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Reduced Myocardial Perfusion Reserve in Type 2 Diabetes Is Caused by Increased Perfusion at Rest and Decreased Maximal Perfusion During Stress

OBJECTIVE

To examine differences in myocardial blood flow (MBF) at rest and during stress between patients with type 2 diabetes and controls, and to identify potential predictors of changes in MBF at rest and during stress.

RESEARCH DESIGN AND METHODS

A cross-sectional study of 193 patients with type 2 diabetes and 20 age- and sex-matched controls. Cardiovascular magnetic resonance was used in order to evaluate left ventricular structure and function, and MBF at rest and during adenosine-induced stress. MBF was derived as the mean of the flow within all segments of a midventricular slice.

RESULTS

Patients with type 2 diabetes had higher global MBF at rest (0.81 ± 0.19 mL/min/g) and lower global MBF during stress (2.4 ± 0.9 mL/min/g) than did controls (0.61 ± 0.11 at rest, 3.2 ± 0.8 mL/min/g under stress; both P < 0.01). Patients with macroalbuminuria had lower MBF during stress (1.6 ± 0.5 mL/min/g) than did patients with microalbuminuria (2.1 ± 0.7 mL/min/g; P = 0.04), who in turn had lower MBF during stress than did normoalbuminuric patients (2.7 ± 0.9 mL/min/g; P < 0.01). Patients with severe retinopathy had lower MBF during stress (1.8 ± 0.6 mL/min/g) than did patients with simplex retinopathy (2.3 ± 0.7 mL/min/g; P < 0.05) and those who did not have retinopathy (2.6 ± 1.0 mL/min/g; P < 0.05). Albuminuria and retinopathy were associated with reduced MBF during stress in a multiple regression analysis. Stress-related MBF inversely correlated with myocardial extracellular volume (P < 0.001; R2 = 0.37), a measure of diffuse myocardial fibrosis. A trend toward lower basal MBF was observed in patients treated with sodium–glucose cotransporter 2 inhibitors (P = 0.07).

CONCLUSIONS

Patients with type 2 diabetes have higher global MBF at rest and lower maximal MBF during vasodilator-induced stress than do controls. Reduced MBF during stress is associated with diabetes complications (albuminuria and retinopathy) and is inversely correlated with diffuse myocardial fibrosis.




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Risk of Major Adverse Cardiovascular Events, Severe Hypoglycemia, and All-Cause Mortality for Widely Used Antihyperglycemic Dual and Triple Therapies for Type 2 Diabetes Management: A Cohort Study of All Danish Users

OBJECTIVE

The vast number of antihyperglycemic medications and growing amount of evidence make clinical decision making difficult. The aim of this study was to investigate the safety of antihyperglycemic dual and triple therapies for type 2 diabetes management with respect to major adverse cardiovascular events, severe hypoglycemia, and all-cause mortality in a real-life clinical setting.

RESEARCH DESIGN AND METHODS

Cox regression models were constructed to analyze 20 years of data from the Danish National Patient Registry with respect to effect of the antihyperglycemic therapies on the three end points.

RESULTS

A total of 66,807 people with type 2 diabetes were treated with metformin (MET) including a combination of second- and third-line therapies. People on MET plus sulfonylurea (SU) had the highest risk of all end points, except for severe hypoglycemia, for which people on MET plus basal insulin (BASAL) had a higher risk. The lowest risk of major adverse cardiovascular events was seen for people on a regimen including a glucagon-like peptide 1 (GLP-1) receptor agonist. People treated with MET, GLP-1, and BASAL had a lower risk of all three end points than people treated with MET and BASAL, especially for severe hypoglycemia. The lowest risk of all three end points was, in general, seen for people treated with MET, sodium–glucose cotransporter 2 inhibitor, and GLP-1.

CONCLUSIONS

Findings from this study do not support SU as the second-line treatment choice for patients with type 2 diabetes. Moreover, the results indicate that adding a GLP-1 for people treated with MET and BASAL could be considered, especially if those people suffer from severe hypoglycemia.




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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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Classroom Observations

Classroom observations occur to document behaviors and to help provide insight to teachers. Teachers are teaching and are typically focused on the overall learning of the entire class. It is not possible for a teacher to catch all of the details of classroom while teaching. An outside observer, often a School Psychologist, can sit in the classroom and observe a student or the entire class. These insights can be used to help provide better instruction, create behavioral or academic interventions, or to document behaviors.

When do classroom observations occur?

- During a special education evaluation The classroom observation is a required component in a special education evaluation. It provides data and insight to the eligibility committee.

- Before a Behavior Intervention Plan or Functional Behavioral Assessment Classroom observations are important before implementing a Functional Behavioral Assessment or a Behavior Intervention Plan. It helps to clarify the current behaviors, identify possible triggers of the behavior, and determine the frequency of the behaviors.

- When a teacher is worried about a particular student Often a teacher will have a concern about a student and ask the School Psychologist to conduct an observation. After the observation the teacher and psychologist will meet to discuss and brainstorm strategies to assist in instruction.




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Look: Netflix shares teaser for 'Baby-Sitters Club' revival

Netflix shared a premiere date and teaser trailer for its "Baby-Sitters Club" series, based on the Ann M. Martin book series.




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Sarah Silverman, Seth Rogen animated series coming to HBO Max

HBO Max announced Friday that it has ordered "Santa Inc.," an adult-oriented animated series featuring the voices of Sarah Silverman and Seth Rogen.




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Sideline Rage -- Sports Parents Go Berserk

Among psychologists who study sports, there is a code word for parents who lose their temper standing on the sidelines of their children's soccer, baseball and football games: THOSE parents -- Tempestuous, Harried, Overwrought, Self-absorbed and Emotional.




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Effectively Serving Children in a Superdiverse Classroom: Implications for the Early Education System

As the number and share of Dual Language Learners (DLLs) continues to grow across the United States, diversity within this population is also increasing. This webinar marks the release of a report providing analysis of the diversity within the DLL population nationwide and at the state and local levels. Speakers discuss data on the three rapidly growing subgroups within the DLL population: Black and Asian American and Pacific Islander DLLs and young children of refugees, and the implications for the early education and care field and K-12 education systems. 




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MPI’s Transatlantic Council on Migration Launches Research Series on Lasting Effects of Mixed Migration Flows

First report examines Canadian challenges & solutions in housing Syrian refugees

WASHINGTON — Four years after the peak of the 2015–16 migration and refugee crisis in Europe and amid swelling arrivals at the U.S.-Mexico border and elsewhere, new evidence sheds light on how well countries have responded to an unprecedented surge in mixed flows of humanitarian, economic and family migrants.




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Open Door for Venezuelan and Nicaraguan Migrants in Latin America &amp; Caribbean Closes a Bit amid Scale of Flows, Strains on Public Services

WASHINGTON – Even as governments in Latin America and the Caribbean have taken generous and innovative steps to address forced displacement from Venezuela and more recently Nicaragua, the warm welcome has cooled in places amid the vast scale of the inflows, strains on public services and growing public concern.




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Las puertas abiertas para los migrantes venezolanos y nicaragüenses en América Latina y el Caribe se cierran un poco a medida que aumenta la escala de los flujos y la presión en los servicios públicos

WASHINGTON – A pesar de que los gobiernos de América Latina y el Caribe han tomado medidas generosas e innovadoras para lidiar con el desplazamiento forzado desde Venezuela y más recientemente desde Nicaragua, la cálida bienvenida se ha enfriado en algunos lugares a medida que el número de entradas, la presión sobre los servicios públicos y la preocupación del público aumenta.




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As U.S. Health Care System Sags under Strain of Pandemic, Immigrants and Refugees with Degrees in Health Care Could Serve as an Important Resource

WASHINGTON – Even as 1.5 million immigrants and refugees are already employed in the U.S. health care system as doctors, registered nurses and pharmacists, another 263,000 foreign-born health care graduates are on the sidelines during the COVID-19 pandemic—many of them because of difficulties getting their credentials accepted by employers and licensing bodies.




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Effectively Serving Immigrant and Dual Language Learner Families through Home Visiting Programs

This MPI webinar marks the release of a policy brief that explores program and policy opportunities to improve home visiting services for immigrant and DLL families currently underparticipating in these programs due to a lack of culturally and linguistically responsive programming and other barriers




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Employment Services for Refugees: Leveraging Mainstream U.S. Systems and Funding

On this webinar, experts and state refugee resettlement program leaders discuss two activities that can be key parts of a broader strategy for sustaining and improving employment services for refugees: Partnerships with experts in workforce development strategies, and access to federal workforce development funding.




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Stir-fried water spinach with preserved bean curd - fu yu ong choy

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of Tony Tan




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Chicken, Chorizo and Chick Pea Casserole

1.25 kg free-range chicken pieces eg thighs and legs 1/4 cup seasoned plain flour 1 1/2 tablespoons olive oil 1 large onion, chopped 2 cloves garlic, crushed or chopped 150g raw chorizo, thickly sliced 1 cup chopped celery 2 medium carrots, peeled and diced 3/4 cup dry white wine eg Riesling, pinot grigio or vermentino 3/4 cup chicken stock 400g can diced tomatoes with juice 1 tablespoon finely chopped fresh thyme or oregano 2 wide strips lemon zest salt and freshly ground black pepper, to taste 400g can chick peas, drained and rinsed* *When in season, use whole peeled and blanched fresh or frozen chestnuts in place of chick peas.





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Preserved lemons

Preserved lemons are exotic, easily prepared at home and impart a flavour and perfume like no other - they are the next best thing to a holiday in Morocco, transforming any dish from the ho-hum to the sublime. When using them cooking, only use the yellow zest, discarding any white pith, pulp and juice. It is best to preserve lemons during autumn and spring when they are in season and have maximum aroma and juice. Any lemon worth its salt can be preserved, although having preserved a number of different varieties I can report most success with the thin-skinned Meyer lemon. I also think organic lemons give the best results. When choosing lemons for preserving, ensure you choose fully ripe, very yellow fragrant fruit with unblemished skin. In the case of store-bought lemons, wash well to remove the wax that is used to make them shiny.




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Spring chicken & mushroom casserole

Easy weekend entertaining featuring another great recipe from Geoff Jansz




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Pakistan shines on pitch with series win

Pakistan highlighted its talent on the pitch to draw the third and final Test against Sri Lanka in Sharjah and win the series 1-0, just days after three former team-mates were jailed for spot-fixing.




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Autologous Umbilical Cord Blood Transfusion in Young Children With Type 1 Diabetes Fails to Preserve C-Peptide

OBJECTIVE

We conducted an open-label, phase I study using autologous umbilical cord blood (UCB) infusion to ameliorate type 1 diabetes (T1D). Having previously reported on the first 15 patients reaching 1 year of follow-up, herein we report on the complete cohort after 2 years of follow-up.

RESEARCH DESIGN AND METHODS

A total of 24 T1D patients (median age 5.1 years) received a single intravenous infusion of autologous UCB cells and underwent metabolic and immunologic assessments.

RESULTS

No infusion-related adverse events were observed. β-Cell function declined after UCB infusion. Area under the curve C-peptide was 24.3% of baseline 1 year postinfusion (P < 0.001) and 2% of baseline 2 years after infusion (P < 0.001). Flow cytometry revealed increased regulatory T cells (Tregs) (P = 0.04) and naive Tregs (P = 0.001) 6 and 9 months after infusion, respectively.

CONCLUSIONS

Autologous UCB infusion in children with T1D is safe and induces changes in Treg frequency but fails to preserve C-peptide.




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Effectively Serving Immigrant and Dual Language Learner Families through Home Visiting Programs

Marking a policy brief's release, this webinar explores the promise of home visiting services that support new parents alongside their infants and toddlers, plus strategies for improving how these programs work with immigrant and linguistically diverse families.




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Employment Services for Refugees: Leveraging Mainstream U.S. Systems and Funding

On this webinar, experts and state refugee resettlement program leaders discuss activities that can be key parts of a broader strategy for sustaining and improving employment services for refugees, including partnerships with experts in workforce development strategies, access to federal workforce development funding, and other policies and resources.




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Leveraging the Potential of Home Visiting Programs to Serve Immigrant and Dual Language Learner Families

Home visiting programs for young families are growing in popularity across the United States, and have demonstrated their effectiveness in supporting maternal health and child well-being. At the same time, more infants and toddlers are growing up in immigrant families and households where a language other than English is spoken. Why then are these children under-represented in these programs? This brief explores common barriers, ways to address them, and why it is important to do so.




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Diabetes Self-Management in a Community Health Center: Improving Health Behaviors and Clinical Outcomes for Underserved Patients

Daren Anderson
Jan 1, 2008; 26:22-27
Bridges to Excellence




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The Miniseries ‘Devs’ Delivers a Delicious Dose of Heroism and Villainy

By Scott T. Allison Devs is the ideal TV mini-series for people to sink their teeth into, for many reasons: (1) It’s both science and science-fiction; (2) it’s brilliant mix of psychology, philosophy, religion, and technology; (3) it tantalizes us with the mysteries of love, life, death, time, and space; and (4) it features a … Continue reading The Miniseries ‘Devs’ Delivers a Delicious Dose of Heroism and Villainy



  • Commentary and Analysis

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How repaying loans with social service transforms communities | Angie Murimirwa

What if you could repay loans through volunteering and mentorship instead of money? Activist Angie Murimirwa shares how a game-changing economic tool known as "social interest" is reinvigorating sub-Saharan communities once trapped in cycles of poverty. Join her as she explains how this approach to lending is creating opportunities for thousands of African women and girls -- and shows why this model can be replicated anywhere with lasting effects.




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School Resource Officer Activates Taser to Awaken Sleeping Student in Ohio

Police in northeast Ohio have placed a school resource officer on unpaid leave for activating a Taser to wake up a sleeping student.




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Will Child-Care Services Help Recruit Teachers? Oklahoma District Aims to Find Out

A small school district in Oklahoma plans to offer low-cost daycare services to its employees next year in an effort to better compete with larger districts when it comes to recruiting and retaining teachers.




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Lincoln Public Schools students getting free hotspot service




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Why Is This Teacher Running for Office? To Help 'Students Get What They Deserve'

High school teacher Jenefer Pasqua is running for Wyoming's state legislature to fight against education funding cuts.




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Trump Taps a Nebraska Education Official for Rehabilitative Services Post

President Donald Trump has tapped Mark Schultz, a deputy commissioner of education in Nebraska, to serve as commissioner of the rehabilitation services administration at the Education Department.




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Nebraska School Cook Who Served Kangaroo Meat to Students Is Fired

A school cook in Nebraska was canned after he mixed kangaroo meat into chili made for students.




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Sharing Services Offers Cost Savings and Better Service, Claims N.Y. Survey

New York superintendents who shared services reported more cost savings and improved service quality than improved student achievement, according to a new research brief.




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Ex-Obama Adviser Who Championed Teacher Evaluations to Seek Senate Seat

Can a Democrat with a record of tying test scores to teacher evaluations win a U.S. Senate seat in Colorado? Mike Johnston, a former Obama campaign adviser, wants to find out.




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Lincoln Public Schools students getting free hotspot service




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Financial Abuse Legal Service

Redfern Legal Centre's Financial Abuse Legal Service provides free, confidential legal information and advice to pe




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Law service for the arts

The Arts Law Centre of Australia is a national community legal centre for the arts.




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New Migrant Employment Legal Service

The new Migrant Employment Legal Service (MELS) is available for migrant workers across NSW.  The Inner City Legal Ce




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Costs in estate matters : the practical implications of the return of the loser pays rule / presented by Bill Ericson, Finlaysons Lawyers.




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Joe Murray / "Walkabout Joe" / "Gibber Joe" : some of his life, dedications and observations.




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Desert Patterns.




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Serious Driving Offences.




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Forum 2019 : 2D: Marketing hacks for legal services in 2019 : slides / presented by Loren Renton, Business Partnership and Digital Strategy Manager, NewsCorp.




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Forum 2019 : 5C Competition and consumer law in the digital age / slides presented by Thyme Burdon and Johanna Croser, Australian Competition and Consumer Commission.




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Ethics and 269W : a case study / Greg Mead SC, Legal Services Commission.




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Twilight Serenade : A black comedy.




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Fee for service in Indigenous land and sea management : impact assessment and analysis.

This evaluation report identifies experiences, motivations, supporting mechanisms, barriers and impacts of fee-for-service commercial activities undertaken by Indigenous Land and Water Management (ILWM) organisations. The report draws on a literature review, interviews with ILWM organisations, administrative data, in-depth case studies, and online survey data.




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Minister's performance assessment report Water plan (Mary Basin) 2006 / compiled by Water Policy and Water Services (South Region) - Department of Natural Resources, Mines and Energy.

This report provides an overview of the implementation of the Water plan (Mary Basin) 2006 and summarises the findings of the assessments undertaken for the last five years. The plan supports urban water supply and a variety of industries including significant agricultural production, a growing tourism industry and fisheries.




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Drastic Fabric : Elizabeth Jenner, Carly Snoswell, Henry Jock Walker and Sera Waters / [text by] Andrew Purvis.