




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Investigation of the Accuracy of 18 Marketed Blood Glucose Monitors

David C. Klonoff
Aug 1, 2018; 41:1681-1688
Emerging Technologies: Data Systems and Devices




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PIONEER 1: Randomized Clinical Trial of the Efficacy and Safety of Oral Semaglutide Monotherapy in Comparison With Placebo in Patients With Type 2 Diabetes

Vanita R. Aroda
Sep 1, 2019; 42:1724-1732
Emerging Therapies: Drugs and Regimens




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Impact of Fat, Protein, and Glycemic Index on Postprandial Glucose Control in Type 1 Diabetes: Implications for Intensive Diabetes Management in the Continuous Glucose Monitoring Era

Kirstine J. Bell
Jun 1, 2015; 38:1008-1015
Type 1 Diabetes at a Crossroads




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Glucose Management Indicator (GMI): A New Term for Estimating A1C From Continuous Glucose Monitoring

Richard M. Bergenstal
Nov 1, 2018; 41:2275-2280
Perspectives in Care




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Diabetes Technology Update: Use of Insulin Pumps and Continuous Glucose Monitoring in the Hospital

Guillermo E. Umpierrez
Aug 1, 2018; 41:1579-1589
Diabetes Care Symposium




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International Consensus on Use of Continuous Glucose Monitoring

Thomas Danne
Dec 1, 2017; 40:1631-1640
Continuous Glucose Monitoring and Risk of Hypoglycemia




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Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Tadej Battelino
Aug 1, 2019; 42:1593-1603
International Consensus Report




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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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National Children’s Dental Health Month highlights optimally fluoridated water

This year the February observance of National Children’s Dental Health Month honors the 75th anniversary of community water fluoridation with its theme, “Fluoride in water prevents cavities! Get it from the tap!”




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Indian Health Service honoring National Children’s Dental Health Month

The Indian Health Service is presenting a four-part series of messages focused on their younger patients’ oral heath in honor of the February observance of National Children’s Dental Health Month.




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Two new dental benefit guides address common hurdles anticipated when reopening practices

In the face of economic challenges, the ADA has released two online guides relating to third-party payment programs available at ADA.org/virus that are intended to help smooth the path of reopening practices: Handling Contract Negotiations and Handling Eligibility Verification




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U.S. fuel prices near last month's levels, unlikely to change

Average fuel prices in the United States started the week at $2.26 per gallon, showing little change from the last month or last week, and may remain flat.